Archive for May, 2013

Keeping Older People Safe from Elder Abuse – Neglect

We all have the right to feel and be safe, regardless of our age or circumstances, so you may be surprised to know that incident reports of abuse towards older people are increasing and many are not reported. It is therefore important that you are vigilant to ensure older people are safe and treated with the dignity and respect they have a right to and deserve.

Unfortunately I come across abuse all too often and typically nothing has been done about it until I ask the following question ” Would you report the matter if your concerns related to a child? Why should it be different for older people?” 91 years of life

A definition of elder abuse

Action on Elder Abuse, defines abuse as: “A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to another person”

Elder abuse is a complex issue

Elder abuse is a complex issue and often involves more than one type of abuse. For example financial abuse may also involve emotional abuse if someone is being threatened as well as complying with inappropriate demands for money.

Over the next few weeks we will look at the different categories of elder abuse that you are likely to come across in relation to older people in a bit more detail so that you know what you are looking for.

Lets begin with neglect.

What is neglect?

Neglect is a form of abuse whereby people responsible for providing care for someone who is unable to look after themselves, fail to meet their needs. Neglect can be intentional or can occur as a result of not understanding what the person’s needs are. Under the Mental Capacity Act 2005, wilful neglect and ill treatment became a criminal offence.

Neglect occurs when there is failure to provide food, shelter, clothing, heating, medical care, hygiene or personal care, and the inappropriate use of medication. Examples could include not giving someone proper assistance with eating and drinking, or failure to provide a warm, safe and comfortable environment, failing to provide adequate personal care or ignoring someone’s health needs. Repeated calls for assistance may be ignored or someone’s care plan may not be read or followed.

Possible signs of neglect are:

•​Urine smell in a person’s environment

•​Pressure sores

•​Depression

•​Lack of stimulation or prolonged isolation

•​Person has unkempt appearance or is dressed inappropriately

•​Signs of malnourishment or dehydration

•​Person has untreated medical condition

•​Not being helped to the toilet when assistance is requested.

•​Home has insufficient or no heating

•​Under or over medication.

Paula’s Story

Rose has Alzheimer’s and lives in a specialist care home for people with dementia. Her only relative, Paula, is unable to visit very often as she lives more than a hundred miles away and works long hours. When Paula visits her aunt she is concerned to find that Rose does not have her own dress on and it is too big for her. Her hair had been cut badly and not been styled and her lower dentures were missing. Paula is aware of a strong smell of urine in the home and observed that her aunt was wearing an incontinence pad that needed changing. The most worrying thing for Paula was that her aunt appeared depressed and withdrawn.

Rose’s care was clearly being neglected and her niece was advised to report the matter to the Safeguarding Team at Social Services

 What to do if you are concerned about elder abuse

If you are concerned or have a concern about someone else about harm or abuse and think the danger is immediate phone the police now on 999!

If it is less urgent, you can phone the local police or contact the Local Authority Adult Safeguarding Team. You will find these numbers on-line or in a  telephone directory.

Living With Dementia – How to Create A Life Story Book

Memories are precious especially for people living with dementia who use past experiences to make sense of their present reality. A Life Story Book will enable you to validate their life. Part of being a person is having your self-worth acknowledged and to feel that you matter. A Life Story Book can also be used to distract attention if the person is feeling anxious or upset.

It couldn’t be easier to produce a Life Story Book. Just gather your loved one’s photos and documents and put them in chronological order in a scrapbook or photo album. It’s a great activity to do with them and I suggest you put simple descriptions on each page.

The power of an image to engage a person with dementia lies, not only in the visual aspect of the image, but also in the following:Untitled

  •    Showing positive emotions such as joy and happiness
  •   A strong sense of narrative that encourages story telling
  •   An element of humour that does not require sophisticated interpretation

You should avoid images that include anything that could be upsetting for someone with dementia such as people in an aggressive or distressed state, or showing people or animals at risk. These can lead to feelings of anxiety or distress that people with dementia may be unable to rationalise.

If you want to go the whole hog  there is a great on-line system that makes it easy and fun to take a treasure hunt through their memories and store them in a beautiful book that becomes a family heirloom. There are written prompts on every web page to conjure up the fashion, sport and news of that time in their life.

What a lovely birthday or Christmas present a life story book would make for an elderly relative!

Living With Dementia – Ten Top Tips For Carers

Do you have an elderly relative living with dementia? It is likely that you do because 1 in 3 of us will know someone with dementia.

My own experience is informed by working for Social Services and the NHS for many years and supporting people living with dementia in my elderly care consultancy. My mother was also diagnosed with dementia over 20 years ago so I understand personally, the devastating effect it can have on an individual and family life. Here are my top tips based on that experience.

Get into the right frame of mind

Breathe deeply, centre yourself, imagine what it would be like to step into the person with dementia’s shoes and enter their world.

Give them your attention

People with dementia need the same opportunities as everyone else to share their worries, feelings and views. Part of being a person is being acknowledged. Observe, imagine and associate with what the person is feeling in your heart.

Allow plenty of time

Managing services for a local authority, struggling to find enough money to meet ever increasing demands with a diminishing budget, we had to focus on a task orientated ‘time and task’ approach which put pressure on staff and often left clients feeling bewildered. You need to allow time for the person to process information as they will become anxious if they are rushed.

Find out about them

I cannot stress enough how important it is to understand an individual’s background in order to deliver person- centred care. Every person living with dementia will have personal attributes, strengths, skills, hobbies and interests, work and life experiences. You need to find out what they are to build up a personal profile so care can be consistent and personalised.

Give the gift of ‘presence’

By this I mean simply be with the person and listen to their feelings and concerns in a non-judgmental way.

Show that you are listening

Get into the moment, respond from your heart and rephrase what they are saying to show that you are listening and that you empathise with them.

Tune into their feelings and emotions rather than what they are saying

Match their tone and say something like  “You are feeling upset. It feels scary when things are changing doesn’t it?” (or whatever you think may really be troubling them)

Use photographs to create a life story book and a memory box with their personal memorabilia MH900341736

People living with dementia use past experiences to make sense of their current reality and these tools will enable you to validate the person’s life. A Life Story Book is really easy to make and you can find out here.

You can also use a a photograph album, life story book or memory box to distract attention if the person is feeling anxious or upset.

Shift their mood when you need to

Connect them with happy memories. “Can you remember a time when you were happy? Lets have a look at some photos to jog your memory”

Use new technology to help manage their care

New technology brings new devices and tools that can help to  reduce anxiety, maintain independence, reduce care costs and create a less oppressive care environment. Just a few of the things I got my mother when she lived at home are a light that stuck over the bed with a motion sensor so it came on when she got up at night that I bought from Wilkinsons, a day clock that just tells the day and time of day and  and a nifty gadget called a wander minder that I used to remind her to turn the tap off on her catheter after she had emptied it. iPads are also great for people living with dementia. Here are some posts where I have written about them. Ten Reasons Why iPads are Magic for Older PeopleTen Smart Apps for Older People To Use On Their iPad- Part One, Ten Smart Apps For Older People To Use On Their iPad- Part TwoThe Arrival of An iPadDigital Technology, Social Care and Older People

There are always new things coming into the marketplace so keep a look out on my shop which is currently being developed. The following sites are also useful to keep your eye on shops at  MyAgeing Parent and Alzheimer’s Society

Look after yourself

Whether you are caring for an elderly relative yourself, managing their care  or working with people living with dementia it can be exhausting and very stressful. Make sure you have someone to talk to, have regular breaks and ask for help if you need it.

 

Top Dementia Tips Dementia From A Personal Story

Throughout my professional career in Social Services and the NHS, I especially enjoyed the time I was responsible for older people living with dementia.

However my interest and passion for dementia stemmed from my mother being diagnosed with the condition over twenty years ago when I came to understand first hand how dementia steals a person’s independence, socially, physically and emotionally. Also how the person has to rely on someone else to listen and interpret their needs in order to maintain relationships and restore some kind of balance and security in their life.

My mother has more than her fair share of physical health problems and suffers from chronic anxiety and depression. Her dementia is also complex and despite having a diagnosis of Alzheimer’s, I suspect there is more than one cause.

Be aware of dementia’s effect on bereavement

My father died last year after a happy 64 year marriage. Mum’s bereavement journey was made much worse by the cruelty of dementia making her forget my father’s death only to remember it again several times, as if it had just happened. IMG_0013

Consider all the care and support options

I find people with dementia often move into residential care too early because they aren’t aware of the choices available to them. In Mum’s case we were able to support her at home longer than her doctor wanted and she could have remained even longer if it hadn’t been for my father’s declining health and the demands she made on him as a result of her deteriorating mental health.

Its not always about the money

Mum’s care home is first class, despite the fact that most residents are funded by Social Services. I have learnt over the years that quality of care does not equate to quality of life and that the more expensive services don’t always deliver a better service.

Behaviour is always trying to tell us something

For the past year or so, Mum’s mood and behaviour has been erratic to the point where the home said they would need to have her reassessed to see whether they could continue to meet her needs. This was due to her lack of cooperation when staff tried to move her.

I struggled with her behaviour at first and found I had to start relating to her in a slightly different way. I had to forget about judging her on her old standards and instead start paying attention, observing and listening to her. This enabled me to enter ‘her world’ and understand what was happening to her from her own perspective rather than my own.

Mum has always been independent and had strong opinions. Her behaviour is the only thing she still has control over so she behaves assertively and at times aggressively. By asserting herself she is showing her independence and that she still has control.Understand things from their perspective

Provide support rather than taking over

We often want to wave a magic wand and make everything better but we can’t. It’s rather like a jigsaw and it’s not up to me to put the pieces together for Mum, I need to support her to finish the puzzle herself.

Worrying changes nothing, talking changes everything

Often she will use something as a symbol to represent something else or something will trigger her behaviour that it is totally unrelated. Instead of worrying I found it better to listen carefully and watch what is happening to find out what is troubling Mum.

Keep an open mind and be creative with your thinking

More often someone has made a seemingly innocent remark which she has either heard incorrectly or taken the wrong way. When she kept wanting to call the police and find a way to escape from the home, I realised she was  expressing her unhappiness at having lost her independence and wanted things to go back to how they used to be.

Feelings are more important than words

I have come to realise the importance of tuning into Mum’s feelings and emotions rather than the content of what she is saying.

Keep your cool when the person living with dementia loses theirs

I have learnt that in a situation where there are strong emotions you need to be in charge of your own.

Be aware their world is changing

I remind myself that her world is shrinking to memories of the past and her current reality. She is beginning to close down, emotionally as well as physically, and has a need to look back, reflect upon and evaluate her life.

A dementia journey has to be on the person’s own terms

Mum’s dementia journey has to be on her own terms, just as the rest of her life has been. I can walk beside her but she has to lead the way

 

Dying Matters

This week is Dying Awareness Week so I have decided to tell my personal story, where I believe knowing what my father wanted at the end of his life made a real difference to him and to my own bereavement journey.

Whether or not to resuscitate

My father’s life journey began to slow down a few days before his 90th birthday, a milestone he desperately wanted to reach as no-one in his large family had managed it, he lost his strength and became confined to bed. I moved in to care for him as he wanted to remain at home and I didn’t want him to spend his last days in an impersonal hospital ward Neither did I want his life prolonged, as his quality of life had deteriorated badly during the past months. I discussed this with his GP as I knew it is what Dad would have wanted and kept the DNR (Do Not Resuscitate) form available in case it was needed.IMG_0005

Knowledge brings confidence

In spite of knowing I was carrying out Dad’s wishes, when I heard his worsening cough, I wondered whether a trip to the hospital with antibiotics and IVs etc. would ease his discomfort. The thought was only fleeting and I was thankful we had discussed the matter before his health deteriorated.

Sleep was so important

Watching someone you love slipping away when there is nothing you can do about it is not easy. I felt as if I had stepped outside normal life and was suspended in some kind of time warp. Dad had a worsening cough, spent most of his time sleeping and must have ached from being in bed so long. I was glad he slept through the indignities to which he had to be subjected and was startled by the realisation of how much like an infant he became. My heart ached when I reflected on the proud, upright and independent man he had been.

Knowing your loved ones wishes

Dad passed away peacefully the day after his 90th  birthday, in his own home with his favourite music playing. I was able to reassure him that my brother, sister and I would make sure Mum was ok in her care home and told him he should be proud of the life he had lived and now deserved a rest. I am so grateful I was able to spend his last days with him and to contribute to him having the dignified death he deserved on his own terms. I could never have done this without knowing how he wanted to make his final journey.

A life well lived

I miss him and my heart aches for what I have lost but I know he is in a better place. My own bereavement journey has also been enhanced by the knowledge that I carried out my father’s final wishes and his affirmation that he had done all he wanted and lived a good life. I can think of no greater privilege than to help someone you love die their way. Dying really does matter.

You can watch this episode of Scott & Bailey on ITV Player until 6th June 2013. The duo investigate the death of a care home resident whose daughter complains about the level of care he was receiving. Will they find evidence of foul play?

https://www.itv.com/itvplayer/scott-and-bailey/series-3/episode-6

 

 

The Impact of Elder Abuse

Did you see the ITV drama, Scott and Bailey, this week? It focused on a care home at which several deaths had been reported in a short space of time. Although they didn’t always get their facts right, for example assuming that a member of staff who had completed NVQ level 3 was qualified to give injections, which they are not (thus confusing health and social care for viewers who already get the two mixed up) some useful issues around elder abuse emerged from the programme that we can learn from.

I thought a definition of abuse would be helpful to ensure we are all on the same wavelength. The charity, Action on Elder Abuse, defines abuse as ‘A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to another person’

Six important ways to lessen the likelihood of elder abuse

Senior Man with Cane

Report concerns straight away

Despite being concerned about her father being subjected to physical abuse and neglect, the relative did nothing beyond reporting her concerns to the Manager, until after her father had died.

Any concerns remaining after being reported to the manager should always be reported to the Safeguarding Team at Social Services straight away.

Expect your concerns to be taken seriously

The Manager was complacent and did not carry out an investigation after a relative had reported incidents or when the Care Quality Commission (CQC) raised concerns.

Relatives are often perceived as ‘difficult’ and while this may occasionally be true, all reports of bad practice should be taken seriously.

Good practice comes from the top

The relative was correct in saying bad practice comes from the top. Any care home is as good or bad as the person/people in charge.The manager’s view that the relative’s standards were unreasonably high is not uncommon.It is important to be able to trust the manager and senior staff in a care home.

Good practice would be for the manager to develop and foster good relationships with residents and relatives and hold regular meetings with them. Also monitor things like incident forms and sickness levels to flag up potential problems. With the right managers and supervisors in place, neglect and abuse in any form should not be possible to go unnoticed.

Staffing levels must be consistently adequate

Low staffing levels were used as an excuse. This is a common problem in homes struggling to provide high standards with inadequate funding from Social Services.

It is important to  recruit and train the right staff.

The importance of staff  support

There was clearly a lack of staff support and monitoring at the care home in the programme.

Working with vulnerable people can be draining especially when low paid staff have to work long hours in order to receive enough money to live on. Good role modelling is important and regular one to one meetings to discuss challenges, identify training needs and give praise, encouragement and support.

People living with dementia need more intensive support

Dementia was  targeted in the  programme

People living with dementia are even more vulnerable and therefore need additional monitoring. Staff need to be recruited who are patient and have the right attitude and values. These ‘softer’ issues are harder to measure and require different and more creative interviewing techniques. There also needs to be more staff and on going training in relationship centred dementia care

Of course elder abuse doesn’t just occur in care homes, it can happen in a person’s own home, at a day centre or when they are in hospital. Surprisingly, the perpetrators of abuse are very often the older person’s relative friend or neighbour or someone who provides support to them such as a home care worker.

I would like to leave you with a final thought. If you saw something happening to a child that was unacceptable, why would it be any different for an older person?

You can watch this episode of Scott & Bailey on ITV Player until 6th June 2013 in which “the duo investigate the death of a care home resident whose daughter complains about the level of care he was receiving. Will they find evidence of foul play?”

Day Clock for People With Dementia

daydisplay

Click image to view on Amazon


For anyone with dementia who becomes confused remembering what day of the week it is, or whether it is morning afternoon, evening or night time, look no further. This clock is absolutely ideal. It is delightfully simple and  provides reassurance which helps everyone  (not just those living with dementia)  I have suggested it to several people who have relatives living with dementia and they have all been thrilled, although some did comment on the high cost. We have just bought one for our Mother’s birthday. As you know my mother has dementia and lives in a care home.

We had sorted out her visits and appointments by attaching a large whiteboard to the wall in her room (with the Managers permission of course)  and used a permanent marker  to rule out the days of the week and we list what is happening during the coming week each Sunday with a dry marker.  Staff are always commenting on how useful it is but Mum struggled because she didn’t know what day of the week it was. This little gem will keep her orientated beautifully.

I have always explained to Mum that dementia is jargon for having memory problems but I know the word upsets some people, as does the word Alzheimer’s disease. If your elderly loved one is likely to be upset, you might want to put it in another box.

Although it certainly isn’t cheap, I think the peace of mind it brings makes it a good investment.