Choosing a home with the right kind of care
Our relationship-centred care approach is especially important for residents living with dementia.
Trust is an essential element of daily life. Only by knowing and understanding an individual’s life journey including their history, personality and the impact of their physical, emotional and lifestyle needs, can we build a trusting relationship that supports their individual care needs.
We tailor the environment, the attention and the support to each individual. And don’t forget the activities. Life is for living, so we ensure every day is as stimulating and enjoyable as possible, and nothing makes us – and residents – happier than the involvement of friends and family.
This brief guide gives you an overview of the way dementia can affect individuals and the ways we can support residents and their loved ones.
What is dementia?
Dementia is an umbrella term for a number of neurological conditions. It is not a natural part of the ageing process, but the risks of developing dementia do increase with age. The symptoms are caused by physical changes to the brain and are unique to the individual.
Symptoms vary, depending on the type of dementia and the progression of the disease. Typical symptoms include difficulties with short term memory, poor organisational and planning skills, confusion and impaired communication skills, understanding and judgement. Despite these difficulties, people living with dementia will still retain many strengths and abilities. For many, the full range of emotions remains intact, however, circumstances and the different situations people find themselves in can have a significant impact causing wide variations of emotions and the resulting behaviours.
Dementia is progressive, which means that symptoms worsen as time goes by. In most cases the combination of sensitive support, trusting relationships and a thorough understanding of the person in an environment designed to maximise their abilities and independence, will help the person to achieve high levels of wellbeing.
Types of Dementia
Alzheimer’s disease is the most common of the 4 main types of dementia; an estimated 500,000 people in the UK are affected. As Alzheimer’s progresses, the number of nerve cells in the brain slowly reduces and the brain shrinks. At the same time, there’s an increasing shortage of important chemicals involved in the transmission of messages to the brain. Together, this causes increasing memory loss and it’s often difficult to learn new skills.
This is the second most common form of dementia after Alzheimer’s, and there is an increasing incidence of people being diagnosed with both Alzheimer’s and vascular dementia. Vascular dementia is most commonly associated with heart disease and diabetes. When the blood supply to the brain becomes damaged, blood cannot reach the brain cells, and the cells die. This can lead to the onset of vascular dementia. The symptoms depend on which parts of the brain have been affected; they can be similar to those found in other types of dementia, such as Alzheimer’s disease.
It is natural for our behaviours to change when we are fearful and forget how to do things that we believe are second nature; this is sometimes an early symptom of both Alzheimer’s and vascular dementia.
Lewy Body Dementia
Lewy bodies are tiny protein deposits found in nerve cells. Where they occur in the brain, they are often linked to lower levels of the chemical messengers that enable the nerve cells to transmit messages effectively. This in turn slows down brain function, making the person appear less mentally and physically agile. Lewy bodies occur in both Alzheimer’s and Parkinson’s disease, and where they are identified in the outer layers of the brain, dementia with Lewy bodies (DLB) is likely. Lewy body dementia accounts for as much as 15% of all dementia diagnoses and results in impaired language skills, reasoning and (to a lesser degree than Alzheimer’s) memory, and it often causes visual and auditory hallucinations.
Frontotemporal dementia is a relatively rare form of the disease, often occurring in a younger age group of people aged between 45 and 65. The term covers a range of conditions, including Pick’s disease. These conditions are caused by damage to nerve cells clustered in the frontal and temporal lobes of the brain which are centres for personality, behaviour and language. However, symptoms vary and the faster progression of frontotemporal dementia can have a profound effect on the person’s emotional, thinking, reasoning and language skills. This form of dementia can have a dramatic effect on an individual’s personality and subsequent behaviours as they try to adjust to the changes happening to them as a result of their dementia.
The most common symptoms of dementia
We all have trouble finding the right word from time to time, but some people living with dementia can forget simple words on a regular basis. This can be very upsetting and frustrating for the person. Sometimes a person can use the wrong word, without realising, which can make conversation or writing hard to follow.
Someone living with dementia can become lost even in places as familiar as their own home or the road where they live. A person living with dementia may forget where they are or how they got there. This level of confusion can extend to not knowing where they keep everyday objects, even items such as toothbrushes or dinner plates. As dementia progresses, confusion between day and night may occur.
A loss of memory, especially short-term memory, is one of the earliest symptoms of dementia. This typically includes not being able to remember recent events or conversations and misplacing objects. It begins as mild forgetfulness but deteriorates over time. Longer-term memories are often easier to access although they may become mixed up. Emotional memory is not affected by dementia. This means a person living with dementia may forget a recent event but the person won’t forget how it made them feel.
Mood, behaviour and personality changes
Each individual’s journey with dementia is unique, and therefore the way a person responds to problems with short term memory, difficulties with word finding and recognition of familiar people, objects and places can vary. The result can be seen as an increase in anxiety, reluctance to go out or do things that in the past the person has enjoyed, or even angry or tearful outbursts.
Sensitive support is essential as these behaviours are often driven by fear or frustration.
Why environment matters
Dementia can introduce a range of symptoms that change the person’s perception of their environment and cause anxiety and disorientation. This can make simple tasks appear overwhelming and sometimes impossible. Creating an environment where the function of each room is clear and homely with discreet, recognisable signage for ease of navigation and way-finding helps to maintain emotional wellbeing and importantly keeps the person in control and independent.
Our communities for residents living with dementia are specifically designed to enhance the quality of life of residents. They offer stability, reassurance and familiarity. Many of our dementia communities feature a dementia-monitoring system to support the wellbeing of residents.
Lighting schemes throughout our dementia environments are arranged to eliminate shadows and dark corners wherever possible. We include large bay windows with low sills to help flood the interiors with natural daylight and provide enjoyable views on the outside world.
Easy access to outside space is vital. Large patio and terraced areas encourage outdoor engagement and gentle exercise, helping people to get a “breath of fresh air” whenever they need. Creative outdoor activities are encouraged on a daily basis all year round, to stimulate mind and body. Raised beds and gardening clubs help support our green-fingered residents to continue to enjoy an important, active hobby.
Food for life
Mealtimes are important not only for ensuring residents are well nourished and hydrated but also because they are social occasions.
The physical changes sometimes experienced by people living with dementia can include the reduced ability to chew or swallow. Visual or cognitive impairment can also make it difficult to recognise different types of food. These factors can make it difficult for people living with dementia to enjoy a balanced and nutritious diet as their condition progresses. Weight loss is not a symptom of dementia but can result from a person’s diminishing ability to prepare something to eat or remembering the need to eat. Sensitive support in recognising the unique needs of the individual and how and what they prefer to eat and drink can improve health and wellbeing and maximise the person’s abilities.
We ensure that residents have the support they need to continue to enjoy their food and maintain a balanced diet. We do this by ensuring that we understand likes and dislikes and recognising early when a person’s needs and preferences change. Respecting the individual and recognising the diversity of needs, we have a range of dining areas to promote dignity and minimise distractions.
Snacks and drinks are always available 24 hours a day, and our teams are trained to give sensitive support to those who need assistance with eating and drinking. Most of our care homes have cafés that provide vibrant social hubs for residents and their loved ones to enjoy fresh tea, coffee and homemade cakes.
Taking care of daily life
There are some things we all take for granted: getting up, using the bathroom, getting dressed, doing the laundry, cooking a meal, going shopping and so on. But these little things – known as activities of daily living – can be a huge challenge for somebody living with dementia. As anyone who’s been supporting a relative or partner at home will know all too well, often the loss of independence can dramatically change relationships.
With sensitive support, families can get back to being husbands, wives, daughters and sons, rather than primary carers. Visits are all about spending quality time together. What’s more, we look after any domestic chores that may have become overwhelming and deliver personal care that’s tailored specifically to the needs and preferences of each individual. Our aim is to promote independence and sensitively support the person receiving care to remain in control of their lives in a dignified way.
All of our homes have a choice of areas where people can relax, socialise and enjoy a selection of activities planned with residents by our Lifestyle Teams. The events, clubs and classes provided are based on the lifestyle choices of residents, and we offer individual support for those who prefer not to join larger groups.
Most of our care homes have a purpose-built salon for hairdressing and therapies, and some homes have a dedicated cinema room.
Family and friends
It wouldn’t be home without family. We encourage families and friends to be as involved as possible in their loved ones’ lives. We hope you’ll be a frequent visitor and become part of our extended Hallmark Care Homes family.
As well as joining us for numerous social events throughout the year, you can join our carers’ support groups. They’re a welcoming place where you can meet other people who understand your concerns about the future and gain strength through sharing your experiences and knowledge. Hallmark Care Homes also offer opportunities for information sessions with professionals. We encourage families, friends and visitors to actively engage with and become Dementia Friends – a national initiative by the Alzheimer’s Society to raise dementia awareness. Each of our homes has a Dementia Friends Champion who regularly runs these sessions. Hallmark Care Homes also has a dementia strategy which explains the vital role families and friends have in developing support for residents living with dementia.
Worried about a loved one?
If you are concerned about your partner or relative’s memory, the first step is always a visit to the GP. Early diagnosis can mean better quality of life and alleviated symptoms, whether through medication, increased social interaction or a range of therapies. It also means you have more time as a family to plan for the future.
Diagnosing the specific dementia can be difficult, but the tools most often used to assess a resident are memory tests, for example, the mini mental state examination (MMSE), a computerised tomography (CT) scan or magnetic resonance imaging (MRI). There is also the possibility of a referral to a memory clinic or a specialist such as a psychogeriatrician.
The GP will want as much information as possible, so before you go, write down the specific changes you have noticed and that are causing concern. Your GP will establish if there is an alternative reason for the symptoms, identifying if a person has an infection or is depressed, and treating these may resolve the symptoms completely. If this is not the case, there are a group of prescribed medications called the anti-dementia drugs. Although not a cure, these medicines can treat some of the symptoms experienced by people living with dementia.
There is increasing evidence to show that supporting the person living with dementia to remain in control of their lives and effectively manage pain and symptoms associated with other conditions such as arthritis, heart disease and diabetes has a positive effect on the person’s well being.
The balance of the combination of therapeutic interventions by the GP and specialists can often take some time to achieve the best outcomes. Our teams work closely with the resident, their family and specialists to achieve the best outcomes.
Of course, it’s not just the person diagnosed with dementia who has dramatic changes to adjust to. It can be difficult and traumatic coping with the effects of dementia on a loved one. Your GP or mental health professional will be able to tell you of any local dementia support groups, such as those held at our care homes, where you can get reassurance and support on your journey.
The communities within the Hallmark Care Homes family are members of Dementia Action Alliance. We report quarterly at a national level on our progress to meet our annual action plan to improve dementia care services. We have signed up to the national Dementia Pledge and Dementia Care & Support Compact as part of the Prime Minister’s challenge for dementia care and are actively involved in a range of research projects with universities in England and Wales to improve standards of dementia care nationally.
All of our care teams receive extensive training to give them the additional communication and observational skills to support our residents who live with dementia. We conduct regular observational audits to ensure that quality of life is always improving for the people living and working in our communities.
Hallmark Care Homes has its own dementia strategy called TOGETHER. This title was chosen to highlight the value we place on close partnerships working with residents and their families. To request a copy of Hallmark Care Homes’ Dementia Strategy please contact [email protected]