21-06-17 @ 18-30hrs
Relatives supporting 3 residents
ST Elmo staff – Lesley, Kathie and Vicky
Lesley thanked relatives for attending and asked them to help themselves to cheeses, wine etc, otherwise we will get in trouble from the catering team!
Lesley explained the theme of today’s meeting was to talk about improvements at St Elmo both environmentally and caring.
Lesley explained that after years of complaining about the old but working system, the home has just had an addressable fire alarm system, which will save us valuable time if the fire alarms are set off.
St Elmo is at present working with WHCCG, this is around falls prevention and risk management of falls. We hope to be starting the National Early Warning system ( NEWS) trails in July. These are to help prevent hospital admissions by being pro-active on resident’s changes. It also means if we have a concern, when talking to external professionals we can give detailed information and talk the same language.
Staffs continue to update their knowledge by on-going training. In April I attended a four day course on communication and care giving in dementia. Prior to doing this course I believed I had a good idea around dementia; in fact I now know that I knew nothing.
You have all been through the early stages, before care home placement was looked for but as we all know dementia is progressive and a debilitating disease. We know a lot about the brain but there is more we do not know. As yet there is no known cure for the numerous types of dementias.
Lesley then talked about the believed memories of people with dementia and the dementia bookcases.
Every minute of the day and night our brains are bombarded with information. If we think of our memories as words on a blackboard. Some people have big blackboards and some especially those have small one. There is one rule around the blackboards that is when it’s full it’s full. Then we have to clear information to make room for more. That is why we all forget things. We have wiped some important information off. It does not mean that we have dementia. If however we have dementia with a small blackboard which say for example can only hold 3 words, can you understand why things get forgotten or there is not enough room to hold all the information in the sentence. That is why when communicating with residents with dementia we have to make every word count and not correct them if things have been forgotten.
When we clear our blackboard, some of it is irrelevant so it is wiped and some is important and put onto bookcases. We all have 2 main bookcases. 1 is factual but it is made of cheap plywood. The 2nd is emotional; this one is made of solid oak.
The factual bookcases first
The factual bookcase has memory shelves- it is believed that each shelf holds about 5 years of memories. The top shelf hold resent memories. If a person has dementia the bookcase starts to wobble.
Known as a micro wobble. New memories fall off the top shelf and there are numerous small errors which are easy to explain away. At this stages mistakes made are being noticed by others and are believed to be deliberate and intentional. People suffering compensate by making lists, covering their mistakes up or blaming others. They know something is wrong, they are frightened and it is hard work
As the wobble becomes worse, mistakes are more noticeable to others. Many errors around resent information, known as short term memory loss. Things get forgotten, mixed up, memory gaps, cannot recall events.
Until the bookcase collapses. When this happens memories get dispersed, difficult to access and recall. Oldest memories tend to get wedges in the centre becoming easiest to recall. People suffer from difficulties with time perception.
Remember it is made of solid oak!
The emotional bookcase is believed to have 5 shelves and it is believed to have memories of:-
- Women- cared and loved you
- Men –cared and loved you
- Negative authority figures- people who got up your nose e.g. bullies, strict teachers etc
- Favourite places
- Animals and pets
When the factual bookcase collapses people will use their emotional bookcases.
They can still store information on these shelves. It is known that residents in care homes can still tell other who they do and do not like. They quickly learn who they want to be with and recognise staff even though they do not know their names. More importantly where they feel safe.
At St Elmo all staff are taught about Maslows hierarchy of needs.
- Physical needs- physical requirements for human survival e.g. air, water, food, clothing, shelter and sex
- Safety needs – personal security, financial security, health and well-being
- Social belonging – friendship, family
- Esteem – need to be respected, self-respect, sense of contribution or value.
Emotional expression is part of Callaham’s category of needs.
He describes humans as rational creatures, feeling subjects, social animals and beings who choose to live by certain values.
What do we do at St Elmo to promote emotional well-being –
Vicky will now tell you-
Vicky introduced herself and explained that she organises activities to try and keep the mind active, using various types of activities and she also manages namaste. Namaste is delivered by the care staff, as it one to one interaction.
What was identified by St Christopher’s Hospice that people who are bed bound apart from interaction by their families and friends have little stimulation from care staff when they are not doing a care-related task. This gives the person quality time.
Namaste stimulates the mind, body and soul. As is it delivered on a one to one basis we are using for those who are bed bound or less able. It aims to stimulate touch, smell, sounds etc, tapping into the resident's emotional bookcases. Simple things like hand massages, music therapy or just reading to residents, help them to relax and have a calming effect.
Since doing namaste the staff have reported a huge difference from relaxing or presenting as relaxed by opening usually clenched hands etc to smiling.
Hand massages and other touch methods produce the biggest results.
Lesley than talked about the stages of dementias
Stages of dementia
Stage 0- micro wobble- as already discussed- time line anything between 10-20yrs
Stage 1 – factual bookcase is wobbling. Short term memory, attention, logical thinking ability becoming fragile. People coping with assistance of lots, reminders from families, afraid of going crazy, good verbal communication. Aware of their mistakes and are defensive, deny, blame others, misplacing items. Later errors of unable to manage money and mistakes with shopping. Difficult to persuade them of the right facts. This causes misunderstanding, suspiciousness and feelings of being deceived by a loved one.
- Tired from the amount of exertions involved in trying to remember.
- Deny or blame others is aware that something is not quite right
- Threatened by people at stage 2
- Most of the time able to cope with personal care may struggle with chores, grooming and hobbies.
- Obey social rules and norms strictly to appear normal
- Voice is harsh when feeling threatened
- May respond with wry humour/ sarcasm/irony to deflect errors
- Continent-although accidents are starting to happen
- Anything between 5-10yrs
Stage 2- time confusion. Short term memory and attention damaged disorientated, disinhibition.
People have noticeable time perception difficulties or where they are. Less insight into awareness of their memories and mistakes less focused on social rules. Unable to cover up mistakes, confabulate or lie any more
Become disinhibited-ref thinking, feeling may flirt with others unaware they are old, married or widowed. Allow for warm, open, emotional, spontaneous communication. Facts scare or correct
- Speak in present tense of deceased parents living, adult children as small children again, living in a previous home, childhood home, still employed.
- Fearful and wishing to go home, unable to find important items.
- Communication and comprehension obviously affected need for constant contact, demanding of immediate attention from carers, responds readily if someone is genuinely interested in them
- Anything between 5-10yrs
Stage 3- repetitive motion and speech.
Language reduced, weight bearing possible but mobility poor, cannot find object due to lack in visual field. In the absence of stimuli, people seem to be self-stimulating.
- Limited verbal abilities, short phases, humming, swearing or repeated calling out (nurse, nurse, nurse.)
- Singing, recite poetry or prayers
- Have super human strength when trying to grasp for comfort self or others
- Unable to remember names but aware family members who are important to them
- Time 5yrs plus
- Non-awareness of double incontinence.
Stage 4 – most people never reach these stage- physical conditions often cause death before reaching this stage. End stage withdrawal
- Sleep-close off from the outside world
- Stare intently at things but are still capable of slapstick type humour.
- Few body movements
- Do not appear to recognise family members
- Will respond to loud noise, massage, nurturing voice
- Time unknown
A relative asked if research had been done into the use of vitamins etc.
Lesley responded according to the press, there are a number of things which will help sufferers of dementia. These have been usually done on small trial groups. Once the press gets hold of it, it becomes headline news. Talking to Gemma Jones, who has done a lot of work with dementia it is in fact she is a world leading professor, it is a way of making people feel guilty as well as a waste of money. Especially people who are at zero stage or stage 1. As it makes them guilty about what if, if only.
A relative as about other chemical factors e.g. infections.
Lesley responded it is usually a change of behaviours which alert us to look for infections or constipation. Firstly we check urine samples and if these come back clear, as for a GP visit to exclude chest infections etc.
Lesley also commented we record everything which goes in and most things that come out. To prevent dehydration and constipation.
Lesley asked if anyone had any suggestions of how to improve our services. As we hope to be a forward thinking Care home. There were no suggestions.
Lesley reminded relatives that we have an open door policy and in management absence to speak to a member of staff wearing dark blue.
Lesley asked about any themes for the next relatives meeting – there were no suggestions.
Kathie suggested we could do a relatives meeting so relatives could freely talk to each other- like a support group, without staff involvement.
It was asked if there was support for partners when their loved one had to go into care.
Lesley suggested the Alzheimer’s cafe etc, but the support was asked for in the relatives own home.
Lesley said she did not know but would try to find out.
Nothing else to discuss meeting finished at 20-30hrs