Today I had the pleasure of speaking at the Sydney Better Practice Conference on Decision making and Sex in Dementia Care: What to do when.
I shared the decision making chart “Is it OK?” which I created to support care staff in those moments when they are faced with making decisions about whether or not to allow or support or prevent a person having a close interaction with another person with dementia. This decision making flow chart has several key moments in it where the staff member has to confront the matter of consent, competency or capacity. Does the person with dementia have the capacity to make this decision to engage in this interaction with another person.
As many of you will know I take the approach that the person has the capacity to let me know in their behaviour that they feel good right now sitting with, touching, being touched by the person they are with. If they are showing behavioural signs of wellbeing then they are indicating to me that they are agreeing to participate in this interaction.
The Positive and Negative Signs Scale (PANSiS) is a simple and easy to use tool that I have developed to assist and guide staff to measure the presence of wellbeing or illbeing. If the person is showing illbeing rather than wellbeing then you have documented evidence of the need to change the situation for them if they are not able to change it themselves – ie remove them or draw them to something more pleasant and safe for them. They would need to be showing signs of freezing, displeasure, withdrawing, or other indicators of unhappiness with the interaction. Many people with dementia cannot work out what to do about a stronger person dominating them so we have to step in at that point to protect.
It was well received. Let me know what you do to respond to sexual behaviour in care situations.