Valuing women staff in dementia care
Care homes have had a very bad press lately, but we must not forget those homes which provide good care. I have met many care assistants in residential and nursing homes who provide an excellent service. Most are middle-aged women with no academic qualifications to speak of, yet whose intuitive and empathic reactions to people with dementia are appropriate, caring and imaginative.
I remember one staff member who was greeted by a distressed woman resident who had hallucinations because of Lewy body dementia. The resident expressed horror at the (totally imaginary) creepy crawlies that were covering her duvet. Without a moment's hesitation, the care assistant opened the window, picked up the duvet and shook it vigorously outside, dislodging all those hallucinatory creatures and restoring peace of mind to her resident! Obviously the resident trusted her implicitly.
Other staff members have gone out of their way to make their care home a welcoming, attractive and appropriate environment for people with dementia. When one home was redecorated, staff in their own time and out of their own pockets, provided decorative curtain rails and prettily draped curtains to enhance the bare, institutional feel of the corridor.
In addition to this, having heard about person-centred care, they themselves provided display cases (memory boxes) which they imaginatively filled with miniaturised items representing their individual resident's life history. The result provided an instant, very visual 'life story book' for anyone who came to that resident's room. They created miniature knitting using cocktail sticks. A toy cow represented a resident's farming background and a tiny crucifix her Catholicism.
The management never appeared to appreciate this dedication. Care assistants were regarded as disposable pawns, to be replaced if ever they failed to make the correct entry on a piece of paper. Loving kindness, that essential quality, counted for nothing.
I used to run training courses for care assistants and nurses in the care sector. One of my aims was to build up their self-confidence and self-esteem. In the first session, we always counted up how many years' experience of caring there was in the small group of trainees. Quite often, it amounted to over a century! This experience is invaluable but seldom acknowledged. During the course, I also tried to model person-centred care, valuing each person's experience, interests and attributes. They really appreciated my attitude and, at the end of the course, always clubbed together to buy me a present. It has been suggested that some care assistants have never experienced person-centred care in their own lives and are not shown it by their managers. How can you give if you have never received?
Besides having a suitable personality, care assistants need an intimate knowledge of the language and idioms of the elderly people they are caring for. Communication in dementia is difficult, even if you speak the same language. I remember teaching nurses from overseas about dementia care. They did not know the meaning of the words 'comfort' and 'comfortable'. This vocabulary had not been deemed necessary in their British acclimatisation training! Training in dementia care cannot be tacked on as an afterthought. Care assistants need knowledge of person centred dementia care, visual and hearing impairment, identification of pain and depression, sources of confusion, environmental support, providing activities and a basic knowledge of neurology on top of an induction into the life history and personal preferences of each individual resident.
Maybe they need to be re-designated "dementia neuro-therapists" and paid accordingly?
The ultimate care assistant triumph took place in a dementia home in Holland, when two of the care assistants lost their mothers in close succession. They both agreed how relieved they were that their mothers had never had to endure life in that care home. As a result, they planned and enabled the building of a new concept, the dementia village of Hogewey near Amsterdam.
Why does care sometimes go wrong? Even in Hogewey, that almost ideal care environment, sadly, there is a relatively high turnover of staff. Care work is emotionally demanding, not always rewarding and certainly not well paid. As Whitby and Gracias (2013) cogently explain, staff may become dehumanised by the conditions in which they work. What Kitwood (1997) describes as 'malignant social psychology' may exist intermittently even in the best care homes. Nolan et al (2006) identify the underlying problem. They explain that 'relationship-centred care, in conjunction with the Senses Framework, makes explicit the importance of acknowledging and seeking to address everyone's needs'.... 'if the dignity of older people is to be assured then so too must that of practitioners .... The Senses Framework and relationship-centred care point the way towards creating an 'enriched' environment of care that meets this wider more inclusive vision'.
To ensure good dementia care, first class care of staff is needed. Staff need to be appropriately trained, appreciated and their contribution recognised. They need to be valued in terms of pay and status. Only then will we build a workforce with the complex skills needed to care for people with dementia.
Kitwood T (1997) Dementia Reconsidered: the person comes first. Buckingham: Open University Press
Nolan, M. R., Brown, J., Davies, S., Nolan, J. And Keady, J. (2006) The Senses Framework: improving care for older people through a relationship-centred approach. Getting Research into Practice (GRiP) Report No 2.
Whitby P, Gracias S. (2013). Reflecting on the Francis Report: This has happened before. Clinical Psychology Forum, 249: 13-17
|Tags: care homes, workforce||Written 2014-10-22|