In anticipation of a new dementia strategy, Andrew Mickel talks to Anchor Trust’s dementia expert about how practice in the field can be transformed with thorough training
I’ve got my dream job,” says Victoria Metcalfe (pictured right), a dementia specialist team manager at the Anchor Trust, which provides housing and support for older people. This may seem to some an unlikely proposition, but her infectious enthusiasm (she was named a Community Care champion at last year’s Excellence Network awards) shows that she, and the people she works with, gain a lot from her labour.
So how do you make work with dementia sufferers effective? While the following five points of advice cover several topics, Metcalfe comes back to one back-to-basics recommendation: “Get to know the person. They’re not just their symptoms, but have a unique life history. Dementia doesn’t alter this.”
1 Be open to all types of Communication
Getting to know people is based on good communication, which can be difficult to fit into a busy working day. Metcalfe suggests making sure clients are involved in everyday tasks where possible. “Every interaction is an opportunity to get to know the person,” she says. “You walk across a room, and that’s a chance to communicate. Or if you’re walking down the corridor, take someone with you.”
But some clients can be more difficult to talk to. “Recently we had a team saying that a woman, Josie, couldn’t communicate. She would just scream and bang on the door,” says Metcalfe. “But you have to understand that behaviour is a form of communication. That woman is trying to communicate by banging on the door – people use behaviour to communicate because it works.”
2 Accept and manage risk
After a visit from Metcalfe’s team, it transpired that the cause of Josie’s banging was relatively straightforward – she was an energetic person who was trying to get out of the building. However, staff were afraid that Josie, who tended to walk quickly, would run away.
Metcalfe says that just keeping Josie inside would avoid, rather than manage, the risk of that happening. “We’ve become adept at being risk averse, and while that may be standard good practice, you’ve got to become more accepting of risk. Assessing risk is vital, but it has to be accepted that you can’t avoid all risk.
“So we devised an interesting route where she could walk quickly with a member of staff who would take them back to the building.”
3 Design the environment with clients in mind
Creating visual clues and cues to make an environment visually comprehensible can help people with failing faculties. Anchor Trust uses both pictures and words on door signs to help clients grasp where they are. Shiny flooring is avoided because it can appear wet. And contrasting colours are used to help support people’s visual acuity. “If you have one room with blue carpet and blue chairs, and another with all red carpet and red chairs, just swap the chairs over,” says Metcalfe. “It can prevent people not being able to see the chairs when they sit down.”
It’s important that any changes are implemented to ensure that change doesn’t cause distress. Jamal was in an Anchor Trust home, and was becoming distressed on the days his bed sheets were changed. It was only after completing a training course that staff realised he was becoming upset because he used his yellow bed sheets to identify his room.
4 Encourage daily activities
“Taking part in activities helps people you care for to maintain their skills – and they don’t have to have an outcome or be scheduled,” says Metcalfe. “It could be everyday tasks like making the bed.
“Many tasks you have to do alone, but lots you don’t. It’s that interaction, not what the activity is, that counts.”
To aid daily interaction, Metcalfe advises using life history books to build up a profile of clients. One was created for Jack, a new resident at an Anchor Trust home who was reluctant to mix with other residents. The life history work showed that he was an enthusiastic newspaper reader who struggled to read with the onset of dementia, so staff arranged for a talking newspaper to be delivered. “And even though he can’t retain that information, he still enjoys it,” says Metcalfe. “Then it turned out that someone else in the home read newspapers too, so now they spend time together and Jack has a friend.”
5 Provide training and support
“Training is often used in an isolated sense,” says Metcalfe, “but although that may have some value, it should not sit alone – it must go alongside support and great leadership.”
Training helped the team to support Jenny, a client in an Anchor Trust home who was getting up at 4am to eat breakfast, but refusing food for the rest of the day. After staff training, workers completed a life history document with Jenny, and discovered that she had always got up at 4am. A nutritional course then gave staff the knowledge to support her specific eating habits.
“Support is about applying criteria from training and assessing whether it has improved someone’s life,” says Metcalfe. “If it hasn’t worked, then it needs changing.”
● Names of residents have been changed
Published in the 29 January 2009 edition of Community Care under the heading How to Work with People with Dementia