Bupa Care Homes

The care home challenge: leadership and skills

Dr Graham Stokes, Divisional Director of Dementia Care, Bupa Care Services

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Bupa Care Homes 2010: The Growth in Registered Dementia Care Beds Since 2003

• 85% increase in registered dementia care beds, 2003 – 2010

• Increasingly less meaningful

• Prevalence of dementia in non-specialist care homes is 62%+

• Average resident is 83 years old

• 1:5 >80 years have dementia

• 40% of people aged 85 are disabled by frailty, disease or sensory loss

• 29% of people aged 85 years with cancer, heart disease and respiratory disease have Alzheimer’s disease

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Bupa International Care Home census 2009United Kingdom• 44% of residents diagnosed with dementia

• 63% of residents assessed by staff to be living with dementia (as measured by memory impairment and disorientation)

New Zealand• 50% of residents were diagnosed with dementia

• 62% of residents were assessed to be living with dementia

Australia• 53% of residents were diagnosed with dementia

• 73% of residents were assessed to be living with dementia

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An aged person with advanced dementia

• People with dementia living in care homes have complex needs

• Dementia no longer a memory disability but multiple cognitive impairments including

• John’s story

• Co-morbidity, frailty and sensory disability, including sight loss

• Orientation, recognition and recall exacerbated by sight loss

Visual agnosia

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The built environment

• Both cognitive impairments and sight loss exacerbated by design (e.g. corridor length), colour scheme (e.g. minimal colour contrasts) and lighting (e.g. low level)

• Signage versus natural cues

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The social environment

• Malign care is insensitive and unthinking - the unseen ‘taken for granted’ world of care

• Poor approach behaviour leads to confrontation and resistance

• Exclusion from activity and occupation

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Enhanced model of dementia avoids ‘diagnostic overshadowing’

• Dementia

• Health – illness, pain, sensory loss

• Person – life story and psychology

• Social environment

• Built environment