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Key principles of person-centred dementia care

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					                 “ Promoting
                 quality care through
                 the not-for-profit sector   ”




           STATEMENT OF BEST PRACTICE

Key principles of person-centred
dementia care
                          “ Promoting                                             Key principles of
                          quality care through
                          the not-for-profit sector ”                     person-centred dementia


Introduction: promoting
person-centred care                                     the potential vulnerability of some people
                                                        with dementia there is a need for a good
                                                        understanding of adult protection requirements.
The primary purpose of the National Care Forum          Each of the principles contained in this Best
(NCF) is to promote quality outcomes for people         Practice Statement is supported by example key
who receive care and support through the not-           indicators.
for-profit sector. NCF members make a formal
commitment through the chief executives to
adhere to NCF’s underpinning values and promote         Assessment, care planning and
quality for all people receiving care services.         review

This Statement of Best Practice has been                Assessment, care planning and reviewing
prepared by the NCF Older People and Dementia           are key aspects of best practice.
Care Committee to specify indicators of quality         Documenting the service received by
in relation to person-centred dementia care             individuals is vital. The way in which care
services. It is not intended to be definitive or to     services are documented will evidence what
provide detailed information on dementia. The           is occurring for the individual as well as
Statement will be periodically reviewed. It is          demonstrating whether person-centred care
expected that a person-centred approach will            is integral to the service provided.
be evidenced in the Statement of Purpose and
Service User Guides produced by NCF members.            Key indicators of best practice:
                                                        • a full assessment is undertaken prior to a
Dementia is defined by the Mental Health                  service being provided
Foundation (006) as:                                   • evaluation and reassessment is ongoing
                                                        • all relevant documentation used by the
                                                          organisation demonstrates that
    “… a decline in mental ability which                • the individual is fully involved
    affects memory, thinking, problem solving,          • cultural needs are appropriately considered
    concentration and perception… Dementia is           • well-being for the individual is actively
    almost invariably a disease of ageing.”               promoted
                                                        • the language used will be acceptable to the
                                                          person receiving care
A person-centred approach to providing care and         • care plans are used as communication tools -
support is as important for people who receive            evaluation is meaningless in the absence of well
services (and their family or significant others)         documented care
as it is to staff. The emphasis should always           • a key worker system matches individuals and
be on the person as an individual. In a person-           staff
centred approach the unique qualities of the            • relatives (and significant others) feel involved
individual as determined by their life history and        and supported
experiences, likes and dislikes, are their defining
characteristics. People with dementia have the
same rights as citizens. This includes the right        Valuing communication
to be treated with dignity and respect. Care
and support services should build on individual         Effective communication improves the
strengths and abilities to maximise and promote         quality of life of people with dementia. It is
independence. Services should enable people             essential that efforts are made to enhance
to feel valued and safe. The inherent risks of          communication, make time to listen and to
life should be recognised. However, given               understand.

                                                                       NCF STATEMENT OF BEST PRACTICE
                        “ Promoting                                             Key principles of
                        quality care through
                        the not-for-profit sector ”                     person-centred dementia



Key indicators of best practice:                      engagement in life, is crucial to well-being
• staff are aware of the different communication      and fulfilment. Activity can give meaning
  needs of different individuals including taking     and purpose to life. Self respect and self
  account of any hearing or visual problems or        esteem arise from day to day activities. Life
  where English is a second language                  should be fun in whatever way is meaningful
• staff are trained to understand the importance      to the individual, irrespective of disability or
  of verbal and non-verbal communication and          impairment.
  barriers to effective communication
• a multi-disciplinary approach is used to            The key principle to achieving well-being and
  implement communication strategies                  fulfilment for people with dementia is that
• staff are able to access specialist advice and      activities should lead to a sense of feeling
  information                                         enabled and empowered.
• advocacy services are utilised
                                                      Key indicators of best practice:
                                                      • the relationship between staff and service users
Access to services                                      is empowering and gives meaning to every
                                                        day events which can otherwise be taken for
People with dementia are entitled to full               granted
access to other services. The coordination of         • it is never too late to learn new skills
health and social care services to meet the           • life stories are used to ensure a good
needs of people with dementia is essential.             understanding of individuals
This should include a joint approach to               • a balance between stimulating and calming
assessment and joint planning of local                  activities
services.                                             • staff recognise individuals’ styles of
                                                        participation through observation and
Key indicators of best practice:                        assessment
• each person has a full assessment of their need.    • measurements of well-being and satisfaction
  This should include diagnosis and access,             are regularly reviewed
  where necessary, to specialist professional         • risk is accepted as an integral part of enjoying
  advice and support.                                   life.
• specific services are accessed promptly
  in response to the person’s assessed
  need, including for example, health care,           Staff support and development
  physiotherapy and nutrition
• mental health needs are acknowledged and            Staff are any organisation’s most valuable
  appropriate services are provided                   asset. The organisation is responsible for
• medication is taken as intended                     creating a culture that enables staff to
• a palliative care approach to end of life           reflect, to learn and to develop. It is essential
  care is adopted including appropriate pain          that a person-centred approach to dementia
  management                                          care is consistently applied throughout the
• advocacy services are made available where          whole organisation.
  necessary
                                                      Key indicators of best practice:
                                                      • recruitment procedures and practices reflect
Well-being and fulfilment                               a culture and style of the organisation which
                                                        supports a person-centred approach.
Fulfilment means different things to                  • as much importance is given to staff retention
different people. Enjoyment of, and                     as to staff recruitment.

                                                                     NCF STATEMENT OF BEST PRACTICE
                        “ Promoting                                              Key principles of
                        quality care through
                        the not-for-profit sector ”                      person-centred dementia



• a focus on abilities, promoting appropriate         • there is a sense of ease and freedom where
  attitudes and enabling staff to contribute fully      people can be themselves
  to the provision of care                            • the building does not rely on a person having
• valuing diversity                                     a memory – people should be able to find their
• staff have a non-judgmental approach and a            way around easily
  positive regard for each other and for those they   • changes in colours in different areas assist with
  care for                                              orientation
• systems are in place for professional supervision   • culture/ethnic needs are acknowledged
  and support                                         • the design maximises independence,
• appropriate learning and training opportunities       compensates for disabilities and impairments
  are provided                                          and is safe for all who work or visit the building
                                                      • The outside garden space is an extension of the
                                                        environment providing accessible and usable
Embedding a person-centred                              space.
approach
                                                      The use of technology to support person-centred
In order for a person-centred approach to be          care
embedded in an organisation, appropriate              Technology and telecare should complement
relationships have to be established. This            the services provided by staff. It should be used
will be evidenced in areas such as:                   to enable individuals to function safely and to
                                                      maximise independence.
• the philosophy of care
• the person with dementia being at the heart of      Key indicators of best practice:
  all services                                        • technology enables people with dementia
• the person with dementia being enabled to             to conduct their daily lives and retain their
  maintain the relationships with significant           integrity
  others as they choose                               • technology enables staff to maintain high
• respect and value for human life                      standards of care
• communication will be open and honest, and          • technology is a discrete component of an
  presented in a way that is understood                 individual’s assessed need and subsequent care
• staff presenting a positive attitude                  plan
                                                      • technology is used to support person-centred
                                                        care and not to reduce the need for human
The care setting                                        contact

The care setting can have a significant effect        Disseminating best practice
on the ability of a person with dementia
to be independent or to be appropriately              Disseminating best practice is vital if perceptions
supported. Receiving care and support in a            regarding dementia and dementia care services
care home can bring additional challenges.            are to change. This includes both public and
The design of the building can impact on the          professional attitudes. Success needs to be
creation of a homely environment.                     shared and celebrated e.g. demonstrating from
                                                      the individual’s perspective the benefits of joint
Key indicators of best practice:                      health and social care, or how a specific therapy
• the environment supports a person-centred           has helped.
  approach to care



                                                                      NCF STATEMENT OF BEST PRACTICE
                          “ Promoting                                             Key principles of
                          quality care through
                          the not-for-profit sector ”                     person-centred dementia



    Key organisations for resources

    There is a growing literature, knowledge            Dementia Services Development Centres
    and resource base in dementia care                  (www.dsdcengland.org.uk) are regional centres
    provision. In addition there are a number           providing service development support on
    of important organisations which offer              all aspects of dementia care services. They
    information, guidance and advice. This              include:
    listing is not intended to be exhaustive.           The Dementia North Centre is a partnership
                                                        between the Dementia North Trust and
    The Alzheimer’s Society (http://www.                Northumbria University covering the North and
    alzheimers.org.uk/) is the UK’s leading care and    Yorkshire region. Dementia North helps service
    research charity for people with dementia, their    providers to use this knowledge to develop
    families and carers. The organisation produces      their services through information, education
    a range of publications and practice guides         and training, research and evaluation. www.
    promoting quality care services including:          dementianorth.org.uk
    • Quality dementia care in care homes: person
      centred standards                                 The North West Dementia Centre (NWDC)
    • A guide to implementing good practice in          based within the Personal Social Services
      care homes                                        Research Unit (PSSRU) at the University of
    • Home care standards for the care of people        Manchester. The aim of the centre is to promote
      with dementia                                     awareness of dementia, its consequences and
    • A package for providers of home care service      effective management to professionals and the
      to plan and deliver care to people with           general public through information and service
      dementia                                          development. www.medicine.manchester.
    • Food for Thought practice guides                  ac.uk/pssru/nwdc/
    • Raising awareness of the challenges
      experienced by people with dementia               The Dementia Services Development
      concerning food, eating and drinking. It has      Centre, at the University of Stirling, was
      practical suggestions to help support the         established in 1989 through the Dementia
      knowledge and experience of health and            Services Development Trust and the University
      social care staff.                                to provide extensive information about
                                                        dementia services and is involved in developing
    The Bradford Dementia Group was                     and disseminating research and good practice
    established in 199 at the University of Bradford   about services for people with dementia. The
    to develop teaching, education and research in      centre, based in the Iris Murdoch Building
    the field of dementia care. Their mission is to     which is an exemplar of dementia-friendly
    improve the quality of life and quality of care     design, offers organisations access to
    for people with dementia and their families.        consultancy, training and specialist services.
    The Group offers training in person-centred         www.dementia.stir.ac.uk
    care and Dementia Care Mapping and has
    an international reputation. The Group edits        National Institute for Mental Health in
    the Jessica Kingsley series of Good Practice        England (NIMHE), a part of the Care Services
    Guides on Dementia Care. The series is a set        Improvement Partnership (CSIP), is responsible
    of accessible, jargon-free good practice guides     for supporting the implementation of positive
    for practitioners and professionals. www.brad.      change in mental health services. www.nimhe.
    ac.uk/acad/health/bdg/                              csip.org.uk


                                                                       NCF STATEMENT OF BEST PRACTICE
                         “ Promoting                                             Key principles of
                         quality care through
                         the not-for-profit sector ”                     person-centred dementia




    The Social Care Institute for Excellence           SCIE also hosts a website disseminating good
    (SCIE) has produced a series of Research           practice materials. www.scie-socialcareonline.
    Briefings on aspects of dementia care which        org.uk
    can be downloaded from www.scie.org.uk



Produced by the National Care Forum Older People and Dementia Care Committee April 2007




Join the NCF


The NCF members are not-for-profit care                adults and older people receiving care and
providers. They are united by a common                 support services through the not-for-profit
social purpose in which a commercial                   sector.
business approach to the provision of
services enables reinvestment in services              If you are interested in joining the NCF and
and development. By bringing together the              would like more information please contact
entrepreneurial drive of a business approach           the NCF office on 024 7624 3619 or visit our
with the ethos of public service, not-for-profit       website www.nationalcareforum.org.uk
organisations offer an innovative model of
service delivery to the care sector. In this
way NCF members are already making a
significant contribution to communities and
local economies through the full range of
social care services.

The NCF embraces the diversity of the care
sector and includes within membership                                    The National Care Forum
a wide range of services. This includes:                                           3 The Quadrant
home care, housing with care, day care,                                        Coventry CV1 2DY
intermediate care, outreach, residential and                                         024 7624 3619
nursing care, and specialist provision for all                       www.nationalcareforum.org.uk

6                                                                      NCF STATEMENT OF BEST PRACTICE

				
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