Person-centred care should be at the top of our list!
Person-centred care should be at the top of our list!
Arthur is my husband's uncle. He has early onset dementia and began to deteriorate noticeably about 10 years ago. Although he was physically fit, his confusion was becoming more apparent.
We began to visit him weekly. We got to know his carers and the agency supporting him. His social workers wanted him moved into a care home but this idea frightened Arthur greatly.
I could see that things were going wrong with his care but it seemed to me that a lot of the things causing concern could be sorted out easily just by adjusting the way everyone was thinking. I was working as a trainer and consultant in person-centred practices in health and social care, I felt strongly that I could help Arthur by using the person-centred thinking tools that were so familiar to me, although this approach had never been taken before with someone living with dementia.
Arthur and I sat down and developed his one-page profile. On a single piece of paper, we summarised what was important to him and how best to support him. Arthur told me that it was important to him that his food was served piping hot and that someone sat with him while he ate. He loved his woolly bobble hat and wanted to wear it constantly and he must, at all times, have a £10 note in his back pocket. These small details may seem insignificant: they're not, they are what made Arthur's life complete.
The next step was to convene a person-centred review meeting, which I facilitated and which was attended by everyone involved. We looked at what was working and not working – and many things weren't working. Although Arthur wanted his food served hot, his carers were worried he'd burn his mouth. Arthur wanted company while he ate, but the carers didn't have time after they'd prepared his meals from scratch. The result was that he was throwing the uneaten food into his back garden. He was becoming malnourished and the garden was infested with rats.
Things were going wrong with Arthur's £10 note, too. Carers were putting it into a drawer to keep it safe but he'd forget and get down on his hands and knees to find it. Often, he couldn't get up. He'd ring my husband at 2am asking for help.
All of these little things were causing distress to everyone so we took a step back and agreed on action points to address these and other issues. I agreed to cook meals for Arthur a week at a time. If we froze them in bulk, the carer could quickly re-heat them in the microwave and would then have time to sit with Arthur while he ate. Carers agreed to respect Arthur's wishes about his £10 note and to use his one-page profile as a source of information about him.
Arthur's story shows how understanding what is important to someone, finding out how they want to be supported and then acting on what we learn, can make a huge difference. It's a new way of working that represents a shift in power and a change of culture. Traditional models of care revolve around the efficient execution of daily routines – washing, dressing and eating. By focusing equally on what mattered to Arthur as a unique individual, as well as the things that needed to happen to keep him healthy and safe, we were able to improve the quality of his life dramatically.
Over the last few years we have been introducing one-page profiles and other person-centred practices to people living with and working with dementia in residential and care home settings. Support for this approach is gathering momentum. Jeremy Hughes, chief executive of the Alzheimer's Society, has commented that: "Person-centred practices can make significant changes for all people regardless of their type or stage of dementia." Victoria Metcalfe, a dementia consultant with Anchor, has said that one-page profiles will change people's lives.
Statistics tell us that by 2021 there will be one million people in this country living with dementia and there are widespread calls for change in how we support and care for them. Could these simple person-centred practices be the change we need?
Story taken from The Guardian on-line.
I believe that getting alongside family and friends can help us greatly in our endeavor to implement real person-centred care. It is often the small things that make a big difference. It has always been at the heart of my practice and I am over the moon to see that people are recognizing its importance.
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