ALAS HEALTHCARE
Scope
Policy Statement
The Policy
Principles of Care for People with Dementia
Accessing Information
Consent
Impact of Dementia on Personal Relationships
Adult Safeguarding
Training and Development of Health and Social Care Staff
Promoting and Maintaining Independence
Managing Risk
Palliative Care and End-of-life Issues
Related Policies
Related Guidance
Training Statement
This organisation believes that people with dementia should not be excluded from any services because of their diagnosis, age (whether designated as too young or too old), or co-existing learning disabilities, and that our staff should treat people with dementia and their carers with respect at all times.
The Policy
Principles of Care for People with Dementia
At the assessment of need and in the care plan, we identify and address the specific needs and, wherever possible, the preferences of people with dementia and their carers:
Care plans are based on an assessment of the person with dementia’s life history, social and family circumstance, personal preferences, physical and mental health needs and current level of functioning and abilities.
There should be a coordinated delivery of health and social care services. This should involve a combined care plan agreed by health and social services that take into account the changing needs of the person with dementia and their carers; wherever possible, a named member of staff should operate the care plan. There should be a collaboration between staff, the service user, and their family to develop the care plan, with formal reviews at a frequency agreed between all those involved at this stage.
Specific needs might include ill health, physical disability, sensory impairment, communication difficulties, problems with nutrition, poor oral health, and learning disabilities.
Diversity might include issues of gender, ethnicity, age (young or old), religion, and personal care. Wherever possible, we aim to accommodate the diverse preferences of people with dementia and their carers, including issues of diet, sexuality, and religion.
Accessing Information
We help people to access support services who are suspected of having dementia because of evidence of functional and cognitive deterioration, but who do not have sufficient memory impairment to be diagnosed with the condition.
Language or acquired language impairment can be a barrier to accessing or understanding services. During treatment and care, the information that we provide is given in the preferred language or an accessible format, with the ability to access independent interpreters as required.
We support service users to access information on their right to receive direct payments, individual budgets (where available), and the difference between NHS care and care provided by local authority social services (adult services), so that they can make informed decisions about their eligibility for NHS Continuing Care.
We provide any support required for the individual to access advocates to speak on their behalf.
Consent
Valid consent from people with dementia should always be sought; this should entail informing the person of options, checking that they understand, ensuring that there is no coercion and that the person continues to consent over time. If the person lacks the capacity to make a decision, the provisions of the Mental Capacity Act 2005 are followed.
People with dementia and their carers are always informed about advocacy services and voluntary support, and we encourage their use. When required, such services should be available for both people with dementia and their carers independently of one another.
People with dementia are given equal opportunity to convey information to our staff and other care professionals .confidentially. Only in exceptional situations would confidential information be disclosed to others without the person’s consent, as identified in our Confidentiality Policy; however, as dementia worsens and the person becomes more dependent on family or other carers, decisions about sharing information should be made in the context of the Mental Capacity Act and its Code of Practice. If information is to be shared with others, this should be done only if it is in the best interests of the person with dementia.
Wherever possible, this situation should be discussed with the person who has dementia, while they retain capacity, and with their carer; the following aspects might be considered:
Advance statements, which allow people to state what is to be done if they should subsequently lose the capacity to decide or to communicate.
Advance decisions to refuse treatment.
Lasting power of attorney (LPA): a legal document that allows people to state in writing who they want to make certain decisions for them if they cannot, including decisions about personal health and welfare.
A preferred place of care, which allows people to record decisions about future care choices and the place where the person would like to die.
Impact of Dementia on Personal Relationships
The impact of dementia on relationships, including sexual relationships, should be assessed sensitively. When indicated, people with dementia and/or their partner and/or carers will be supported to maintain their relationships and given information about local support services.
Adult Safeguarding
Because people with dementia are vulnerable to abuse and neglect, all our staff receive information and training, and they abide by local multi-agency protocol. All staff are aware of the need to be vigilant and report to their manager any actual, alleged, or suspected abuse.
Training and Development of Health and Social Care Staff
We ensure all our staff have access to dementia-care training (skill development) that is consistent with their roles and responsibilities and meets the changing needs of the person with dementia. We liaise with outside professionals to provide specialist training and support, e.g. the local mental capacity team or Alzheimer’s Society. [INSERT HERE THE OUTSIDE PROFESSIONAL AND ORGANISATIONS YOU WORK WITH]
Promoting and Maintaining Independence
Through our care planning, we aim to promote the independence, including mobility, of people with dementia. Care plans address activities of daily living that maximise independent activity, enhance function, adapt and develop skills, and minimise the need for support. When writing care plans, the varying needs of people with different types of dementia are addressed using support from outside dementia specialists. Care plans should always address:
Consistent and stable staffing.
Retaining a familiar environment.
Minimising relocations.
Flexibility to accommodate fluctuating abilities.
Assessment and care-planning advice regarding activities of daily living (ADL), and ADL skill training from an occupational therapist
Assessment and care-planning advice about independent toileting skills. If incontinence occurs then all possible causes should be assessed and relevant treatments tried before concluding that it is permanent.
Environmental modifications to aid independent functioning, including assistive technology, with advice from an occupational therapist and/or clinical psychologist.
Physical exercise, with assessment and advice from a physiotherapist, when needed.
Support for people to go at their own pace and participate in activities they enjoy.
If our service users with dementia develop non-cognitive symptoms that cause them significant distress or develop challenging behaviour, they will be offered an assessment at an early opportunity to establish likely factors that may generate, aggravate, or improve such behaviour. The assessment should be comprehensive and consider:
The person’s physical health.
Side effects of medication.
Social, cultural, and environmental influences that affect mental health and behaviour.
Physical environmental factors.
Depression.
Possible undetected pain or discomfort.
Individual biography, including religious beliefs and spiritual and cultural identity.
Behavioural and functional analysis conducted by professionals with specific skills, in conjunction with carers and care workers.
Individually-tailored care plans that help carers and staff address challenging behaviour are developed, recorded in the notes, and reviewed regularly; the frequency of reviews should be agreed upon by all involved in the service user’s care. Approaches that may be considered, depending on availability and service user choice, include:
Aromatherapy.
Multisensory stimulation.
Therapeutic use of music and/or dancing.
Animal-assisted therapy.
Massage.
These interventions may be delivered by a range of health and social care staff and volunteers, with appropriate training and supervision.
Following NICE guidelines, we see pharmacological intervention in the first instance only if the person is severely distressed or there is an immediate risk of harm to the person or others. We work closely with GP’s and other professionals to find alternative sources of support.
Managing Risk
Recognising the importance of managing risk, we identify, monitor, and address environmental, physical health, and psychosocial factors that may increase the likelihood of challenging behaviour, especially violence and aggression, and the risk of harm to self or others. These factors include:
Carers at home being unable to cope well with the service user and becoming distressed.
Service user’s own home can create some safety issues, as their condition becomes more severe.
Lack of activities.
Staff not trained to deal with challenging behaviour.
Poor communication between the person with dementia, their carer, or staff.
Conflicts between staff and carers.
Weak clinical leadership.
We train our staff to anticipate challenging behaviour, and how to manage violence, aggression, and extreme agitation, including de-escalation techniques and methods of physical restraint. [INSERT AND DELETE AS APPLICABLE]
Palliative Care and End-of-life Issues
Dementia care is incorporated into a palliative care approach from the time of diagnosis until death. The aim is to support the quality of life of people with dementia and to enable them to die with dignity and in the place of their choosing, while also supporting carers during their bereavement (which may both anticipate and follow death).
Related Policies
Assessment of Need and Eligibility
Care and Support Planning
Deprivation of Liberty Safeguards
Dignity and Respect
End of Life
Equality and Diversity
Meeting Needs
Mental Capacity Act 2005
Related Guidance
Dementia Equity and Rights:
http://www.raceequalityfoundation.org.uk/
Dementia: Assessment, Management and Support for People Living with Dementia and their Carers (NG97), June 2018:
https://www.nice.org.uk/guidance/ng97
NICE Quality Standard [QS184] June 2019:
https://www.nice.org.uk/guidance/qs184
Dementia UK: Information for those looking after someone with dementia
Training Statement
All staff, during induction, are made aware of the organisation’s policies and procedures, all of which are used for training updates. All policies and procedures are reviewed and amended where necessary, and staff are made aware of any changes. Observations are undertaken to check skills and competencies. Various methods of training are used, including one to one, online, workbook, group meetings, and individual supervisions. External courses are sourced as required.
Date Reviewed: October 2022
Person responsible for updating this policy: Dann Karr
Next Review Date: October 2023
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