1. Person-Centered Care and Dementia
Cathie Jones
Acting Matron Warrington Living Life Well
Date: 20/04/16

2. Person-Centred Care
What does it mean?

3. Personhood Personhood (Tom Kitwood, 1997)
Basis of person-centred care (PCC)
Security – feeling safe in living environment
Continuity – Links between the past, present and future goals
Belonging – Having a ‘place’ of my own, being accepted
Purpose – direction in life
Fulfilment – Something meaningful
Significance – Feeling I matter, life has been/is important

4. Person-centred care is:
Definition
Person-centred care is:
‘A partnership aimed towards improving and maintaining the person’s quality of care by recognising and meeting the human needs of comfort, attachment, inclusion, identity, occupation and love’
(Kitwood, 1997)

5. Person-Centred Care WHO AM I ! LOOK AT MY LIFE STORY BEFORE YOU JUDGE ME

6. Person-Centred Components
Being ‘Person-centred’ is about:
Respect and dignity
Being valued
Seeing people as unique human beings
Retaining sense of identity
Enabling feelings of self-worth

7. Impairment of Personhood in Dementia
Many losses are occurring-cognitive, emotional, social, physical.
Loss is demonstrated in changes to the persons self-perception, awareness and responses.
The loss of self-perception can lead to disorientation, apprehension, distress, anxiety, depression, elation, withdrawal from others.
The person’s behavior's are often labeled as Behavioral & Psychological Symptoms of Dementia (BPSD)
the person’s quality of life suffers if the BPSD label dominates staff thinking and negatively influences care and therapy delivery.
(Chenoweth, 2011)

8. Views of people with dementia
" I realize I sometimes do not make sense
when I open my mouth and out comes a
string of words, each of which is
understandable, but when placed next to
each other it is hard to figure out what the
hell I'm talking about. My mind wanders, a
lot. More and more I start talking about things
I was thinking about, but we weren't
necessarily talking about them at the time.”

9. PCC and Dementia Remember………..
Each person with dementia is a unique individual with their own individual experiences, their own needs and feelings, their own likes and dislikes
Remember………..
person with DEMENTIA PERSON with dementia

10. Unfortunately…..
There is a belief that the ‘self’ (personhood) is gradually lost in dementia, and behaviour is a response to brain death
This leads to a ‘social death’ whereby people are treated as if they are not there, and their life history, feelings and needs do not matter
(Chenoweth, 2011)

11. How would you feel and react if this was you?
Imagine…….
You are asleep in your chair at home when suddenly you are woken by a person you have never seen before trying to undress you
You are feeling bored and restless at home so you decide to go for a walk. But you find your front door has been locked and a stranger appears and tells you to go and sit down.
How would you feel and react if this was you?

12. How would you feel and react if this was you?
Imagine…….
You are feeling really angry about something, but nobody around you will take your grievance seriously and they keep telling everything is fine.
You are sick and lying in bed, but no-one answers your requests to go to the toilet, and so you wet the bed
How would you feel and react if this was you?

13. PCC Communication
Whatever stage of the journey of dementia a person is at - we need to connect with them in their reality in an attempt to reach them. This is called the Bridge of Dementia and its our duty of care to try to reach them.
Gladys Wilson

14. What can limit person-centred care in a care environment?
PCC
What can limit person-centred care in a care environment?

15. PCC: Challenges
Widespread prejudice in society (against older people and against people with mental health problems)
Task-orientated working practice
Inadequate staffing levels
Lack of training
Poor supervision/support for staff
Our imperfections!

16. People as individuals
Each person with dementia will change and react to their difficulties in a different way
It is very helpful to know about a person. This will help to think about what the person could be experiencing. SO……………….
Finding out all about a person’s life is very important.

17. Person-Centred Care Therefore : Importance of life history/identity
Validation of a persons experience and feelings
Understand ‘challenging behaviour’ as expression of unmet need
View all actions and verbalisation as potentially meaningful messages
Meaningful and regular activity and occupation
Holistic care that is empowering and includes personal choice

18. What not to Do! Unmet need = COMFORT: Unmet need = IDENTITY:
Intimidation: frightening a person, by threats or physical power
Withholding: refusing to give asked for attention, or to meet a need (e.g. for affectionate contact)
Outpacing: providing information or presenting choices too fast for a person to understand or respond
Unmet need = IDENTITY:
Infantalization: treating a person patronisingly, as an insensitive parent might treat a very young child
Labelling: using a pattern of behaviour or a category like dementia or ‘organic’
Disparagement: telling a person they are useless, incompetent or worthless; giving messages that are damaging to self-esteem

19. Unmet need = ATTACHMENT:
Accusation: blaming people for what they have done, or failed to do, that arise from their lack of ability, or misunderstanding
Treachery: using deception to distract or manipulate a person, or force them into compliance
Invalidation: failing to acknowledge the subjective reality of a person’s experience, and especially what they are feeling
Unmet need = OCCUPATION:
Disempowerment: not letting a person use abilities they do have; failing to help them complete actions they have initiated
Imposition: forcing a person to do something, denying possibility of choice on their part
Disruption: disturbing a person’s action or inaction

20. Detractions Unmet need = INCLUSION:
Stigmatisation: treating a person as if they were a diseased object,
Ignoring: carrying on (in conversation or action) in the presence of a person as if they were not there
Banishment: sending a person away, or excluding them; physically or psychologically
Objectification: treating a person as an object to be pushed, lifted, filled or drained, without referring to them as human beings
Mockery: making fun of a person’s actions or remarks; teasing, humiliating, making jokes at their expense

21. Person-Centred Care Promote positive health/minimum medication
Identify opportunities to enhance well-being
Collaborative care planning
Recognise the contribution of families and significant others (engage in choices, activity, care decisions)
Address staff needs/support issues
Recognise power and equality in relationships

22. PCC Communication Physical and verbal communication
Use clear speech and eye contact
Avoid speaking with hand covering mouth, or with head turned
Speak slowly
Reduce length of sentences - do not overwhelm with too much information
Reduce distractions (e.g. TV, radio)
Include the confused person in conversations
Verbalise what you are doing
Use gestures to assist understanding

23. “This is Me” Maintaining PCC
This leaflet will help you support me in an unfamiliar place
(Alzheimer’s Society, 2013)

24. Maintaining PCC
‘Good dementia care is care which enables the sufferer to feel supported, valued and socially confident. The achievement of this is dependent upon the skills of the staff providing that care’
(Kitwood, 1997)

25. Am I getting it Right?
Do my actions show that I respect, value and honour this person?
Am I treating this person as a unique individual?
Am I making a serious attempt to see my actions from the perspective of the person I am trying to help? How might my actions be interpreted by them?
Do my actions help this person to feel socially confident and that they are not alone?

26. Any Questions ?