There are increasing calls from various stakeholders in elderly care for a greater recognition of dementia as a serious disease and terminal illness. Dementia is very much a hidden disease as far as care services are concerned, especially when compared with diseases like cancer.
Acute hospitals are supposed to have an older people’s mental health liaison team in place to ensure that people with dementia – arguably the most vulnerable people in our society – are discharged into the most appropriate care.
What’s alarming, however, is that most people with dementia, whether receiving day-to-day care in their own homes or in a care home, end up in the hands of carers who may just have an NVQ but no other relevant qualifications or skills relating to the needs of people in their care. They often have no specific experience of dementia and no specialist training.
A recent Care Quality Commission report highlights that in 25% of care homes surveyed, staff were unsure about the health needs and care requirements of the people in their care. If a sick child were placed in the care of someone who was unqualified to look after it, there would be uproar. And yet it seems ‘OK’ for this to happen to elderly people with a serious brain disease.
If you’re currently looking for a care home place for a relative with dementia, do your homework. Obtaining a list of care homes in your area providing EMI (Elderly Mentally Infirm) care is fairly straightforward, but actually choosing the home can be harder.
If the care home you’re visiting has a special Elderly Mentally Infirm Unit (EMI), always ask to see it. It may be a separate EMI unit that is kept locked. Although keeping people safe is important, EMI residents still need fresh air, sunlight, access to the garden and other stimuli. In some homes EMI residents never go outside that locked unit.
There are some good care homes though, and it’s vital to ask the manager specific questions to get a good idea of their approach to people with dementia. These 3 critical questions will get you off to a good start:
1. How much knowledge do the carers and nurses have about dementia and its associated challenges?
The home may say that it has other residents with dementia, but this doesn’t necessarily mean the residents’ needs are well understood. Ask open questions such as, “What specific training do you give your carers in looking after someone with dementia?” or “What do carers do differently when they’re with someone with dementia?” The answers will indicate more fully how much they really understand the disease. If the answer is simply that the staff are ‘fully trained’, keep asking questions. How exactly does the care home educate its staff about dementia? It’s also worth asking whether the home invites any specialist dementia nurses in to help train staff in dementia.
2. What patterns and designs are on the carpets and curtains?
This might sound like an odd question, but people with dementia or mental confusion can find some bold patterns or certain prints disorientating and sometimes frightening. It can also worsen the severity of hallucinations. The same applies to lighting where certain shadows are cast. A good care home will be aware of this. The Alzheimer’s Society has an interesting web page about patterns and lighting for people with dementia.
3. How much do residents get involved in the day-to-day operation of the home?
For example, if your relative likes gardening, what opportunities are there for them to make important decisions about maintaining the garden? Generally speaking, the more involved residents are, the greater their sense of purpose and value will be, the more they will engage with activities (instead of being passive recipients). This often manifests itself in stronger mental health and wellbeing.
Be persistent with your questions about dementia at any care home, and don’t be pressured into making a quick decision. Then, once you’re satisfied that the home can provide proper care, ask for a trial period to start with.
Finding a care home can be difficult – and it’s hard to know if you’re making the right choice. It’s vital to ask good questions when you visit, especially about the financial stability of any care home company, how they operate and the morale of the staff.
Many people also find that their NHS and local authority are less than proactive in providing accurate guidance and advice.
If you have health needs, when you first go into a care home you should be assessed by the NHS for NHS Continuing Healthcare funding.
