Transforming specialist dementia care in Scotland
As people live longer, dementia becomes more of a challenge across Scotland. We want to make sure that health and social care staff have the right skills to provide well-coordinated support, and offer as much dignity and choice as possible.
That’s why in 2014 we established the Dementia Specialist Improvement Leads (DSIL) programme. This develops participants’ knowledge and skills in a range of specialist areas: leadership, change management, practice development and quality improvement; and enhances their ability to work in partnership and facilitate learning in others to support improvements in dementia practice.
The programme included training in the following four core components for people with dementia:
- Meeting complex physical healthcare needs
- Pharmacological care
- Essentials in psychological care
- Palliative and end of life care
Additional elements consisted of facilitation skills and supporting change and improvement.
Seven years on, 109 professionals across health and social care have graduated from the programme. A fourth cohort of 40 students will complete in March 2023.
Yvonne Manson of Abbottsford Care graduated from Cohort 3 in March 2020. A Queen’s Nurse, whose career has been exclusively in the care home sector, Yvonne relates her experience of the DSIL programme and how it has supported her during 2021.
“As Director of Care and Dementia Services for eight care homes across Fife I thoroughly enjoyed the programme and meeting people from a variety of services in health and care. I loved the community of it - there were nurses from a variety of settings: hospital, community, agency, care-at-home, and care homes as well other disciplines such as podiatry.”
“The facilitators and the courses were fantastic. I love to learn. I enjoyed the different projects we worked on, how we could share in our groups, exchange different ideas, learn from each other and benefit from that extra support.
“Some of the most positive aspects for me were the Train the Trainer courses. The pharmacological care course, although intense, was one of my favourites and I learned a lot. I have been able to factor elements from these courses into my own training programmes and I have adapted the learning to fit the care home sector and current practice. Examples include brain health, palliative care, pharmacological care, and trauma.”
Yvonne described the impact the DSIL programme has had:
“It has helped me focus on what is most important to me in my practice and in my working environment. The reason I went into nursing was to care for people living with dementia. Relationships and choice are two areas my teams and I have worked hard to maintain. These represent two of the quality of life (QoL) outcome indicators for people with dementia, their families, and carers.”
Relationships and visiting
For prolonged periods in 2020 and the early part of 2021 public health guidance prohibited indoor visits to care homes to safeguard older people. Instead, visits had to be conducted through a window.
“These were heart-breaking to observe, and the accompanying communication challenges. Families with loved ones at end-of-life or dying due to COVID had to say goodbye at windows, and we moved beds closer to windows so they could see one another.
“We used technology to help maintain relationships. We used iPads and bought ‘tiny tablets’ which were in fact giant 44-inch screens. These provided a nice large picture when families were talking to each other this way.
“Once we had testing available to us and revised Infection Prevention and Control (IPC) guidance for care homes in place, there was no reason families could not follow the same guidelines as staff and visit their loved ones - but only in their bedroom. It was critical to support these social interactions for people’s wellbeing. We all need our families.
“I believe in a risk assessed approach to visiting and throughout COVID I fought for families to be involved. Every time the guidance changed, which was frequent, due to the dynamics of the virus and its impact, we issued questionnaires, spoke to families, and held engagement gatherings where families could ask senior management questions.”
Yvonne highlighted another QoL outcome indicator where people with dementia feel empowered and enabled to exercise rights and choice, maintain their identity and to be treated with dignity and equity.
“One example of how we supported choice was by creating one-page care plans. These were very visual, incorporating speech bubbles to make it easy to see the topic or question. Staff used these 1:1 with people.
“One topic was ‘how to support me to socially distance/isolate’. Guidance for care homes specified that people should isolate in their bedrooms, particularly when COVID was present. That is much more difficult than isolating at home where you might have several rooms or a whole house.
“How do you respond to a person who does not understand that they need to stay in their room? On the one hand we had to respect their right to choose but equally had to ensure the safety and security of everyone in the care home. That was all quite difficult to manage.
“Staff were great. If people did leave their bedrooms and go for a walk along the corridor, staff would clean that area once the person returned to their room.”
Staff education and development
One challenge for Yvonne has been maintaining learning and education for staff. She explained:
“We had our dementia ambassadors and a WhatsApp group where we shared ideas and different things. I also hosted different competitions that could be done in the care home. And when people had to isolate in their bedrooms, we had to keep the education going about the need to keep people socially involved - but it was an incredibly tough time.
“However, this year (2022) I am excited to be leading our very first face-to-face training for dementia practice coordinators from each of our services. I chose this staff role because it is in the Alzheimer's Scotland 8 Pillars Model of Community Support. Also, I wanted to have a key person in each of our care homes trained to the Enhanced Level of Promoting Excellence in dementia care."
Looking back over the turbulent period that was 2021, Yvonne reflected on the outcomes she was most proud of.
“When we first went into lockdown, we observed a change in presentation in people living with dementia. There was a reduction in stress and distress although it was more a quiet stress and distress. People became withdrawn because of the removal of families visiting. Now that care homes have fewer restrictions, with families able to come and go, people are vibrant again.
“Feedback is one of our main measures of success - especially from families. The regular staff and family surveys we conduct now enjoy high completion rates, which was not the case, previously. As part of my role, I also do Dementia Care MappingTM (DCM) which provides an ongoing evidence base for developing person-centred practice and achieving practice change. We are seeing DCMTM scores rising, which is encouraging.
“Other successes this past year were our relationships, partnership working and visiting strategy. I learned a lot from COVID. Our networking has improved, we have better, stronger relationships between health and social care and COVID has accelerated the pace of some aspects of integration.
“Overall, the DSIL programme has reinforced that I am continuously learning and adjusting to suit practice, because things change, quite rapidly. Yet the core elements are still there - that involvement and partnership working to transform dementia care, which is what the DSIL programme represents.”
Further information links
Dementia Care MappingTM enables staff to take the perspective of a person with dementia in reflecting upon and assessing the quality of the care they provide https://www.bradford.ac.uk/dementia/training-consultancy/dcm/
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This case study is of part of our Year in Review 2021.
May, 17 2022