The Dementia Care Awards recognise and reward the first-class services, and very best people, who work in the field of dementia care. Through showcasing excellence and innovation, the awards celebrate the provision of outstanding care for people living with dementia. At the 2020 awards, the team at Adderley Green Care Centre, in particular colleagues at Gladstone House, saw off high-quality competition from across the social care sector, to win the coveted Best Dementia Training Initiative 2020. In this article we chat with two of the main therapists from the team behind the training, Psychology Lead, Dr Darren Perry and Physiotherapist, Damien Humphreys. We discuss why dementia training is so important, what good dementia training looks like and the positive impact that it has both on residents and the care team that support them.
Hi Darren, Hi Damien, would you mind introducing yourselves for our readers.
“Hi, I’m Darren Perry. I’m a Consultant Clinical Psychologist and Psychology Lead at Adderley Green Care Centre. Prior to being appointed by Elysium, I worked for 20 years in NHS Neuropsychology, Physical Health and Older Adult Mental Health Services. During that time I helped to establish and refine assessment and diagnostic pathways within Older Adult and Young-Onset Dementia services. The consistent theme across all my clinical experiences has been a focus on psychological adjustment to changes in neurological and physical health.
“Working together with Damien and the team, we set out to develop a training package that would enable all our colleagues to feel properly informed about dementia and equip them to provide the best possible care for residents.”
“Hi, I’m Damien Humphreys and I am the Lead Physiotherapist at Gladstone House, Adderley Green Care Centre. I’ve worked in a variety of settings over the past 10 years in neurological rehabilitation and management of musculoskeletal conditions. I have a specialist interest in dementia.
“Alongside Darren and other colleagues I helped devise the dementia training so that all staff were confident providing care for residents, even if they exhibited challenging behaviour or had complex forms of dementia.”
Thanks both. Let’s start at the beginning. Can you tell us more about your award-winning training?
Darren: “The training is really comprehensive. The first section looks at the functions and organisation of the brain. We then focus on how the main types of dementia disrupt the normal functioning of the brain and how this underpins the emotional, cognitive and behavioural changes that people affected by dementia may experience.
“We wanted to provide a good foundational knowledge whilst pitching the training at a level that engages all staff. We feel that it is important for staff to understand that changes in the brain, which are beyond the control of the individual, are a key factor in most of the difficulties they face.
“An awareness of how neurological decline might affect any one of us if we developed dementia is crucial in helping staff to de-personalise challenging aspects of behaviour and encourages empathy as a starting point in all the care interactions they deliver.’’
“In the afternoon session, we build on this theoretical knowledge by focusing on the technical skills needed to provide excellent care for people with dementia. We draw on experiential learning exercises to really emphasis the core principles of care provision that we aim to instil in all our colleagues.’’
“We wanted the training to be as comprehensive as possible so we run it over the course of a full day. Setting aside that amount of time is quite unique and not always possible for other dementia care services, but at Adderley Green it something that we have prioritised and both residents and our team are seeing the benefit of it.’’
So in addition to being thorough and providing in-depth knowledge, what else do you think stands out about your training?
Damien: “We take a dynamic approach to learning and include numerous exercises and activities in our training. I think that if you want participants to actually put the training into practice when they’re on the units supporting residents, then you need to make sure the learning can be applied practically and isn’t just words that stay on the page.
“Our training includes interactive sessions throughout the day, ranging from icebreakers to trust-building exercises and group tasks. When training is a shared experience between the attendees, with higher engagement levels, then more information is retained. They can connect more with the material and are more open to learning.”
I imagine that is particularly important for team members who are new to care?
Damien: “Yes exactly. Many individuals who are new to care don’t have prior experience of supporting someone living with dementia and often only have limited understanding of how the condition affects a person’s capacity to complete daily tasks.
“To help team members improve their knowledge and develop empathy for how day to day experiences are impacted by dementia, the training also includes a sensory deprivation exercise, which uses aids and specialist equipment to reduce a person’s sensory capacity.
“Participants wear gloves to inhibit their sense of touch and tactile experience. They use ear defenders to reduce their hearing levels and special goggles to limit their vision. We also get them to wear particular shoes that are difficult to walk in and will then ask them to complete the simple functional task of putting on an item of clothing, like a jacket.
“We then follow this by asking a care worker to support them to complete another functional task without telling the participant what that task is. The care worker in this scenario then assists the participant to go and make a drink at a nearby table.
“It isn’t possible to fully replicate the effects of dementia but by withdrawing much of the sensory input it can give team members some understanding of the difficulties that our residents may face. The purpose of the exercise is to demonstrate the importance of empathy and how we can use that to regulate our own emotions or feelings in sometimes challenging scenarios.
“We get lots of positive feedback from the participants about this particular exercise and it seems to have an impact on people.”
And what have been the benefits of your training for staff?
Darren: “We find that the more knowledge and awareness our team have of what is happening for the individual, the more confident and compassionate they are in providing care.
“For example, people living with dementia often experience difficulties creating memories for recent events and this leaves gaps in their day-to-day awareness. They might make sense of the here and now by drawing on autobiographical memories from the past to fill in the gaps in their understanding. So, for instance, an individual may think that they have to go to work when they awake in the morning, despite having retired many years ago. If a carer confronts them too abruptly with the reality of their current circumstances, this can add to their confusion and anxiety.
“After completing our training, participants understand the need to be careful and considerate with their communication so they do not cause unnecessary distress for the person. We encourage them to acknowledge and validate the emotion that the individual is experiencing and then attempt to engage them in conversation. In our example, they would start with a conversation about the person’s previous occupation and gradually evolve this into a wider discussion about their past life. The individual can often be diverted away from their initial anxiety and gently refocused on aspects of the here and now.”
So it requires a more flexible, empathetic approach?
Darren: “Yes that’s right, and to do that I think there are three main factors to consider. First of all we encourage our team to get to know each person that we support as an individual and understand that they have unique needs that are specific to them. Everything we do should be person-centred.
“Secondly, we think about stepping into their shoes, putting ourselves in their place and understanding the world from their point of view. This is particularly important if we are supporting individuals who exhibit challenging behaviour. Yes, the physical behaviour can be challenging to the care professional but we ask staff to flip their thinking about challenging behaviour around. Rather than see themselves as the person being challenged by the particular behaviour, they should view the behaviour as an indication that the person with dementia is feeling challenged by some aspect of their circumstances or environment and this is their only effective way of communicating their frustration or distress.
“This perspective, coupled with their greater understanding of how dementia affects cognitive, motor and sensory functioning makes colleagues less likely to respond negatively to the behaviour and allows a calmer and more caring attitude.
“Then finally, we advocate an engagement-focused approach which adapts all activities to the appropriate level of stimulation and interaction for each individual. It is vital that colleagues are adaptive and tailor their communication style and their overall approach to suit the cognitive, communicative and sensory-motor level of the dementia-affected person.
“The three factors we emphasise are interconnected, hence the more we get to know a resident, the easier it becomes to understand their behaviour in context and the better able we are to find activities that will be personally meaningful and more engaging for them. This means that whatever we are doing we always place the needs of each person first and our overall aim is to support their sense of wellbeing.”
It’s clear that the training has a really positive impact both on participants and the people that you support, so how did it feel to win the award?
Damien: “It was a fantastic feeling when they announced that we had won the award. We are all passionate about providing the highest level of care that we can for our residents. It was very much a team effort and a lot of time and energy was invested into making the training interactive and engaging for the participants. We are all very proud of our achievement.”
Darren: “We would also like to thank Ronan Flood, Elysium Neurological Training Manager, for his input in the early stages. He really helped us to think about the way training is delivered in order to make it as interactive and easily digested by the participants.’’
And to conclude the interview, do you have any thoughts about how you might develop the training in the future?
Damien: “Following the success of the dementia awareness training we have plans to employ the same approach for a brain injury awareness training. We hope to support our colleagues to provide the same flexible and empathetic approach by providing the knowledge and skills to care for people with brain injuries.”
Darren: “I think the award prompted us all to feel an even greater sense of ownership and investment in the dementia training. We regularly review the package after we have delivered it and make minor adjustments and additions to it. In this way, we feel we are honing it and keeping it fresh which helps us to stay actively engaged each time we deliver it.’’
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