The Bromley Care Home Project (CHP) is an advisory service to care home staff providing education and support to reframe thinking and encourage understanding around behaviours that challenge in dementia.
The team identified a need to help care home staff better recognise distress in dementia patients through their behaviour, to avoid medication being used in certain circumstances. They developed an approach to address this need which is person-centred and holistic, and looks to other health care services that can be brought in to add to the patients’ existing care package.
Through their innovative approach, Bromley CHP has developed a system for understanding the communication of a person with dementia, which is currently known as the “Bromley and Oxleas Dementia Care Tool” (Dementia Care Tool).
The Dementia Care Tool is a simple set of questions designed to help care home staff to work through when presented with a distressed patient who has dementia. The tool addresses 7 areas:
- Physical health
- Side effects of medication
- Life history
- Social world / communication
On completion of the assessment using the questionnaire the member of staff develops a tailored care plan.
The Bromley CHP team provides case study based training to care home staff to:
- explore why people with dementia experience distress
- detail and explain bio-social suggestions based on the presenting distress using the Dementia Care Tool
The Dementia Care Tool promotes and validates care staff in using their knowledge of an individual to help them care for that person in a way which promotes wellbeing and aims to reduce behaviours that concern, without the unnecessary use of medication. However it is also reducing the number of people with fairly straightforward problems, (such as pain or infection, boredom, experiencing different realities) from being inappropriately referred on to other services.
Implementation of the Dementia Care Tool has led to improvements in following key areas:
- Embedding of person-centred care and concept of personhood through increased understanding
- Observed attitudinal change in care staff leading to quality of care improvements
- Improved communication amongst care staff in describing the person with dementia’s distress
- Improvement in documentation and care planning
- Improvements for the person with dementia – openness to seeing the person as a person and therefore a shift in the expectations for the person and wanting a better outcome
- Increased numbers of appropriate onward referrals to other health care services, including dieticians, SALT, D.N, tissue viability, physiotherapy, psychology, falls services, O.T. & GP
The Bromley CHP has developed opportunities to engage key stakeholders in dementia care by conducting focus groups with family carers and relatives of people living with dementia. This has created a valuable space for relatives to share their views, allowing the team to gain an insight into their lived experiences, which has had a direct, positive impact on the way the team delivers their service.
At the end of every 6 months input, measures are taken to find out whether there are any discernible benefits from the programme. Mostly these measures seem to show positive results including:
- Residents in care homes who were brought to case discussion in the follow up sessions with the CHP team in a 6 month period have not been admitted to acute dementia care wards
- Reduced use of anti-psychotic medication in a 6 month period with other inputs; pain medication, activities etc. producing beneficial change. It is important to note that anti-psychotic medication can be appropriate and this work is aimed at preventing its inappropriate use
There are therefore savings in the use of hospital care and also savings in nursing home care as people with behaviour that challenges are treated more holistically.
Apart from individuals benefitting from more appropriate care, avoiding the upsetting disruption of a move, care staff are gaining confidence in their ability to manage behaviour that challenges.
The Bromley CHP is now looking to develop the tool further and are aiming to disseminate to other organisations.