Supporting Persons with Dementia and their Caregivers from Hospital to Community

Transcription

1 Supporting Persons with Dementia and their Caregivers from Hospital to Community Presented By: Jenny Goh Principal Medical Social Worker Manager (Medical Social Service)

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3 Recommends that every country develop a national dementia plan and provides a framework for action: Advocacy & awareness raising Developing & implementing dementia policies & plans Health & social system strengthening It is essential that health & social care systems are equipped to provide the range of care & services that people with dementia & their carers need. This includes capacity building and education (capability building) among health care professionals & investments in health information systems

4 Supporting Persons with Dementia (PWD)

5 Intervention for Persons with Early Dementia(I) Early detection Early treatment (drug) Educate (person with dementia & family) DEEP programme Disease & its consequences Resources & help available Empower DEEP programme & BCC Advanced planning (finance, personal welfare) Lasting Power of Attorney, wills Allow & facilitate control despite dementia Emancipate - BCC Free from tasks they can no longer perform eg. driving Counselling (adjustment, coping, losses)

6 1. Advanced Care Planning (ACP) For all PWDs diagnosed with early Dementia (eventual loss of mental capacity) Explore values and beliefs, understanding and experience of illness/disease Will vs. Lasting Power of Attorney (LPA) Mental Capacity Act (MCA) vs. Advanced Medical Directive (AMD) Plan for finances, long-term care, even treatment modalities eg. NGT, resuscitation

7 2. Early Dementia Counselling Chance to talk about memory problems, fears and daily challenges Move them towards acceptance of disease, making future plans Discussions about family relationships including marital work Reminiscence to empower Explore regrets

8 Intervention for Persons with Early Dementia(II) Enable Continue a familiar lifestyle, modify if necessary Purposeful occupation eg. cognitive training, rehab, stimulation support group Engage Keep active and enable sense of control Continued engagement(support) with others & professionals Purpose of cognitive interventions

9 A New You" A cognitive stimulation programme to invigorate minds and sustain personhood in persons with early cognitive impairment To enrich, enable and empower persons with early cognitive impairment to achieve a greater sense of control and purpose in their lives.

10 A New You - Core interventions Clinical Psychologist, Nurse Specialist, Medical Social Worker Structure (3hrs) Physical and Psychomotoric exercises (mind-body coordination) Cognitive Training & Stimulation (speed processing, memory, reasoning & logic, problem-solving, perceptual organisational tasks) Psychosocial & Recreational (creative story telling, sharing, singing, reminiscence, interactive games, discussion of topics of interest, reality orientation)

11 TimeSlips Storytelling

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13 A New You English Group 21 August 2008 TILL WE MEET AGAIN Dogs Names: Romeo & Juliet The 2 dogs are involved in a conversation. They stopped at a red light. I presume they are not driving the cars! They must be on the backseat of the car at least one of them. They are talking about their masters. They are talking dog s language. How are you? They look happy. Maybe they are friends. It s a nice day. One of them is wearing a collar. They look like the same breed but one looks smaller, one looks older. The small one is a female. Both are looking for a date. They may be from the same mother! One dog said: You look like me! The other replied: You re older than me. No way that you look like me. I look better than you! Story told on 21 August 2008 by Ajoy, Kam Ying, Gladys, Myrna, Mr Boudville, Dr Sum, Sze Onn

14 Supporting Families and Caregivers

15 Seeing the person many of us who work with confused elderly people would agree that our knowledge of their past lives, as opposed to the diagnosis and progress of their illness, is inclined to be somewhat sparse if these patients are seen as the sum total of their problems then the outlook is bleak. We need to see the person behind the disease. Mill & Chapman in Hunters 1997

16 Core Psychological Needs LOVE Dementia Reconsidered the person comes first, Tom Kitwood 1997

17 Person-Centred Care - a contemporary definition: Where PCC = V + I + P + S V = Value people with dementia I = Treat people as Individuals P = Perspective of person with dementia S = Supportive Social environment Dawn Brooker, Bradford Dementia Group, Bradford University

18 1. Behavioural Care and Counselling (BCC) - Goals To help caregivers understand the needs of the person with dementia and improve the way they respond to him/her. To explore the life story of the person with dementia. His/her personality and life experience are clues to his/her current behaviour and the management of it. To equip caregivers with concepts and skills so that they may be able to manage behaviours more creatively and confidently. To provide Dementia psychoeducation and caregiver support through educational materials, videos and counseling support. Target caregiver group: Caregivers who love, empathise and want to provide good care for the PWD

19 2. Grief Counselling Acceptance of disease progression Coping with anticipatory grief Regrets and unresolved matters Creating memories Caregiver s role in end stage dementia When PWD no longer recognises Saying goodbye

20 3. Carer Support Groups Educational group Spousal therapeutic group - topical discussion eg. Challenging behavious, long-term care planning, self care - aim at self-help

21 Collaborating with Community Partners

22 C a r i t a s

23 Outreach MH awareness Service linkages No of clients referred : 53 No of clients accepted : 43 Thye Hua Kwan (THK) CREST Client / Caregiver s Needs Awareness of dementia and its symptoms Avenues to diagnosis condition Locate suitable health/social care and support services O Joy COMIT Counselling, psychoeducation Caregiver support No of clients referred : 69 No of clients accepted : 63 Khoo Teck Huat Hospital Specialist care Training and support (community partners) Temasek Cares provided seeding funding to pilot COMIT & CREST (from Jan 12) 23

24 O Better Health Outcome for Mental Health Improved accessibility COMIT O O Pre-pilot phase 1 st just 16 days after start day. As at 31 Jan 13 total 69 referrals / 63 became case CREST O As at 31 Jan 13 total 53 referrals / 43 accepted service O Reached out to 3500 with MH awareness information O Reduced impact O Home based intervention & caregiver support O Building relationship - support physician O Individualised intervention/care management O Escalations when necessarily MDT meeting 海 悦 辅 导 中 心 O'JOY CARE SERVICES 24

25 Efficient Utilisation of Resource O Adopting care pathway O Data collection - in the absence of IT system O Documentation AIC staff attachment O Mapping of Process Flows O Potential cost saving (Aging in Place) O Investing in Capability - Specific trainings on Dementia such as Dementia Care Mapping 海 悦 辅 导 中 心 O'JOY CARE SERVICES 25

26 Re-integration back to Society O Increasing duration of client living in community O A success story of Mdm T, 70 plus with 7 children O During their journey - supporting caregiver/family O Re-integration another nursing home patient to another resident living in the north. 海 悦 辅 导 中 心 O'JOY CARE SERVICES 26

27 Dementia Care Mapping (DCM)- Definition Dementia care mapping is a way of looking in detail at the process of care for the purpose of bringing about improvements. It is both a tool and a process. a serious attempt to take the standpoint of the person with dementia, using a combination of empathy and observational skill (Kitwood, 1997) Dementia Care Mapping:Principles and Practice, 8th edition

28 Capability & Capacity Expansion Dementia Eldersitter services Client: Engagement & companionship Caregiver: Skills, support & respite GOALS Outreach Mental health awareness Service linkage Structured Day activity programmes Thye Hua Kwan (THK) CREST Shared Care Partners Sree Narayana SWAMI Home Awareness & understanding of dementia and its repercussions Avenues to diagnosis & management Provide targeted health/social care support & services O Joy COMIT Primary Care Yishun Polyclinic Counselling, psychoeducation Caregiver support Khoo Teck Huat Hospital Specialist care Leadership, training and support (community partners) 28

29 29 Thank You