Five tips to improve dementia support in care homes

Four Seasons Health Care has halved use of antipsychotic medication for adults with dementia through its specialist Pearl care programme. Head of dementia care Caroline Baker outlines the key learning points for all care homes.

Engaging residents in old hobbies is a key part of the Pearl programme

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Four Seasons Health Care launched its Pearl (Positively Enriching And enhancing Residents’ Lives) programme to improve the lives of care home residents with dementia in 2008. Five years on, an evaluation has found that the use of antipsychotic medication has fallen by 48% on average across homes using the Pearl programme, while use of anti-depressant medication fell by 19% and well-being increased for 46% of residents.

Although it is a specialised dementia care programme, requiring 12 months on average for a home to reach the standards to gain Pearl accreditation, there are many lessons from the programme that can be applied throughout all care homes nationwide. Here are our top five tips: 

See beyond the dementia to understand the person as an individual

The start point is to help staff to see beyond the condition of dementia to understand the person. Recognising and treating each resident as an individual is a core component of Pearl, which places an emphasis on the need for engagement. We work with the resident, their family, friends and important influencers, such as their GP or social worker, to build a picture of the resident’s life, their routines, hobbies, likes and dislikes and so on. This is taken into account in developing their personal care and activities plan. A story board based on a resident’s life history is placed outside their room. This provides staff with talking points and a focus of communication. In this way it is possible to create a form of reality that may previously have been lost.

Communication is key

Communication and engagement, informed by knowledge and understanding of the person as an individual, is paramount. We recognise that what is still regarded as “challenging behaviour” in too many care settings is more often a distress reaction. The way to manage it is to identify the cause of the distress and deal with it, rather than giving antipsychotic medication to quieten the person down.

We train staff to be sensitive in dealing with distress. For example if a resident is distressed about picking up their children from school, care staff don’t simply tell them that their children have grown up and have children of their own. They are trained to talk to them about their children, and the feelings behind their anxiety.

Understand care from the perspective of residents

To deliver person-centred care we believe that our staff have to understand the care that is being delivered from the perspective of the resident. We have developed ‘resident experience training’ for our staff.

In the first session, staff are given an experience of poor care and not being treated as an individual. They are left wearing damp incontinence pads under their clothing; spectacles are smeared; staff talk over them and not to them; they are given food and drink without any consideration of whether it is to their taste; are administered medication without being spoken to; have their hair brushed in a way they would not wear it and are taken into a room and left there with nothing to do and no explanation. In the second part of the session they are once again treated as individuals with their own personality and preferences. The contrasting experience is memorable and ensures that staff understand the meaning and importance of person-centred care.

Use a range of therapies, tailored to the individual’s needs

Providing a variety of alternative approaches and activities helps all residents to feel engaged and valued as a person. Staff provide reminiscence sessions or memory boxes to engage people in conversations. Providing a resident with a significant item or asking them about one of their favourite holidays helps to induce positive memories. Similarly, music therapy sessions are held in order to acknowledge that a certain song has significant meaning for a resident.

Doll therapy is another effective form of alternative therapy. Residents are introduced to a doll with which they can form an emotional attachment. The dolls particularly help people who have a sense of loss when they come into a home so they hold the doll for comfort or speak through the doll.

Promote independence

We encourage our residents to look after themselves as far as possible in order to maintain their dignity and independence, providing assistance as it is needed. The ethos of Pearl is to appreciate the individual and to support them to live their lives as they always have. It is a more effective form of therapy to assist the individual in the tasks they are able to do, no matter how small, rather than staff doing it to save time.

Caroline Baker is head of quality and dementia care at Four Seasons Health Care

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