Dementia - health and social services staff: framework - Promoting Excellence 2021

Dementia Skilled Practice Level

The Dementia Skilled Practice Level describes the knowledge and skills required by all health and social services staff who have direct and/or substantial contact with people who have dementia.

Stage - Keeping well, prevention and finding out it's dementia

What staff know (knowledge)

• Appreciate that people with dementia have a right to continued engagement in life's roles and relationships.
• Appreciate the importance of supportive networks and/or therapeutic connections for people with dementia, their families and carers.
• Appreciate that people with dementia can continue in employment with support and reasonable adjustments.
• Appreciate the benefits for people with dementia of engaging in activities as a means of maintaining their independence and enriching their lives.
• Understand the types of health behaviours that can support physical health and contribute to prevention of certain types of dementia.
• Appreciate the short- and long-term benefits for people with dementia of remaining active and, where possible, increasing their physical activity and following a healthy diet.
• Appreciate the potential benefits to self-esteem of mental stimulation, education and knowledge sharing for people with dementia.
• Recognise the importance of maintaining the spiritual and cultural aspects of life for people with dementia, their families and carers.
• Appreciate that the effects of dementia can mean that people may require support or environmental adjustment to maintain meaningful engagement in community life and valued activities.
• Appreciate that the environment incorporates physical, cultural and social aspects that can impact on the experience of people with dementia, their families and carers.
• Understand the different types of dementia and the particular implications and impact on the person, their family and carers.
• Recognise the differences between dementia and other physical and mental health problems, particularly delirium and depression.
• Understand a range of effective communication techniques and strategies to suit people who are affected by memory difficulties or confusion.
• Understand how a range of augmentative and alternative communication can support people with dementia to express themselves.
• Know and understand the range of local professional and community services and specialists who can provide assessment, advice and support for memory problems.
• Understand the anxiety and uncertainty that people can experience before, during and following a diagnosis of dementia.
• Understand and appreciate the potential impact of a diagnosis of dementia on people, their families and carers and their wider network.
• Understand that the way staff support people through a diagnosis of dementia will have a lasting impact on their wellbeing.
• Understand the range of local professional, specialist and community and voluntary resources that provide services such as counselling, psychological or pharmacological supports, and peer and group support.
• Understand how technology can enable connectedness, communication, autonomy and independence.
• Have awareness of the principles and key provisions of relevant adult support and protection and equalities legislation.
• Have critical knowledge of local guidelines and protocols to respond to neglect and abuse.

What staff are able to do (skills)

• Support and enable people with dementia to develop new roles, skills and relationships.
• Support and enable people with dementia to maintain their chosen activities, social life and community involvement.
• Support people with dementia to continue in employment and signpost/refer to appropriate support services if required.
• Provide information and signpost to relevant services, including those that reflect the person's spiritual and cultural wishes.
• Enable people to access and explore a range of information about strategies and healthy lifestyle behaviour that can reduce the likelihood of developing some types of dementia.
• Work alongside people with dementia to support them to remain active, engage in physical activity and follow a healthy diet.
• Support people with dementia to access opportunities to engage in education and knowledge-sharing.
• Support people to maintain the spiritual and cultural aspects of life.
• Contribute to making environmental adjustments, including the use of enabling technology, to suit the individual requirements and needs of people with dementia.
• Respond appropriately to the diverse range of issues that people with dementia may experience that reflect the impact of specific types of dementia.
• As part of a multi-disciplinary team, provide appropriate support, treatment and management in response to the recognition of delirium and depression.
• Adapt communication to meet the individual strengths and needs of people with dementia.
• Communicate respectfully and sensitively with people with dementia in a personalised way, giving consideration to the potential impact of memory difficulties or confusion.
• When appropriate, communicate with people with dementia using their preferred augmentative and alternative methods.
• Support people to access services and specialists who can provide assessment, advice and support for memory problems.
• Respond sensitively using person-centred approaches to support people through the diagnosis of dementia.
• Support people with dementia to access emotional support, counselling or psychological therapies and interventions to promote mental wellbeing.
• Contribute to supporting people with dementia to access enabling technology.
• Use the principles of legislative frameworks to support people with dementia to exercise their rights and choices.
• Contribute to the assessment and support of people with dementia who may be experiencing neglect, harm or abuse.

Stage - Living well with dementia

What staff know (knowledge)

• Appreciate that stigma and the impact of dementia can lead to social isolation and withdrawal from previously valued social connections and activities.
• Understand the concepts of risk and risk enablement in relation to supporting people with dementia, their families and carers.
• Appreciate the potential of enabling technology to positively support and promote independence and quality of life for people with dementia.
• Recognise the diverse range of services and supports that help people with dementia to maintain valued activities, social engagement and inclusion.
• Understand the impact of the environment on the safety and wellbeing of people with dementia.
• Know how to use a range of enabling technology safely to support people with dementia, their families and carers.
• Understand the impact of the progression of dementia on the physical, emotional and psychological health and wellbeing of people with dementia, their families and carers.
• Understand the impact the progression of dementia may have on relationships, including sexuality and intimacy.
• Appreciate that people with dementia have a right to be sexually active.
• Understand the models, concepts and underlying causes of stress and distress in dementia.
• Appreciate the range of multi-sensory, therapeutic and recreational activities that promote wellbeing and independence.
• Appreciate the importance of getting to know the person, both in the present and the past, using a range of approaches, including life-story work and reminiscence.
• Appreciate how life-story work can positively facilitate a person's sense of self and self-value and inform future planning.
• Appreciate how life-story work and reminiscence can be used to communicate with people with dementia and engage them in meaningful and valued interactions, activities and experiences.
• Understand the value to families and carers of recording a life story to maintain the sense of person and their relationships.
• Appreciate the benefits of engaging in life-story work for families and carers.
• Appreciate the role of emerging technology in providing a creative means of exploring, compiling and recording life stories.

What staff are able to do (skills)

• Challenge any signs or actions that stigmatise people with dementia.
• Contribute to enabling people with dementia to take considered risks to maximise their opportunities.
• Work with people to support them to understand risk enablement and risk.
• Take an individualised approach to risk by acknowledging that dementia affects people in different ways.
• Using person-centred approaches, utilise a range of enabling technologies to positively support and promote independence and quality of life for people with dementia.
• Engage with people with dementia, their families and carers in a warm and empathic manner that takes account of the progression of dementia on their health and wellbeing.
• Work with people with dementia, their families and carers in a way that supports and respects their right to engage in sexual and intimate relationships.
• Utilise detailed knowledge of the person to recognise when they are at risk of becoming distressed.
• Identify areas of concern and potential triggers for stress and distress for people with dementia, their families and carers and respond appropriately.
• Support people to engage in activities and experiences which they find meaningful and valued.
• Use a range of approaches, including life-story work and reminiscence, to get to know the person and support their engagement in meaningful and valued activities relating to their interests, abilities and experiences.
• Work with families, carers and the person to compile and record their life story in their preferred format, including the use of emerging technology.

Stage - Living well with increasing help and support

What staff know (knowledge)

• Appreciate that people with dementia have the right to continue to be actively involved in all decisions that help them to live well with dementia.
• Understand the requirements of formal assessment of capacity under the terms of the legislation.
• Appreciate the benefits of ongoing and supportive relationships to the health and wellbeing of people with dementia, their families and carers.
• Understand the range of challenges that people with dementia, their families and carers might face as their dementia progresses.
• Identify when people with dementia, their families and carers are experiencing barriers to accessing support for physical, social or psychological difficulties.
• Know about a range of methods of communication with people with dementia who may be experiencing increasing difficulties with their memory and life skills.
• Appreciate that people with dementia are more at risk of developing changes that might impact on their physical health, such as becoming dehydrated and/or malnourished, or having continence problems.
• Recognise when previous psychological trauma has occurred, and that people will react and respond differently.
• Appreciate that a person might feel distressed or even re-traumatised in certain situations if they are reminded in some way of past trauma.
• Understand that for some people with dementia, previous trauma can impact on mental health and wellbeing and on physical health and relationships with others.
• Recognise that through engagement in life-story work and reminiscence, a person with dementia may recall and share previous physical and psychological traumatic experiences.
• Understand the complexity of experiencing multiple illnesses for people with dementia.
• Recognise that people with dementia who also have frailty are at risk of adverse outcomes that include dramatic changes in their physical and mental wellbeing after an apparently minor health event, such as an infection or the introduction of new medication.
• Understand that people with dementia may have a reduced or changed ability to communicate physical illness, pain and mental distress.
• Understand that people who know the person well may recognise unique and individual signs that indicate the person is in pain or distress.
• Have knowledge of how pain assessment tools can help establish when a person with dementia is in pain, particularly when communication is compromised.
• Understand that a person-centred approach, working with family and carers, is required to identify when a person with dementia is experiencing pain.
• Understand the particular environmental and individual physical and cognitive issues for people with dementia that can intensify the possibility of slips, trips and falls.
• Understand that visual impairment and perceptual changes can increase the risk of slips, trips and falls for people with dementia.
• Know how to use a range of aids, adaptations, techniques and technological solutions to support independence.
• Understand the range of anticipatory and preventative measures, including consideration of technology, that can be put in place to prevent hospital admission for people with dementia.
• Understand that when hospital admission is necessary, potential solutions are available to improve the experience and outcomes for people with dementia.
• Understand that open and frequent communication with people with dementia, their families and carers during acute hospital admissions can reduce anxiety and distress and promote partnership-working.

What staff are able to do (skills)

• Work with people with dementia, their families and carers to maximise their ability to participate in decisions and choices.
• Contribute to formal assessment of capacity to enable people to achieve their expressed choices, wishes and desires.
• Support people with dementia to maintain their valued personal and community connections.
• Work with the person, family and carers to manage or challenge barriers to accessing support.
• Support and signpost the person with dementia, their family and carers to access counselling or psychological therapies that can enhance coping skills and maintain intimate relationships.
• Assess the person's preferred approach to communication, taking account of the individual progression and variable nature of dementia, and use this in all interactions with the person.
• Provide direct support in eating, drinking and continence, when appropriate to role, to promote physical wellbeing.
• Use local protocols and procedures to obtain informed consent to share information to facilitate the team and enable them to respond in a trauma-informed manner.
• Provide support, including personal care, in a way that reflects trauma-informed practice.
• Work as part of a multi-disciplinary team to support people with dementia who have a range of co-morbid conditions.
• Working as part of the multi-disciplinary team, adopt a strengths-based approach to holistically assess people's physical and mental health needs, and monitor changes and deteriorations in their health.
• Working as part of the multi-disciplinary team, contribute to person-centred assessment of pain and monitor and report any changes in the person that may suggest they are experiencing pain and discomfort.
• Recognise when people with dementia may be at risk of slips, trips and falls and take appropriate action/utilise the most appropriate solution in line with the multi-disciplinary assessment and care plan.
• Implement a range of appropriate changes and adaptations to support people with dementia.
• Working as part of the multi-disciplinary team, implement anticipatory and preventative measures to support people with dementia to remain in their familiar environment.
• Work in partnership with families and carers as an integral part of the assessment and care-planning and delivery process when the person is in hospital.

Stage - End of life and dying well

What staff know (knowledge)

• Understand the interdependence of the physical, psychological, emotional and spiritual care needs of a person with dementia, their family and carers in relation to palliative and end of life care.
• Understand the importance of values, beliefs and communication in the delivery of person-centred palliative and end of life care for people with dementia, their families and carers.
• Understand that anticipatory care plans or advance plans should help inform decisions relating to the person's needs, wishes and choices to support dying well.
• Understand the complexities of decision-making and the legal and ethical framework necessary to ensure the wishes of the person with dementia are heard and respected.
• Understand the specific needs of people with dementia and promote comfort and dying well.
• Recognise the changes that indicate that a person with dementia is nearing the end of their life.
• Appreciate the important role and support needs of family, carers and friends, including after the death of the person with dementia.

What staff are able to do (skills)

• Work as part of the multi-disciplinary team and in partnership with the family and carers to provide palliative and end of life care that reflects the unique needs, wishes and choices of the person with dementia.
• Working as part of the multi-disciplinary team and in partnership with the family and carers, ensure the wishes of the person with dementia are heard and reflected in the care and support provided, which takes account of relevant legal and ethical frameworks.
• Work as part of the multi-disciplinary team to provide person-centred care that promotes comfort through palliative and end of life care.
• Respond appropriately when changes indicate that a person is nearing the end of their life.
• Contribute as part of the multi-disciplinary team to supporting family, carers and friends, including following the death of the person with dementia.