Schemes that improve lives of people with dementia

About 6% of people over 65 will develop some degree of dementia, increasing to about 20% over 85. Of course, the percentage of older people in care homes with dementia is substantially higher – perhaps as high as 75%. Here Graham Hopkins looks at three schemes that aim to preserve the safety and dignity of people with dementia in care homes and the community

Trinity Lodge

The aim of any changes to the furniture and furnishings for a person with dementia is to help them find their way around and to maintain a familiar environment it should also help trigger memories and support mobility.

These principles were applied in the design and décor used at Trinity Lodge, a specialist dementia care home built by housing and support charity Anchor Trust, which opened in Coventry last month.

Food colours – such as orange, coffee and cream – are used in the dining room. Indeed, soft moderate tones and non-reflective paint are the order of the day. “Bright, brash colours increase people’s agitation,” says Debbie Fox, member of Anchor’s specialist dementia team. “It’s about keeping things calm, using colour to identify, define and orientate.”

Soft colours are specifically used in the bathrooms. Says Fox: “They give a much better body image than a harsh white bathroom with a harsh white light. Not many people want to see their body in that kind of stark light.”

Another striking design element at Trinity Lodge is the percentage of wall given over to windows – and all with views. “Natural light gives a better perception of colour than false light,” says Fox. “As well as lots of windows, there are also lots of circular paths around the home so corridors don’t lead to dead ends. The home is almost designed on a figure of eight so people can walk around and about – a corridor will lead to a lounge, dining room or kitchen.

“And even on the one occasion it does lead to a dead end there is a seat there for people to sit and look out of the window. It is a recognition that walking up and down corridors is frustrating and increases people’s agitation – so we’ve been careful to make sure that they went somewhere.”

Fox points out that the design also gives people different clues, for example, throughout the home all the toilet doors are the same colour, have a sign that says “toilet” and a little picture. “So a person with dementia has three opportunities to recognise that it is the toilet door: the colour, the word and the picture,” she says.

Trinity Lodge is bricks and mortar recognition that caring for people with dementia is a specialist task. “It’s a demanding job and you need specialist staff to do it,” concludes Fox. “I think providing the right environment in a specialist care home is the way to go.”

What do you think?

“The design of Trinity Lodge sounds well thought out. However, I think we should be wary of thinking that technical solutions are any more than helpful tools. It’s how the home is run that counts – the relationships, the atmosphere, the culture. I also think we should be careful not to think that specialist dementia care is somehow superior to what goes on in ordinary good care homes where there are people living with all sorts of abilities, disabilities and problems, including a wide variety of dementias.”

John Burton, author Managing Residential Care

The Safely Home Scheme

Many people with dementia feel compelled to walk about or leave their homes. This can be worrying for their carer, and can at times put the person in danger. But it is important to find a solution that preserves the person’s independence and dignity.

And a simple bracelet could prove to be the answer to a complex problem. The Safely Home scheme – run by Torbay Care Trust, Devon and Cornwall Constabulary, Torbay Council and the Alzheimer’s Society – will make it easier to identify and help older people with dementia who have walked away from home and are lost and confused.

The bracelet, which is free, has a unique ID code. There is also a telephone number which links to a 24-hour support service where trained and experienced operators can help return them home safely. No personal details are provided, and carers’ details are held on a secure database only shared with the emergency services.

“It can be easy for a person with dementia to become lost and confused, especially if they wander away from familiar surroundings,” says James Drummond, the care trust’s lead officer for carers’ services. “If the person is wearing a Safely Home bracelet, it is straightforward for the emergency services to alert our operators who can arrange for them to be quickly reunited with their carer.”

Jim Delves, chair of the Alzheimer’s Society in Torbay, agrees: “Safely Home will be of immense benefit to carers, giving them additional peace of mind and helping to minimise the stresses involved in being a main carer.”

Indeed, the scheme has already had its first success. “The Safely Home scheme has ensured the safe return home of a man with dementia who was found wandering and confused in Ashburton, Devon, some 15 miles from where he lived,” says Drummond. “A local shopkeeper telephoned the number on the bracelet and police returned him to his home in Paignton. The number of cases like this is not expected to be great but it is the peace of mind the scheme gives carers which is a key element of the service.”

What do you think?

“There are bracelets such as these which can be purchased from medic alert. However, for them to be provided free of charge is a credit to Torbay. I have come across several cases where they have proved extremely useful.”

Madeline Armstrong, admiral nurse at the For Dementia agency

Dining with Dignity

Treating somebody who has dementia with respect means valuing them as individuals. Rather than focusing on their dementia, it’s all about trying to understand the people and things that matter to them.

Such a person-centred approach is at the heart of the work of housing and support charity Anchor Trust’s Specialist Dementia Team (SDT), which provides information, advice, guidance and training for the organisation’s care staff. Part of its remit includes food and nutrition, and is best reflected in its Dining with Dignity training programme.

The one-day training course looks at the practical, nutritional, cultural and social aspects of meals and mealtimes. “It’s about recognising, for example, people with dementia are no different to anybody else when it comes to a healthy diet,” says SDT member, Debbie Fox. “They need good diets to help them stay fit, healthy, and maintain good levels of concentration. And it’s also about understanding things such as why people might refuse to eat, and the processes they go through. They might be able to put food on their fork but then forget that putting their fork to their mouth comes next.”

The programme highlights positive thinking in terms of the dining environment: how crowded tables are, how noisy is the experience and might this be frightening? “If you serve people with dementia white porridge in a white bowl on a white table cloth, anybody who has visual acuity or perception problems may struggle to find that white porridge.”

The problems faced at mealtimes by care staff and people with dementia certainly gave the SDT food for thought. “If you have dementia and your skills are beginning to fail and you are aware of that, mealtimes are the one part of the day when you are on public display,” explains Fox. “This is especially so if you’re living in a care home and are being encouraged to come out and socialise. So, it becomes a flashpoint for people, a difficult time of the day.”

The course emphasises the importance of the dining experience to the individual, how emotionally involved people can become with their food, and the importance of maintaining the social aspect of mealtimes. “Realising how important food can be for people,” says Fox, “and sitting down and enjoying a meal with them or just having a cup of tea while they have their meal provides a range of practical cues as well as social opportunities.”

Dining with dignity

What do you think?

“This is a really important training programme. A large number of people with dementia lose weight quickly for the very reasons described. In particular, some people who also have Parkinson’s disease may become very embarrassed when eating because of their tremor, and this has to be addressed. Some of these people may prefer to eat on their own and this is their choice.”

Madeline Armstrong, admiral nurse at the For Dementia agency

If you have introduced, or heard of, a new idea for adults’ or children’s services please let us know. Contact graham.hopkins@rbi.co.uk

This article appeared in the 23 August issue under the headline “Schemes that improve lives of people with dementia”