Profile 1 Darent Valley Hospital - Dementia Care Settings, Services and Staff [Update 1 - 18/11/13]

Related Posts
Profile 1A for dementia-related matters for admittance at Darent Valley Hospital (DVH).
Profile 1B  for the volunteer Buddy Scheme at DVH.

Introduction
DVH is the principal hospital within the area of Dartford, Gravesham Swanley Clinical Commissioning Group (DGSCCG). Most of the population living in Swanley are likely to be admitted there.

Numbers
The number of people with diagnosed dementia in the area of the DSGCCG is 1256 (July 2013), which means there are likely to be another 1200 or so who are not diagnosed. (The latter are more likely to require admission to DVH as a result of a crisis.)

Patients with dementia who are admitted to hospital with non-related conditions, eg a stroke, or following a severe injury in dementia- related crisis, eg a fall, will be cared for in the specialist ward for the illness or a dementia ward.

Accommodation
DVH has specialist units for dementia, including:

• several  dementia wards
• a memory clinic for those with memory problem - providing assessment, diagnosis and, if appropriate, treatment 
• a secure unit temporary admission for those who may harm themselves or other treatment.

The dementia wards and other care facilitities have been or are being redesigned and redecorated to make them more dementia friendly. This initiative is in line with policy and funding under the national Dementia Declaration (see Post No 5).

Key Staff

In the last few years personnel concerned with the treatment and care of those living with dementia at DVH have been appointed, or further trained and developed. The key staff for dementia include:

• consultants
• nurses, at least one of whom is a specialist dementia nurse 
• a group of volunteers known as "Dementia Buddies"
• NHS who have become Dementia Champions (seemingly a different role to that of Dementia Friends Champions) .

DGSCCG (July 2013) Dementia - The forgotten disease, DGSCCG

Review 1 "The Dementia Diaries" [ Update No 2 04/11/13]

Four youngsters. Brie, Fred, Sarah and Sam wrote the 28 entries in The Dementia Diaries. With nearly 100 pages this booklet deserves to be a best seller. Yes a best seller! When the second volume arrives in the world's  bookshops the words "International Best Seller" will not be a cliche. It is now available on Amazon.

From the first page I had smiles, laughs out loud, tears in my eyes and numerous moments of reflection! The book is described as a "novel of cartoons". Written and illustrated by Matthew Synman (and, I suppose, the now famous four), we have been given a gem.

The four grandchildren tell us, in their own words, of life with a grandpa or grandma who begin to have memory problems, minor crises, bouts of wandering, and who are eventually assessed and diagnosed as four of those living with "demensias" (which became "dementia" in a later diary entry - after some googling).

The book vividly describes in various ways, but without jargon, the clinical symptoms of dementias in the words of  grandchildren of about 9 to 14 years.  In addition we are given by each diary author some insights (with illustrations and comments) into life as young persons.

All adults have been through childhood - those who can remember will smile (or cry) at some of the comments of family life in a home community. That aside may not seem pertinent, but it should not diminish the important messages for adult readers about the implicit (mis)behaviour towards those who come to live with dementia by friends. At thde same time their are heartwrming stories of help in naturally dementia friendly communities.

Finally, the natural acceptance of their grandparents life with dementia, although expressed at times with a sense of loss and sorrow, is an example to all.

The book ends with a useful 'directory' about dementias and sources of information about them and the support services available, particularly in Kent but also nationally.

[Please note that if you want to read The Dementia Diaries it is available in all Kent CC's public libraries and has been distributed to Kent County County's schools. Otherwise, it is available from KCC SILK office for £5.99 including packaging and postage. It is likely that special arrangements will be made for bulk purchases. Also see Post 15.]

Publisher:     SILK Publishing, Social Innovation Lab Kent, Kent County Council, 3rd Floor, Invicta House, County Hall, Maidstone, Kent ME14 1XQ.
ISBN:  978-0-9576600-0-7  

9 Preventing or Mitigating a Propensity to Wander with Assistive Technology [Update 2 - 25.13.13]

In the book The Dementia Diaries (TDD) one grandchild recounts how grandpa took to wandering very frequently about his home community. In earlier times he had become a local celebrity such that when he did wander many residents would tell his family of his whereabouts - the community was dementia friendly.

'Wandering' is a term used to describe a memory concern where a person, perhaps with a memory problem or in early onset dementia, cannot remember how to get home or to their destination, is lost, and may appear confused.

A seemingly a-technological, anti-wandering device is a simple mock-up "bus stop". The idea is that when a person with dementia mentions wanting to collect the grandchildren or to go shopping etc, they may start to go, ie wander. A "honeypot" for many, if not most seniors in life is the bus as a means of transport. We all wait for buses. If a care home garden has a bus stop two possible functions arise: 

1. the place becomes a meeting place
2. the bus stop is then honeypot for social interaction
3. it is a place where a wanderer may be found.

This post attempts to flag up findings in the literature on the need to give  attention to more technological ways of preventing or mitigation a propensity a person with dementia may have to wander.  Not all living with dementia will wander and if a person does, it may be a passing phase. Nevertheless it may become a concern for all including carers and families.

The practical steps and assistive technology at home or in a care setting  that might be taken are numerous, and some are not without opposing views. They include:

1. A life record and a recent head and shoulders photograph (taken within the last six months
2. a card giving personal details - name, address etc - and contact details of the person's carer or family member 
3.  'assistive' care technology involving which surveys movement within the home or care setting, eg care home
4. exit doors and gates with devices clocks, lights or other means of informing the wanderer or warning alarms to warn a carer or nurse
5. Signage which shows the individual, for example, that the route being taken leads to a particular location, eg the garden
6. A GPS device carried by the person with dementia which shows where he or she is if wandering.  

For Swanley and the county, the charity, Kent Search and Rescue (KSAR) (coordinating with Kent Fire and Rescue Service and the Kent Police) will conduct a search for a missing person. KSAR recommends the writing the life history or record to include:

• places which the wanderer particularly likes or dislikes
• a colour photograph taken on the days on which the clocks are changed [For the benefit of readers who are overseas - our clocks are changed by one hour twice a year  for daylighting purposes.]
• Any other information which may assist in any search.  

A note of the clothing a person is wearing or may be thought to be wearing might also be useful to the searchers.

Other assistive technology allows a carer to have a record of or to monitor the movement of a resident within their home, or when they leave it. However, devices at the exit doorway may be in place to set off an alarm in the supervisor's office or to gently warn the wanderer of the time of day by say, "It is night time." or by showing an illuminated clock. Another device might be a mat with an embedded warning signal. [It is of course important not to distress the person.]

The Sussex Police have a scheme based on a GPS device for persons living with dementia. It shows where the wearer is located. More detail of the adoption of the device is given by copying/pasting the link:

 http://www.theguardian.com/commentisfree/2013/may/01/dementia-police-tracking-device

Finally, in South Korea Dr Young Mi Lim is conducting research into links between wandering and wayfinding by those with dementia. 

8 Dementia and a Community's Businesses [Update 4 - 14/12/13]

 If you are the owner or employee of a business, you are likely to have someone in the family or a friend or customer who is living with dementia. About 40 million of our population in England know at least one of the 600,000 or so who have one or more of the dementias.

Businesses are being or will encouraged in dementia friendly communities, eg Swanley, to build on good practice in developing ways of being more supportive of those with dementia, and their carers and families.

Just a short information and awareness session will be enough to create insights into the challenges you, your spouse, partner or another may face as a carer of someone just beginning to live with dementia.

Listed below are some of the matters which have or are being addressed by private, public and third sector businesses. It cannot be exhaustive and merely records findings from focused and casual searches; in some instances a note of changes have been given.

1. Employees who care for a person with dementia is likely to need flexi-time to accommodate the needs of the person living with dementia.
2. Employees who regularly meet members of the public are likely to meet in increasing numbers those with memory problems or a with one of the dementia. Many employees will need to be able to recognise the symptoms of a dementia, and learn to behave in an appropriate manner. In a dementia friendly community opportunities for in-house training are likely to become available. Much will be common sense but some behaviour can be challenging.
3. An employee who develops memory problems may not have dementia but it is pertinent to encourage him or her to seek the advice of their GP. The National Health Service has, under the national Dementia Challange, developed health and care pathways for assessment, diagnosis and the appropriate treatment of those with memory problems.   
4. It is posssible for an employee over say, 30 years of age to develop dementia: although the chance is that the onset will be at a much later age. If diagnosed the capability to continue working in their current position would need to be kept under review. At the same time concerns about about being able to work and so continue to support any family will need to be addressed. 
5. Many organisations are encouraging managers and other staff to become Dementia Friends in the workplace. Early in the formation of a dementia friendly community volunteers are likely to become Dementia Friends or Dementia Friends Champions (DFC). The latter will be able to offer in-house awareness and information sessions for potential Dementia Friends within a local organisation (see Post No 6). 
6. After such an awareness and information as is offered by a DFC a more targetted training might be required for those in certain kinds of business is likely to be more focussed, eg for a retail business, a bank or a public library, than would normally be offered by a Dementia Friend Champion (see Post No 6).
7. Nationally, some of the nations professions, particularly in the health sector, are adopting a strategy on dementia for their members, eg the Chief Fire Officers Association.
8. Similarly, many of the nation's large businesses and organisations have joined the National Dementia Action Alliance which is developing ways in which its members progress the policies and action progammes arising under the 18 objectives of the Dementia Declaration. 
9. At a more local level trends may or are emerging, namely:

• Local branches of the national orgaisations may be expected to adopt practices obtained from their national parent bodies - this is beginning to happen in Swanley
• Local Dementia Action Alliances are developing among county city or town dementia friendly communities
• Where a local Dementia Action Alliance exists it is likely that busineses will take onthe likes of a) staff training to become aware of dementia, b) take up specified training, c) premises are adapted to be more dementia friendly,  etc, then retail and other premises will post a distinctive dementia logo, eg a purple angel, in view of the street etc. 

Post 8A [30.10.13] gives details of the the initiative for the nation's financial institutions to become more dementia friendly.  Profiles 1 to 5 show how businesses and services in Kent around Swanley are meeting the challenges of dementia.

6 Dementia Friends and Dementia Friends Champions

A Dementia Friend is a person who undertakes to make small changes which might help an individual who has dementia or might make life easier in a community for those with dementia. The 'Dementia Friends' initiative comes with support from the Cabinet Office and with the backing and of a National Lottery Fund grant to the Alzheimer's Society (see Post 5).  

The aim is to recruit 1,000,000 individuals who have each attended an information session on dementia and have then registered as a Dementia Friends with the Alzheimer's Society. At present there are about 30,000 Dementia Friends.

 The information sessions are delivered by Dementia Friends Champions - individuals who have progressed from being a Dementia Friend by further practical session on the delivery of information sessions. About 2,000 Dementia Friends Champions are registered. Dates for training days for Champions can usually be found at:

http://www.dementiafriends.org.uk/

Each Dementia Friend Champion undertakes to prepare and deliver of information sessions to various groups - such as:

• relatives and friends 
• a local community group
• the staff and pupils of a local school 
• small parties of employees of local businesses
• meetings open to the public.  

The Alzheimer's Society offers considerable support - handouts, materials, 'games' etc - for a DFC's information session. The Society keeps a register of proposed meetings and provides a support and a communications network for those who become Dementia Friends.

5B National Vision, Strategies, Policies and Actions for Dementia in England [Update 5 - 16.12.13]

Viewers in Indonesia, South Korea, Ukraine, USA and other places overseas might like to note that these Posts are about a small town in Kent (a county in England). This series of rolling Posts is, therefore, about dementia 'governance' in England* only, but with particular reference to changes coming about in Swanley over the coming months and years. This is a result of an initiative to encourage the town to become a more dementia friendly community (see Post 1).

Although France's national dementia strategy was about eight years earlier than England's, over the last four years England's national vision, strategies and policies for dementia have been formulated and their implementation has begun.  Just a few are included in the list below:

• "A National Dementia Strategy - Living well with dementia" (3 February 2009)
• the National Dementia Declaration (October 2010)
• the National Dementia Action Alliance (2010)
• A policy of upgrading of care settings for those with dementia is funded by £50m - for hospitals, and care and homes (see Profile No 1)
• the Dementia Friends initiative and the Dementia Friends Champions initiative (see Post 6)
• the Dementia Friendly Communities initiative (see Post 4)
• the Dementia Friendly Pledge for businesses and other organisations 
• 'Making a Difference in Dementia Nursing Vision and Strategy'
• The G8 Summit (Decemeber 2013) agreed cooperation and the enhancement of funds for research into dementia.   

Each of these will be described briefly in later Posts together with a rolling account of their local impact in Swanley. 

At the moment there are a growing number of dementia friendly communities in Kent, eg Northfleet, Dartford, Eastry, West Malling, and Westgate. In due course KCC aims to have 12 such settlements - but it is likely that as a result of the three 'pilot' communities many others will be initiated.

Footnotes:

 1  For  the record, Swanley is administered by a 'town council', within the administration of Sevenoaks District Council, which in turn is within the administration of Kent County Council.

2   However, Swanley is in the area of Dartford, Gravesham and Swanley Clinical Commissioning Groups.  

*[ Northern Ireland, Scotland and Wales are likely to have similar and different policies, etc but the institutional bodies formulating and implementing are probably different in each country.]

4 Some Ways to Understand a Dementia Friendly Community [Update 5 - 05.12.13]

The concept of community is various! In many posts on this blog it is a settlement - village, town or city. In other posts the term community means an organisation or even an industry. Could I suggest that a family might be a "community" which is or is capable of becoming dementia friendly?

A dementia friendly community is one where all are pulling together for those living with dementia in their midst. Any initiative for a dementia friendly community (DFC) is likely to be underpinned by the following vision:

1. Those living, working or visiting a village or town will have awareness of dementia or will be able to readily obtain information and guidance about dementia - so gradually developing for themselves a good knowledge of the needs of those living with dementia - and so be able help them, particularly in shops, offices and service facilities.
2. Those living in the community who have memory problems are encouraged to visit their doctor or a local memory clinic for assessment, diagnosis and treatment, if necessary.
3. Those living with dementia in the community will have in time the support of a local team of health and social care professionals offering easily accessed, well-defined and integrated services for early assessment, diagnosis and treatment which is GP-lead and supported by specialists. 
4. Where appropriate, the physical environment gradually changes by adaptation, improvement or development so that homes, shops and other buildings enable those with dementia experience good accessibility, and safety, and so enables them to live in their own homes for as long as possible.   
5. Finally, those with dementia, their carers, and their families will feel that they can live well in a supportive community which meets their concerns and needs for information and help at appropriate times.  [For KCC Library Services and dementia see Post 15.]    

In Post 8 (21.10.13) a more detailed vision of the way in which the community's businesses may respond to a DCF initiative are explored. An approach which is often adopted is to join a local Dementia Action Alliance (DAA)- it is commonly a community- or county-based group or county. A local DAA is registered with the National Dementia Action Alliance.