Putting the Person First

Rebecca Lambert is head of Occupational Therapy at South London and Maudsley NHS Foundation Trust. She talks to The Daily Sparkle about some of the issues facing dementia care, what she thinks person-centered care really means and how activities need to become a more integral part of the day-to-day

Over the last few years there has been a massive push to improve the quality of dementia care provided within health care settings. This is obviously a really good thing. The Prime Minister’s Dementia Challenge, for instance, has really helped towards getting funding for training and resources within hospitals in particular, while the focus on ‘person-centered care’ has made a big difference in putting the person, not the disease, first. This is so important.

Person-centered care simply means understanding what really matters to the individual person – not what the medical teams or families think is the most important thing, but what matters to the person with dementia, at that specific moment in time that you are with them, and responding to that need.

Often this need centres around a desire for the familiar - people, events or things from their past that are easy to remember and that they use to make sense of the world. This is where it’s been great to see more focus on things like reminiscence, which, if it is done well, can bring positive and enjoyable memories and feelings. For care staff, who are often younger than the people they care for, it can also be a way of connecting with the person who has dementia and can help with their own understanding of the world that the person with dementia lives in, and what they have been through in their lives

This is where it’s been great to see more focus on things like reminiscence, which, if it is done well, can bring positive and enjoyable memories and feelings.

Most importantly, reminiscence, like other activities, is something that can, and should, happen all the time, every day. Activity shouldn’t be something that is done for half an hour once a day at a set time. Sometimes the idea of ‘providing activity’ to people with dementia can be over-complicated. It’s really just about identifying their strengths and helping them to keep involved in the things they enjoy. Sometimes the best activities are the ones they have done all their lives and they don’t have to learn

These are the kinds of things that need to be worked more seamlessly into the day-to-day happenings of care home and hospitals. People with dementia need time from the people who provide their care, and with an increasingly stretched NHS system, there can often be some difficulty having enough staff with the right skills in the right place to provide the care and support people with dementia need. I’m increasingly worried about the recent change in NHS bursaries for staff, which will mean we may get less nurses and therapists from a variety of backgrounds.  In order for dementia care to be real quality, you need a variety of people from different backgrounds, who have the right attitude, interest and motivation to work with the older population.

It’s clear that the most important aspect of dementia care is the right people with the right skills, and plenty of time, which is why I get concerned about the increasing use of technology throughout the care sector. In some cases, it can enable people with dementia to remain living at home independently for longer, but in other cases it feels a bit like a sticking plaster, and it should never be used in place of a real person – there is no replacement for real human interaction, communication and emotion.

And so, while there are lots of positive things happen in the care sector, there is still plenty of work to be done. The biggest challenge is keeping the momentum up - as with other health conditions, there is a push from the media to raise awareness, but then a new subject will come up and they lose interest. We have to keep the pressure on and keep aiming high.

What is most encouraging though, through all of this, is that every day I see beautiful interactions between staff and patients who learn to look past the condition and find the person. Families express how grateful they are that their relative is being cared for by staff who know about dementia, and how to respond to the complexities it can bring.

Rebecca has worked for the NHS for the last 12 years in the acute setting. She started out as a healthcare assistant in Bristol, before moving to London where she decided to become an Occupational Therapist. She has since worked in a number of London hospitals and currently works as the head of therapy at South London and Maudsley NHS Foundation Trust across inpatient and community services. Throughout her training and subsequent career she has always felt most comfortable in geriatric medicine. "Older people have the most incredible life stories and you can learn so much from them," she says. "I feel that healthcare is doing an amazing job at helping people to live longer, but there isn’t always the support there for them to live well in older age. This is especially relevant for patients with dementia. My grandmother had Fronto-temporal dementia for 15 years so I have experienced first-hand the impact that a loved one with dementia can have on a whole family unit and the challenges that can be faced when the person with dementia has to come into hospital. I realised that with my personal experience and interest in this area, I could specialise and play a part in the massive challenge that is adapting healthcare services to better support patients who have dementia."