Dementia awareness and good practice

Author details

Elaine Farrer is operations director at Colten Care. 

Southern England care home provider Colten Care has invested in practice development, dementia care awareness, and the appointment of an Admiral Nurse.  Elaine Farrer explains the positive difference this has made, especially during the pandemic. 

Looking back, we always knew we were a good fit for Admiral Nursing. We own and operate 21 care homes in the south of England, all of which are registered for nursing, while four are dedicated dementia care homes.  

Two of these specialist homes, the Aldbury and Fernhill in Dorset, became accredited practice development units for dementia care as long ago as 2012. Working closely with our accrediting body, Bournemouth University’s School of Health & Social Care, we took these homes’ experience and shared their learnings right across our group.  

Our aim was to strengthen our overall strategy for clinical governance, evidence-based practice and interdisciplinary working. Practical projects implemented at all our dementia care homes included daily communication meetings involving all work disciplines, not only clinical roles, regular creative craft sessions for residents and “communication diaries” to record daily events in each resident’s life, useful as conversation prompts.  

We also introduced “Ten golden rules about me” charts reminding staff of each resident’s preferred daily routines, such as when they like to brush their teeth or have their hair done, as well as “scrapbooks” of reflections on life at the home compiled with input from residents and relatives, and “Butterfly Boxes”, a range of materials to stimulate socialisation and memory work.  To shape our overall strategy, we devised and communicated a headline promise for residents and relatives: “Helping you overcome the challenges associated with dementia”. We held off-site “Dementia Utopia” team conferences, with representatives from all homes meeting to discuss and nurture innovation in relationship-centred approaches to care.  

Taking a “one team” approach to help fulfil our stated promise, we ensured that basic dementia care awareness was made available to all staff, whatever their role, and we enabled everyone to follow the Alzheimer’s Society initiative and become Dementia Friends.   

It was against this background that we recruited our first Admiral Nurse, Kay Gibson, from the NHS in autumn 2016. While our Admiral Nurse provision has expanded and contracted at different times over the past five years, what has remained constant is the confidence we and Dementia UK share that you can indeed live well with dementia and that Admiral Nurses can play a pivotal role in enabling this to happen.  

Kay’s expertise and input has added immense value to what we do for our residents and their families. Third-party recognition of this is evident from successive inspection reports by the Care Quality Commission (CQC). Fernhill, our Hampshire dementia care home Linden House and another Dorset home Newstone House – a hybrid home offering both nursing for those who are elderly and frail as well as dedicated dementia care – have all been rated outstanding by CQC inspectors.  

Motivation and context 

Our care homes benefit from being geographically concentrated and our dementia-specific settings are located near each other, which is unusual among big home care providers.  If you operate across a wide geography, you risk an individual Admiral Nurse being on the road more than they are giving support.  

For smaller local providers, on the other hand, investing in an Admiral Nurse may be seen as too much of a luxury, especially in the wider context of nursing recruitment challenges. In addition, for Dementia UK to want to partner with you on Admiral Nurse provision, you have to be serious about dementia care and share the same vision.  

With her community support remit, Kay quickly began running regular drop-in sessions for families and made herself available to answer questions online on our “Ask-an-Admiral-Nurse” website. She has also led on our support for Dementia Action Alliances in the communities served by our homes in Dorset, Hampshire, West Sussex and Wiltshire.  

Working alongside residents and families, she gives the one-to-one support, handholding, expert guidance and practical solutions they need. Here, supplemented by her own words, are four practical examples of where Kay adds value:  

Early support 

People in the community will always need help in arranging a diagnosis or a referral for community mental health support but the pandemic has caused huge difficulties. As Kay explains: “Primary care services in the social care sector have been really challenged to do face-to-face pre-admission assessments and some day care services have simply had to shut down.  

“There are many sad cases of people struggling to find the support they need and families reaching their limit. Where I can, I get in early and help families to have an honest conversation about what is needed. During the pandemic, I have spent a huge amount of time on the phone and on Zoom calls. The Dementia UK helpline signposts people to me. Many people are struggling and need to talk. You become someone to rely on for encouragement and reassurance, a lifeline.”  

Care moves 

One of the most critical moments in a person’s dementia journey is the transition from where they normally live, whether it’s their own home or a nursing or residential care home, into a dedicated dementia care setting. We ensure this is done with Admiral Nurse support.   “With a care home, I go in to support staff doing risk assessments and care plans,” Kay says. “Ideally, we will have a triadic relationship involving the resident, their relative or relatives and professional care staff. Each point on the triangle is as important as the next. You need all three to function properly.  

“While staff know how mum is now, they don’t know how she was before. In the same way, the family will know her background and character but may not be aware she has suddenly become more confused. The resident needs both the family and staff points on the triangle to be communicating.   “If a resident needs to move from a residential home with nursing to a dedicated dementia community then the family have the reassurance that I know both homes, can add my insight to nitty-gritty decisions and actually accompany the resident when they move.   “For example, I built up a good rapport with a lady and accompanied her in a phased move designed to avoid any anxiety and make it as easy as possible for her.   “First, some of her belongings were brought to the dementia care setting in advance. This meant that when she arrived, she already had her paintings on the wall, her photos on the bedside table, her hairbrush in place and so on. We then brought the rest of her things with her, such as pot plants and her eiderdown duvet.   “It’s all about maintaining familiarity, routine and reassurance.” 

Sharing best practice  We see it as essential that dementia awareness and training is available for everyone who works in our homes. Kay devised and continues to deliver our education programme with help from our learning and development team.   “There are recommended national standards for training and a framework for what to include, but we go much further,” Kay says. “Our first tier of training is for all staff regardless of role. It is tailored as between our dedicated dementia care settings and our other homes.  

“The difference is that someone in a dedicated setting will already have a well-established diagnosis whereas their needs may not be so clear in a non-dementia-specific home. They may have Parkinson’s, for example, and your approach to communication may therefore be different.  

“We seek to identify where to approach and communicate and where to back off and let them be. Our second tier is specifically for clinical staff, home managers and clinical leads, and includes more scope for reflection and emotional support. We look at case studies and try to understand why someone is presenting in a particular way and how they got to this point.  

“The more we can understand the emotional needs and thought process behind the behaviour, the better equipped we are to help. With the training, you can decide when to take a step back and think about how best to respond. I’m now working on a third tier with even more enhanced training for our clinical leads, senior nurses and home managers.”  

Preparing for the future 

It is well recognised that, with an ageing population, more people will go on to live with dementia.  The trend is notable on the south coast, which has the UK’s highest proportion of people over 80 years old.  “It’s a huge issue,” Kay says, “but compared to five years ago, families are more aware there are people like me who can help. I think we are also better at recognising a dementia diagnosis. The pandemic has certainly not helped, and many families are desperately in need of time out, so the demand for respite care is likely to intensify.  

The availability of respite and day care can be a huge weight off people’s minds. My focus is all about helping people to live well with dementia. It is the great equaliser because it can affect anyone but, if you have the right support, I believe you can have emotional memory that leaves you feeling happy, content and secure.  

“We pursue a model of ‘positive risk’. In other words, we take the starting point of asking what someone is able to do rather than what they can’t do. We then manage the risk involved. At the end of the day, why make someone miserable to make them safe?   “Either you do that or you say, ‘we can manage the risk to help them live well’. I believe this will become an increasingly accepted approach as the dementia trajectory continues.”      

For Colten Care’s “Ask-an-Admiral Nurse” website, go to www.coltencare.co.uk/admiral-nurse.