School of Medicine
Home Support for People with
Dementia:
The ingredients of a good service
7/1/2016
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School of Medicine
The Fidelity Index Project
• Key stages of the research project:
– Literature review – what does the literature say about how good
services should be organised and commissioned
– Building a Service Template – Listing the principal factors that enable
the delivery of a good service
– Designing and testing a measuring tool (a Fidelity Index) – What
questions should be asked in order to determine the efficacy of a good
home care service
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Ten things the literature suggests enable a
good service (Our Service Template)
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Commissioning (a dementia specific service)
Integration, coordination and care management (joined up care)
Person and relationship centred care (services designed around the client and carer
rather than the commissioner and embrace the person’s unique biography).
•
Continuity of care (Allocation of the same care worker(s) to the client in order to build a trusting
relationship).
•
Support for carers (Early home care may allow the carer to acclimate to the range of demands
placed upon them and can be extremely cost effective).
•
Care planning (Attention is often paid to ‘secondary purposes’ such as legal standards which produce
a plan that is ‘document centred’ rather than client focused (Keenan et al, 2008)
•
•
•
•
Training (One of the attributes regarded as being of most value in supporting someone with dementia)
Support for staff
Flexible and responsive services (Staff are afforded the necessary time and flexibility)
Organisational factors (Policies, procedures, processes, systems and
culture)
We’re going to ask your opinion of this Service Template later on!
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School of Medicine
Characteristics of good care (‘Not Just a Number’ CQC, 2013):
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•
•
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7/1/2016
Providers and commissioners manage identified issues together
Relatives and carers are routinely involved in decisions about care
Care plans are kept up to date, reviewed and adjusted in response to
changing needs and preferences
There is continuity of care workers
Staff have a good understanding of dementia and are not asked to
undertake tasks unless they have the necessary knowledge and skills.
There are regular staff and team meetings, and regular information and
updates for staff
Managers carry out systematic quality checking. They capture feedback
from staff and use it to improve services, survey results are acted on and
inform improvements
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Three key themes arising from this work:
•
Commissioning (a dementia specific service)
•
Integration, coordination and care management (joined up care)
•
Person and relationship centred care (services designed around the client
and carer embracing the person’s unique biography)
•
•
Continuity of care (Allocation of the same care worker(s) to the client in order to build a trusting relationship).
Support for carers (Early home care may allow the carer to acclimate to the range of demands placed upon
them and can be extremely cost effective)
•
Care planning (An accessible, client focused, person centred plan of care)
•
•
•
•
Training (One of the attributes regarded as being of most value in supporting someone with dementia)
Support for staff
Flexible and responsive services (Staff are afforded the necessary time and flexibility)
Organisational factors (Policies, procedures, processes, systems and culture)
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School of Medicine
Person Centred Care Planning
The Soundtrack to My Life Tool
Feedback on Research
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School of Medicine
The Soundtrack to My Life – A person
centred adjunct to care
• What is the Soundtrack?
• How was it evaluated?
• What did the evaluation find?
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School of Medicine
We all talk about ‘person-centred care’ but
what does it mean?
• “The term person-centred care has become all-pervasive on
the UK dementia care scene. It has been suggested that it has
become synonymous with good quality care. It seems that any
new approach in dementia care has to claim to be pc (personcentred)…………..although what lies behind the rhetoric in
terms of practice may be questionable” (Dawn Brooker)
School of Medicine
We all talk about ‘person-centred care’
but what does it mean(2)?
• Assisting people to maintain their individuality is
important in person-centred care (Ericson et al, 2001)
• This involves an awareness of the individual’s life
before dementia, so as to be able to understand the
individual in his or her own biographical context
(Stokes, 1997)
School of Medicine
Music as part of a person centred
approach:
• Age UK, highlight the ‘power of music’, as an
increasingly key feature of dementia care,
designed to unlock memories and ‘kick start the
grey matter’. ‘It seems to reach parts of the
damaged brain in ways other forms of
communication cannot’.
• A systematic study by Ziv et al (2007) found that
music also made people with dementia ‘calmer’
and seemed to evoke a more positive mood.
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School of Medicine
Evaluating the Soundtrack
• Soundtrack Implemented with support from two
homecare teams
• A number of citizens and their care workers involved
• Care workers asked to feedback their experience of
using Soundtrack
• Key individuals asked about their experience of
implementing Soundtrack
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School of Medicine
Feedback from care workers:
• “It’s reopened a window to the past…It’s bought
new conversations, seen new emotions. Seen a
different side”.
• “Good concept and clearly valuable to help
carers connect with people with dementia”.
• “Improved communication. Getting to know
citizen better”.
• “Empowers citizens, gets teams seeing the
person rather than the disease”.
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School of Medicine
Ingredients for success:
• The support of key staff, training that is aligned to
local need, familiar and user friendly
documentation and an agreed project
implementation plan, are all deemed to be
important considerations for success.
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School of Medicine
References
•
Bellamy, C. 6, P and Raab, C. (2006), Joined-up Public Services: Data-sharing and Privacy in
Multi-Agency Working, Economic and Social Research Council , Swindon: RES-000-23-0158.
•
Brooker, D. (2003), What is person-centred care in dementia? Reviews in Clinical Gerontology /
Volume 13 / Issue 03 / August 2003, pp 215-222 Cambridge University Press
•
Brooker, Edawrds and May (2009), Enriched Care Planning for People with Dementia: A Good
Practice Guide to Delivering Person-Centred Care
•
Ericson, I., Hellstrom, I., Lundh, U. and Nolan, M. (2001) ‘What constitutes good care for people
with dementia?’, British Journal of Nursing, Vol. 10, No. 11, pp. 710–14
•
Sheard, D. (2004) ‘Person-centred care: the emperor’s new clothes?’, Journal of Dementia Care,
March/April, Vol. 12, Issue 2, pp. 22–4
•
Stokes, G. (1997) ‘Reacting to a real threat’, Journal of Dementia Care, January/ February, Vol. 5,
Issue 1, pp. 14–15
•
Ziv N, Granot A, Hai S, Dassa A, Haimov I. The effect of background stimulative music on
behaviour in Alzheimer's patients. J Music Ther. 2007;44(4):329-343.