Enable rights and
choices for
individuals with
dementia whilst
minimising risks
Dem 304
Name:
Date:
Assessor’s Name:
Assessor’s Signature:
Signature:
Legislation to support and assist with rights and risks for
people living with dementia
Mental Capacity Act (2005)
The mental capacity act was introduced in order to empower and
protect people who may lack capacity to make some decisions for
themselves. It makes it clear who can take decisions in which
situations, and how they should go about this. It also allows
people to plan ahead for a time when they may lack capacity.
It covers major decisions about someone's property and affairs,
healthcare treatment and where the person lives, as well as
everyday decisions about personal care (such as what the person
eats), where the person lacks capacity to make those decisions
themselves.
Key Principles
There are five key principles in the Act:
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Every adult has the right to make his or her own decisions and must be
assumed to have capacity to make them unless it is proved otherwise.
A person must be given all practicable help before anyone treats them as not
being able to make their own decisions.
Just because an individual makes what might be seen as an unwise decision,
they should not be treated as lacking capacity to make that decision.
Anything done or any decision made on behalf of a person who lacks capacity
must be done in their best interests.
Anything done for or on behalf of a person who lacks capacity should be the
least restrictive of their basic rights and freedoms.
Understanding Safeguarding and Whistleblowing
It is important that you are aware of the various policies and procedures so that you
are working in a way which supports Your organisation’s s legal duty as a care
provider, and your personal legal responsibility.
As part of your induction you will need to understand the policies and procedures of
the Trust in the following areas within the first 6 months. All policies and procedures
are important, but these are the main areas that you will need to go through with
your mentor/supervisor:
You will need to be familiar with your Safeguarding Vulnerable Adults policy. The
No Secrets guide for Alerters and Reporters also gives you vital information on
abuse and what to do if you suspect abuse.
Abuse can take many forms. You need to know about the main types of abuse.
These are:
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Physical/sexual abuse
Emotional/psychological abuse, including that related to age, race, gender,
sexuality, culture or religion
Financial abuse
Institutional abuse
Self-neglect
Neglect by others.
Abuse could happen in many settings. It could happen in care homes or nursing,
homes, sheltered housing, day centres, people’s own homes and in the community
generally.
Nobody should have to tolerate abuse. However, some people may be more
vulnerable to abuse than others. The reasons for this will vary from person to
person. Some people may be more vulnerable to abuse due to issues within
themselves such as physical or mental illness or learning difficulties. Some people
may be more vulnerable to abuse because of the circumstances they live in; they
may live alone or in poor housing, for example. Some people may be more
vulnerable to abuse because of factors in the care environment they live in, such as
low staffing levels
Your responsibility
Every employee who has contact with Vulnerable Adults has a responsibility to
report concerns about abuse. Abuse can happen in any setting, and comes to light in
different ways. Sometimes a service user may voice their concerns, but more often
suspicions are raised by behaviour that can be observed. It may be reported by
another person, such as another service user or carer.
Whatever the source of the information it must be treated seriously, recorded and
shared with an appropriate manager. If staff are unsure they should discuss
concerns with their manager.
Person-centred practice is a way of working with people who receive care services
that discovers and acts on what is important to a person. It involves really listening
to the person and other people who know them and planning what they need now
and for the future. A person-centered care plan reflects what is important to the
person. It supports staff by giving them the information they need to provide the care
the person wants in the way that they want.
It is important that we promote empowerment for people who use care services. In
the past, people who used care services had often had little power over the
decisions made about their care. People using care services can still feel as though
all the power is with the staff who support them. People are empowered to make
decisions if they are given time, support and information they can understand.
The people we support can face risks in their daily life. It is important that people
continue to do the activities they wish to. We can manage risks by supporting people
to exercise choices and rights. Risks should be managed through risk assessments
that recognise the balance between managing risk and enabling independence,
choice and control. Risk assessments can help to prevent abuse occurring. Care
Workers must also be familiar with the 5 principles of the Mental Capacity Act 2005
when supporting people to manage risks:
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Presume residents have capacity
Support residents to make their own decisions
Residents are allowed to make unwise decisions
Make decisions for residents who lack capacity in their best interests
Use the least restrictive option when making a decision for a resident
who
lacks capacity.
Whistleblowing
Members of staff should be able to raise questions about any area of concern
regarding service or service delivery informally, during supervision or in staff
meetings. In this way, practices can be modified and improved on an on-going basis
and issues resolved long before they reach the "whistle blowing" stage.
However, this policy and process must be followed if the concerns are
serious and would appear to involve the physical, sexual, psychological
or financial abuse of a service user or an employee or involves issues of
neglect and acts of omission which impact on the service user or the
employee in a negative manner. The service user comes first and issues in relation
to their welfare will be treated seriously and sensitively. Managers will be expected to
respond appropriately to protect the needs of the service user.
Raymond’s Money – video case study
The film portrays Raymond, a man in his 80s and recently diagnosed with dementia, and
Wendy his paid care worker. The setting is Raymond's flat. Wendy visits daily to provide
Raymond with practical support to manage at home. The context of the drama is whether
Raymond has capacity to make a decision about spending 50 pounds on lottery tickets.
1. Does Raymond have capacity to ask Wendy to purchase the tickets?
2. Should Wendy be the one to purchase them?
3. What information might need to be shared or recorded with regard to this?
4. What monitoring might there need to be around this situation?
5. Think about the legislation covered earlier. How do you think this applies to
Raymond’s situation?
Risk Taking and Dementia Exercise
Think about someone you work with who might sometimes make unwise decisions, or do
things you consider risky
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How could the identifying risks and impacts table and the Heat Map be used for
people that you work with?
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What role could you have in this?
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Who else should be involved in identifying risks, and best interests decisions
Confidentiality
Confidentiality is the right of people who receive care to have personal, identifiable
information kept private. Confidentiality is vital when working in care. The General
Social Care Council Code of Practice for social care workers is clear that respecting
confidentiality is a key part of the care worker's role. The Data Protection Act 1998
also requires organisations and their staff to keep information secure and
confidential.
You will have access to records about the people you support and personal
information about them. You will also keep and store records about people. You will
also at times need to discuss individual people with managers, colleagues and other
professionals.
Sometimes you may need to pass on
information that might normally be
considered to be confidential. This should
not be done lightly but may be required by
organisational policies or the law. Policies
you need to be aware of in this regard
include:
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Confidentiality policy
The Safeguarding Adults policy
The Whistle-blowing policy.
You also need to be aware of your duty of
care to the people you support. You may
need to break confidentiality if there are
issues of concern. You should explain to
the person you are supporting and where
ever possible, explain why and who you will
be talking to.
How would you deal with these concerns and complaints?
1. You arrive at a service users home for the first time and the service user says that the
previous carer never used to turn up on time and was lazy.
2. A person that you visit regularly says that she is concerned that she is not getting
everything that was agreed with her in her original care plan.
3. The wife of the person you visit says that she is unhappy with the amount of time it is
taking ( that she is paying for) to help her husband to get washed and dressed in the
morning. She believes it can be done quicker and continually asks you to not spend so long
with her husband getting him to help with his care.
4. A service user complains that two cardigans have been ruined by care staff who have
washed her clothes.
Knowing how to recognise and handle complaints.
It is important that people who are receiving a
service are able to make complaints about that
service without being labelled as ‘difficult’ or
suffering any repercussions.
Organisations providing health and social care
should be transparent in relation to acknowledging
where there are concerns or complaints about a
service, and problems are resolved and not hidden.
Staff should welcome justified complaints as they
provide an opportunity to improve the quality of the
service.
Many of the people who receive services from care
providers may well approach you with their
concerns. It is important that you know how to
respond.
You will need to listen carefully and help them to communicate their concerns as
accurately as possible.
Assistive Technology to promote independent living
Prompts and reminders
These are devices that can act as memory prompts and reminders by providing visual,
verbal or audible cues. Clocks and calendar clocks provide information about the day, date
and time. Memo minders play a pre-recorded message when a person walks past to remind
them to do something or not to go out during the night. Medication reminders and dispensers
can help a person to remember when to take their tablets. Signs and notice boards can be
used as reminders and to post messages.
Talking Tins have been designed to help people who are visually or cognitively impaired to
identify the contents of their tinned food. This could also be attached to other metal things in
the house such as the fridge to record short messages/ reminders. This product comes in
the form of a magnetic cap that sits on top of any sized steel tin. The cap allows you to
record a voice message, which can then be played back at any time with the touch of a
button.
This striking clear visual kitchen timer takes some of the guesswork out of cooking and
reminds you when the food is done which helps prevent burnt food or disasters in the
kitchen. Simply twist the top half of the unit to gradually reveal an easy-to-read analogue
dial, stopping when you reach the required number of minutes and seconds (up to 1hr).
Release the bezel and the unit begins counting down, leaving you free to concentrate on
other tasks. The graphic dial allows you to monitor progress at a glance, even from a
distance, and when the time is up, a classic alarm bell sounds to attract your attention. The
unit has a silky, soft-touch finish. No batteries required.
Date and time
These devices can help support people who have difficulties keeping track of the day or
time. They range from large wall mounted clock calendars which show the day, date and
time, to electronic calendars which digitally display the day, date and time of day e.g.
‘morning’, afternoon’, ‘evening’, or ‘night’.
Item locator devices
These are devices that can help locate commonly mislaid items in the home such as keys,
wallets, glasses case etc.
Medication reminders and dispensers
These devices can help support people who have difficulties remembering to take their
tablets. They range from simple flip lid pill boxes labelled with the day of the week and time
of day, to automatic pill reminders and dispensers which give an audible and visual alert
when it is time to take a tablet (the alert stops as soon as the tablet is tipped out). Telecare
medication dispensers will also alert the carer or monitoring centre if the tablets are not
taken out of the dispenser so that an appropriate response can be made.
Voice recorders and memo minders
These devices can help support people who have difficulties remembering to carry out tasks.
Memo minders can record a short verbal message (usually up to 20 seconds) and be placed
near a doorway or other suitable location. A passive infra-red motion detector will sense
when the person walks past the device and the message will be played. Some also have a
timer device that can be set e.g. to remind someone not to leave the house during the night.
These devices may not be suitable for people who are hard of hearing.
Signs, notices and other environmental aids
These are simple visual devices that can act as memory prompts and range form signs or
labels that can be placed on doors to notice boards and wipe boards for pinning or writing
reminders and messages. In this category we also include other items that may be used in a
setting to make it more "enabling" for people with dementia.
Activity monitors
These devices can be used to detect activity and inactivity. Passive infra-red (PIR) sensors
can look for movement at pre-set times e.g. every 4 hours. If the person has not moved for
this time an alarm will be sent to the carer or monitoring centre. Activity monitoring systems
use wireless sensors around the home which send information on the daily activities of a
person to a monitoring service for short term assessment purposes or to provide information
to a carer.
Alarm and pager units
These devices are used to alert a carer or a community alarm monitoring centre to provide a
response when a sensor is triggered. Some assistive technology devices will trigger a
portable pager or bleeper that is carried by the carer within the same home. For people who
are often on their own at home, telecare devices will trigger a table-top alarm unit which will
automatically dial a carer outside the home or a 24 hour monitoring centre.
Fall detectors
These devices detect when a person who as been assessed as being at risk of falling is
getting out of a bed or a chair or when they have had a fall. Pressure sensors or mats on the
bed, chair or floor will send a signal to a portable receiver/pager to alert a carer that the
person is getting up and about. Fall detectors are worn by the person and will trigger an alert
to a carer if an impact is detected and/or the person remains in a lying position. Telecare fall
detectors will also alert the monitoring centre so that an appropriate response can be made.
Flood detectors and water temperature monitors
These devices detect flooding and dangerously hot water. Flood detectors range from a
simple plug that releases excess water if the taps have been left running in the bath or sink
to prevent water overflowing, to wireless sensors that provide an audible alarm when they
detect water rising above a certain level or when water is running onto the floor. Telecare
flood detectors will also alert the carer or monitoring centre so that an appropriate response
can be made. Water temperature monitors provide a visual or audible warning when water is
dangerously hot.
Gas, carbon monoxide, smoke and extreme temperature detectors
These devices detect gas, carbon monoxide, smoke and extremes of temperature. Gas
detectors provide a visual and audible alarm if a gas cooker or a gas fire is left unlit or there
is a gas leak. In addition, some devices link to a cut off valve which will automatically cut off
the gas supply. Carbon monoxide (CO) detectors provide a visual and audible alarm when
dangerous CO emissions have been detected due to a blocked flu or fault in a fuel burning
appliance. Smoke detectors provide an audible alarm when smoke is detected in the home.
Extreme temperature monitor for excessively high and low temperatures and a rapid rate of
rise in temperature. Telecare devices will also alert the carer or monitoring centre that the
sensor has been triggered so that the emergency services can be called.
Lighting
These devices provide easy to use or automatic lighting in the home. Touch lamps are easy
to use lamps which can be turned on by touching the base area. Automatic night lights range
from lights that come on at dusk and switch themselves off at dawn, to lights that come on
automatically when a person gets out of their bed or chair or opens a door during the night.
Other safety and security devices
These devices are used to improve general safety and security in the home. Devices include
key-safes for use by authorised carers and other persons who may need to access the home
if the person is unable to open the front door.
"Wandering"/Safer walking technologies - to locate a person who may be lost
There are a growing range of devices that fall under this heading. They vary greatly in
design and how they may be used. For example a card may be carried by the person
containing emergency contact details should the holder become lost or experience
difficulties. New GPS (Global Positioning Satellite) technologies now enable devices
(including mobile phones) to locate the precise position of the carrier. As with the application
of all technologies, ethical issues, including best interests and consent, should be thoroughly
considered.
"Wandering"/Safer walking technologies - to alert when someone gets up or leaves
These devices may trigger a sensor (door, bed, chair, floor) and notify another person
(perhaps a carer in the same house or living elsewhere, or a monitoring centre) should a
person open a door where a sensor is located or leave a designated area. As with the
application of all technologies, ethical issues, including best interests and consent, should be
thoroughly considered.
Computer aids
These include easy to see and use computer keyboards with large keys, magnifying screens
and accessible computers and software.
TV, Radio & Music
These include easy to see and use TV remote controls, radios and music players, with
simple large buttons to switch them on and off.
Books, Photographs & Reminiscence materials
These include specially designed books to be shared with people with dementia, talking
photo albums which play a short message next to each photograph and a sample of other
reminiscence materials that are available.
Games
These include talking games that can be played on the computer and electronic games and
consoles.
Dem 304
You will need to answer these questions following the training session in
order for you to successfully complete the QCF unit Dem 304 enabling
rights and choices for individuals whilst minimising risk. If you are unsure
about how to answer any of the questions you should discuss this with
the person who will be assessing you.
1 Explain the impact of key legislation that relates to fulfilment of rights and choices and the
minimising of risk of harm for an individual with dementia
2. Think about two different service users that you work with who have dementia. Describe
how the care plan for each person helps to maintain and promote the person’s rights and
choices. How well do you think each care plan manages to do this. Is there anything that
could be improved?
3. Explain how and when personal information may be shared with carers and others, taking
into account the requirements of the Mental capacity act, safeguarding procedures, lasting
power of attorney and your own service’s policies and procedures.
4. Briefly describe how the best interests of a person that you provide a service for have
been considered when planning and delivering care and support. What role do you have to
make sure that the person’s best interests in this situation are met and understood.
5. Describe a situation where you have helped a person with dementia to exercise their
rights and choices even when a decision has not been deemed to be in their best interests.
6. Explain why it is important not to assume that an individual with dementia cannot make
their own decisions
7. Describe how the ability of an individual with dementia to make decisions may fluctuate
8. Describe how a conflict of interest can be addressed between the carer and an individual
with dementia whilst balancing rights, choices and risk
9. Describe how to ensure an individual with dementia, family and others feel able to
complain without fear of retribution
10. Describe how to maintain privacy and dignity when providing personal support for
intimate care to an individual with dementia
Real work situations
You will also need to complete all three of the following real work
situations, to demonstrate that you are able to put your knowledge into
practice for for you to successfully complete the QCF unit Dem 304
enabling rights and choices for individuals whilst minimising risk
For each of the following statements you will need to describe how you
have actually put these into practice in your work. You will also need to
have each explanation signed by your manager, a senior colleague, or
somebody actually involved in the situation you have described who can
confirm that your account of the action you took is a true account.
1. Explain how you have involved family members and others in planning support that
promotes the rights and choices of an individual with dementia and minimises risk of harm
I am signing to say that I confirm that this is a true account of the actions taken by
this care worker
Signature of witness
Relationship of witness to you
2. Explain how key physical aspects of the environment have helped you to show respect
and dignity for an individual with dementia
I am signing to say that I confirm that this is a true account of the actions taken by
this care worker
Signature of witness
Relationship of witness to you
3. Demonstrate that key social aspects of the environment are enabling care workers to
show respect and dignity for an individual with dementia
I am signing to say that I confirm that this is a true account of the actions taken by
this care worker
Signature of witness
Relationship of witness to you