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Dem 304 Enable rights and choices for individuals with dementia whilst minimising risks. Jacqui Ramus Practice Development Manager. Learning outcomes. - PowerPoint PPT Presentation
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Dem 304Enable rights and choices for individuals with dementia whilst minimising risks
Jacqui RamusPractice Development Manager
Learning outcomes• To understand how legislation, policy and
procedure affects the way you work with people living with dementia to support their rights and choices, while minimising the risk of harm.
• To maximise the rights and choices of people living with dementia
• To involve carers and others in supporting people with dementia.
• To be able to maintain privacy, dignity and respect of individuals with dementia while promoting rights and choices
Introducing the new identity
THE ROLE OF LEGISLATION IN PROTECTING PEOPLE’S RIGHTS
Dem 304Enable rights and choices for individuals with dementia whilst minimising risks
Approaches to enable rights and choices for individuals with dementia whilst minimising risks
Key legislation:
Mental Capacity ActSafeguarding adultsLasting power of attorneyVetting and barring scheme,
Key legislation affecting those living with dementia
Mental Capacity Act: Five principlesAssume the person has capacity in the first instance Ensure that all practical steps to help person to make a decision have be taken before deciding they lack capacityDo Not treat someone as unable to make a decision because he makes an unwise decision. Make any decisions in the Best Interests of the person concernedEnsure that any preventative action is the least restrictive option
Introducing the new identity
The MCA in practice• Ken is 78 and lives at home with his wife,
Lucille. Ken’s memory is variable (he has dementia) and he has to be reminded to wash and told that he has already eaten. Lucille makes a lot of his day-to-day decisions for him. However, he still goes on his own to his local social club once a week with his neighbour where he meets with friends. Sometimes he loses a lot of money at card sessions at the club. Lucille wonders if she should take control of all his finances to limit his spending. This is causing considerable conflict between them. She asks you about it?( Example from Community Care and Primary Care Training Set, DOH 2007)
• What could you say?
Introducing the new identity
You could:• Help Lucille to think that Ken’s decision
about spending his money at cards is a separate decision which has to be assessed separately from his capacity to make other types of decisions
Safeguarding vulnerable adults
There are six main reasons for
safeguarding policies and procedures
• To empower people• To protect people,• To prevent possible abuse or
neglect• To identify proportionate
responses to any concerns • To encourage partnership and
accountability of agencies involved.
Criminal records (CRB)
Criminal Records Bureau checks are designed to bar unsuitable individuals from working with vulnerable groups including children, and in ensuring that organisations can access criminal record information on individuals when the role justifies it.
Independent Safeguarding Authority
The ISA makes independent barring decisions following
referrals from employers or other
organisations and the notification of relevant
(automatic barring) offences.
Employers have a legal duty to refer to the ISA when a person
working in regulated activity has harmed a child or adult, or there
was a risk of harm (usually following their own disciplinary processes). Anyone barred by
the ISA cannot work or volunteer with the group or groups from
which they are barred.
Disclosure and Barring Service (DBS).
On 1st December 2012 the Criminal Records Bureau (CRB) and the Independent Safeguarding Authority (ISA) will merge into the Disclosure and Barring Service (DBS). This new organisation will combine the criminal records and barring functions.
Lasting Power of AttorneyA Lasting Power of Attorney (LPA) can be used to
help planhow a person’s health, wellbeing and financial
affairs will belooked after. It allows someone to plan in advance:
• the decisions s/he wants to be made on their behalf if they lose capacity to make them their self
• the people he/she wants to make these decisions • how he/she wants the people to make these
decisions• it has to be registered with the Office of the
Public Guardian before it can be used
MAXIMISING RIGHTS AND CHOICES
Dem 304Enable rights and choices for individuals with dementia whilst minimising risks
Raymond’s money The film portrays Raymond, a man in his 80s and recently diagnosed with dementia, and Wendy his paid care worker. The setting is Raymond's flat. Wendy visits daily to provide Raymond with practical support to manage at home. The context of the drama is whether Raymond has capacity to make a decision about spending 50 pounds on lottery tickets.
– Does Raymond have capacity to ask Wendy to purchase the tickets?
– Should Wendy be the one to purchase them? – What information might need to be shared or recorded
with regard to this?– What monitoring might there need to be around this
situation?– Think about the legislation covered earlier. How do you
think this applies to Raymond’s situation?
Raymond’s money• Despite Wendy's efforts to engage him in conversation,
Raymond remains largely silent until she goes to leave. He then becomes animated about the lottery and asks her to buy 50 pounds worth of ‘lucky dip' tickets. Initially Wendy's response lacks respect for Raymond's request. After further discussion, Wendy decides that Raymond has capacity to make what others might think an ‘unwise decision'.
• While supporting Raymond to make his own independent decision, Wendy records the decision to comply both with the MCA and good record-keeping practice. The final scenes show Raymond enjoying himself as he checks his tickets against the results.
Risk and rights
People with dementia are often seen as more vulnerable to risk than other people but it may be more useful to think about vulnerable situations rather than vulnerable people. Nothing Ventured, Nothing Gained’: Risk Guidance for people with dementia, DOH publication 2010
Personal account of living with dementia,“Each day brings its own catalogue of risks, some minor and some dangerous. But over time and with forgetting, there is the risk of being put on the side-lines, of being seen as a hindrance, and having control taken away from you, under the guise of it being for your own good. So, while we can, we must challenge the risks… People living with a dementia must be allowed to take risks, because if we don’t, we are in danger of relaxing into the disease. At times we feel hopeless. At times the hurt we feel is indescribable and we can let it be a barrier to life. But there is a life for us, if we risk it.” (Quote: Morgan, 2009, 28 from Nothing Ventured, nothing gained risk guidance for people living with dementia, 2010 DOH publication )
Risk management and best interests decisions
take an individualis
ed approach to risk and dementia;
find out what each individual knows and
understands about the impact that their
dementia has - instead of making assumptions about what they know;
try to solve problems
practically.
Positive risk taking
• Step 1 – Understanding the person’s needs.
• Step 2 – Understanding the impact of risks on the person.
• Step 3 – Enabling and managing risk.
• Step 4 – Risk planning.
Nothing Ventured, nothing gained risk guidance for people living with dementia, 2010 DOH publication
Justifiable actions to prevent someone from doing something because it is ‘risky’ should only be taken if : -
• all reasonable steps have been taken to make the action safe;
• reliable assessment methods have been used which consider it unsafe;
• information has been collated and thoroughly evaluated;
• decisions are recorded, communicated and thoroughly evaluated;
• policies and procedures have been followed; and • practitioners and their managers adopt an
investigative approach and are proactive.
In relation to risk taking and best interests decisions:-
• Understand your own fears and concerns about risk
• Understand the legislation of safeguarding and mental capacity
• Identify the real risk level and the benefits of the activity to the person in question
Identifying risk and impactRisk Area What would
be the impact if harm happened?
How likely is it that any harm would happen? ( H/M/L)To self / others
How severe would the harm be? ( H/M/L)To self / others
A person with dementia who wishes to continue to cook her own meals but has been forgetting to eat.
The person could become severely malnourished and ill
H - Without any intervention it is highly likely that there would be harm
H - The harm could be severe
Source: Nothing Ventured, nothing gained risk guidance for people living with dementia, 2010 DOH publication
Introducing the new identity
Risk and quality of life of one example at issue Contribution to quality of life Risk to individual
High ‐ relates strongly to top needs
High ‐significant harm is likely
Medium ‐ delivers value but not much
Medium ‐likely or significant but not both
Low ‐ weak contribution to needs
Low ‐harm neither likely nor significant
Source: Nothing Ventured, nothing gained risk guidance for people living with dementia, 2010 DOH publication
HEAT MAP (Nothing Ventured, nothing gained risk guidance for people living with dementia, 2010 DOH publication)
Maximise safety to manage risk to protect the individual and manage the activity
Carefully balance safety and management to protect the person
Some safety improvement necessary
Consider how the same personal benefit can be substituted or delivered in a different way
Carefully balance safety improvement and managing the activity to protect the person
Improve safety to ensure the activity can be safely carried out
The person is at severe risk with little benefit to him/herself
Consider the real value of the activity to the individual and seek alternatives that are lower risk, but meet the same needs
Allow the activity
High Medium LowRisk of harm or quality of life to the individual
Contributionto quality of life
High
Medium
Low
Practical useThink about someone you work with who might sometimes make unwise decisions, or do things you consider risky
• How could the identifying risks and impacts table and the Heat Map be used for people that you work with?
• What role could you have in this?
• Who else should be involved in identifying risks, and best interests decisions
Introducing the new identity
WORKING WITH OTHERS
Dem 304Enable rights and choices for individuals with dementia whilst minimising risks
What information should be shared with others? • What do we mean by confidential information?
• When might it be harmful to share information with relatives, other carers or other professions?
• When might it be harmful not to share information relatives, other carers or other professions?
INVOLVING FAMILY AND SIGNIFICANT OTHERS IN DECISION MAKING
Dem 304 Approaches to enable rights and choices for individuals with dementia whilst minimising risks
Involving others in decision making?
• Why should family and other significant people be involved in decision making?
• What conflicts might there be in relation to agreeing risks, promoting rights and choice and agreeing solutions?
Managing concerns and complaints - exercise
• If a service user is unhappy about a service what would you do?
• If a relative is unhappy about a service being delivered what would you do?
MAINTAINING PRIVACY, DIGNITY AND RESPECT
Dem 304 Approaches to enable rights and choices for individuals with dementia whilst minimising risks
Exercise How can you maintain privacy and dignity when providing personal and intimate care?How can you provide choice when providing personal and intimate care?
Social aspects to promote dignity and respect
• How do we know that a person is showing us respect and treating us in a dignified manner?
• How can you apply this to the people that you provide a service for, and their relatives and significant others
Introducing the new identity
HOW PHYSICAL ASPECTS OF THE ENVIRONMENT ENABLING CARE WORKERS TO SHOWRESPECT AND DIGNITY FOR AN INDIVIDUAL WITH DEMENTIA
Dem 304 Enable rights and choices for individuals with dementia whilst minimising risks
Physical aspects of the environment and living with dementia
• Signs: use signs to direct people to things
• Colour: use colour contrast to help to identify edges of crockery.
• Flooring: changes in flooring can be ‘seen’ differently and interpreted as wet, slippery, steps etc due to changes in processing depth and perception in brain function
• Assistive Technology and home adaptations
Introducing the new identity
Managing technology • Use simple instructions on, or beside equipment
• Use colour contrast on switches (a dark background with light numbers often helps people to see)
• Try to encourage use of the equipment to help retain memory
What we have covered today?
• How legislation, policy and procedure affects the way you work with people living with dementia to support their rights and choices, while minimising the risk of harm.
• How to maximise the rights and choices of people living with dementia
• How to involve carers and others in supporting people with dementia.
• To maintain privacy, dignity and respect of individuals with dementia while promoting rights and choices
How will any learning from today’s session be put into practice?• Stop: Is there anything that you believe you will
stop doing in relation to enabling rights and choices in the future, as a result of today’s workshop, which will improve your practice.
• Start: Is there anything that you believe you will start doing in relation to enabling rights and choices in the future, as a result of today’s workshop that will improve your practice.
• Continue What will you continue to do in relation to enabling rights and choices in the future, as a result of today’s workshop that will maintain your practice.
Jacqui Ramus Practice Development Manager