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Promoting Excellence: A framework for all health and social services staff working with people with dementia, their families and carers

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Expertise in Dementia Practice Level

The Expertise in Dementia Practice Level outlines the knowledge and skills required for health and social services workers who by virtue of their role or practice setting play an expert specialist role in the care, treatment and support of people with dementia.

Expertise in Dementia Practice Level

Stage in the dementia journey

Keeping well, prevention and finding out it's dementia

Outcome

What workers know (knowledge)

What workers are able to do (capability/skill/ability)

People with dementia feel empowered and enabled to exercise rights and choice, maintain their identity and to be treated with dignity and equity.

  • In-depth knowledge of positive approaches to enable and support people to be empowered to exercise rights and choices.
  • Comprehensive understanding of the impact that discrimination and stigma may have on the life of the person with dementia, their family and carers.
  • Advanced understanding of the value of person-centred approaches in therapeutic relationships and communication.
  • Comprehensive understanding of the impact that a diagnosis of dementia can have on person's identity and emotional wellbeing.
  • Comprehensive understanding of the impact of a diagnosis of dementia on peoples' families, wider social networks and relationships.
  • Promote awareness of the person's right to exercise choice, social inclusion and citizenship.
  • Challenge any discrimination and stigma people with dementia may face within health and social care services and their wider communities.
  • Support people to exercise their rights if they experience discrimination and stigma.
  • Use a range of person-centred assessment approaches to assist in making a diagnosis of dementia, when appropriate to role.
  • Use specialist psychological and psychosocial skills to support the person to manage receiving a diagnosis in as positive a way as possible.

People with dementia have access to a timely and accurate diagnosis of dementia.

  • Understand how diversity ( e.g. age, gender and ethnic group) can influence the presentation of dementia.
  • Understand how people from diverse backgrounds and cultures may understand and respond to a diagnosis of dementia.
  • Comprehensive knowledge and understanding of the particular impact of a diagnosis for younger people with dementia.
  • Comprehensive understanding of the equality and diversity, issues that should be considered in relation to receiving a diagnosis of dementia and post diagnostic support.
  • Comprehensive understanding of how access to appropriate services and support can be enabled in a way that respects diversity and challenges inequalities.
  • Comprehensive knowledge of how to assess the wide range of requirements of people with dementia including younger people and those with a learning disability.
  • Demonstrate empathy and respect when supporting the person, their family and carers through the diagnosis process in a way that values diversity.
  • Adopt a person-centred approach to sensitively communicate a diagnosis in a way that responds to the unique needs and situation of the person, their family and carers.
  • Challenge, and take steps to address, any inequalities in access to early diagnosis and post diagnostic support that may be experienced in relation to diversity, e.g. people with a learning disability.
  • Adapt assessment approaches to reflect the diversity of people who may receive a diagnosis of dementia.

People with dementia, their families, friends and carers, have access to the information, education and support that enhances the wellbeing of the person with dementia and those that support them.

  • Knowledge of the increased risk of developing dementia for people learning disabilities understanding of the complex interaction that results.
  • Knowledge of the range of changes in behaviour and communication that can signify dementia in a person with learning disabilities.
  • Expert knowledge of specific neuropsychological assessment tools and techniques to assist in diagnosis appropriate to role.
  • Expert knowledge of the range of pharmacological interventions that may enhance memory.
  • Adopt a person-centred approach to regular assessment and review of people with learning disability to ensure accurate and timely diagnosis when dementia is present.
  • When appropriate to role undertake specific neuropsychological assessments.
  • When appropriate to role discuss with the person the benefits and implications of pharmacological interventions that may enhance memory.
  • When appropriate to role sensitively engage with the person and their family in monitoring and reviewing the impact of pharmacological interventions.

Stage in the dementia journey

Living well with dementia

Outcome

What workers know (knowledge)

What workers are able to do (capability/skill/ability)

People with dementia have access to quality services and can continue to participate in community life and valued activities.

  • Comprehensive knowledge of the concepts of person-centred care and personalisation, and the implications for practice, service design and delivery.
  • In-depth understanding of the need for citizen leadership, user and carer expertise and participation in creating systems and services which meet the individual needs of people with dementia.
  • Understand the principles and roles of co-production, participation, empowerment, enablement and community capacity building in promoting independence.
  • Support and enable the person with dementia to find the right solutions for them and actively design and select the services they require.
  • Contribute to the development of practices and services which meet the individual needs of people with dementia.
  • Provide expert advice on strategies to adapt lifestyle that supports continued engagement in communities, employment, relationships and social networks.
  • Support and encourage all staff to adopt attitudes and practices that values the importance of existing natural community resources in supporting people with dementia.
  • Demonstrates leadership in shaping service design and delivery that reflects co-production, participation, empowerment, enablement and community capacity building.

" If we're having problems, then no matter how far on we are in our dementia, we deserve the problem to be challenged and an answer to be found if at all possible."

Through our eyes, a life with dementia

Stage in the dementia journey

Living well with dementia

Outcome

What workers know (knowledge)

What workers are able to do (capability/skill/ability)

People with dementia are able to maintain valued relationships and networks, and have the opportunity to develop new ones both personal and professional.

  • Comprehensive knowledge and understanding of the principles, processes, implications and procedures involved in utilising self-directed support.
  • Knowledge of the principles and options for the application of outcomes-based approaches including a joint outcomes approach for people with dementia, their families and carers.
  • Knowledge of a range of methodologies for delivering, measuring and monitoring outcomes to ensure that the needs and wishes of people with dementia, their families and carers, are met.
  • In-depth knowledge of person-centred and relationship focussed approaches to dementia care and support, e.g. the Senses Framework.
  • When appropriate to role, support the person with dementia, their family and carers, to understand and make informed choices about self directed support.
  • Support the person with dementia, their family and carers to access self directed support if desired.
  • Promote the use of an outcomes based approach which builds on people with dementia's existing capabilities when assessing the support needs of people with dementia.
  • Use person-centred and empathic approaches to assessment, treatment and support for people with dementia.

People with dementia maintain their best level of physical, mental, social and emotional wellbeing.

  • Comprehensive understanding of the relationship between dementia, depression and delirium.
  • Expert knowledge of the range of options and interventions that support people with dementia who are experiencing anxiety and depression.
  • Expert knowledge of the complexity of co-morbidity in dementia.
  • Thorough understanding of evidence based approaches which can enhance psychological, social and physical wellbeing.
  • Comprehensive understanding of how stress may impact people with dementia and their families and carers and how to support people to manage this.
  • Knowledge of the pharmacological treatment of dementia and the impact on the person with dementia.
  • Instigate and involve others in providing the most appropriate treatment for depression and delirium in people with dementia.
  • Provide role appropriate social, emotional and psychological support and interventions to help people with dementia, and their families and carers, address issues such as anxiety or depression.
  • Draw on a range of different social, psychological and psychosocial approaches to provide support appropriate to the person with dementia.
  • When appropriate to role provide expert advice on pharmacological interventions that support emotional wellbeing.

People with dementia feel empowered and enabled to exercise rights and choice, maintain their identity and to be treated with dignity and equity.

  • Expert understanding of the specific interpersonal and relationship issues that may impact on people with dementia, their families and carers.
  • Expert knowledge of the self help strategies that enable people with dementia to deal with memory changes and enhance their memory.
  • Expert knowledge of the range of approaches that can enhance people's home environment to promote physical safety and emotional security.
  • Comprehensive understanding of the concept of 'dementia friendly environment'.
  • Work with the person, their family and carers in responding to complex interpersonal and relationship issues associated with dementia.
  • Provide expert advice to other practitioners on responding to complex interpersonal issues associated with dementia.
  • Work with the person with dementia to support them to enhance their coping skills and strategies to address memory changes.
  • Provide dementia specific expert advice, education and guidance on enhancing the physical and social environment to ensure physical safety and emotional security.
  • Assess, audit, review and where necessary ensure adaptations are made to the physical and social environment to support people with dementia where they live or work.

People with dementia feel safe and secure and are able to be as independent as possible.

  • Comprehensive understanding of the particular environmental and individual physical and cognitive issues for people with dementia that can intensify the possibility of slips, trips and falls.
  • Expert knowledge of the range of measures that can contribute to the safety and privacy of people with dementia, including prevention of falls, without compromising their right to dignity or independence.
  • Expert knowledge of the different perceptions of risk and the range of approaches to the management of risk.
  • Understand the reasons and rationale behind an aversion some may have to risk and risk taking.
  • Make recommendations regarding the various ways in which the environment and environmental adaptations can contribute to the person's privacy and safety.
  • Make recommendations regarding environmental design, including signage to assist the person with dementia to be orientated and independent.
  • Act as a source of expert advice on the benefits of risk enablement in supporting the person with dementia to have choice and control.
  • Apply flexible and responsive approaches to eliminating risk aversion.

People with dementia and their families, friends and carers, have access to the information, education and support that enhances the wellbeing of the person with dementia and those that support them.

  • Expert understanding of advance planning processes for example, advanced statements, power of attorney and planning and end of life care.
  • Expert understanding of the sensitivities associated with advance planning processes for a person with dementia, their family and carers.
  • Support people with dementia and their families and carers to engage in advance planning.
  • Provide support and advice to services and professionals involved in supporting people with dementia, their families and carers to engage in advance planning.

Stage in the dementia journey

Living well with increasing help and support

Outcome

What workers know (knowledge)

What workers are able to do (capability/skill/ability)

People with dementia feel empowered and enabled to exercise rights and choice, maintain their identity and to be treated with dignity and equity.

  • Comprehensive knowledge, understanding and synthesis of rights-based legal, ethical and professional guidance to inform practice in relation to dementia.
  • Comprehensive understanding of the principles of assessment of capacity for people with dementia and the underpinning evidence and legislation.
  • Expert knowledge in the application and understanding of the legislation, guidance and policy in all pertinent areas, including ethical decision making in relation to people with dementia.
  • Expert knowledge and in-depth understanding of impact of dementia on communication.
  • Expert knowledge and skill to individually tailor evidence-based psychological or pharmacological interventions relevant to people with dementia.
  • Act as a source of expert advice when informed consent may be compromised.
  • Sensitively carry out assessments to inform consent and capacity where this may be compromised in relation to peoples' rights and choices.
  • Actively promote ethical decision making in relation to people with dementia.
  • Respond expertly to the diversity of communication challenges experienced by the person with dementia.
  • When appropriate to role individually tailor evidence based psychological or pharmaceutical interventions relevant to people with dementia.
  • When appropriate to role modify and adapt social, psychological and psycho-social interventions and evaluate effectiveness for the person with dementia.

People with dementia maintain their best level of physical, mental, social and emotional wellbeing.

  • Knowledge and understanding of the theory behind evidence based cognitive stimulation and rehabilitation approaches and best practice for use.
  • Expert knowledge of the benefits of multi sensory stimulation, recreational activities and use of combined therapies.
  • In-depth knowledge of the sources of stress and distress and the approaches and evidence based interventions to support people who cannot communicate their needs.
  • Knowledge of approaches which promote multi-disciplinary assessment and interventions to support people with dementia with distressed behaviours perceived to be challenging.
  • Engage the person with dementia in activities to maximise and improve their memory such as cognitive stimulation and cognitive rehabilitation.
  • Act as a source of expert advice and guidance in sensory stimulation, recreational activities and use of combined therapies.
  • Expertly use person-centred interventions to support people with dementia who are stressed or distressed.
  • Promote and lead on multidisciplinary assessment and interventions to support people with dementia with distressed behaviour that may be perceived as challenging.

People with dementia are able to maintain valued relationships and networks, and have the opportunity to develop new ones both personal and professional.

  • Comprehensive knowledge of a range of person-centred approaches to support people with dementia who have unmet needs or whose ability to communicate needs is compromised.
  • Understand the importance of partnership working in the provision of support, care and services for people with dementia, their families and carers.
  • Expert knowledge of the opportunities and challenges in implementing an outcomes based approach to provision of support for people with dementia, their families and carers.
  • Actively promote person-centred responses to people with dementia with unmet needs or whose ability to communicate their needs is compromised.
  • Actively liaise with partners in care to promote best practice in dementia care.
  • Act as a source of expert advice in implementing outcomes focussed practices and services for people with dementia, their families and carers, to drive continuous improvements.

Stage in the dementia journey

End of life and dying well

Outcome

What workers know (knowledge)

What workers are able to do (capability/skill/ability)

People with dementia feel empowered and enabled to exercise rights and choice, maintain their identity and to be treated with dignity and equity.

  • Expert knowledge of the specific palliative care and end of life care needs for people with dementia.
  • Expert knowledge of legal, ethical and human rights issues relevant to people with dementia at the end of life.
  • Expert knowledge and understanding of the complexity of interactions and potential conflicts that arise which may compromise the wishes of the person with dementia.
  • Provide expert advice on meeting the specific needs of people with dementia to promote comfort and dying well.
  • Act as a source of expert advice on legal, ethical and human rights issues relevant to people with dementia at the end of life.
  • Act as a source of expertise in conflict resolution relating to decision making and compliance with the wishes of the person with dementia.