Supporting the

homecare workforce

working with people

with dementia

The Presenters

Area officer 1

Area officer 2

Chapter 1

Supporting new staff into the

homecare sector and addressing

misconceptions about dementia

1. Only old people get dementia

2. There is no treatment for dementia

3. Nothing can be done for people with

dementia

4. There is no point visiting people with

dementia – they won’t remember me

5. People with dementia are aggressive and/or

violent

6. There is nothing I can do to lower my risk of

getting dementia

Dementia - Misconceptions

1. Make dementia awareness training part of every

new employee’s induction process

2. Do not overwhelm new workers with huge

amounts of statistics – provide information in bite

size chunks

3. When training more than one new worker,

understand that they will have different learning

needs/learning styles

Top Tips

4. Provide continuity of care for the

person with dementia, this will enable

new workers to build a solid foundation

with them

5. Incorporate different training techniques,

ranging from group training sessions to

on the job training

Top Tips

What’s your learning style?

Activity

What dementia training do you

provide for new workers?

How do you cater for

different learning styles?

Group discussion

• Common Induction standards

• Common Core Principles Self Care,

Dementia, EofLC, Dignity

• Supporting People in the Advanced

Stages of Dementia

• SCIE Dementia Gateway

• Alzheimer’s Society website/factsheets

• Dementia Friends campaign

Resources

Chapter 2

Motivation of homecare workers who

support people with dementia

• Top tips for managers from the Good Care

Group

• Staff motivation – why it’s important and

what the challenges are

• Resources and best practice guidance to

support the top tips

• Discussion – considering what else your

organisation could do to motivate staff

Introduction

• Base recruitment on values and competences.

• Ensure employees have the expertise, support and tools they need.

• Understand situations from the worker’s perspective.

• Treat homecare workers as professional experts and support their career development.

• Have clear and achievable goals so that success can be verified and celebrated

Top Tips

• Motivated workers deliver higher quality care

because they care about what they are doing

• They often learn faster and have more ideas

and are less likely to make mistakes

• Motivated homecare workers are enthusiastic,

patient and encouraging to others. This impacts

on the care they deliver to individuals and

families

• Direct links between high motivation and high

retention rates

•

Importance of staff

motivation

• Lone working

• Varied hours / zero-hour contracts

• Complex work

• Poor integration across health & social care

services

• Funding

• Levels of pay

Motivation of homecare staff

- challenges

• Turnover in the domiciliary care sector in England is

currently 28.2% (NMDS-SC)

• Ensuring the ‘right’ people for the role are selected is

the first step towards developing a motivated workforce

• New skills and knowledge can be taught, but attitudes

are more difficult to change

• Cavendish Review: “Organisations that recruit people

for their values and commitment to caring…know that it

improves care and staff engagement which in turn

reduces attrition rates and the cost of hiring”

Values Based Recruitment

• 15FQ+ Personality Questionnaire: www.15fq.com/

• Value Based Recruitment Toolkit:

http://profiles4care.com/participate/

• A Question of Care: www.aquestionofcare.org.uk

• Finders, Keepers

• Culture Toolkit: www.skillsforcare.org.uk/culture

• Social Care Commitment:

www.thesocialcarecommitment.org.uk

Values Based Recruitment

Resources

• Training in dementia care skills and related

topics – CIS/Care Cert; Diplomas; Awards &

Certificates; e-learning; Apprenticeships

• Having support 24/7: It is important for

homecare workers to know that there is

someone out there offering support

• Clear lines of escalation: definition of roles,

responsibilities and professional boundaries is

critical in homecare

Ensuring people have the

things they need

• Seeking feedback and acting upon it – use of

employee surveys, opportunities for group

verbal feedback, annual appraisals and

supervisions (‘Providing Effective Supervision’

resource)

• Fostering a culture where feedback is always

received as a gift is vital

• Having a robust process for when a worker

raises a concern, grievance or resigns

Understanding the workers

perspective

• Offering CPD opportunities (‘Keeping up the

good work’ resource)

• Empowering workers – involvement in the

development of creative solutions to support

clients

• Ensuring employment packages reflect the

professional status of the homecare worker’s role

Professional

experts/CPD

• Understanding what good looks like: CCPs, NICE

guidelines

• Celebrating and publicly recognising success:

Accolades

• Care Planning meetings – ensure all goals are

SMART

Clear goals

1) What you currently do to motivate your

staff

2) Anything you might do differently after

hearing the presentation today

3) How you can make this happen

Discuss in groups

Chapter 3

The importance of a flexible

workforce and continuing

professional development

• This section was developed by Ann Tuplin Care Services in North Lincolnshire (Scunthorpe)

• This is a Home Care service who are providing support to people with dementia who want to remain at home and live as independently as possible for as long as possible…

Introduction

• Because individual’s needs can change rapidly

• The support delivered often needs to change as the person’s needs change

Support in the person’s

home is challenging

A workforce that is:

• Able to respond to the individual’s need at that moment in time

• Able to adapt to the ever changing needs of an individual

Flexible workforce means?

• Staff need to have skills and confidence in themselves

• Staff need to have confidence in their line managers

• Staff need to be involved in the process of delivering support

• Line managers need to have confidence in their staff

This means that…

• The consistency and continuity that contracted staff can offer, only using ‘bank’, casual workers when there is a compelling reason.

• Ensuring that staff do not work excessively long shifts.

• Responsive rotas based on person centred plans.

Clear systems

As Managers, what kinds of

things are in place to support your workforce deliver quality

services?

Discussion

• Regular 1-1 / supervision sessions – how frequent? Are they recorded?

• Appraisals – do they take place each year? Are they recorded?

• Does each member of staff have a Personal Development Plan?

Supporting the workforce

• What kinds of learning and development activity do staff have access to? How is information recorded?

• Shadowing / observations?

• Taught sessions?

• Peer discussions?

• Own research?

• Internal / external meetings / events?

Supporting the workforce

1. Continuity is as important for staff as it is for people who need care and support

2. Support and supervision for staff is essential 3. Ensure company ethos is sympathetic and

encouraging for staff learning requirements 4. Involve staff in planning their own learning and

development 5. Match staff to work, taking into account capability

and interest

Top Tips

Information for Leaders and Managers https://www.nsasocialcare.co.uk/about-us/leadership-qualities-framework http://www.skillsforcare.org.uk/Document-library/Standards/Manager-Induction-Standards/Manager-Induction-Standards.pdf

Resources

Chapter 4

Supporting workers providing care

for people whose behaviour may

challenge, in their own homes

What behaviours do you

consider are ‘challenging’?

Question

Aggression Agitation Restless

Being sexually inappropriate

Repeated questioning Repetitive actions

Clinging & following Losing things

Delusions or hallucinations

Behaviours

Discuss these behaviours

and share techniques to

deal with them

Group discussion

http://www.scie.org.uk/socialcaretv/video-player.asp?guid=bce0a383-9d9e-45bd-8593-e9c4fe6318ed

Des video sent to link officers by Karen S

Video

• Try not to see the behaviour in the same

way you might from a ‘well’ person

• If possible, remove what’s causing the

problem

• Stay calm, don’t shout or argue

• Give the person some space

• Reflect on the situation

Supporting staff to manage

behaviour they may find

challenging

1. Leadership: be clear on your leadership influences and translate

these into your business plan. Have a clear vision of what

services you want to provide, and include workers, people who

need care and support and their carers in shaping your services.

2. Developing and supporting workers is a sharing process; assist

workers to be accountable for communicating difficulties and the

changing needs of the people they are supporting.

3. Dig deeper when faced with labels such as “challenging

behaviour”; often the person who needs support is trying to

communicate.

Top Tips

4.Person-centred care is challenging to get into

every day care; attention to detail on support plans

and their formulation process is key to working this

way.

5.Look at the lines of communication open to

workers, people who need care and support and

their carers and let them witness the effectiveness

of communicating. Highlight changes that have

taken place due to their input.

Top Tips

• A Positive & Proactive Workforce

• Supporting staff working with people

who challenge services

• Domiciliary Care Lone Worker Safety

guide

• Effective supervision

• Carers resources

Resources

Chapter 5

Enhancing quality of life through

activity-based support

Benefits: • Improved independence

• Maintain skills

• Learn new skills

• Mitigate dementia symptoms

• Improved wellbeing

• Improved health

• Communication

Enhancing life quality

through activities

1. Always have a dementia link worker at

meetings

2. Find out something new each week about the

person living with dementia

3. Know what is going on in your area

4. Empower your dementia link workers to work

in partnership with other agencies, family,

friends, etc.

5. Use the Kitwood equation

Top Tips

• Read the case study provided

• Working in groups devise an activity for one or more of the following visit times: – 15 minutes

– 30 minutes

– 1 hour

– 3 hours

• How can the workforce be supported to undertake activities / meaningful moments?

Activity

• Activities handbook

• Local activity champion groups

• Community mapping

• Assistive technologies

• Skills around the person

• Alzheimer's Society

• College of Occupational Therapists / NAPA

• Qualifications

Other tools/resources

Chapter 6

Co-production between the social

care workforce and carers

• Skills for Care resources

• Working alongside carers to support

co-production

• Case study – Home Instead

• Top tips for working with carers

Introduction

• Dementia: Carers and workers

resources – guide book and

information resource

• Carers matter, everybody’s business

Resources

What are some of the benefits and some of the challenges of working alongside family carers of people with dementia in their own homes?

5 mins - Discuss and feedback as a group.

Discussion

• Train staff to be trainers

• These staff train carers locally on dementia for free

• In addition others sectors are supported to learn more about dementia

• Supports working together

Case Study – Home Instead

How might we need to support staff working alongside family carers of people with dementia in their own homes?

5 mins - Discuss and feedback as a group.

Discussion

“The worker came bustling in and

turned the radio off. It had taken me

ages to settle Dad with the soft music

he likes so much. The worker said it

was boring, but Dad soon got restless

when he couldn’t hear the music.”

Carer perspective

• Find out as much as you can before you visit

• Treat the home as you would want a visitor to treat

your home

• Build a supportive, respectful relationship with the

carer

• Notice anything that is changing, including the carer

seeming stressed

• Find ways to complement the carer’s role and make

their life easier

• Don’t forget the needs of carers who lives elsewhere

Top tips from carers guide

and Home Instead

Chapter 7

Using assistive technology to

increase the uptake of personal

budgets and self-directed support for

people with dementia

• Background about HomeCareDirect

• Assistive technology – definition and

use

• Benefits of using assistive technology

• Key messages

• Ways of embedding practice in your

setting

Introduction

• National provider of support services

• Key outcome focus on managing

individual’s care team

• Developed an iCareBuddy app

• Created an online tool to create and

amend the rotas

HomeCareDirect

“any device or system that allows an

individual to perform a task that they

would otherwise be unable to do, or

increase the ease and safety with which

the task can be performed”

Royal commission of long term care 1999

Assistive Technology

• Using existing devices

• Individual and family members

• Adult social care workers - Logging of

information

• Organisational - Use information

Benefits of using icare

buddy app

• Can be used by anyone with a secure

log in

• Can be accessed 24 hours a day

internationally

• View information

• Coupled with iCareBuddy app, alert to

on call service

• Provides peace of mind

Benefits of using online

tool

• Wide range of similar tools available

• Website www.atdementia.org.uk

• Having dementia friends within the

service

• Skills for Care assistive technology

framework

• Skills for Care ALT resource hub

• Digital learning strategy

Resources

• What other examples can you share ?

• What are the potential challenges of

using assistive technology?

• What other benefits can you highlight

for

1. Individuals with dementia

2. Adult social care workers

3. Organisation

Thinking and sharing time

Chapter 8

Supporting workers to deliver end of

life care to people with dementia in

their own homes

Introduction

• Top Tips for Managers as developed by Cherish Care

• Signpost to resources to support each top tip

• Consider own service and workforce development

Top Tips

• Build a strong, qualified team to support people at End-of-Life

• Train all your staff to be "Carer Aware" - carers may need as much support as the person diagnosed

• Plan as early as possible; leaving it till later means you may not know the wishes of the person

• Research and use the excellent resources and training materials available

• Work closely with the other partners in the person's care - see "A Triangle of Care"

Build a strong & qualified team

• As part of their “Living Well at End of Life with Dementia” – workforce plan to include:

– Use of Common Core Principles

– Support development of champions, coaches within staff Workforce Development Innovations Fund

– Qualification Credit Framework (QCF) – team were developed using mini qualifications and units covering end of life care and dementia

– Workforce Development Funding to support on-going attainment of QCF

Train all your staff to be "Carer Aware"

• Gather information

– “Little Things Mean a Lot”

– Good Day / Bad Day looks like

– Like and admire

• Carers Matter, Everybody's Business

• Carers are provided with places on in-house training sessions and some ex- carers are now volunteers with the service

Plan as early as possible

• Make sure individuals wishes are understood

• Good resources for staff to use

– “Planning for Your Future Care”

– Difficult Conversations for Dementia

• Locally agreed Advanced Care Plan

Resources

• E-learning via National Minimum Data Set – Social Care

• Social Care Institute for Excellence

• Conversations for Life

• Improving end of life care - Yorkshire and the Humber

• Skills for Care End of Life Care skills development page

Workforce development

• Induction & Team meetings

• Dementia Friends training as a whole

• Supervision & reflective learning logs

• Materials stored online for access “out of hours”

Work closely with the other partners

• Triangle of Care A guide to best practice for dementia care including a self assessment checklist

• Dementia Friendly Communities work

Consider what you would do

• In pairs identify one thing that you could do to develop staff to support end of life care and dementia within your service.

• Write this on a ‘post it note’ and place on the poster

Chapter 9

Supporting workforce integration

across health and social care -

Preventing hospital admissions

• Top Tips for Managers as

developed by Meritum Independent

Living

• Signpost to resources to support

each top tip

• Consider workforce plan to support

integrated development

Introduction

• Train staff well

• Work in harmony with health and

social services.

• Agreed aims and objectives are

important

• Consistency of care workers is

essential

• Develop a flexible workforce

Top Tips

• Good grounding – dementia Qualification Credit Framework (QCF) level 2 or 3

• Extended with in-house scheme covering:

– What is dementia – building on current understanding and

sharing experiences

– Understanding what is meant by ‘crisis’

– The pressures on carers and families dealing with memory loss

– The impact environment has on behaviour

– The principles of enablement and occupational therapy

– ensuring that they are working to support others who may be

involved in care and support,

– Dealing with dementia crises - Assessment and reassessment of

the crisis situation, recognising and supporting resolution of the

crisis

Train Staff Well

• Members of team encouraged to present case studies

• Used as part of on-going assessment and support – what going well, risk and what can learn for similar situations in future?

• What successful outcomes would be for the person and the service.

Case study discussions

Think about an area of service

development that will involve working

in a more integrated way.

Using the template start to design a

training plan covering some key areas

for development and how this will

happen.

Activity

Template

• Workforce Capacity Planning Model

• Guide to Workforce Planning

• Health & social care case studies – many have a dementia focus and include:

• Reducing avoidable hospital admissions

• Reablement and timely hospital discharges

• Smoother transitions

• Better use of resources

Resources

• Aim to open a discussion on what we mean by workforce integration and help us to think through and act to make it happen.

• For staff working in any role in social care, health or housing and for anyone whose work interacts with care and support - leisure, transport, retail, etc.

• Six principles (listed on next slide)

Title

Resources

1) Focus on better outcomes for people who need care and support

2) Involves the whole system

3) Acknowledge and overcome resistance to change and transition.

4) A confident, engaged, motivated, knowledgeable and properly skilled workforce

5) Process matters- it gives messages, creates opportunities, and demonstrates the way in which the workforce is valued

6) Successful workforce integration creates new relationships, networks and ways of working.

Principles of workforce

integration

Chapter 10

Partnership working between the

homecare workforce and other people

working in health and social care

• Skills for Care resources

• Discussion points

• Case Study – Cardinal

• Top tips

Introduction

Skills for Care and other

resources

• Link up: http://www.skillsforcare.org.uk/Finding-and-

keeping-workers/Practical-toolkits/Link-Up.aspx

• Skills for Care resources around integration

• Dementia resources on Skills for Care website

What might be some of the

challenges in working in an

integrated way particularly with

healthcare colleagues? 5 mins

Discussion Points

What are some of the way we can

encourage our teams to become

more integrated with colleagues in

healthcare? 5 mins

Discussion Points

• Partnership working focussed on how care pathways

would be optimised, whilst at the same time being

responsive to the specialist needs of individuals to

assist with avoidable hospital admissions, hospital bed

blocking and integrated discharge planning.

• Weekly multidisciplinary team meetings attended by

hospital consultants, social workers, hospital discharge

planning together with the Cardinal team, all working

together to ensure rapid hospital discharges and re-

ablement care.

Case Study - Cardinal

• GPs referring directly to cardinal to avoid acute

admissions

• Employing staff with specialist skills, not

normally seen in a community care service

including occupational therapist and

physiotherapists

• Dementia coaches deliver a number of training

sessions to all the team which has shown

alternative ways to deal with difficult situations

• Staff carry out life story work with relatives

Case Study - Cardinal

• GPs referring directly to cardinal to avoid acute

admissions

• Employing staff with specialist skills, not

normally seen in a community care service

including occupational therapist and

physiotherapists

• Dementia coaches deliver a number of training

sessions to all the team which has shown

alternative ways to deal with difficult situations

• Staff carry out life story work with relatives

Case Study - Cardinal

• Be Courageous - really listen to what’s important for

successful integration from acute to community settings

and visa versa then provide a unique flexible service

• Create a workforce culture embracing positive social

interactions – establishing a true relationship centred

service

• Aim for continuity of care to develop a bond with the

person and their family and to gain trust in exploring

different ways to achieve daily living tasks.

Top Tips

• Comprehensive training and particularly

the effective use of in-house dementia

coaches is one very effective way of

achieving this.

• Ensure an on-going commitment to

support staff and relatives in practical

ways to tailor care delivery to each

person’s individual needs - each day is

different!

Top Tips

Chapter 11

Adapting home environments for

people with dementia

Kitchen

Bathroom

Living room

Bedroom

Outside space

Activity

• Open shelving

• Label hot / cold taps

• Plain floor coverings

• Reminder notes / post its

• Use labels or photographs

• Cooking and baking smells

• Glass jars for tea and coffee

• Monitors – very hot or very cold

Kitchen

• Door signs on toilets

• Open shelving

• Cover or remove mirrors

• Contrasting colours for toilet seats etc

• Set thermostats to avoid scalding

• Bath plug that allows water to drain away /

flood detectors*

• Shower doors/panels could be reflective

Bathroom

• Avoid low coffee tables

• Keep clutter to a minimum

• Keep things within reach

• Have a drawer for rummaging

• Display photos, ornaments etc

• Try and keep the room as familiar as possible

• Use open cupboards/shelves for storage

• Can get confused if there is not enough light

Living Room

• Night / day clocks

• Sign, pictures or photos

• Cover or remove mirrors

• Personal items can be reassuring

• Ensure access to the bed from both sides

• Bed covers should contrast from carpet

• Pictures on wardrobes and drawers

• Contrasting colour for bedroom door

Bedroom

• Provide seating

• Avoid poisonous plants

• Avoid paths with patterns

• Should be safe and secure

• Can help with feeling of well being

• Pets provide interest and activity

• Sensory stimulation – colours, smells

Outside/Garden

http://www.scie.org.uk/socialcaretv/video-

player.asp?v=dementiaenvironmentathome

Video

1. Enhance quality of life and help reduce

behaviours that happen in Dementia by

adapting a home environment to suit the

changes in a person with Dementia

2. Provide opportunities for more involvement

in all daily living activities

Top Tips

3. Give workers the opportunity to be involved in adapting a

person’s home they are supporting by undertaking these

activities with the person with Dementia.

4. Don’t be frightened of asking for physical changes to

happen to the person’s home giving explanations of why you

feel it would work better for the person you are supporting.

5. Be sensitive to changes that happen in Dementia, what’s

worked one week may not work the next. Don’t be put off by

this “get more creative”

Top Tips

• The University of Sterling

• Alzheimer’s Society

• SCIE Dementia Gateway & Social

Care TV

Resources

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