Dementia ; Important aspects of good care

So many aged care workers burn out or suffer compassion fatigue because of inadequate knowledge or training. Effective dementia care requires strong leadership and support by managers as well as by direct care staff. It also requires more staff to care for residents than general residential care and a focus on resident centred care. Resident centred care provides individualised care

 Staff need training and skills in dementia care and management of special needs in order to provide good care. Staff should be encouraged to adopt and implement a resident centred approach to care. This provides the individual resident with support at a level required to maintain their well being. In providing the necessary support for an individual, the service encourages the resident to maintain their independence, preferences and chosen lifestyle as much as possible.

Experience has shown that some separate areas are beneficial for the good care of people with dementia who have special needs. These needs may arise from behaviour such as restlessness or wandering which are common in people with dementia. If a dementia specific unit is not possible, then an area such as a wing, or even a room, could be utilised to provide separation and safety.

Other ways of caring for people with dementia who may be agitated or restless are:

• Good dementia design including safe wandering areas 

• Individualised activity programs

• A quiet area away from the TV

• A massage with calming perfumed oil

• The presence of pets may have a significant calming effect

At times it may be necessary to get advice from a psychogeriatrician, who might suggest a medication review, or in extreme cases, assessment in a special unit.

Any special care needs should be addressed in the care plan. You should be asked for your input in developing strategies and actions that may be required to manage specific behaviours.

Adopting a care approach that seeks to know and understand each resident in the context of their culture, is a start to providing good care to people with dementia from all cultural backgrounds. Every effort should be made to communicate in their preferred language and to provide a culturally familiar environment.

Good dementia care must involve relatives and friends as much as possible. This includes consulting and actively involving them in care planning and review. They should be treated as partners in caring, not just as someone who can help at meal times. Family and friends should be encouraged to be involved in residents’ meetings and committees and to join any support groups.

Often when people with dementia are in pain they are unable to tell anyone. The only way that we know that they are in pain is through changes in their behaviour, such as restlessness, irritability or aggression. It is important to be sure that pain is not the underlying cause of any change in behaviour.

Good pain management lowers the occurrence of confusion and distress and reduces the need for psychotropic medications (medications which relax and sedate people). Staff should have the clinical skills in pain assessment and management and should acknowledge and utilise the experience of families and carers in this area. The goal of good pain management is to ensure that the resident is pain free. This can also mean looking at alternative approaches to pain control such as massage, acupuncture etc.

Best practice nursing care means that physical and chemical restraint is rarely necessary except in extreme circumstances.

Physical devices such as vests, straps, wrist ties, splints, casts, mitts, restraining belts, bed rails, wheelchair bars and brakes, binders and bed sheets are some mechanisms that are sometimes used as restraints. Other approaches such as isolating the person in a locked or separate room can also be considered as restraint.

Chemical restraints include tranquillisers and sedatives when used outside their therapeutic role.

Access to specialist psychogeriatric assessment and advice in the management of dementia is important in providing good care for people with dementia. The advice of other allied health professionals such as physiotherapists, occupational therapists, speech pathologists, dieticians or psychologists may also be very useful in attaining the best quality of life for the person with dementia.

The key to good care is ensuring that the environment is as home-like as possible and centred on a flexible approach to providing the best possible support for the resident.

Dementia Australia consumer informed advice ;

>understand diversity and maintaining identity through relationships

>involve carers and advocates as vital partners in care

>flexibility in provision of care and how and when services are received

>inclusion in community, meaningful activities and decision making

>community and home-like setting design, look and feel

>feedback and complaints taken seriously

>dementia trained staff

>change in leadership and culture to understand and support dementia.

We need to improve.