6. Recognising high-quality care
This section looks at some important principles for caring for people with dementia in residential or nursing care home settings. The way that a care home approaches these can give you a good indication of whether they offer high-quality care.
A good care home will follow the principles of person-centred care. This approach aims to see the person with dementia as an individual, rather than focusing on their illness or on abilities they may have lost. Person-centred care takes into account each individual's unique qualities, abilities, interests, preferences and needs. Person-centred care also means treating residents with dignity and respect.
Care homes that follow the philosophy of person-centred care aim to bring out the best in the people with dementia who live there. Each home has its own written philosophy, or mission statement, based on this concept. This should influence every aspect of life in the home, and makes it possible to measure how well the home is living up to its standards at any time.
It is important that you ask managers quite specific questions in relation to their philosophy on person-centred care to get a real sense of whether they are putting the vision into practice. A good way of finding out about a manager's understanding of dementia, for example, might be to ask what approach they would take if a resident continually asked to go home or wanted their mother. A 'good' answer would be one that recognises the emotional needs of insecurity and loss and an attempt to respond to these needs.
Respecting the individual
Each person with dementia living in a care home should have his or her own individual care plan. The care plan should summarise how staff can encourage and maintain the unique strengths of the person with dementia while meeting his or her needs for support. This plan should be reviewed at regular intervals.
Staff at all levels should have received training in how to care for people with dementia. This will enable them to understand the difficulties in communication that a person with dementia may face, and to help them express their wishes and needs.
Personal dignity and privacy should be respected at all times. Individual cultural or religious beliefs should also be taken into account. For example, staff should address the person with dementia in the way the person prefers, whether by their first name or more formally. However advanced the state of the person's dementia, the person should be treated as an adult and with courtesy at all times.
People with dementia have the right to expect those caring for them to try to understand how they feel and to make time to offer support rather than ignoring or humouring them. Staff should chat to residents while they are helping them with physical tasks such as washing and dressing. One member of staff should have particular responsibility for the care of each person with dementia. This staff member should have a clear idea of that person's life history, routines and interests.
The right to choose
People don't lose their right to take part in decisions about their lives just because they have dementia, or because they have moved into a care home. They should be included in plans and decisions about their care, and helped and supported to make choices. Whether it is choosing food, clothes or activities, their likes and dislikes should be taken into account fully. If the person with dementia can do particular things for themselves, they should be encouraged to continue to do so.
According to the Mental Capacity Act in England and Wales (and the Department of Health, Social Services and Public Safety (DHSSPS) guidance and case law in Northern Ireland), all adults have the right to make decisions for themselves unless it can be shown that they are unable to make them. Everyone should be given appropriate help and support to make a decision. Any actions or decisions taken on behalf of someone who does not have the capacity to make decisions for themselves must be in their best interests. This legislation should underpin everything that health and social care professionals do when working with a person with dementia.
A meaningful life
Care staff should show a sensitive approach to helping people with dementia maintain a good level of personal care and ensuring that they get enough to eat and drink.
Many care homes will have some structured group activities during the week which may or may not be of interest to the person with dementia. It is important that life does not centre around these activities. The starting point for leading a meaningful life will be ensuring that a person's preferred activities are integrated into the care plan. This might include details of favourite radio or television channels, where and when a person likes to go out or whether they like an alcoholic drink in the evening.
You may want to ask about the activities programme in the home, but it is also important to ask specific questions in relation to the person who is going to be living in the home, for example 'My mother likes to do her shopping on Saturdays - can she continue to do this?' or 'My father is a keen cricket fan, how might he be helped to keep up this interest if he lived here?' The answers to these questions will give you a good indicator of the home manager's willingness to respond to individual needs.
The care team should create opportunities for residents to spend time together and get to know each other through a wide variety of social opportunities.
People with dementia should also be encouraged to maintain relationships with people outside the care home. Just because a person has entered a care environment, this should not mean the end of many of the familiar routines which have helped shape their day.
The physical environment
The environment of the care home should be as comfortable and homely as possible. A smart hotel-style environment might impress you as a visitor initially, but remember that it is going to be a place to live. People with dementia often need to have things to stimulate their interest and so an overly tidy environment is not always helpful. A home with pictures and objects on tables, and with opportunities for residents to do household tasks such as dusting or folding towels, will give you an indication that residents are welcome to get involved in the community of the home.
Spaces should be clearly signed and laid out to minimise any of the confusion or distress that people with dementia may sometimes feel. Residents should also be able to spend meaningful time outdoors. Some residents with dementia who don't live on the ground floor might not have easy access to the outside, so extra requirements may be needed so that they can spend time outdoors. Regular exercise, fresh air and natural light are important for a person's well-being.
Staying in touch
There should always be a member of staff available to talk to the person with dementia, their friends or relatives about any worries they have. Staff, in turn, should be supported at all times by the care home manager. They should also see relatives and close friends as playing an important role in complementing the support and care offered by the home.