Transcript Dementia and care homes

Promoting Quality of Life in Care Homes
Building an environment to support best
practice in dementia care
Professor Julienne Meyer CBE
Promoting Quality of Life in Care Homes
My Home Life mission
Promoting quality of life
for those living, dying,
visiting and working in
care homes for older
people.
Promoting Quality of Life in Care Homes
Dementia and care homes
• 676,000 people with dementia
(England)
• Expected to double (next 30
years)
• Approximately 1/3 live in CHs
• 70% of residents have dementia
• More likely to go into hospital
(avoidable)
Alzheimer’s Society (2016)
Promoting Quality of Life in Care Homes
Architects & Providers
Promoting Quality of Life in Care Homes
Guidelines/Checklists
•
Greasley-Adams C,Bowes A, Dawson A,McCabe L (undated) Good Practice
in the Design of Homes and Living Spaces for People with Dementia and
Sight Loss. Stirling: Dementia Services Development Centre.
•
Marshall M (2001) Environment: how it helps to see dementia as a disability
in care homes. Journal of Dementia Care 6(1) 15-17.
•
Health Facilities Scotland (2007) Dementia Design Checklist. Design checks
for people with dementia in healthcare premises. Edinburgh: NHS National
Services Scotland.
•
Social Care Institute for Excellence (2013) Dementia Friendly Environments.
London: SCIE.
•
King’s Fund (2014) Is your care home dementia friendly? EHE Environmental
Assessment Tool. London: King’s Fund
•
Dementia Therapeutic Garden tool (www.enablingenvironments.com.au)
Promoting Quality of Life in Care Homes
EHE Environment Assessment Tool
• Care homes
• Health centres and GP
premises
• Housing with care
• Hospitals
https://www.kingsfund.org.uk/projects/enhan
cing-healing-environment/ehe-designdementia
King’s Fund (2014)
Promoting Quality of Life in Care Homes
Impact of the design of the built
environment
• 169 research studies
• Impact of design (behavior,
function, well being, social abilities,
orientation, and care outcomes).
• Cognition not affected by
environmental design
• Basic design, environmental
attributes, ambience and
environmental information
Marquardt et al (2014)
Promoting Quality of Life in Care Homes
The impact of improved environment in
a care home
We looked at:
• Routine data
• Review of
research/guidelines
• Use of assessment
tools
• Interviews with staff
and relatives
Promoting Quality of Life in Care Homes
Interviews with staff
We found:
• Impacts on residents
(beneficial) and staff
(mixed)
• Differing views on
“homeliness”
• Environmental design
not enough
Promoting Quality of Life in Care Homes
Impacts on residents and staff
“[Before] I felt it like a torture
going into this room, because it
was just black and white. And
now it has the colour and the
plants. And they are asking to
have a shower now, they queue!
‘I am next, I am next…’ Where
before, it was, ‘I don’t want that’.
So it is a lot more friendly… “
(S3)
Promoting Quality of Life in Care Homes
Differing views on “homelieness”
“It was homely. We had the
clutter, we had the magazines in
the magazine rack, and we had
stuff on the tables for residents
to pick up and fiddle with or
games laid out so… And that
worked very well because
somebody will sit down and
they’ll start playing cards,
because there’s a pack of cards
there.”
(S1)
Promoting Quality of Life in Care Homes
Environmental design is not enough
“At the end of the day, it is all
about the carers
encouraging. You can have
the nicest place going but… if
there’s not a carer sitting
there talking to them, making
them feel worth something,
then it won’t work.”
(H3)
Promoting Quality of Life in Care Homes
Most effective, when combined with …
• Well trained staff
• Positive philosophy of care
• Strong leadership
Promoting Quality of Life in Care Homes
Four Conceptual Frameworks
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Evidence based
Relationship-centred
Appreciative
Action-oriented
www.myhomelife.org.uk
Promoting Quality of Life in Care Homes
Evidence based themes
Personalisation
Maintaining identity
Sharing decision-making
Creating community
Transformation
Keeping workforce fit for
purpose
Promoting positive cultures
Navigation
Managing transitions
Improving health and health care
Supporting good end-of-life
NCHR&DF (2007)
Promoting Quality of Life in Care Homes
Relationship-centred Care
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Security – feel safe
Belonging – feel part of things
Continuity – make connections
Purpose – have goals
Achievement – move towards goals
Signifiance – matter as a person
Nolan et al (2006)
Promoting Quality of Life in Care Homes
Summary
• We do have an evidence base to guide
• Impact (behavior, function, well being, social
abilities, orientation, and care outcomes), not
cognition.
• Dilemma of making this individual (non-dementia,
different cultures, stages of dementia)
• Navigate their dementia journey - personal way
• Depends on staff and culture of the home
Promoting Quality of Life in Care Homes
Promoting Quality of Life in Care Homes
Contact Details
My Home Life
School of Health Sciences
City University London
Northampton Square
EC1V 0HB, London, UK
Tel: +44 (0)20 7040 5776
Email: [email protected]
www.myhomelife.org.uk