Training is only the
beginning…
Extra Care Housing for People with
Dementia
Beth Noray, Consultancy & Training
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Thoughts…….
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I want to talk about the importance of training and
what it should include
But also to say that it is only the beginning and there
are other systems and planning that need to be in
place to support the training, the staff and the person
with dementia.
Beth Noray, Consultancy & Training
2
Staff require training
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Supporting people with dementia
requires specific skills.
It is hugely rewarding, but not easy.
Staff need to be equipped with the
knowledge and skills to do the job
effectively.
Training is not just for care staff, it is
also needed for housing staff, care
managers and management and
anyone involved in assessment.
Learning is a life long process and
people need to be offered training as
they grow and develop to make use of
their experience and to learn new
skills and techniques
In 2004 the Alzheimer’s Society
discovered that only 10% of those
caring for people with a dementia,
were given training.
Beth Noray, Consultancy & Training
3
What training?
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Dementia Training
The approach
How to increase Well-being
Communication skills
Understanding behaviour
that may be difficult or
challenging
Making assessments
Risk assessment
Working with families
Activities
Beth Noray, Consultancy & Training
4
Understanding Dementia
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Understanding dementia,
what it is and to have myths
debunked.
The difference between the
various illnesses that cause
the symptoms
The major problems it can
cause like agnosias,
dysphasias and dyspraxias.
The progression of the
dementing process.
Beth Noray, Consultancy & Training
5
Person-centred approach
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What good support looks like for a person with dementia.
To recognise the person’s strengths as well as needs and work
with them.
To genuinely promote independence, to maintain existing
skills for as long as possible
To see each person as a unique individual with specific needs
To help the person remain connected to the outside world..
Understanding the importance of knowing the person’s likes &
dislikes, their life history, their preferred lifestyle and routines.
Beth Noray, Consultancy & Training
6
Increasing well-being
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Increasing well-being is the most
important aim of good support
Support tailored to meet each
individual’s needs and strengths.
Behaviour is not set in stone, it
can be changed just as ours can be
changed by the right approach and
behaviour.
Knowing how and when to divert
effectively and when to go with it.
Beth Noray, Consultancy & Training
7
Communication skills
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To understand the communication
difficulties the person is likely to
experience and the skills to
compensate for them.
Understand the importance of
nonverbal communication.
Learn to work effectively with the
person’s reality.
Understand the symbolic
language a person with dementia
may use.
Develop empathy, self-awareness
to hone their skills.
Understand the importance of and
develop their interpersonal skills
Beth Noray, Consultancy & Training
8
Understanding Behaviour we find
Difficult & Challenging
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Challenging behaviour is the
greatest cause of moving people
on from sheltered housing.
Behaviour is a form of
communication, we need to learn
to understand what the person is
trying to tell us by their behaviour
and the skills to know how to
respond appropriately
Be able to pick up clues, in their
life history, their lifestyles and
possible triggers in the
environment.
Beth Noray, Consultancy & Training
9
Not just the illness
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People tend to put all
behaviours down to the
dementia.
Most behaviours are in
fact due to other factors
which cannot be
properly communicated
or understood and dealt
with because of the
dementing process.
Beth Noray, Consultancy & Training
10
Personality
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Personality alone can cause
challenging behaviours.
My mother could have
stayed in sheltered housing
much longer, had she not
rebelled against home care
telling her what & when to
eat. Her independence
caused her to try to do
things which were now
beyond her and was
constantly visited by the fire
brigade.
Beth Noray, Consultancy & Training
11
Life History
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Life is not an easy business and
we all are scarred and uplifted by
what happens to us. Events leave
an imprint.
Will the work routines you have
learnt over the years now become
challenging behaviours?
The trauma of your life, your war
experiences or rape will return to
haunt you in your dementia, but
you may no longer be able to
explain this, you will just feel.
Beth Noray, Consultancy & Training
12
Physical Health
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The person may be in pain
because they do not know what to
do when this feeling happens,
what you call it or forget to tell
someone who can help and may
not remember what a painkiller is.
The person’s hearing or sight may
be impaired but they forget to
wear their glasses or hearing aid,
no longer understanding their
relevance.
Beth Noray, Consultancy & Training
13
Mental Health
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If the person has come into extra
care because their life partner has
died, they are going to search for
them. If they are distressed they
are going to search for the
emotional support and comfort
that a partner or parent gave them
and ‘wander’.
They may be very confused and
frightened because suddenly they
have been transported from their
home to this strange unfamiliar
environment, they find hard to
understand.
They may be depressed because
life has nothing much to offer
them any more.
Beth Noray, Consultancy & Training
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Current Environment
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It is very important that people do not
move into extra care when they are no
longer able to make friends or join in any
social events or become familiar with the
environment.
Many residents are very intolerant of
people with dementia and can make them
feel very unwelcome. Some residents are
subject to abuse and harassment due to
their disability
There tends to be a big difference in wellbeing between people who have developed
dementia once safety ensconced in the
scheme and those who move in with a
dementia and may never be accepted.
People who still have their life partner and
family and friends who visit are likely to
be much happier than people who have no
one.
Beth Noray, Consultancy & Training
15
Activities and Occupation
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These are not just group activities
An activity can be used
therapeutically to raise well-being
or to divert at a stressful time of
day
It is understanding that activities
need to be offered at different
levels of ability.
They should be failure free but
provide a sense of achievement
Beth Noray, Consultancy & Training
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Assessment
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Experience/training in interviewing
people with dementia.
What is their diagnosis? What stage is
the person in their dementia? How
disorientated are they?
What can this person really do for
themselves, the need to check this
out.
The emotional needs of this person
and the support they will need.
The personality, life history, lifestyle
or routine of the person and any
problems these are likely to cause.
Cultural & spiritual needs and can
these be met.
Beth Noray, Consultancy & Training
17
Management systems
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Support plans need to be integrated with care plans so everyone is clear
what they are trying to achieve and they concur.
Life histories, likes and dislikes, lifestyle preferences identified and known
to all staff.
Emotional needs should be identified and plans devised to improve wellbeing e.g. overcoming grief or become more assertive.
Strengths and skills noted and support and care plans created that enable
people to use their remaining skills.
Difficult behaviours are noted and strategies identified to deal with them
and known to all staff.
Supporting people with dementia takes time and a lack of time tends to
cause difficult & challenging behaviour
Provide information and guidance to other residents about dementia and
how they can help.
Beth Noray, Consultancy & Training
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Support for staff
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If we are to work in a person-centred
way, we need to be person-centred
towards all staff, both care and
housing.
Staff working with people’s emotions
need support for themselves, because
it is not easy, sometimes it’s
disturbing.
They need critical incident analysis
An opportunity to talk through issues,
approaches, problems, triumphs.
If staff are denied this they will revert
to a task orientated or administrative
approach.
Beth Noray, Consultancy & Training
19
Risk
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People with dementia do not
understand the risk there now is for
them, in doing things they have
always done.
Assessing the actual risk and seeking
to minimize that risk is much better
than saying no. If no really has to be
said, how can the person effectively
be diverted.
Life with risks is exciting, being
wrapped up in cotton wool is boring.
Share the potential risk with family,
think about the quality of the person’s
life, not just their physical safety.
Beth Noray, Consultancy & Training
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Working with the family
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Families need information about
dementia and to approach situations
appropriately
They need advice in not buying
microwave ovens or replacing hob
kettles with electric ones.
They are not always right.
They know the pre-demented person,
the professionals know dementia and
how the person functions in the
scheme.
They need to be part of and
understand the support plans
It is important that all staff understand
the grief that families will often feel
which may mean they cease to visit.
Beth Noray, Consultancy & Training
21
Severe dementia and death
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No one wants to die alone, many people
with dementia do.
You probably would prefer to die at home
in familiar surroundings with people you
know and love.
Physical comfort and pain relief
Spiritual or emotional support, people may
well be frightened.
Mental stimulation, like music, company.
People will not understand drips, catheters
or peg feeds, so invasive assistance should
be kept to a minimum.
We need to have a range of peripatetic
services who can come to meet the needs
of a person, rather than take them to
another strange and confusing place to
receive the care they need.
Beth Noray, Consultancy & Training
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People with dementia
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People with dementia are firstly
people like you and me.
Training is a block to stand on
and build from, but it cannot stand
alone.
Extra care can provide the support
that people with dementia need
without the institutionalisation of
care homes; it can be the ideal
environment to take someone
through the varying stages of
dementia whilst remaining in their
own home and retaining their
independence for as long as
possible.
Beth Noray, Consultancy & Training
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