Promoting Excellence: A framework for all health and social services staff working with people with dementia, their families and carers

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Dementia Skilled Practice Level

The Dementia Skilled Practice Level outlines the knowledge and skills required by all health and social services workers who have direct and/or substantial contact with people who have dementia.

" I'm trying to create a dementia friendly community. I'd like a dementia friendly world, but I'll start with my community."

Through our eyes, a life with dementia

Dementia Skilled Practice Level

Stage in the dementia journey

Keeping well, prevention and finding out it's dementia

Outcome

What workers know (knowledge)

What workers are able to do (capability/skill/ability)

People with dementia are able to maintain valued relationships and networks, and have the opportunity to develop new ones both personal and professional.

  • Appreciate that people with dementia have a right to continued engagement in life's roles and relationships.
  • Understand the importance of supportive networks and/or therapeutic connections for people with dementia, their families and carers.
  • Awareness of the benefits for people with dementia to engage in activities as a means of maintaining their independence and enriching their lives.
  • Understand the importance of maintaining the spiritual and cultural aspects of life for the person with dementia, their family and carers.
  • Understand that the effects of dementia can mean that people may require support or environmental adjustment to maintain active engagement in community life and valued activities.
  • Understand that the environment incorporates physical, cultural and social aspects that can impact on the experience of people with dementia.
  • Support and encourage the person with dementia to develop new roles, skills and relationships.
  • Support and encourage the person with dementia to maintain their chosen activities, social life and/or work and community involvement.
  • Provide information or signpost to services including those that reflect the person's spiritual and cultural wishes.
  • Make environmental adjustments to suit the individual requirements of the person with dementia.

People with dementia have access to quality services and can continue to participate in community
life and valued activities.

  • Knowledge of the different types of dementia and the particular implications and impact on the person, their family and carers.
  • Knowledge of a range of effective communication techniques and strategies to suit people who are affected by memory difficulties or confusion.
  • Awareness of local professional and community services and specialists, who can provide assessment, advice and support for memory problems.
  • Understand the potential impacts of a diagnosis of dementia on people and their families and carers.
  • Knowledge of local professional, specialist and community and voluntary resources that provide services such as counselling, psychological or pharmacological supports, peer and group support.
  • Respond appropriately to the diverse range of challenges that people with dementia may experience that reflect the impact of specific types of dementia.
  • Adapt communication to meet the individual needs of the person with dementia.
  • Communicate respectfully and sensitively, with the person with dementia, giving consideration to the potential impact of memory difficulties or confusion.
  • Support people to access services that address memory issues.
  • Support the person with dementia to access emotional support, counselling or specialist psychological therapies.
  • Support the person with dementia to access pharmacological treatments to alleviate distress and support mental wellbeing.

People with dementia feel empowered and enabled to exercise rights and choices, maintain their identity and to be treated with dignity and equity.

  • Knowledge of the types of health behaviours that can support physical health and contribute to prevention of certain types of dementia.
  • Awareness of the principles and key provisions of legislation such as the Human Rights Act (1998), Mental Health (Care and Treatment) (Scotland) Act (2003) Adults with Incapacity Act (2000), Adult Support and Protection Act (2007) and the Equalities Act (2010).
  • Provide people with a range of information about strategies and healthy lifestyle behaviour that can reduce the likelihood of developing some types of dementia.
  • Use legislative frameworks to support the person with dementia to exercise their rights and choices.
  • Support people with dementia in risk enablement by contributing to risk assessment and management.
  • Contribute to the assessment and support of people with dementia who may be experiencing neglect, harm or abuse.

Stage in the dementia journey

Living well with dementia

Outcome

What workers know (knowledge)

What workers are able to do (capability/skill/ability)

People with dementia feel safe and secure and are able to be as independent as possible.

  • Knowledge of the services and supports which can help people with dementia to maintain valued activities, social engagement and inclusion.
  • Understand that stigma and the impact of dementia may lead to social isolation and withdrawal from previously valued social connections and activities.
  • Understand how tele-healthcare and assistive and innovative technology, can positively support and promote the independence and quality of life for people with dementia.
  • Knowledge of how to safely use tele-health and assistive and innovative technology to support the person with dementia, when appropriate to role.
  • Provide information and access to supports for risk enablement and maintaining independence, such as tele-healthcare.
  • Utilise assistive technology where appropriate to promote people's independence and quality of life.

People with dementia, their families, friends and carers, have access to the information, education and support that enhances the wellbeing of the person with dementia and those that support them.

  • Knowledge of the impact of the progression of dementia on the physical, emotional and psychological health and wellbeing of the person with dementia their families and carers.
  • Understand the impact of the environment on the safety and wellbeing of the person with dementia.
  • Understand the ways in which the impact of environmental challenges can result in frustration and distress.
  • Awareness of the benefits of cognitive stimulation in maintaining people's independence and alleviating frustration and distress.
  • Awareness of the range of multi sensory, therapeutic and recreational activities that promote wellbeing and independence.
  • Engage with the person with dementia, their families and carers in a warm and empathic manner when responding to frustrations and distress.
  • When appropriate to role engage with the person with dementia in undertaking informal cognitive stimulation activities.
  • Encourage and support the person with dementia to participate in therapeutic and recreational activities.

" We want to stay active and in the community as long as possible. We're not stupid, we know we have a condition and we know our condition progresses and that many of us will get to that stage where we'll need home care support and may go into a home."

Through our eyes, a life with dementia

Stage in the dementia journey

Living well with dementia

Outcome

What workers know (knowledge)

What workers are able to do (capability/skill/ability)

People with dementia have access to individuals, groups and organisations that can support their spiritual or personal beliefs and reflect their cultural wishes.

  • Understand the benefits to the person with dementia in undertaking life story work in relation to sense of self and value both now and the future.
  • Understand how life story work can be used to communicate with the person with dementia and engage them in meaningful interactions and activities.
  • Understand the value to families and carers of recording a life story in order to maintain the sense of the person and their relationships.
  • Use the person's life story to support their engagement in meaningful activities relating to their interest and abilities.

Stage in the dementia journey

Living well with increasing help and support

Outcome

What workers know (knowledge)

What workers are able to do (capability/skill/ability)

People with dementia are able to maintain valued relationships and networks, and have the opportunity to develop new ones both personal and professional.

  • Understand that people with dementia have the right to continue to be actively involved in all decisions that help them to live well with dementia.
  • Understand the requirements of formal assessment of capacity under the terms of the legislation.
  • Understand the benefits of ongoing and supportive relationships to the health and wellbeing of people with dementia, their families and carers.
  • Understand the range of challenges that might face people with dementia, their families and carers, as their dementia progresses.
  • Knowledge of a range of methods of communication with people with dementia who may be experiencing increasing difficulties with their memory and life skills.
  • Work with the person with dementia, their family and carers to maximise their ability to participate in decisions and choices.
  • Work with the person with dementia in a way that attends to their previously expressed choices, wishes and desires.
  • Support the person with dementia to maintain their valued personal and community connections.
  • Support the person with dementia, their family and carers to access counselling or psychological therapies that can support and enhance intimate relationships or build coping skills.
  • Use communication strategies that take into account the individual progression and variable nature of dementia.

People with dementia feel safe and secure and are able to be as independent as possible.

  • Understand that people with dementia are more at risk of issues that might impact on their physical health, for example, becoming dehydrated, malnourished or have continence issues.
  • Knowledge of how to use a range of aids and adaptations to assist with eating and drinking and continence.
  • Understand the particular risk people with dementia have to falling because of visual impairment.
  • Understand that people with dementia may have a reduced ability to communicate physical illness, pain and mental distress.
  • Understand that acute hospital admission may have a negative impact on the experience and outcomes for people with dementia.
  • Understand the range of anticipatory and preventative measures that can be put in place to prevent hospital admission for people with dementia.
  • Provide direct support in eating and drinking, when appropriate to role, to ensure the person maintains good nutrition and hydration.
  • Recognise when a person with dementia may be at risk of falls and take appropriate action.
  • Monitor changes and deteriorations in the person's physical and mental health and take appropriate action.
  • Report changes that may compromise the person's health and wellbeing and /or safety and security.

Stage in the dementia journey

End of life and dying well

Outcome

What workers know (knowledge)

What workers are able to do (capability/skill/ability)

  • Knowledge of the specific palliative and end of life care needs of people with dementia.
  • Contribute to the palliative and end of life care of people with dementia.

"The goal of palliative care is the achievement of the best quality of life for people and their families."

(World Health Organisation)