Home Support for People with Dementia: The ingredients of a good service 11/6/2018

The Fidelity Index Project Key stages of the research project: Literature review – what does the literature say about how good services should be organised and commissioned Building a Service Template – Listing the principal factors that enable the delivery of a good service Designing and testing a measuring tool (a Fidelity Index) – What questions should be asked in order to determine the efficacy of a good home care service 11/6/2018

We’re going to ask your opinion of this Service Template later on! Ten things the literature suggests enable a good service (Our Service Template) Commissioning (a dementia specific service) Integration, coordination and care management (joined up care) Person and relationship centred care (services designed around the client and carer rather than the commissioner and embrace the person’s unique biography). Continuity of care (Allocation of the same care worker(s) to the client in order to build a trusting relationship). Support for carers (Early home care may allow the carer to acclimate to the range of demands placed upon them and can be extremely cost effective). Care planning (Attention is often paid to ‘secondary purposes’ such as legal standards which produce a plan that is ‘document centred’ rather than client focused (Keenan et al, 2008) Training (One of the attributes regarded as being of most value in supporting someone with dementia) Support for staff Flexible and responsive services (Staff are afforded the necessary time and flexibility) Organisational factors (Policies, procedures, processes, systems and culture) We’re going to ask your opinion of this Service Template later on!

Characteristics of good care (‘Not Just a Number’ CQC, 2013): Providers and commissioners manage identified issues together Relatives and carers are routinely involved in decisions about care Care plans are kept up to date, reviewed and adjusted in response to changing needs and preferences There is continuity of care workers Staff have a good understanding of dementia and are not asked to undertake tasks unless they have the necessary knowledge and skills. There are regular staff and team meetings, and regular information and updates for staff Managers carry out systematic quality checking. They capture feedback from staff and use it to improve services, survey results are acted on and inform improvements 11/6/2018

Three key themes arising from this work: Commissioning (a dementia specific service) Integration, coordination and care management (joined up care) Person and relationship centred care (services designed around the client and carer embracing the person’s unique biography) Continuity of care (Allocation of the same care worker(s) to the client in order to build a trusting relationship). Support for carers (Early home care may allow the carer to acclimate to the range of demands placed upon them and can be extremely cost effective) Care planning (An accessible, client focused, person centred plan of care) Training (One of the attributes regarded as being of most value in supporting someone with dementia) Support for staff Flexible and responsive services (Staff are afforded the necessary time and flexibility) Organisational factors (Policies, procedures, processes, systems and culture) Care planning – a care plan that exists ‘on the cloud’ and can be accessed by everyone who needs it. Mostly as Sara Deakin puts it “Face book type stuff” anyway. Jo Harvey tells the story about a patient who was challenging to care for, but one staff knew that he liked John Wayne, the relationship changed. Soundtrack is one example of an adjunct to good care planning. Mike Craven will be exploring other idea after lunch, and you will have the opportunity to think of other innovations / ideas during the afternoon group work. 11/6/2018

Person Centred Care Planning The Soundtrack to My Life Tool Feedback on Research

The Soundtrack to My Life – A person centred adjunct to care What is the Soundtrack? How was it evaluated? What did the evaluation find? 11/6/2018

We all talk about ‘person-centred care’ but what does it mean? “The term person-centred care has become all-pervasive on the UK dementia care scene. It has been suggested that it has become synonymous with good quality care. It seems that any new approach in dementia care has to claim to be pc (person-centred)…………..although what lies behind the rhetoric in terms of practice may be questionable” (Dawn Brooker) Person-centred planning is the result of nearly 30 years’ dialogue and investigation. Having been developed in the US and Canada it has grown in importance in the UK. Its origins can be traced to changes that took place in the early 1970s as part of a move to ‘normalisation’ or ordinary living when long-stay institutions for disabled people began to close down. However, the trend towards a person-centred approach can be found in the work of Carl Rogers (1958) and his approaches to client-centred psychotherapy (Brooker, 2004). Initially developed to support people with learning difficulties, person-centred planning has since influenced work across the range of social care services. In the field of dementia care and services for older people, personcentred care is the term that tends to prevail.

We all talk about ‘person-centred care’ but what does it mean(2)? Assisting people to maintain their individuality is important in person-centred care (Ericson et al, 2001) This involves an awareness of the individual’s life before dementia, so as to be able to understand the individual in his or her own biographical context (Stokes, 1997)

Music as part of a person centred approach: Age UK, highlight the ‘power of music’, as an increasingly key feature of dementia care, designed to unlock memories and ‘kick start the grey matter’. ‘It seems to reach parts of the damaged brain in ways other forms of communication cannot’. A systematic study by Ziv et al (2007) found that music also made people with dementia ‘calmer’ and seemed to evoke a more positive mood.  11/6/2018

Evaluating the Soundtrack Soundtrack Implemented with support from two homecare teams A number of citizens and their care workers involved Care workers asked to feedback their experience of using Soundtrack Key individuals asked about their experience of implementing Soundtrack 11/6/2018

Feedback from care workers: “It’s reopened a window to the past…It’s bought new conversations, seen new emotions. Seen a different side”. “Good concept and clearly valuable to help carers connect with people with dementia”. “Improved communication. Getting to know citizen better”. “Empowers citizens, gets teams seeing the person rather than the disease”. 11/6/2018

Ingredients for success: The support of key staff, training that is aligned to local need, familiar and user friendly documentation and an agreed project implementation plan, are all deemed to be important considerations for success. 11/6/2018

References Bellamy, C. 6, P and Raab, C. (2006), Joined-up Public Services: Data-sharing and Privacy in Multi-Agency Working, Economic and Social Research Council , Swindon: RES-000-23-0158. Brooker, D. (2003), What is person-centred care in dementia? Reviews in Clinical Gerontology / Volume 13 / Issue 03 / August 2003, pp 215-222 Cambridge University Press Brooker, Edawrds and May (2009), Enriched Care Planning for People with Dementia: A Good Practice Guide to Delivering Person-Centred Care Ericson, I., Hellstrom, I., Lundh, U. and Nolan, M. (2001) ‘What constitutes good care for people with dementia?’, British Journal of Nursing, Vol. 10, No. 11, pp. 710–14 Sheard, D. (2004) ‘Person-centred care: the emperor’s new clothes?’, Journal of Dementia Care, March/April, Vol. 12, Issue 2, pp. 22–4 Stokes, G. (1997) ‘Reacting to a real threat’, Journal of Dementia Care, January/ February, Vol. 5, Issue 1, pp. 14–15 Ziv N, Granot A, Hai S, Dassa A, Haimov I. The effect of background stimulative music on behaviour in Alzheimer's patients. J Music Ther. 2007;44(4):329-343.