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P3. Residential and community care

Detailed Programme, abstracts and presentations

P3.1. New innovations in care home practice: Friends of the Elderly & The Orders of St John Care Trust Admiral Nurse Service - supporting families, care staff and people with dementia

Cheryl Rothschild, Angie Williams, Karen Harrison Dening

This presentation will outline an innovative service of Admiral Nurses working in partnership with care home organisations to support both family carers and care home staff in caring for people with dementia. As a person with dementia moves into residential care it often worsens an already confused situation as the person with dementia enters their new environment, creating new demands and pressures as both they and their carer attempt to adjust to the transition.

Friends of the Elderly (FotE) & The Orders of St John Care Trust (OSJCT), in collaboration with Dementia UK can provide support from ‘day one’ in the family setting right through to the care home.

The Friends of the Elderly & Order of St John Admiral Nurse Service

Living with dementia can be a new experience for a person with dementia and their families. Relationships with family carers can be difficult as they may not understand how to communicate effectively to reach someone with dementia, which can result in greater anxiety; this can also be true with the care staff in our homes.

Providing greater access to effective counselling and support services can yield considerable benefits for both the person with dementia and family carers. Research shows the carer(s) builds a greater tolerance for patient memory loss and behavioural problems which can greatly improve the wellbeing of the person with dementia and the people around them.

Admiral Nurses in this unique role provide the following:

  • Direct consultancy and supervisory work with home managers and care staff to support residents with complex care needs.
  • Develop assessment/risk management and action planning to enhance the delivery of care.
  • A driving force in raising dementia awareness and promotion of person centred dementia care in the care home(s)
  • Promote the benefits of life history work and maintaining personalisation and identity of residents.
  • Continue to support the carer(s) and act as a link for the person with dementia once they have entered the care home.
  • Provide Relatives Support Groups enabling families to learn more about the illness and how to communicate more effectively with the person with dementia.
  • Be a source of information and support on any care planning and also as changes in their dementia develop.

OSJCT uses The My Home Life framework in their homes.

P3.2. Strengthening care outcomes and avoiding mistakes for people with dementia in residential aged care

Deirdre Fetherstonhaugh, Rhonda Nay, Maree Cameron, Margaret Winbolt, Michael Bauer.

Avoiding mistakes in the care of people with dementia involves mitigating the clinical risks to which they can be exposed. This paper will describe an Australian government funded project in residential aged care which aimed to: identify and prioritise clinical risks; develop standardised evidence-based care processes in these areas of clinical risks; pilot these care processes in a number of residential care services across the state; and evaluate this pilot implementation with consideration of a state wide rollout. In the first stage of this project a working definition of clinical risk had to be developed. Eighteen clinical risks were identified and care processes were developed for ten of them which were then piloted. Evaluation of the pilot implementation found that for all the clinical risk areas the implementation of standardised care processes improved the level of education and development of resident/family information resources and increased adherence to the evaluation of care provided.

P3.3. Ageing-in-place: the integrated design of a conceptual dwelling for people with dementia

Joost van Hoof, Marco Blom, Willem Bastein

Ageing-in-place is the preferred way of living for older persons in an ageing society and can be facilitated through support for (instrumental) activities of daily living and support for physical activity. In addition, homes in which older adults dwell can be modified in terms of architectural and technological solutions. Dementia poses additional challenges when designing, constructing or retrofitting housing facilities that support ageing-in-place. At present, there is a quantitative and qualitative shortage in the number of modified dwellings that support ageing-in-place in general, and for people with dementia, in particular. Despite the shortage of suitable dwellings, the majority of people with dementia reside in the community. Older adults with dementia and their partners ask for living environments that support independence, compensate for declining and vitality, and lower the burden of family care. More research is needed on how housing facilities for people with dementia should be designed and built in order to maximally support this special group of persons, and lower the burden of family care.

This study deals with the development and design process of this conceptual home for people with dementia. It addresses and integrates the following aspects of the home environment: (i) architectural and interior design, (ii) the physical indoor environment, and (iii) technological solutions connected to the dwelling. The paper further presents results of focus group sessions, and shows the progress of the construction of the dwelling.

The dwelling is part of the larger Technology@Home Programme, which was initiated by the University of Applied Sciences Utrecht and OTIB. This programme aims to investigate integrated home modification solutions in terms of effectiveness, usability, user preference and implementation by building services’ installers. The dwelling for people with dementia can be used to investigate the many aspects of supportive living environments for older adults with dementia, and as an educational and training setting for professionals from the field of nursing, construction, and building services engineering.

P3.4. A group home cluster model for providing community-based dementia care

Matthew P. Janicki, Philip McCallion

A study was undertaken of an innovation group home program operated by a provider organization serving older adults with intellectual disabilities. The provider built three co-located group homes for five adults within a neighborhood setting. Each of the adults resident at the homes have some degree of diagnosed dementia. There were both male and female adults, all were age 50+, and some had Down’s syndrome. The homes are staffed by paid staff working 24/7. The residents were studied for health co-morbidities, program activities, and degrees of impairment and compared with a matched group of adults without dementia. The study examined administrative and programmatic factors related to the operation of the homes, as well as shifts in characteristics related to their intellectual disability and the effects of dementia.

P3.5. Exploring the unmet needs of residents with dementia- nurses´ experiences using “understanding diagnostics” in daily care

Daniela Hardenacke, Margareta Halek, Herbert Mayer, Sabine Bartholomeyczik

Background: Challenging behaviour is highly prevalent in nursing home residents with dementia. At any given time, up to 90% of nursing home residents show challenging behaviour in the course of their disease. Challenging behaviour can be the result of unmet needs that people with dementia can no longer communicate directly. The concept of “understanding diagnostics” takes up this aspect of communication und focuses on the understanding of the behaviour. So far there are only few studies that examined the application of “understanding diagnostics” from the perspective of nurses in nursing homes in Germany. Therefore, the following study investigates the experiences of nurses using “understanding diagnostics” in daily care of people with dementia in German nursing homes.

Method/Design: The study was part of an intervention study on the effects of “understanding diagnostics” on challenging behaviour and quality of life in older people (aged > 65 years) with mild to severe dementia (MMST ≤ 24) living in nursing homes. A multimodal intervention was used to introduce “understanding diagnostics” in 18 wards of 15 different nursing homes. Nurses were first trained in “understanding diagnostics”. Subsequently, monthly structured case conferences were introduced on the basis of the assessment IdA (Innovatives demenzorientiertes Assessmentsystem) to deepen their knowledge and to apply it to specific cases. The overall intervention lasted nine months. Throughout the intervention, twenty nine feedback interviews with single nurses and eighteen group interviews were conducted to explore nurses´ experiences using “understanding diagnostics”. The interviews are analyzed in accordance to the method of hermeneutic case reconstruction.

Results: Preliminary results indicate that little or no communication about the reasons for residents´ challenging behaviour took place during daily care, among others, due to lack of time and dementia-specific knowledge before the intervention. With the introduction of “understanding diagnostics” nurses reported that they started to look for potential reasons of resident´s behaviour. Nurses recognized that they have little knowledge about residents´ biography and their personality prior to dementia. The intervention led to changes in the behaviour of nurses as well as to changes in the behaviour of residents. Nurses developed a different attitude towards the residents and their challenging behaviour. They also could describe the residents´ behaviour more precisely after the intervention. Nurses identified reasons for residents´challenging behaviour and therefore initiated targeted interventions that led to changes in residents´ behaviour.

Discussion: The final results of the study including possibilities as well as limits of using “understanding diagnostics” on the basis of structured case conferences and the assessment IdA will be presented and critically discussed.



Last Updated: Wednesday 26 October 2011


  • Acknowledgements

    Alzheimer Europe gratefully acknowledges the support of the following sponsors: Fondation Médéric Alzheimer, Fondation Roi Baudouin, Janssen, Lilly, Pfizer, Sanofi and SCA Global Hygiene
  • Fondation Médéric Alzheimer
  • King Baudouin Foundation
  • SCA Global Hygiene