Enhanced Sensory Day Care: Developing a new model of day care for people in the advanced stage of dementia

@Karen Watchman

Dr Karen Watchman Senior Lecturer

University of the West of Scotland

Paula Cochrane Service Manager Alzheimer Scotland

Presentation & Discussion

• Background

• What is ESDC?

• Evaluation of the pilot project

Background – why is this work needed?

• Gap in provision of services for people living at home with advanced dementia

• Increasing numbers of people in later stage of dementia

• Increased demand for care at home services

• Standard day care struggles to meet need

• Family caring compromised by lack of alternative provision

What is Enhanced Sensory Day Care?

• Sensory-based and non-pharmacological

• Connections with senses

• For individuals whose needs could no longer be met by standard day care

• Delivered twice weekly, 10am-4pm for up to 5 people with ‘severe’ dementia

• Staff and volunteers trained to enhanced level

Smell: food, flowers, scents of perfume or after shave Sight: lighting, colours, lava lamp Sound: individualised mp3 players, instruments Touch: massage, dolls, soft toys Taste: finger food, ice cream, fruit, chocolate

Objectives:

• Understand and explain the model in practice

• To measure its contribution to quality of life based on family carer perception

• To evaluate contribution to place of care

• To explore impact from the perspectives of staff and volunteers

• To identify areas of refinement to support wider implementation

Aim of Evaluation:

To collaboratively evaluate and refine an Alzheimer Scotland Enhanced Sensory Day Care Model (ESDC) for individuals with advanced dementia.

What did the research team do? (1)

• Quality of life questionnaire with ESDC family carers at weeks 1 and 12

• Individual emotional touchpoint interviews with ESDC family carers at week 12

• Group emotional touchpoint interviews with staff/volunteers at weeks 1 and 12

What did the research team do (2)

• Self-efficacy questionnaire with staff/volunteers at weeks 1 and 12

• Observational log and documentary photography

• Feedback interviews at 12 weeks with staff/volunteers

• For comparison - emotional touchpoint interviews with 8 family carers at non-ESDC day service

Emotional touchpoints – staff/volunteer group interviews

• Building a new team

• Communicating with people with advanced dementia

• Being with people with advanced dementia

• Selecting appropriate sensory interventions Week 1

Challenges

• Lack of referrals

• Low attendance (illness, hospital stays, Sunday death) – decided to over-subscribe

• Small sample size

• Lack of recording experience among day care staff

• Carers situation

• Staff/management changes

Findings after 12 weeks – from ESDC family members

• 3 of 4 - higher quality of life, believed due to increased staff interaction.

• Felt supported in day care arrangements

• Belief that if service did not exist would mean no day care or respite at all

• Families would have preferred more training to continue sensory activities at home

• Concern expressed about future and potential for move to care home

(After Enhanced Sensory Day Care) ‘She would be trying to walk and do things she wouldn’t normally do… she’d be wanting to do things for herself… she was just happier with herself’

Findings after 12 weeks – from staff and volunteers

• Quality of life for those attending increased due to increase in communication from staff and higher staff ratio

• Shared sensory activities facilitated ‘magic moments’ in the caring relationship

• Increased confidence in ability to engage with person who has little/no verbal communication, especially across sensory activities

‘I honestly thought she couldn’t speak, I’d never heard her say a word at ordinary day care… here she says words and sentences. Her family said they are getting more communication back’

Staff efficacy (confidence)

0

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2

3

4

5

6

7

Lifestory Interact Meals Interventions Physical Smell Touch Taste Hearing SightTime 1 Time 2

Conclusions

• Demonstrated viability and potential benefit of Alzheimer Scotland Enhanced Sensory Day Care

• Need for partnership approach that supports communication between care recipient, care provider and family

• ESDC contributes to positive quality of life of person living in advanced stage of dementia

• ESDC provides support for family carers

• Further work needed to refine and develop the model in practice

‘It’s the touch, Mum needs that, she misses it, it’s human, it’s warmth, it’s basic’

Recommendations

• Implications for future dementia strategies (across settings)

• Development of day service options using this model to support inclusion as dementia advances

• That appropriate day centre staff & volunteers are trained and supported to safely deliver service

• Increased partnership between health, social care and families with guidance developed for continued use at home

• Recognise & investigate, future potential for ESDC to prevent or delay admission to long-term care

• Further work to define criteria for referral and admission, for timely transition

Research Team:

Professor Debbie Tolson

Dr Karen Watchman

Dr Naomi Richards

Amy Dalrymple

Jenny Henderson

Margaret Brown

Professor Graham Jackson

Staff at Alzheimer Scotland, Dumfries & Galloway

Funded by : Dumfries and Galloway Putting You First Change Fund & Alzheimer Scotland

Thank you

Dr Karen Watchman

Senior Lecturer in Dementia

Alzheimer Scotland Centre for Policy and Practice

School of Health, Nursing and Midwifery

University of the West of Scotland

Karen.Watchman@uws.ac.uk

www.uws.ac.uk/ascpp

Paula Cochrane

Alzheimer Scotland Service Manager

Dumfries & Galloway Services

Gordon Street

Dumfries

PCochrane@Alzscot.org

www.alzscot.org