Care Homes and End of Life Sophie Meredith and Nicole Beeching

Pathways 4 Life 7 Dementia Cafés; providing people with vital advice about the condition and an opportunity to socialise. Run on a monthly basis alongside a weekly dementia café held at Walsall Manor Hospital. Dementia Advisor Service; acting as a first point of call for people with dementia and their carers. Dementia Support Workers; at Walsall Manor Hospital. Dementia Diagnosis Support Worker; working alongside the memory clinic to provide support, advice and guidance. Dementia Support Worker: Hard to Reach; working within the community to engage and support people with dementia from hard to reach communities. A monthly Mind Matters café’ to support older people and families living with mental health conditions and depression. Dementia Support Workers: Care Homes and End of Life; to offer advice and support to care home staff working across Walsall. Personal Assistant Dementia Support Workers, providing guidance to people for the first 12 weeks following a diagnosis of Dementia; Dementia Friendly Communities; working alongside the Alzheimer's Society to help make Walsall become a Dementia Friendly Community

Pathways 4 Life Accord Group Dementia Support Worker: Care Homes and End of Life Dementia Café/ Mind Matters Coordinator Dementia Support Worker: Hard to Reach Personal Assistant Dementia Support Workers Dementia Friendly Communities Age UK Walsall Dementia Advisors Dementia Support Workers Dementia Diagnosis Support Worker Personal Assistant Dementia Support Workers

St Giles Hospice Established in site in Walsall, 1 site in Whittington Registered charity providing high-quality medical and nursing care for local people living with cancer and other serious illnesses St Giles has over 400 staff, over 1,500 volunteers and 31 charity shops, with over £9 million spent on providing care every year

About: Care Homes and End of Life Project The two Dementia Support Workers; Are dedicated to improving end of life and dementia care across care homes in Walsall Funded by Walsall Clinical Commissioning Group Empower care home staff, people with dementia and their carers through training, support and guidance Use a joint approach by working alongside care staff, nurses, OT’s, volunteers and community groups Service provision is ‘needs led’ and not ‘provider led’ recognising that every service user is different

Overall Aims of the project; Improve dementia and End of Life in care homes; Improve the use of evidence based tools, e.g Abbey Pain Scale, IMS Increase the level of activity in care homes Improvement of the dementia care environment; Increase the use of assistive technology Adaptation of the Namaste care approach across Walsall More people to die in their own home (care home) than in acute hospitals

Why is this needed? Care needs improving within settings where people are living with dementia In Walsall there are just over 2,000 people with a formal diagnosis of dementia. Prevalence is approaching 3,100 and this will increase year on year. Two thirds of people with dementia die in acute hospitals.

Objectives Formulate an improvement plan for homes using Care Fit for VIPsCare Fit for VIPs Prompt the use of the “This is Me”/Life Story work Prompt the use of Wellbeing Action Plans and Individual Management Strategies where behavioural issues are identified to better understand the cause Make suggestions to improve the environment Prompt good hydration and nutrition and the use of nutritional screening tools Prompt socialisation, activity and meaningful engagement Support care homes in adopting the Namaste care approach Provide information in the appropriate format for staff, residents/service users and carers

Case Study 1- Beryl Beryl has a diagnosis of mixed dementia She has limited communication with others Only 1 word is ever used- “Birmingham” Lack of confidence to socialise with others within the care home Appears to be very frustrated and anxious within herself

Challenges Staff had a lack of understanding of the importance of activities, in particular music Staff members having a lack of confidence to deliver activities Lack of confidence in identifying ways in which they can communicate with Beryl Lack of understanding of Beryl’s dementia Staff didn’t full understand residents interests/ past history / likes/dislikes Risk adverse

What we did… DSW’s spent time with staff to help support with understanding Life Story work and the benefits this can bring Each staff member was set a ‘task’, to identify one piece of important information about a person - from this information they were to provide a meaningful activity With Beryl, staff identified she loves music DSW provided a wide variety of activities around music, i.e music quiz, use musical instruments They also offered Beryl an i-Pod… MAGIC!!!

Following the introduction of an I Pod: Initially played ‘Le Fabuleux Destin d Amelie Poulain’ soundtrack for approximately 30 minutes Beryl is now communicating more, asking others: “Can you hear this?” “Listen to this with me” ‘this is fantastic’ – whilst clapping her hands and tapping her feet Beryl is now making friends within the care home for the first time since moving in Beryl is now ‘smiling’

Case Study 2 ‘Traditional’ nursing home setting Task driven culture Lack of meaningful engagement for residents living with advanced dementia Activity co-ordinators and senior members of staff feeling demotivated, as a result of feeling the residents they care for “are not living, but, are just existing” Limited family/friends input, resulting in lack of support when fundraising for residents comfort fund etc. Several staff feel uncomfortable acknowledging end of life

Challenges Time constraints Staff’s lack of confidence Task driven culture Fear of discussing end of life Limited understanding of people living with dementia Risk adverse

What we did… Delivered development sessions to staff to help them gain a better understanding of meaningful engagement for people living with advanced stages dementia Supported staff to implement new paperwork that allows them to spend more time with residents, resulting in a less task driven environment Signposted staff to local services within Walsall that provide assistive technology to support residents Supported staff to implement the Namaste Care Approach, with incredible results!

The Power of the Namaste Care Approach During one Namaste session with a gentleman, a very moving moment occurred… Staff used his Wife’s old perfume, which he had not smelt for many years. The gentleman cannot communicate verbally, but, staff explained that during the Namaste engagement, they witnessed a “tear fall down his cheek and a smile stretch across his face.”

Results of implementing the Namaste Care approach Improved sense of wellbeing for residents Improved family/friend engagement Staff feeling more enthusiastic about their role: “We’ve needed this for a long time!” Improved understanding of the importance of creating meaningful moments for residents Staff have an improved understanding of how important it is to make the “sunset as good as the sunrise” (Simard.J)

Contact Details Sophie Meredith Dementia Support Worker: Care Homes and End of Life Nicole Beeching Head of Service Development, Accord Group Joanne Jinks Dementia Support Worker: Care Homes and End of Life

References missioning_unit.pdf (2015) missioning_unit.pdf End of Life Namaste Care: Program for People Living With Dementia, Professor Joyce Simard

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