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  1. Training is only the beginning… Extra Care Housing for People with Dementia Beth Noray, Consultancy & Training

  2. Thoughts……. • I want to talk about the importance of training and what it should include • But also to say that it is only the beginning and there are other systems and planning that need to be in place to support the training and the person with dementia. Beth Noray, Consultancy & Training

  3. Staff require training • Supporting people with dementia requires specific skills. • It is hugely rewarding, but not easy. Staff need to be equipped with the knowledge and skills to do the job effectively. • Training is not just for care staff, it is also needed for housing staff, care managers and management. • Learning is a life long process and people need to be offered training as they grow and develop to make use of their experience and to learn new skills and techniques Beth Noray, Consultancy & Training

  4. What training? • Understanding dementia, what it is and to have myths debunked. • The difference between the various illnesses that cause the symptoms • The major problems it can cause like agnosias, dysphasias and dyspraxias. • The progression of the dementing process. Beth Noray, Consultancy & Training

  5. Person-centred approach • What good care looks like for a person with dementia. • To recognise the person’s strengths as well as needs and work with them. • To genuinely promote independence, to maintain existing skills for as long as possible • To enable and facilitate, collaborate and not to ‘do for’. • To increase assistance as the dementia becomes more severe, but still not disempower them. • To help the person remain connected to the outside world. • Empower the person, comfort, sustain, validate their emotions, create freedom, promotes relationships and confirm identity. • Understanding the importance of knowing the person’s likes & dislikes, their life history, their preferred lifestyle and routines. • Understanding how to use your knowledge of the person effectively. Beth Noray, Consultancy & Training

  6. Increasing well-being • Increasing well-being is the most important aim of good support • Support tailored to meet each individual’s needs and strengths. • Behaviour is not set in stone, it can be changed just as ours can be changed by the right approach and behaviour. • Knowing the importance and use of well-being keys. • Knowing how and when to divert effectively and when to go with it. Beth Noray, Consultancy & Training

  7. Communication skills • To understand the communication difficulties the person is likely to experience and the skills to compensate for them. • Understand the importance of nonverbal communication. • Learn to work effectively with the person’s reality. • Understand the symbolic language a person with dementia may use. • Develop empathy, self-awareness to hone their skills. • Understand the importance of and develop their interpersonal skills Beth Noray, Consultancy & Training

  8. Understanding Difficult & Challenging Behaviour • Challenging behaviour is the greatest cause of moving people on from their homes. • Behaviour is a form of communication, we need to learn to understand what the person is trying to tell us by their behaviour. • Be able to pick up clues, in their life history, their lifestyles and possible triggers in the environment. • To offer support in ways that are acceptable and not upsetting for the person. • To understand the importance of knowing the person and varying the approach to suit their personality and needs. Beth Noray, Consultancy & Training

  9. Transcendence to help others find self-fulfilment Self Actualisation: to find self-fulfilment and realise one'spotential Aesthetic: symmetry, order, and beauty; Cognitive: to know, to understand, and explore Esteem: to achieve, be competent, gain approval and recognition. Belongingness and Love: affiliate with others, be accepted, loved Safety/security: Security, Freedom from fear, Protection Physiological: Food, Water, Sleep, Warmth Beth Noray, Consultancy & Training

  10. Activities and Occupation • These are not just group activities • An activity can be used therapeutically to raise well-being or to divert at a stressful time of day • It is understanding that activities need to be offered at different levels of ability. • They should be failure free but provide a sense of achievement Beth Noray, Consultancy & Training

  11. Not just the illness • People tend to put all behaviours down to the dementia. • Most behaviours are in fact due to other factors. Beth Noray, Consultancy & Training

  12. Personality • Personality alone can cause challenging behaviours. • I am going to be a pain. I am a worrier, perfectionist, control freak, a fighter and very independent. Life is going to be very frustrating and huge amounts of reassurance and comfort will be needed. • My mother could have stayed in sheltered housing much longer, had she not resented home care telling her what to eat & when to eat. Her independence caused her to try to do things which were now beyond her and was constantly visited by the fire brigade. • We all cope with illness in different ways, even with something as trivial as a cold. Beth Noray, Consultancy & Training

  13. Life History • Life is not an easy business and we all are scarred and uplifted by what happens to us. Events leave an imprint. • Will the trauma of your war experiences or rape return to haunt you in your dementia? • Will the work routines you have learnt over the years now become challenging behaviours? Beth Noray, Consultancy & Training

  14. Physical Health • The person may be in pain because they do not know what to do when this feeling happens, what you call it or forget to tell someone who can help and may not remember what a painkiller is. • The person’s hearing or sight may be impaired but they forget to wear their glasses or hearing aid, no longer understanding their relevance. Beth Noray, Consultancy & Training

  15. Mental Health • If the person has come into extra care because their life partner has died, they are going to search for them. If they are distressed they are going to search for the emotional support and comfort that a partner or parent gave them and ‘wander’. • They may be very confused and frightened because suddenly they have been transported from their home to this strange unfamiliar environment, where often people obviously do not want them. • They may be depressed because life has nothing much to offer them any more. Beth Noray, Consultancy & Training

  16. Current Environment • It is very important that people do not move into extra care when they are no longer able to make friends or join in any social events or become familiar with the environment. • Many residents are very intolerant of people with dementia and can make them feel very unwelcome. Some residents are subject to abuse and harassment due to their disability • There tends to be a big difference in well-being between people who have developed dementia once safety ensconced in the scheme and those who move in with a dementia and may never be accepted. • People who still have their life partner and family and friends who visit are likely to be much happier than people who have no one. Beth Noray, Consultancy & Training

  17. Cognitive disability • This is the degree of damage the person has sustained and their stage in the dementing process. • The difficulties their particular illness has created, e.g. hallucinations. Beth Noray, Consultancy & Training

  18. Assessment • Experience/training in interviewing people with dementia. • What is their diagnosis? What stage is the person in their dementia? How disorientated are they? • What can this person really do for themselves, the need to check this out. • The emotional needs of this person and the support they will need. • The personality, life history, lifestyle or routine of the person and any problems these are likely to cause. Beth Noray, Consultancy & Training

  19. Management systems • Support plans need to be integrated with care plans so everyone is clear what they are trying to achieve and they concur. • Life histories, likes and dislikes, lifestyle preferences identified and known to all staff. • Emotional needs should be identified and plans devised to improve well-being e.g. overcoming grief or become more assertive. • Strengths and skills noted and support and care plans created that enable people to use their remaining skills. • Triggers identified and alternative activities created. • Well-being keys identified for each person. • Difficult behaviours and strategies identified and known to all staff. • Supporting people with dementia takes time. • Provide information and guidance to other residents about dementia and how they can help. Beth Noray, Consultancy & Training

  20. Support for staff • If we are to work in a person-centred way, we need to be person-centred towards all staff, both care and housing. • Staff working with people’s emotions need support for themselves, because it is not easy, sometimes it’s disturbing. • They need critical incident analysis • An opportunity to talk through issues, approaches, problems, triumphs. • If staff are denied this they will revert to a task orientated or administrative approach. Beth Noray, Consultancy & Training

  21. Risk • People with dementia do not understand the risk in doing things they have always done. • Assessing the actual risk and seeking to minimize that risk is much better than saying no. • Life with risks is exciting, being wrapped up in cotton wool is boring. • Sharing the potential risk with family, thinking about the quality of the person’s life, not just their physical safety. Beth Noray, Consultancy & Training

  22. Working with the family • Families need information about dementia and to approach situations appropriately • They need advice in not buying microwave ovens or replacing hob kettles with electric ones. • They are not always right. • They know the pre-demented person, the professionals know dementia and how the person functions in the scheme. • They need to be part of and understand the support/care plans • It is important that all staff understand the grief that families will feel. Beth Noray, Consultancy & Training

  23. Severe dementia and death • No one wants to die alone, many people with dementia do. • You probably would prefer to die at home in familiar surroundings with people you know and love. • Physical comfort and pain relief • Spiritual or emotional support, people may well be frightened. • Mental stimulation, like music, company. • People will not understand drips, catheters or peg feeds, so invasive assistance should be kept to a minimum. • We need to have a range of peripatetic services who can come to meet the needs of a person, rather than take them to another strange and confusing place to receive the care they need. Beth Noray, Consultancy & Training

  24. People with dementia • People with dementia are firstly people like you and me. • Training is a block to stand on and build from, but it cannot stand alone. • Extra care can provide the support that people with dementia need without the institutionalisation of care homes; it can be the ideal environment to take someone through the varying stages of dementia whilst remaining in their own home and retaining their independence for as long as possible. Beth Noray, Consultancy & Training