Person centred care coordinator

It is not often that we see aged care organisations making person-centred care a formal part of their organisational structure and function.

Kalyna Care in Delahey (western metropolitan Melbourne, Vic) has done this by seeking a suitably qualified person for this new and interesting role of Person Centred Care Coordinator. Do you fit the bill? See what you think.

Position Description Person Centered Care Coordinator

Changi Prison

I have just visited Changi Prison Museum and Chapel in Singapore. I am here for four days to conduct a Dementia Care Mapping course with Virginia Moore in the Lions Home for Elders.

The museum is a very moving chronicle of the tragedy of 1942-1945 in Singapore under the Japanese. I am reminded of the several POWs I have had the privilege to talk to in my time as a psychologist working with people living in nursing homes and hostels in Victoria, Australia., many of whom had dementia and were reliving the horrors of those 3 1/2 years in prison.

Changi was not the only POW camp. 16,000 died on the Thai-Burma railway. Many civilians died in the villages of Singapore and beyond. Stories of heroism and immense suffering in the face of unthinkable cruelty made me numb with the barbarity of some of the things that were done to people. But it still happens if you look at the newspapers and TV. People can be both cruel and wonderful to each other. I was viewing it for a moment in my life but the soldiers and civilians who lived through it endured it for 3 1/2 years not knowing if it would end.

Not all Japanese were cruel. There is the story of the Japanese man who was in Changi prison for spying before the war and  was released when the Japanese overtook Singapore, to take up a position with the military government in charge of welfare. He ensured many survived with permits and passes that he did not have to give. Thirty years after the war he was welcomed back by the people who remembered his goodness. There are photographs of two unnamed young Japanese soldiers who gave Vitamin B tablets to soldiers.

Weary Dunlop has demonstrated the way to build bonds of relationship that can overcome fearful anger and resentment. We had the pleasure of hosting a Japanese student a couple of years ago and it was a happy sharing of stories and perspectives that I am sure will build interest and positivity into the future.

I wonder from the safety of my room how I would cope. What would I do? Would I be able to withstand the daily punishments and deprivation. I guess those men and women must have asked themselves similar questions. They were ordinary people much like you and me, asked to do extraordinary things under extraordinary circumstances.

I can only say thanks for the example and the memory of their endurance.

I think of them today and remember the men and women I have come across who have suffered not just physically but now in the course of the progress of dementia find themselves mixing up present and past. Unfortunately their past contains unpleasant memories that confuse and hurt them, causing them to be fearful or angry or afraid. It calls on all my empathy and compassion to try to understand what it must be like to live in that reality again. For many their bodies now look and feel like they did but now due to ageing and the wasting of inactivity rather than starvation and malnutrition. The very weight loss is enough to convince their brains that now is then.

Tell me about your experiences caring for people who have endured the punishments of being a POW.

Person centred care DVD set NEW!

The person centred approach to the care of people living with dementia is now ‘best-practice’. Valuing people regardless of disability, tailoring an individualised approach with respect for the person’s preferences and supporting the social dimension of each person are the cornerstones of this person centred approach.

You can view this DVD/CD set in a flexible way individually or in a group, at home or at work. There is a workbook for those who wish to apply for CNE points or if you just want to improve your skills.

DVD One: 1. What is dementia? 2. Person centred dementia care 3. The enriched model of dementia 4. Five fundamental needs

DVD Two: 5. Behaviours of concern 6. Positive and Negative Staff Care Actions 7. Needs-based Problem Solving

Audio CD: All seven sessions are included in MP3 format for flexible listening on the move.

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Being fit into my old age

A glass of GewurztraminerImage via Wikipedia

Its cold here in the mornings still. Spring time officially but cold enough for a jacket on my early morning walks. I have been walking for the past three weeks in an effort to be fitter and lose some of hte 10kgs I need to lose to be within the OK range for waist measurement and my BMI.
I am at an age (52) when I have become more conscious and been reminded often enough that I am more prone to illnesses that if not picked up now and remedied can become chronic conditions that plague me for the next 30-40 years. I want to be healthy in my old age and now is the time to remedy the excesses and lacks of the past 10-15 years since I began putting on weight.
You see I have a good history of being fit, having run competitively in my teens and early twenties and run one marathon at age 25 years. But since about the age of 35yrs I have focused on building my business and let physical wellbeing slide off the agenda. I have relied on my residual fitness to carry me through and I am now finding that i can’t rely on that anymore.
I recently had my annual physical check with my GP with the usual battery of blood tests and measurements. It all added up to borderline glucose and cholesterol, and overweight by 10-15 kgs (20-35lbs), with a waist measurement over by about 6-10 cms (3-4 inches). Waist measurement is a good indicator of diabetes risk. So I am keen to get that down.
I also use alcohol in excess at the end of the week to relax and wind down. That is not good as my measurement of a glass is the glasses we have at home and not the standard drink which is 10gms of alcohol ( By volume of wine at 13% alcohol that volume is about 110mls of white wine. Recommended daily intake is 2 standard drinks to remain healthy and 4 at any one sitting.
So my guess is that my glass contains about 1.5 standard drinks I am going to measure it out to take hte guess work out of it. Once I have a clear understanding of how much of my glass is one standard drink I will try to stick to 2 standard drinks per day . I already try to limit it with reasonable success to Friday and Sunday.
I have been walking for three weeks so far and today I noticed that I strode up hte hill through the bushland near our home with much more confidence and less puffing at the end. I am getting the feeling that I want to run and I will do that next week. 2 minutes running and 4 minutes walking for half an hour. Lets see how that goes.
Are you getting fit? How are you doing it?

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Sex and dementia

Sex and dementia sounds like a strange recipe. Yet it is an area of growing concern for older people with dementia and those who care for them, both at home and in residential settings. As a clinical psychologist working in aged care settings and with older adults more generally I am often called on to provide behaviour management advice and reports or training to caregivers.

Older people are remaining more robust for longer and being interested in maintaining their sexual lives for longer. In the context of dementia this provides us with a challenge to be responded to well, with an eye on the benefits to the person with dementia and an eye on the risks to others and to the person themselves. The benefits are sustained wellbeing in the form of positive feelings from physical enjoyment as well as social interactions that are pleasurable, that satisfy that deep need we have to form attachments and bonds of affection. The comfort that comes from close physical contact as well as the presence of someone who loves us in an intimate closeness can bring deep comfort that is rare for a person whose brain is gradually limiting their ability to generate these experiences independently.

They must also evaluate risk to others and to the person themselves. The risks are generally in terms of the safety of others who may be affected by a person with dementia not judging the social appropriateness of an action or words. This can be in the form of touching a person in a way that is not welcomed or in a public place that causes embarrassment. It can also be in the form of dominance behaviour that causes distress to someone else who does not give their permission for it. Other risks can be in the form of intrusiveness into private rooms.

When judging whether it is OK for a behaviour or relationship to proceed it is important to check for signs or indicators of wellbeing and illbeing. Signs of wellbeing include positive mood, engagement with others, smiling, relaxed body posture and gestures, creativity. Signs of illbeing include negative mood, crying, depression, withdrawal, listlessness, apathy, being easily walked over. Using this checklist approach to signs of wellbeing and illbeing gives caregivers (paid and unpaid) a semi-objective set of criteria by which to make their judgment rather than just relying on their subjective feelings or personal mores.

In this person-centred approach it is important to recognise that the person with dementia can indicate that they are willing participants in a sexual interaction even though from a medico-legal standpoint they are not able to give consent. The presence of signs of wellbeing and the absence of signs of illbeing show that the person is a willing participant and is feeling good about the interaction. We must continue to monitor for change in this willingness to participate because it can change quickly with the person’s feelings and changes in the activity they are engaging in. It may be that Mary feels good about holding hands with Tom in the lounge as he sits beside her but when he begins to undo the buttons on her dress as they stand in her room she may well begin to feel uncomfortable. If this occurs staff must be ready to respond quickly to retrieve the person to a safe place. This monitoring can be done discretely but frequently.
So sexuality is an essential part of an happy life for most of us and this is the case as dementia progresses and people remain physically and socially interested in maintaining their relationships in their changing time in their lives.

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Pleasure and disturbed behaviour

Have you thought about what motivates people to act the way they do? One theory suggests that people seek pleasure and avoid unpleasant experience. Sounds reasonable. In fact it makes sense of the the fact that people living with dementia, who are no different to you and me in their emotional repertoire and their psychological needs, act more peacefully when they are in a good mood. Think about it. If we as caregivers maintain the person in a good mood we are more likely to have a person in our care who is peaceful and contented, happy and pleasant to be with. Unhappy people who are depressed or despairing are more likely to be angry and aggressive. Happy people don’t hit people. Happy people don’t tend to get out of their cars to remonstrate with others about their driving. Happy people don’t complain or whinge.

So what does this mean for caregiving in dementia care? It means that if you want to avoid having angry people in your care, maintain the person in a good or positive mood. One of the easiest ways to do this is to offer opportunities for pleasure. People who do not experience pleasure are more likely to be in a depressed or despairing mood. Pleasurable experience releases “feel good” hormones into our system which relax us and give us a feeling of wellbeing and peace.

When was the last time you experienced pleasure?

Exercise and anger

A recent study of mood (  has shown that exercise has the effect of controlling anger in young men who are chronically angry. These men were better able to moderate their anger after engaging in exercise. It had been known that exercise affected mood but it was not known if anger specifically could be affected by exercise. This University of Georgia study explored the effects of bicycle exercise on the anger levels of young men who viewed pictures designed to provoke anger. The exercise helped them to control the levels of anger that were much higher when they did not exercise.

What are the implications of this study for people with dementia who become angry quickly and often? Does this mean that regular exercise activity may assist people with dementia to be more moderate in their angry expression. Certainly it makes more sense to provide exercise opportunities for its benefit on bone density, muscles strength and mood generally. Now it is also suggested that regular (even daily) exercise might be a valuable part of their daily life. Supervised bike exercise may be possible for some.

Worth thinking about.