Bupa Care Homes The care home challenge: leadership and skills Dr Graham Stokes, Divisional Director of Dementia Care, Bupa Care Services

Bupa Care Homes Bupa Care Homes 2010: The Growth in Registered Dementia Care Beds Since % increase in registered dementia care beds, 2003 – 2010 Increasingly less meaningful Prevalence of dementia in non-specialist care homes is 62%+ Average resident is 83 years old 1:5 >80 years have dementia 40% of people aged 85 are disabled by frailty, disease or sensory loss 29% of people aged 85 years with cancer, heart disease and respiratory disease have Alzheimer’s disease

Bupa Care Homes Bupa International Care Home census 2009 United Kingdom 44% of residents diagnosed with dementia 63% of residents assessed by staff to be living with dementia (as measured by memory impairment and disorientation) New Zealand 50% of residents were diagnosed with dementia 62% of residents were assessed to be living with dementia Australia 53% of residents were diagnosed with dementia 73% of residents were assessed to be living with dementia

Bupa Care Homes An aged person with advanced dementia People with dementia living in care homes have complex needs Dementia no longer a memory disability but multiple cognitive impairments including John’s story Co-morbidity, frailty and sensory disability, including sight loss Orientation, recognition and recall exacerbated by sight loss Visual agnosia

Bupa Care Homes The built environment Both cognitive impairments and sight loss exacerbated by design (e.g. corridor length), colour scheme (e.g. minimal colour contrasts) and lighting (e.g. low level) Signage versus natural cues

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The social environment Malign care is insensitive and unthinking - the unseen ‘taken for granted’ world of care Poor approach behaviour leads to confrontation and resistance Exclusion from activity and occupation

Bupa Care Homes Enhanced model of dementia avoids ‘diagnostic overshadowing’ Dementia Health – illness, pain, sensory loss Person – life story and psychology Social environment Built environment