12.1 Some Legal Points on Housing and other Care Settings for Seniors with Dementia

When seeking accommodation, seniors with dementia have many of the concerns which other seniors have, but also have other needs particular to their circumstances. As a person's life with a diagnosis of dementia starts it may not be very different that that of the others. In fact the former may already be addressing the concerns touched on above. These are likely to include:

• the prospect of downsizing from a much loved home
• the types of accommodation needed: bungalow, flat, serviced accommodation, care home, rest home, accommodation in a family member's home, etc   
• the practical tasks faced in getting ready for such a move, namely: a) emptying the loft, b) reducing the quantum of furniture, and which items to discard,  c) identifying the criteria for the search for suitable alternative accommodation eg location, size, facilities, services, etc 
• the need to seek professional and other advice and services in respect of the last items.

Where a person has been diagnosed with dementia, it is a similar set of concerns but is likely to be laden with the following:

• having need to make decisions, so depending on how far along the dementia jouney an individual has reached he or she may find questions about mental capacity to act on certain decisions
• this leads to pointers as to whether there exists any valid legal documents, such as: a) a Will, b) a Lasting Powers of Attorney concerning property and finance, c) a Lasting Powers of Attorney concerning health, care and wellbeing
• if at a late stage of dementia, perhaps following a crisis, it is found that none of these exist or for some reason they are invalid. Here, if mental capacity is lacking, it may be necesssary for a family member, friend or professional to seek an order of the Court of Protection (UK). 
• Finally, an important point is that the wishes which might have been held earlier may not be known by the health and care team in assessing suitable treatment.
• Where valid legal documents are available the wishes of the individual must normally be observed  by those handling property and finance, but perhaps more importantly, prosessional medical and care staff are required to see that the wishes of the patient are addressed appropriately in accord with wishes as to treatment. Similarly, on death the deceased estate passes under the rules of intestacy unless there is a valid Will (see Post 12). 

Review 2 "The Journal of Dementia Care" [Vol 21 No 2]

Forty pages of text with very few advertisements give the reader a wide coverage of topics on care for those living with dementia.
Three pages of News brief the insights into many topics which I need -

• +Dementia Friends
• +Dementia Champions for NHS and social care staff  (cf Dementia Friends Champions)
• List of 21 Research Projects 
• and many more.

Seven pages of Networking gives an interesting series of comments and insights into what idividuals are doing in many fields. At one year old, the impact of the @Dementia Challenge is explored by six individuals. 

Two items on  Life Story Work , and others items give awareness and knowledge - one was very well referenced.

Care Practice gives the reader a) writing and dementia b) garden design for dementia, and and c) mattering in dementia contexts. separate 

Finally, the magazine gives three sections on "Sexuality, Dementia and the Care Home", Resources, and a Research Review. 

Published six times a year the Advisory Board is well embedded in universities, clinical practice and business aspects of dementia. 

ISSN 1351-8372

Contact : Hawker Publications, 2nd Floor, Culvert House, Culvert Road, London SW11 5DH,  

Telephone details 02 7720 2108 

12A Dementia and the Need for a Will and Other Documents [Update 10 - 22.12.13]

A person with dementia in the end of life (EOL) phase should be receiving appropriate care, in an appropriate place, and in accord with his or her wishes. Hopefully, he or she would have made arrangements to be in place so as to cover important decisions about their care, place, and their finances and property. If the individual is young the decisions may affect a young spouse or partner and any children. The decisions can only be known and acted upon in law by the family, carer, doctors, health and care workers if there is a Will, and powers of attorney, etc covering property, finances and, in particular, health and welfare (care) matters.

The above and other pre-EOL matters which might be listed. [see Post 12B]. They include:

• Will
• Lasting power of attorney for a) property and finance, and  b) health and care 
• Decisions on refusal of treatment
• Funeral arrangements 
• Donations of organs and pacemaker, etc
• Family records and history for future generations
• Messages for family members and friends 
• Decisions about distribution of sentimental items
• Declutting of papers, records and chattels
• Trusts and other arrangements for vulnerable members of the family, eg children, vulnerable adults.

A lawyer who specialises in family law, estate planning and the like might be expected to give advice on the likes of the following documents:

• Will
• Lasting powers of attorney for financial and property affairs (see a later Post)
• Lasting powers of attorney for health and welfare (see a later Post)
•  

Will

It is surprising how many individuals do not have a Will (or "mirror" Wills in the case of a couple). 

A Will is a formal legal document which states the wishes of an individual (testator) as to the likes of the following:

• distribution of his or her estate after death 
• provisions for a spouse or partner and any children 
• gifts to other persons, etc. 

Formal Preparation of a Will

When preparing a Will certain formal conditions are required by law, including

• the testator must have mental capacity to make a Will 
• provision for one or more executors who will administer the estate in due course
• a signing of the Will by the testator
• the witnessing of the act of signing by two persons.

A Will is normally prepared by a solicitor or legal executive after an explanation of the testator's intentions - where necessary, with guidance on how the law affects the intentions. 

Absence of a Will 

Unless an individual has made a Will his or her intentions for his or her estate would most probablty not be met.   This is likely in the following kinds of circumstances:

• no Will was made 
• the Will is void as a result of re-marriage taking place after it was made
• the testator did not have mental capacity at the time the Will was signed 
• the Will is otherwise invalid, eg it is defective in form, eg not witnessed. 

In any of these circumstances the deceased's Estate will pass under the Rules of Intestacy.

Finally, even if a Will has been made, it may be disputed and contested in law because, for instance, no provision was made for the deceased spouse or children who are minors. Here one or more aggrieved parties may seek a deed of variation.  

Solicitors for the Elderly
Many solicitors may advise or act on these matters but in the 1990s a national body was set up, Solicitors for the Elderley. It authorises individual solicitors, barristers and legal executives requiring of them the following:

• to have a specified number of years of advising seniors
• to pass a qualifying examination on the relevant areas of law
• to comply with the SFE Code of Practice.

More details are available on the following website: http://www.solicitorsfortheelderly.com/

Footnote: This mention of Will Aid - see www.willaid.org.uk/ which, I understand, runs in November every year, and allows individuals or couples to obtain a Will or mirror Wills respectively at relatively low prices.

Profile 1A Dementia Services at Darent Valley Hospital (DVH) [Update 1 - 28.10.13]

See also Profile No1[25.10.13] for a brief description of Darenth Valley Hospital (DVH).

The prevalence of dementia in the area of the NHS Dartford, Gravesham and Swanley Clinical Commissioning Group (CCG) is now about 51% - some 49% of those living with dementia are, therefore, not currently diagnosed.  In line with national diagnosis standards the CCG has commissioned services so that the rate is targetted to rise to about 66% by 2015.

All this is important since those living with dementia who may be expected to go to DVH are likely to increase in the immediately foreseable future. They will be going fort the following reasons:

• a non-dementia related crisis in their health 
• a routine consultations with a consultant on health matters which are non-dementia related
• a person with memory problems who may be referred to the hospital's memory clinic after assessment by say, their GP
• after an event where a person has been found lost, they may be taken to the memory clinic at the hospital 
• after an event where a person has been found lost - wandering - they may be taken to the memory clinic at the hospital or, temporarily, to the secure unit for an assessment, etc 

In addition it may be noted that any patient over the age of 75 who is admitted for more than 72 hours will normally be assessed for memory problems. If the possibility of dementia should be indicated, he or she will be referred for diagnosis.

[The Dementia Buddy programme of volunteers at DVH is an important developoment which is being rolled out to other hospitals in Kent (see Post 13) when published shortly)].  

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.