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Better Domiciliary Care
for people with dementia

With two-thirds of people living with dementia remaining in their homes, properly trained homecare staff are the key to enhancing the quality of life of these people and ensuring your business meets the rising demands of your client-base. James Cross explores top tips to help providers deliver better quality homecare for people with dementia.

According to Department of Health research two thirds of all people with dementia live in their own home. Therefore it is critical that domiciliary care providers ensure their employees can access quality learning and development opportunities to offer the best possible care and support for people with dementia.

To help providers, Skills for Care has compiled Better domiciliary care for people with dementia, a good practice guide that includes best practice top tips and practical examples from social care employers and key partners across England. The guide sets out 11 areas which help contribute to providing better domiciliary care for people with dementia. Whilst all 11 areas are key to providing better domiciliary care for people with dementia, in this feature we will focus on a selection of those areas.

Supporting new staff

Unless a new worker has encountered dementia through a family member or in a previous field of care, then their experience can be limited. They may also have some common misconceptions. These can include:

  • Only older people get dementia.
  • People living with dementia are all aggressive and/or violent.
  • Nothing can be done for people living with dementia.
  • People living with dementia are a danger to themselves and possibly to those looking after them.
  • People living with dementia cannot advocate for themselves.

To support new staff into the homecare sector, it is essential to address any misconceptions. These five top tips can help.

  1. Make dementia awareness training part of every new employee’s induction process.
  2. Do not overwhelm new workers with huge amounts of statistics – provide information in digestible sections.
  3. When training more than one new worker, understand that they will have different learning needs.
  4. Provide continuity of care for the person with dementia, this will enable new workers to build a solid foundation with them.
  5. Incorporate different training techniques, ranging from group training sessions to on the job training.

Enhancing quality of life through activities

Activity-based support can help alleviate the symptoms and enhance quality of life and independence of someone with dementia. Activities don’t need to be excursions, or take a long time. They can be adapted to suit they length and type of visit someone receives. For example, a short visit can be enhanced by a chat about something in a person’s home, sharing a news story, or a walk around the garden. Potting a plant, playing a game, or companionably watching television all provide an activity-based focus. For longer visits, baking a cake, visiting a coffee shop or going to a community event can give stimulation and enjoyment. It could be anything that meets the person’s interests.

Equally important is to be reactive to circumstances. This means workers should try to provide spontaneity and avoid activities being too rigid and prescribed. Considering a person’s own skills can be the key to successful activities – a person can pass on their skills to workers, whether that’s teaching them crochet or explaining the offside rule.

To enhance the quality of life of people living with dementia through activity-based support, try these five top tips.

  1. Always have a dementia link worker at meetings, to ensure due consideration is given to this important area of care.
  2. Ask a support worker to find out something new each week about the person with dementia and report back to the team. This encourages more varied conversation and activities with individuals.
  3. Know what is going on in your area and who are the key people to contact, for example, who are the dementia advisers? Who is the village agent? These people will help keep you up-to-date with activities and events which might be beneficial to individuals with dementia.
  4. Empower your dementia link workers to liaise with social workers and families; families in particular will have a wealth of knowledge about their loved one which can be the basis of activities, conversation and meaningful moments.
  5. Use the Kitwood equation to problem solve: life history is very important but this needs to be combined with knowledge about an individual’s health conditions, their social psychology and personality. Together this will give a true understanding of the person’s needs and help with a person-centred approach.

Motivating staff

Motivation refers to the energy and commitment with which an individual or group performs a task or role. Motivated workers deliver higher quality care because they care about what they are doing. They often learn faster and have more ideas and are less likely to make mistakes. Motivated homecare workers are enthusiastic, patient and encouraging to others. This impacts on the care they deliver to individuals and families (Benson and Dundis 2003).

Retention in the homecare sector remains a challenge for employers, with average turnover rates of 32.6 per cent (Unison 2012). Undoubtedly, staff motivation plays a critical role in maintaining workforce stability. Motivation remains such a challenge in homecare workers supporting people with dementia for a number of reasons, these include lone homecare workers, varied hours, complex work, poor integration across health and social care services, funding and poor levels of pay.

Care work is one of the most rewarding and self-fulfilling career choices. Homecare workers spend time giving to the most vulnerable people in our communities; they support families to stay together, give older people the choice to remain in their homes and people with disabilities the chance to lead an independent life. Homecare workers go home at the end of the day knowing that they have made a real difference to somebody’s life and how they choose to live it. These factors mean that intrinsic motivation is the key to a homecare worker’s performance and fulfilment. Therefore it is important that employers should strive to create an environment where intrinsic motivation can flourish. These five top tips can help:

  1. Base recruitment on values and competences to ensure you’re employing the right people with the right values for the role.
  2. Ensure employees have the expertise, support and tools they need.
  3. Understand situations from the worker’s perspective.
  4. Treat homecare workers as professional experts and support their career development.
  5. Have clear and achievable goals so that success can be verified and celebrated.

When behaviours change or challenge

When supporting people with dementia there may be times when their behaviour changes and this could be regarded by some as challenging. In this instances, the person may be trying to communicate or share their emotions. Life histories and knowing personal life details about the person can help to understand what may be triggering any behaviour changes. Consider the following top tips when supporting staff whose clients’ behaviour may have changed.

  1. Leadership: be clear on your leadership influences and translate these into your business plan. Have a clear vision of what services you want to provide, and include workers, customers and carers in shaping your services.
  2. Developing and supporting workers is a sharing process; assist workers to be accountable for communicating difficulties and changing needs.
  3. Dig deeper when faced with labels such as ‘challenging behaviour’; often the person who needs support is trying to communicate.
  4. Person-centred care is challenging to get into every day care; attention to detail on support plans and their formulation process is key to working this way.
  5. Communication: what do we do with it? Look at the lines of communication open to workers, customers and carers and let them witness the effectiveness of communicating. Highlight changes that have taken place due to their input.

These are only a few areas that Skills for Care has explored to help providers and support staff caring for people with dementia in their own homes. There is further information plus lots of useful examples of how organisations put this into practice in Skills for Care’s guide Better Domiciliary care for people with dementia.

The best practice case studies are from domiciliary care employers developing their workforces to support people with dementia. They include useful, practical solutions to implementing some of the key aspects of delivering great domiciliary care for people with dementia living in their own homes. The best practice examples are given from organisations including Home Instead, Cardinal Healthcare, Meritum Independent Living, Cherish Care, Care Direct Salford, HomeCareDirect, Quality Care Home Services Limited, The Good Care Group, Ann Tuplin Care Services and DoCare.

Further reading

www.skillsforcare.org.uk/dementia

James Cross is an area manager at Skills for Care. Email: james.cross@skillsforcare.org.uk

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