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There is always someone behind Dementia

Dementia

The following is an extract from ‘The Dementia Whisperer’ by Agnes B. Juhasz, which looks at the importance of a ‘person-centred’ approach in dementia care and how to understand the person hidden behind the condition of dementia.

There is a personality in every single human being, an absolutely unique code and pattern built up over a lifetime, and the way to understanding the person hidden behind the condition of dementia must not be blocked by obstacles such as language differences, communication problems, short-term memory loss or other physical and mental causes. This is the fundamental aim of the person-centred
care model I have always used – to help overcome these obstacles while finding out what the person with dementia really needs and what he or she really want. That is why the person must be taken into account first, before the disease.

I cannot emphasise too strongly the importance of the person-centred approach in dementia care. Taking each affected person as an individual, carers must start to learn their life history, habits, hobbies, fears, things they are proud of and all the tiny elements that make them happy or sad. They must get to know the subjective world of dementia, the world of the forever ‘I don’t know’. Carers must try to make contact with the personality that is hidden behind the barricades and search for an indirect connection while constantly checking on the physical needs of each person in their care, ensuring their comfort and doing their best to make them feel at home and safe. It is not good enough only to hear what people with dementia say; carers must let the words reach their innermost minds, if not their souls, if they really want to understand what dementia sufferers are trying to communicate.

Efforts to make a connection with a person with this condition will be much more effective if these guiding principles are kept in mind. In this way, carers can build up a kind of ‘special manual’ that quickly provides the answers to questions about the whys of seemingly odd or
annoying behaviour patterns.

If somebody desperately wants to go ‘home’, insisting that where they are is not the place where they belong, such behaviour can be
understood as communicating the fact that they do not feel safe or comfortable at that moment for a variety of reasons, and that they want
to go somewhere where they will feel reassured.

If the individual keeps saying they must go to work, even though they have been retired for years, it can mean they yearn to be useful and
busy again, and are feeling bored, worthless and useless.

If a person with dementia is looking for a wife or husband who died years earlier, it might highlight an individual’s lack of company and
need for emotional support.

Speaking this unique ‘language’ helps carers not only to understand different situations but means that they can also be the rock on which these people can rely and trust.

During my time working with Sylvia, I have noticed that it has become an involuntary habit of mine to speak to her more slowly and with more articulation than I usually do with other people. She speaks clearly and deliberately, perhaps because of her background in languages, and at first I think I copied her, which incidentally was very good for my English. Now, I believe that my speaking slowly has the added benefit of giving her the chance to think during the conversation and the time to find and select the right words to express as clearly as possible what she really means or wants to say. I also always take care to eliminate every possible barrier or extraneous noise from our verbal connection.

When Sylvia is watching TV, she usually has the volume up high because of her hearing impairment. Although she has got hearing aids, she prefers not to wear them at home, especially when she is watching television, as they make not only the speech but also the background noise far too loud. Naturally there are moments when she wants to say something during a Poirot or Miss Marple episode, and I always automatically turn the volume down immediately to get rid of a very disturbing communication barrier.

In verbal communication I have learnt never to switch topics quickly as people suffering from dementia are unable to follow quick changes of idea. If I have asked a question and I realise that Sylvia’s response has nothing to do with the question asked, or she says something totally incoherent, I try to rephrase what I have just asked or said, and that usually solves the problem.

[…]

Reminiscence therapy is a crucial part of dementia care work. This person-centred approach concentrates on the personal life history and
the most pleasant memories and occasions of the life of a person with the condition. Recalling personal experiences and skills that the person used to have, while showing a lot of love and interest, provides very strong support to the current mental state so that the mind can function at its maximum. If a person’s mental and emotional states are well balanced, they have a positive effect on the person’s physical health too.

‘The Dementia Whisperer’ by Agnes B. Juhasz is based around real-life stories and provides insights into what she has found works and does not work, and candidly reveals her own emotions of frustration, irritation and – sometimes – amusement, and how she has learnt to cope with these.

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Carers Week 2022

Carers Week is an annual campaign to raise awareness of caring, highlight the challenges unpaid carers face and recognise the contributions carers make to families and communities throughout the UK.
It also helps people who don’t think of themselves as having caring responsibilities to identify as carers and access much-needed support.
This Carers Week, Mary Jordan, author of ‘The Essential Carer’s Guide to Dementia’, details what being a carer to those with dementia means, and how people can lend them more support in their role.

Was there ever a more difficult time to be a carer? Especially a carer of someone with dementia.

Dementia is a very difficult condition to deal with. It is unpredictable. It is not an illness that has a set ‘pattern’, nor despite many texts to the contrary are there set ‘stages’ that the person with dementia goes through as their illness progresses.

The things that can help

A few things are known to be helpful: social stimulation, connections with close friends and relatives, access to good medical attention and support and advice, timely intervention when ‘crisis’ (such as falls, urinary tract infections, or accidents) occur.
All these have been denied to carers over the past two years.

How things changed.

A face to face meeting with the GP has become almost unknown. Appointments with a specialist are fraught with complications. Support services are discontinued. Outside visitors are not allowed during hospital stays. Friends cannot visit. Family members are denied access to residential care homes. Rehabilitation services are not functioning.

What carers are telling me

Rather surprisingly (to my mind) most carers are fairly accepting of the lack of face-to-face contact with GPs. After an initial period, most of them seem to have got to grips with technology enough to manage telephone, or remote contact via internet consultations. The biggest difficulty seems to be with access to ancillary services such as physiotherapy, rehabilitation, falls clinics, speech and language therapy and sight and hearing services. These cannot be delivered remotely and the ‘backlog’ after lockdown seems to have led to long waiting times for appointments and treatment.

Support Services in the community

Many carers rely on social support such as dementia cafes, memory clinics, ‘Singing for the mind’, seated exercise classes, Cognitive Stimulation Therapy, carers support groups. All these services were forced to close during the severe ‘lockdown’ period but it is noticeable that as soon as it was permitted and reasonably possible most of these services re-opened. Sometimes there were restrictions or extra guidelines, but the community and voluntary sector made efforts to provide these vitally needed services.

A wide variation in provision

Once government guidelines were relaxed it might have been expected that access to health services would be quickly brought back to pre-pandemic normality. But there seems to have been a wide variation in maintenance of restrictions and this has created problems for carers. One chain of ophthalmologists still insists on full PPE for staff, face coverings for customers and queuing outside the premises whilst another invites walk-in appointments. Some dentists still (strangely) insist on face coverings for patients whilst others follow government guidelines that these are no longer necessary.  Some physiotherapists and chiropractors do not allow anyone to wait on the premises, others have opened their waiting rooms.

Difficulties for people with dementia

Many people with dementia find difficulties in following social procedures such as standing in a queue, waiting in turn, facing a doctor or health practitioner alone (without the reassuring presence of a carer) wearing a face covering, or following a one-way system.  Whilst these procedures may have been necessary when the pandemic was at its height more thought needs to be given and action taken to end unnecessary restrictions now.
Often health and social care businesses are forced to continue to press unnatural restrictions on customers and clients due to the pressures exerted by those providing Professional Indemnity Insurance. This is wrong. If the Government has indicated that the situation has eased, then this should be definitive.
Life is hard enough for those caring for someone with dementia.  Does society need to make it even harder?

For more information about Mary Jordan’s book, ‘The Essential Carer’s Guide to Dementia’ or to read the first chapter free, click here.

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Caring for the carer

Being a carer is very stressful and very tiring. It can also be very fulfilling and many of us are glad to be ‘giving something back’, especially if it is to a parent who once cared for us. But there is no denying that it can sometimes feel as though we are labouring under an intolerable burden.

In an ideal world, as our relatives or close friends grow steadily more frail, plans would be made for the future, money saved for contingencies, moves made to more manageable accommodation, and help enlisted in advance. In the real world, people fall ill suddenly, accidents happen and the role of carer is suddenly ours without planning or forethought. If at all possible, time should be made after the initial ‘emergency’ to take a step back, draw breath and consider a ‘care plan’. It is very worthwhile at this stage to get the whole family together and agree co-operation with everyone involved.

Care together and cooperate

Lack of communication and co-operation may turn out to be the biggest underlying problem. Group meetings early on will help avoid resentment or guilt developing. Make use of personal strengths here. For example, someone who is not good at practical personal care may instead be able to manage the financial affairs. Someone who enjoys cooking may agree to keep the freezer stocked with ready meals whilst someone who is only free once a week might organise the shopping.

What if you are the only family member? You should not try to take on everything alone. There may well be neighbours or friends of your relative who will help in the same way that family do. Otherwise you will have to turn to professional help. There is no need to feel guilt over this.

Do not neglect to ask for help from the person you care for’s friends and neighbours if you need it. A neighbour will often promise to ‘keep an eye on things’ but it would be much more useful if you asked them to do something specific – say, ‘Can you call round each morning just to check all is well?’ Of course, people may sometimes be unable to help, but unless and until you ask you will never know. Also investigate local clubs and organisations to which the person you care for belongs. For example, their local church, The British Legion, ex-servicemen and women’s organisations, local branches of organisations set up to benefit ex-members of professions or trades. Local and national charities can also be sources of help.

Care for yourself and get the support you need as a carer

Caring for a member of the family is an unpaid ‘occupation’ but you or the person you care for may be able to claim certain grants and allowances and if you are entitled to them you should certainly claim them. You may not realise that, if you are a carer, you can ask the local authority for an assessment of your own needs. The kind of help and support you can get as a carer includes: respite care to give you a break if you are caring constantly for your relative; emotional support from other carers, usually through a local support group; help with caring; and help with household tasks and activities for the person you care for.

As a carer, it is very important that you look after your own physical and mental health. You should never neglect your own health issues because if you are ill the person you are caring for will suffer as well since you will be unable to give the level of care you would wish to. You should take care of yourself physically by eating properly and taking exercise, but you should also build in some sensible respite. For example, pay for a professional carer once or twice a week. A friend, neighbour or other family member could do this, or even some local charities may provide this service.

There are several organisations aimed at supporting carers. Some of these offer information, some offer practical support and some offer ‘moral support’ in the form of local support groups where carers can meet to talk about their problems or concerns with people who are in a similar situation to them. Many support organisations have carers’ support chatrooms and forums accessed via their website and you may find this kind of ‘virtual’ support most helpful.

Make use of all the resources you can to help you and the person you care for. Read books, check magazine articles, ask at the library, search the internet. Buy or arrange provision of any equipment that will make life easier. Above all, ask what is available. Especially ask your district nursing team. They have access to a lot of information and contacts.

It can be difficult, but try not to allow yourself to feel constantly guilty. Those who we care for do not always show their appreciation, and indeed in some cases, they may be unable to do so. Try always to assure yourself that you are doing the best you can.

At this point it occurs to many carers to think about their own future. It is a very good time to make plans whilst you are caring for another because the difficulties and limitations of frail old age will be clearly before you (as well, perhaps, as the compensations). So, this could be an ideal time to think about your pension and will. You can feel secure in that you have made all the plans you possibly can.

Share this blog for Carer’s Week next week (6-12 June) and help highlight the challenges carers face and recognise the contribution they make to families and communities throughout the UK.

Read more advice and guidance for carer’s from Mary Jordan’s book The Essential Carer’s Guide out now as ebook and paperback.