So following on from yesterdays blog about my first conference in my new county – East Yorkshire – up next to speak was Professor Graham Stokes.
He spoke of the fact that having created the ability to have a better life with dementia meant people live longer with dementia – this surpasses the capacity of family to provide care as more people enter the complex late stages of dementia.
Could the e-learning tool they’d researched enable staff to look after people better? No it didn’t. WHY? 15% of residents were prescribed psychotropic medication. It deviated from best practice – there was poor practice of prescribing – the first reaction is to prescribe.
We don’t know WHY this is the case – could there have been little true adherence to interventions? Staff working in care homes were unable to persuade other professionals that drugs weren’t the answer – senior nurse may not listen to a more junior person. Care homes have a high turnover in staff. The culture in care home doesn’t support intervention of dementia champions. It takes a strong willed nurse or Health CAre Assistant to stand up to GP not to prescribe drugs.
What a terrible state of affairs – this needs to be sorted before I go anywhere near a care home……..it left me feeling very sad.
On a slightly more positive note, Professor Graham reported that In BUPA care homes in December 2013 19.5% were prescribed drugs to control behaviour, in July 2014 it fell to 12.9% – Admiral nurses have brought down through bringing in techniques to give staff confidence. By admiral nurses being present the other staff became more confident because they hadn’t before been in a supportive culture.
Professor Stokes then relayed a story from one of their care homes he’d been involved with. A resident propelled himself around the building on his bottom – he was a mystery to staff . The GP knew exactly why he was doing it ‘because he has dementia….’😡 The solution adopted was to put him in a wheelchair – but he would slide out and propel himself around on his bottom again. The person was beyond communicating verbally. Professor Stokes spent 2 hours trying to find why – he was one of 6 people in the room trying to work out why. The Manager went to the mans file. She read out what he’d written in 2009:
‘I fear disability, dependency on others more than anything itself’
So that’s why he didn’t want to be in a wheelchair – at the core was a distaste for disability and reliance. They couldn’t come up with a solution but ‘knowing why’ changed the perception of the issue. The man had lost his dignity by being put in a wheelchair.
“it’s about people and not technology”
Sometimes we have to make accommodation for behaviour as we can’t remove some behaviours. But the conduct could be accommodated if understood.
‘This is why the person is behaving in this way”
You can reduce medication but it has to be replaced by some other action and support or understanding.
Just goes to show that there’s no point in the person with dementia writing family story if no-one reads it and if they don’t continually refer to it as the dementia progresses.
Yet again I was left feeling sad………….final instalment tomorrow…..