Experts demand better training to improve person-centred care, reducing the need for antipsychotic drugs – but still training is not mandatory
Care home worker June Simpson says the dementia training she’s received from her employer has helped her understand that when her clients are aggressive, it is caused by the dementia. “It’s not the person, it’s the illness,” she says.
But not all care staff are given the same opportunity. The Department of Health’s national dementia strategy for England, published in February 2009, said the need for improved training was of “central importance”.
The all-party parliamentary group on dementia identified specific skills gaps in care homes in a report last June. It found there were often failures to provide activities, to find out about an individual’s likes and dislikes and to engage with people.
Boredom, frustration and isolation in people with dementia make it more likely that they will display challenging behaviour which, in turn, can lead to the use and misuse of antipsychotic drugs.
Expense and staff turnover
An independent report for the DH on the use of antipsychotics last year found just one in five of the 180,000 dementia patients prescribed the drugs derived any benefit from them.
It included a recommendation that all health and social care staff have specialist training in dementia to facilitate more person-centred care, which could reduce the use of drugs.
Nadra Ahmed, chair of the National Care Association which represents care homes, says although the importance of training is clear, providers face a double whammy of expense and high turnover among staff.
“Care providers pick people to receive training then those people move on,” she says. “The trouble is that some training providers charge £600-£700 per head. Where is a care home going to find that sort of money?”
At present, dementia training is not mandatory. Paul Edwards, head of training and practice development at the Bradford Dementia Group at Bradford University, says that, if it were made so, training providers would need to be assessed for quality.
“Most homes that I go into have spent a fortune on dementia training, but it’s not practical enough to give staff the skills,” he says.
Work is being done to address the problem. The dementia strategy calls for each care home to identify a senior staff member to take the lead for quality improvement in dementia care.
Skills for Care is expected to have amended its common induction standards for care staff to include dementia awareness by May.
And this autumn, it will make available specific dementia units in the qualifications that are to replace NVQs, under the Qualifications and Credit Framework; the new structure for accrediting all vocational qualifications.
Draft versions of the units for these qualifications, which are at levels two and three, are currently being reviewed by sector experts. And Skills for Care is also exploring how a dementia foundation degree can be developed.
Then there is the dementia gateway, developed by the Social Care Institute for Excellence, which has practical tips and tools to help care staff. This includes a section on common difficult situations such as overcoming problems with toileting and cases when residents refuse help.
But in spite of the increasing focus and resources being put into improving dementia care in residential homes, some barriers remain.
Andrew Chidgey, head of policy and public affairs at the Alzheimer’s Society, wants to see councils incentivise care providers to make dementia training a priority through the commissioning process.
But he says local authority fee levels to care homes are “a real difficulty”.
“On the one hand we’d say local authorities need to stipulate in their contracts that care home staff should be appropriately trained to meet the needs of their residents and that training should be ongoing,” he says. “But on the other hand, local authorities are not paying what might be required to develop that type of workforce.”
Care home culture
However, John Nawrockyi, secretary of the workforce network at the Association of Directors of Adult Social Services, says care providers should not expect more money to meet the demands of the dementia strategy, adding that they should not be unaffected by the need to make public service efficiencies.
“There is never enough money in public services because expectations outstrip budgets. Social care has to take its share of national efficiency targets,” he says.
The culture in some care homes is another obstacle. Edwards says that attitudes need to shift from being task-orientated to thinking about the individual.
Nevertheless, he is optimistic that change can be achieved. He believes that, one year into the dementia strategy, national and local bodies are doing well in leading the way towards better services.
“Local authorities and the Department of Health are trying to do something very difficult. It’s a massive task and it’s going to take a long time,” he says.
Case study: Providing a clear path for dementia training
Samantha Jacobs, education and practice development lead, says one aim of the training is to help staff understand what it is like to have dementia.
“We have a mask that simulates different types of vision that someone with dementia might have. Care staff put it on and then we get them to eat with another staff member assisting them. We get staff into a situation where they can understand what it’s like for a client,” says Jacobs.
There are three levels of dementia training at the organisation.
Level one is a half-day dementia awareness course for all staff, regardless of their role. Level two is a three-day course for all employed in a caring capacity, which tends to be taken over several weeks. And level three is a two-year course for those at a senior level who want to become assistant practitioners, which enables them to take on more clinical work.
The organisation has developed career pathways to encourage staff to develop professionally.
“We feel strongly about staff development. The pathways show how someone can progress and what they need to do to progress. We have people here in senior management who started off as domestic staff,” adds Jacobs.
The organisation spent £500,000 on training and development in 2008 out of a total budget of about £19m. Jacobs admits it is a challenge to make this investment when local authority fees are low.
“We struggle with the fact that we get a very low amount paid for a client per week. Training is expensive and it’s not the only thing that we have to pay for.”
It fills the gap through running an NVQ centre, to deliver training, and accessing funding from the government’s Train to Gain scheme.
June Simpson is key worker for Patricia Barwell, a resident with dementia at the Trevern care home in Falmouth. She says training helps prepare carers for the challenges of looking after someone with dementia.
“It would be very off-putting for someone who’s never dealt with dementia to be put in a position where they’re caring for people with the illness. It would be very frightening,” she says.
Mrs Barwell has been at Trevern since January 1996. Her daughter Janie Penn-Barwell says she is very happy with the care.
“There is a lovely combination of a relaxed attitude with professionalism. They’re extremely patient and understanding,” she says.
This article is published in the 15 April 2010 edition of Community Care magazine under the headline Providing the Skills for Dementia Care