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What's high quality dementia care anyway?

What's high quality dementia care anyway?
3rd September 2009

Interview with Val Gains, general manager of Threshfield Court Care Centre.

A history of care

"I've worked at Threshfield Court, a care home for people with dementia, for 21 years, which means I've seen a lot of changes.

"Back in 1988, there was no choice in meals – in what you ate or when you ate it. There were double rooms with four or five people to a room. People who lived here were served morning and afternoon tea from a trolley using a large, industrial tea pot which sometimes already had the milk and sugar added to it. And it was served in plastic cups. Everyone was toiletted at same time and we had lists for everything: bath lists, bowel lists. Physical cares were of paramount importance. We felt we needed to protect the residents who lived there - rather than enable them.

"When Barchester Healthcare bought Threshfield Court things started to change - especially in our Memory Lane Community (the name Barchester gives to its 'dementia care units'). We introduced china teapots, rather than catering-style stainless steel ones; for starters. Lifestyle kitchens were fitted and the home was embellished with settees, lamps, occasional tables, reminiscence pictures and ornaments. Threshfield became a home and the residents became people who lived there.

“There were other changes too: we began to encourage staff to sit with residents and eat with them and we started to abolish the 'us and them' culture. No separate cups or toilets any more!

"Though it took time and a lot of training, we now have a homely environment that is warm and friendly with interactive corridors and life skills areas. We have a team, which, through dementia care training, have been encouraged to go on their own emotional journey to enable them to connect to people with dementia. We encourage members on our team to look within and ask: "Is this just a job to me?" "Can I take my own life experiences and empathise with the issues that are facing the people who live here?" "Would I want someone close to me to live here?"

Does this benefit the residents?

"Those living in Memory Lane are experiencing an improvement in their quality of life through staff becoming their friends. This has been achieved through breaking down barriers - physical and emotional - with things like the team joining those they support for meals.

"At Threshfield Court, we have moved dementia care from 'warehouse' to 'home-like' with person centred care at our core. The evidence that this approach works for people living and working in our communities is continuously being gathered through observational audits and reflective 'case studies', some of which have clear examples of 'rementing', or measurable recovery of powers that had apparently been lost.

"The reduction in perceived 'aggressive behaviours' in our Memory Lane communities has been in no small part due to the understanding of the whole team that all behaviour is seen as a form of communication. Individuals who are experiencing a dementia can display 'behaviours' that challenge, but there is generally always a reason and a deeper meaning to the ones that might be traditionally perceived. Behaviours stem from feelings which a person may not be able to verbalise due to cognitive decline – these feelings may be of anxiety, abandonment, loss or anger at feeling powerless and being controlled.

The future

The changes to our Memory Lane Community have brought about results beyond our wildest dreams. Through excellent training, huge alterations to both environment and the way we work, and support from all quarters we provide dementia care that has been applauded by the national media. Better than this, the feedback from relatives, prospective clients, visiting professionals and the local community have been overwhelmingly positive.

We want Threshfield Court to be a community that creates a sense of belonging for both the people who live and work here. For the past few months, we have been working together towards creating 'small group living'. We believe that this will further help people who live here to feel that it is their home. We will always be keen to innovate and right now we are looking at 'relationship centred care' - but whatever we do, we want the people who live here to feel fulfilled with meaning and purpose and for Threshfield to be a place where they feel valued and comforted at the end of their lives.

Please click here for more information on Threshfield Court Care Centre.