Introduction
1
“ Ideally we would like other beds… We have eleven patients who are looking for immediate long-term care or more frequent respite care. Ideally we would like other beds… We have eleven patients who are looking for immediate long-term care or more frequent respite care. And that puts terrible emotional And that puts terrible emotional pressure on us. pressure on us. We had a lady discharged last week. We had a lady discharged last week. And her daughter cried by me at the door. And she said I can’t mind Mummy anymore. And we couldn’t do anything except offering her one week respite.” (Clinical Nurse And her daughter cried by me at the door. And she said I can’t mind Mummy anymore. And we couldn’t do anything except offering her one week respite.” (Clinical Nurse Specialist, SCU 1). Specialist, SCU 1). “ When you think how the relatives find it difficult to let go… at a time when they come here on the admission day, you know. Y When you think how the relatives find it difficult to let go… at a time when they come here on the admission day, you know. Y ou can sense their feeling of uncertainty… ou can sense their feeling of uncertainty… guilty of leaving someone behind. guilty of leaving someone behind. So you feel quite similar. So you feel quite similar. ” ” (Clinical Nurse Specialist, SCU 2). (Clinical Nurse Specialist, SCU 2). “ “ It is heartbreaking when you think of how the family finds it It is heartbreaking when you think of how the family finds it difficult to let go”- difficult to let go”- The Experiences of Residents and their Formal and Informal The Experiences of Residents and their Formal and Informal Caregivers of Moving to Specialist Care Units: Findings from Staff Caregivers of Moving to Specialist Care Units: Findings from Staff Focus Groups Focus Groups Dementia and Rehabilitation – Challenges and Opportunities for Health Care Dementia and Rehabilitation – Challenges and Opportunities for Health Care Professionals Professionals DSIDC Autumn Conference, November 26 DSIDC Autumn Conference, November 26 th th 2009 2009 St. James’s Hospital Dublin St. James’s Hospital Dublin Presenter: Andrea Bobersky, PhD Student, Living With Dementia Programme Presenter: Andrea Bobersky, PhD Student, Living With Dementia Programme Supervisor: Dr. Suzanne Cahill, Research Director DSIDC and Research Senior Lecturer Supervisor: Dr. Suzanne Cahill, Research Director DSIDC and Research Senior Lecturer Introduction Introduction It is estimated that some 38,000 people in Ireland have dementia and it is projected that these figures will rise to 50,000 by 2016 and to more than 70,000 by 2026 (O’Shea, 2007). Whilst most of It is estimated that some 38,000 people in Ireland have dementia and it is projected that these figures will rise to 50,000 by 2016 and to more than 70,000 by 2026 (O’Shea, 2007). Whilst most of these people will be cared for at these people will be cared for at home, a not insignificant proportion with high dependency needs will require long-term care. Of these, some will be fortunate enough to be placed in Specialist Care Units (SCUs), especially home, a not insignificant proportion with high dependency needs will require long-term care. Of these, some will be fortunate enough to be placed in Specialist Care Units (SCUs), especially designed to cater for the complex designed to cater for the complex needs of people with Alzheimer’s disease. SCUs are small-scale environments which aim to meet the specific needs of people with a dementia (Teresi et al., 2000). Their key features include a safe needs of people with Alzheimer’s disease. SCUs are small-scale environments which aim to meet the specific needs of people with a dementia (Teresi et al., 2000). Their key features include a safe and unobtrusive domestic and unobtrusive domestic setting, cueing and signage, mea setting, cueing and signage, mea ningful stimulation and activities, private bedrooms, separate rooms for separate functions and a secure ningful stimulation and activities, private bedrooms, separate rooms for separate functions and a secure outdoor area. SCUs aim to enhance the quality of life of outdoor area. SCUs aim to enhance the quality of life of residents and their formal and residents and their formal and informal caregivers. informal caregivers. However, However, little is known about how people with a dementia access SCUs and their short-term and more long-term experiences of settling in (Cioffi et al., 2007). We also know little is known about how people with a dementia access SCUs and their short-term and more long-term experiences of settling in (Cioffi et al., 2007). We also know little about family caregivers’ little about family caregivers’ experiences of placing their relatives with dementia in a SCU and in particular how staff employed, make admission decisions and deal with this process. This study attempts to address this experiences of placing their relatives with dementia in a SCU and in particular how staff employed, make admission decisions and deal with this process. This study attempts to address this current gap in our knowledge. current gap in our knowledge. Research Goals Research Goals This study aims to: This study aims to: (i) (i) explore the short-term and long-term effects of moving into a SCU from an individual and family caregiver perspective explore the short-term and long-term effects of moving into a SCU from an individual and family caregiver perspective (ii) (ii) identify the role and support offered by SCU staff during the transition process identify the role and support offered by SCU staff during the transition process (iii) (iii) examine ways in which front-line staff make decisions about long-term care admission and deal with the practicalities of the transfer examine ways in which front-line staff make decisions about long-term care admission and deal with the practicalities of the transfer (iv) (iv) investigate the more long-term effects of living in a SCU from an individual and family caregiver perspective. investigate the more long-term effects of living in a SCU from an individual and family caregiver perspective. Research Methodology Research Methodology A qualitative exploratory research design is being used. Data is being collected from (i) people with dementia, (N = 7), (ii) their family caregivers, (N = 7) and (iii) SCU staff, (N = 12), A qualitative exploratory research design is being used. Data is being collected from (i) people with dementia, (N = 7), (ii) their family caregivers, (N = 7) and (iii) SCU staff, (N = 12), within 3-4 weeks (baseline) and within 4-6 within 3-4 weeks (baseline) and within 4-6 months (follow-up). Inclusion criteria are (i) a diagnosis of Alzheimer’s disease or any other dementia sub-type and (ii) a recent admission to a SCU and (iii) the availability of a primary months (follow-up). Inclusion criteria are (i) a diagnosis of Alzheimer’s disease or any other dementia sub-type and (ii) a recent admission to a SCU and (iii) the availability of a primary caregiver. Research methods being used to caregiver. Research methods being used to collect data include (i) in-depth semi-structured interviews, (ii) Focus Groups, (iii) self-administered questionnaires, (iv) nursing home record data analysis and (v) the Mini Mental State collect data include (i) in-depth semi-structured interviews, (ii) Focus Groups, (iii) self-administered questionnaires, (iv) nursing home record data analysis and (v) the Mini Mental State Examination (MMSE). In-depth interviews Examination (MMSE). In-depth interviews and Focus Group findings will be analysed by means of Interpretative Phenomenological Analysis. Simple descriptive statistics will be used to analyse MMSE test scores. and Focus Group findings will be analysed by means of Interpretative Phenomenological Analysis. Simple descriptive statistics will be used to analyse MMSE test scores. The research methodology is The research methodology is based on an interpretative based on an interpretative phenomenological framework. This approach is seen as particularly suitable for exploring how individuals experience certain phenomena and how they attach meanings to their experiences (Shaw, phenomenological framework. This approach is seen as particularly suitable for exploring how individuals experience certain phenomena and how they attach meanings to their experiences (Shaw, 2009). 2009). Research Sites Research Sites The sites for this study are two different Specialist Care Units located outside Dublin. Both SCUs are purpose-built and are located within two different Geriatric Hospitals operating under the The sites for this study are two different Specialist Care Units located outside Dublin. Both SCUs are purpose-built and are located within two different Geriatric Hospitals operating under the Irish Health Service Executive. Irish Health Service Executive. Results Results Focus Groups Focus Groups 1) Matching needs and criteria 1) Matching needs and criteria – Due to lengthy wait-lists, front-line staff emphasised the need to apply strict admission criteria and admit those residents who might benefit most from the SCU. – Due to lengthy wait-lists, front-line staff emphasised the need to apply strict admission criteria and admit those residents who might benefit most from the SCU. For this reason, residents’ For this reason, residents’ holistic needs were assessed, and admission decisions were made very carefully by the SCU team in consultation with other health service professionals and with family caregivers. holistic needs were assessed, and admission decisions were made very carefully by the SCU team in consultation with other health service professionals and with family caregivers. 2) Dealing with pressures 2) Dealing with pressures – Some staff members reported they experienced high levels of stress when dealing with new admissions. Sources of stress identified by them included family caregivers’ – Some staff members reported they experienced high levels of stress when dealing with new admissions. Sources of stress identified by them included family caregivers’ guilt and exhaustion prior to guilt and exhaustion prior to admission, the high demand on SCU beds and the difficulties involved in their making decisions about who might and might not most benefit from such placements and the need in some cases to admission, the high demand on SCU beds and the difficulties involved in their making decisions about who might and might not most benefit from such placements and the need in some cases to discharge residents with final- discharge residents with final- stage dementia from the SCU to free up beds. stage dementia from the SCU to free up beds. 3) Easing into the SCU 3) Easing into the SCU – Front-line staff stated that new residents tended to settle into the SCU in their own individual way. This phase was generally described as a gradual process of getting – Front-line staff stated that new residents tended to settle into the SCU in their own individual way. This phase was generally described as a gradual process of getting to know each other. Staff spent to know each other. Staff spent considerable time facilitating the new resident to settle into the SCU environment. Some front-line staff saw respite care as an important conduit, or entr considerable time facilitating the new resident to settle into the SCU environment. Some front-line staff saw respite care as an important conduit, or entr ée into long-term care; it helped to ée into long-term care; it helped to prepare residents gradually for long-term prepare residents gradually for long-term care admission. care admission. 4) Supporting and being supported 4) Supporting and being supported – Front-line staff used a range of practical and psychological supports to assist residents and family caregivers, during and immediately following admission. – Front-line staff used a range of practical and psychological supports to assist residents and family caregivers, during and immediately following admission. Useful initiatives and supports Useful initiatives and supports included, (i) inviting family caregivers to visit the SCU prior to admission, (ii) reassuring family caregivers about the physical setting and informing them about the Unit’s philosophy of care, included, (i) inviting family caregivers to visit the SCU prior to admission, (ii) reassuring family caregivers about the physical setting and informing them about the Unit’s philosophy of care, (iii) collecting information about the (iii) collecting information about the resident including his or her life story and sharing this information with all staff members before admission, (v) taking the time to get to know the new resident after admission and (vi) resident including his or her life story and sharing this information with all staff members before admission, (v) taking the time to get to know the new resident after admission and (vi) subsequently responding to the new resident subsequently responding to the new resident in a person-centered flexible and individualized manner. in a person-centered flexible and individualized manner. 5) Experiencing positive changes following admission 5) Experiencing positive changes following admission – Front-line staff identified positive changes in their residents’ behaviour and mood over the first weeks following admission. Some reported – Front-line staff identified positive changes in their residents’ behaviour and mood over the first weeks following admission. Some reported reduced levels of anxiety, reduced levels of anxiety, improved self-esteem, better interactions, and increased independence in activities of daily living. In addition, in some cases, new residents helped to motivate other residents to share their improved self-esteem, better interactions, and increased independence in activities of daily living. In addition, in some cases, new residents helped to motivate other residents to share their hobbies. This helped to inform the hobbies. This helped to inform the design and delivery of SCUs’ activity programmes. design and delivery of SCUs’ activity programmes. Discussion Discussion Preliminary findings from this study reveal the type of strain experienced by staff conscious of long wait lists and being obliged to make important admission and discharge decisions affecting Preliminary findings from this study reveal the type of strain experienced by staff conscious of long wait lists and being obliged to make important admission and discharge decisions affecting many peoples’ lives. The admission many peoples’ lives. The admission of new residents to a SCU is a complex and on-going process which requires good organisational and communication skills on the part of front-line professional staff. There is a need for better of new residents to a SCU is a complex and on-going process which requires good organisational and communication skills on the part of front-line professional staff. There is a need for better recognition of the choices, recognition of the choices, dilemmas and strains these health care professionals working in dementia care experience during this period. Training programmes should pay particular attention to modules which further up-skill dilemmas and strains these health care professionals working in dementia care experience during this period. Training programmes should pay particular attention to modules which further up-skill staff on topics such as SCU staff on topics such as SCU admission assessment protocols, ways of helping family caregivers adjust to home care relinquishment and mechanisms for helping new residents settle into more purpose-built environments. Some admission assessment protocols, ways of helping family caregivers adjust to home care relinquishment and mechanisms for helping new residents settle into more purpose-built environments. Some family members were family members were disappointed that their relatives failed to meet the eligibility criteria for SCU admission and front-line staff reported feeling pressurised about having to communicate and defend such disappointed that their relatives failed to meet the eligibility criteria for SCU admission and front-line staff reported feeling pressurised about having to communicate and defend such decisions. There is need for improved public decisions. There is need for improved public awareness about the type of individual with dementia best suited for accommodation in SCUs. The short-term benefits of placement in a SCU for persons with dementia in this small qualitative awareness about the type of individual with dementia best suited for accommodation in SCUs. The short-term benefits of placement in a SCU for persons with dementia in this small qualitative study, included reduced anxiety, study, included reduced anxiety, improved self-esteem and better interactions. There is a need for more quantitative studies to be undertaken to estimate the real effectiveness of SCUs both in the short term and more long term. improved self-esteem and better interactions. There is a need for more quantitative studies to be undertaken to estimate the real effectiveness of SCUs both in the short term and more long term. To avoid having to transfer To avoid having to transfer people with end-stage dementia to other facilities, existing SCUs need to consider extending their facilities to include areas for those terminally ill with dementia. people with end-stage dementia to other facilities, existing SCUs need to consider extending their facilities to include areas for those terminally ill with dementia. Acknowledgements Acknowledgements This PhD studentship is part of the Living With Dementia Research Programme and is funded by The Atlantic Philanthropies. This PhD studentship is part of the Living With Dementia Research Programme and is funded by The Atlantic Philanthropies. Literature Literature Cioffi, J. M., Fleming, A., Wilkes, L., Sinfield, M. & Le Miere, J. (2007). The effect of environmental change on residents with dementia: The perceptions of relatives and staff. Cioffi, J. M., Fleming, A., Wilkes, L., Sinfield, M. & Le Miere, J. (2007). The effect of environmental change on residents with dementia: The perceptions of relatives and staff. Dementia 6 (2), Dementia 6 (2), 215- 215- 231. 231. O’Shea, E. (2007). O’Shea, E. (2007). Implementing policy for dementia care in Ireland. Implementing policy for dementia care in Ireland. The Alzheimer Society of Ireland (Electronic Resource). The Alzheimer Society of Ireland (Electronic Resource). Shaw, R. L. (2009). Shaw, R. L. (2009). An introduction to Interpretative Phenomenological Analysis An introduction to Interpretative Phenomenological Analysis (Course materials). Aston University. (Course materials). Aston University. Teresi, J. A., Holmes, D. & Ory, M. G. (2000). The therapeutic design of environments for people with dementia: Further reflections and recent findings from the National Institute on Aging Teresi, J. A., Holmes, D. & Ory, M. G. (2000). The therapeutic design of environments for people with dementia: Further reflections and recent findings from the National Institute on Aging Collaborative Studies of Dementia Specialist Care Units. Collaborative Studies of Dementia Specialist Care Units. Gerontologist 40 (4), Gerontologist 40 (4), 417-421. 417-421.
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““Ideally we would like other beds… We have eleven patients who are looking for immediate long-term care or more frequent respite care. Ideally we would like other beds… We have eleven patients who are looking for immediate long-term care or more frequent respite care. And that puts terrible emotional pressure on us.And that puts terrible emotional pressure on us. We had a lady discharged last week. We had a lady discharged last week.
And her daughter cried by me at the door. And she said I can’t mind Mummy anymore. And we couldn’t do anything except offering her one week respite.” (Clinical Nurse Specialist, SCU 1).And her daughter cried by me at the door. And she said I can’t mind Mummy anymore. And we couldn’t do anything except offering her one week respite.” (Clinical Nurse Specialist, SCU 1).
““When you think how the relatives find it difficult to let go… at a time when they come here on the admission day, you know. YWhen you think how the relatives find it difficult to let go… at a time when they come here on the admission day, you know. Y ou can sense their feeling of uncertainty… guilty of leaving someone behind. ou can sense their feeling of uncertainty… guilty of leaving someone behind. So you feel quite similar.So you feel quite similar.” ” (Clinical Nurse Specialist, SCU 2).(Clinical Nurse Specialist, SCU 2).
““It is heartbreaking when you think of how the family finds it difficult to let go”-It is heartbreaking when you think of how the family finds it difficult to let go”-The Experiences of Residents and their Formal and Informal Caregivers of Moving to The Experiences of Residents and their Formal and Informal Caregivers of Moving to
Specialist Care Units: Findings from Staff Focus Groups Specialist Care Units: Findings from Staff Focus Groups
Dementia and Rehabilitation – Challenges and Opportunities for Health Care ProfessionalsDementia and Rehabilitation – Challenges and Opportunities for Health Care Professionals DSIDC Autumn Conference, November 26 DSIDC Autumn Conference, November 26thth 2009 2009
St. James’s Hospital Dublin St. James’s Hospital Dublin
Presenter: Andrea Bobersky, PhD Student, Living With Dementia ProgrammePresenter: Andrea Bobersky, PhD Student, Living With Dementia ProgrammeSupervisor: Dr. Suzanne Cahill, Research Director DSIDC and Research Senior Lecturer Supervisor: Dr. Suzanne Cahill, Research Director DSIDC and Research Senior Lecturer
IntroductionIntroductionIt is estimated that some 38,000 people in Ireland have dementia and it is projected that these figures will rise to 50,000 by 2016 and to more than 70,000 by 2026 (O’Shea, 2007). Whilst most of these people will be cared for at It is estimated that some 38,000 people in Ireland have dementia and it is projected that these figures will rise to 50,000 by 2016 and to more than 70,000 by 2026 (O’Shea, 2007). Whilst most of these people will be cared for at home, a not insignificant proportion with high dependency needs will require long-term care. Of these, some will be fortunate enough to be placed in Specialist Care Units (SCUs), especially designed to cater for the complex home, a not insignificant proportion with high dependency needs will require long-term care. Of these, some will be fortunate enough to be placed in Specialist Care Units (SCUs), especially designed to cater for the complex needs of people with Alzheimer’s disease. SCUs are small-scale environments which aim to meet the specific needs of people with a dementia (Teresi et al., 2000). Their key features include a safe and unobtrusive domestic needs of people with Alzheimer’s disease. SCUs are small-scale environments which aim to meet the specific needs of people with a dementia (Teresi et al., 2000). Their key features include a safe and unobtrusive domestic setting, cueing and signage, measetting, cueing and signage, meaningful stimulation and activities, private bedrooms, separate rooms for separate functions and a secureningful stimulation and activities, private bedrooms, separate rooms for separate functions and a secure outdoor area. SCUs aim to enhance the quality of life of residents and their formal and outdoor area. SCUs aim to enhance the quality of life of residents and their formal and informal caregivers. informal caregivers. However,However, little is known about how people with a dementia access SCUs and their short-term and more long-term experiences of settling in (Cioffi et al., 2007). We also know little about family caregivers’ little is known about how people with a dementia access SCUs and their short-term and more long-term experiences of settling in (Cioffi et al., 2007). We also know little about family caregivers’ experiences of placing their relatives with dementia in a SCU and in particular how staff employed, make admission decisions and deal with this process. This study attempts to address this current gap in our knowledge.experiences of placing their relatives with dementia in a SCU and in particular how staff employed, make admission decisions and deal with this process. This study attempts to address this current gap in our knowledge.
Research GoalsResearch GoalsThis study aims to:This study aims to:(i)(i) explore the short-term and long-term effects of moving into a SCU from an individual and family caregiver perspectiveexplore the short-term and long-term effects of moving into a SCU from an individual and family caregiver perspective(ii)(ii) identify the role and support offered by SCU staff during the transition processidentify the role and support offered by SCU staff during the transition process(iii)(iii) examine ways in which front-line staff make decisions about long-term care admission and deal with the practicalities of the transferexamine ways in which front-line staff make decisions about long-term care admission and deal with the practicalities of the transfer(iv)(iv) investigate the more long-term effects of living in a SCU from an individual and family caregiver perspective. investigate the more long-term effects of living in a SCU from an individual and family caregiver perspective.
Research MethodologyResearch MethodologyA qualitative exploratory research design is being used. Data is being collected from (i) people with dementia, (N = 7), (ii) their family caregivers, (N = 7) and (iii) SCU staff, (N = 12), within 3-4 weeks (baseline) and within 4-6 A qualitative exploratory research design is being used. Data is being collected from (i) people with dementia, (N = 7), (ii) their family caregivers, (N = 7) and (iii) SCU staff, (N = 12), within 3-4 weeks (baseline) and within 4-6 months (follow-up). Inclusion criteria are (i) a diagnosis of Alzheimer’s disease or any other dementia sub-type and (ii) a recent admission to a SCU and (iii) the availability of a primary caregiver. Research methods being used to months (follow-up). Inclusion criteria are (i) a diagnosis of Alzheimer’s disease or any other dementia sub-type and (ii) a recent admission to a SCU and (iii) the availability of a primary caregiver. Research methods being used to collect data include (i) in-depth semi-structured interviews, (ii) Focus Groups, (iii) self-administered questionnaires, (iv) nursing home record data analysis and (v) the Mini Mental State Examination (MMSE). In-depth interviews collect data include (i) in-depth semi-structured interviews, (ii) Focus Groups, (iii) self-administered questionnaires, (iv) nursing home record data analysis and (v) the Mini Mental State Examination (MMSE). In-depth interviews and Focus Group findings will be analysed by means of Interpretative Phenomenological Analysis. Simple descriptive statistics will be used to analyse MMSE test scores. and Focus Group findings will be analysed by means of Interpretative Phenomenological Analysis. Simple descriptive statistics will be used to analyse MMSE test scores. The research methodology is based on an interpretative The research methodology is based on an interpretative phenomenological framework. This approach is seen as particularly suitable for exploring how individuals experience certain phenomena and how they attach meanings to their experiences (Shaw, 2009).phenomenological framework. This approach is seen as particularly suitable for exploring how individuals experience certain phenomena and how they attach meanings to their experiences (Shaw, 2009).
Research SitesResearch SitesThe sites for this study are two different Specialist Care Units located outside Dublin. Both SCUs are purpose-built and are located within two different Geriatric Hospitals operating under the Irish Health Service Executive.The sites for this study are two different Specialist Care Units located outside Dublin. Both SCUs are purpose-built and are located within two different Geriatric Hospitals operating under the Irish Health Service Executive.
ResultsResultsFocus Groups Focus Groups 1) Matching needs and criteria1) Matching needs and criteria – Due to lengthy wait-lists, front-line staff emphasised the need to apply strict admission criteria and admit those residents who might benefit most from the SCU. For this reason, residents’ – Due to lengthy wait-lists, front-line staff emphasised the need to apply strict admission criteria and admit those residents who might benefit most from the SCU. For this reason, residents’ holistic needs were assessed, and admission decisions were made very carefully by the SCU team in consultation with other health service professionals and with family caregivers.holistic needs were assessed, and admission decisions were made very carefully by the SCU team in consultation with other health service professionals and with family caregivers.2) Dealing with pressures2) Dealing with pressures – Some staff members reported they experienced high levels of stress when dealing with new admissions. Sources of stress identified by them included family caregivers’ guilt and exhaustion prior to – Some staff members reported they experienced high levels of stress when dealing with new admissions. Sources of stress identified by them included family caregivers’ guilt and exhaustion prior to admission, the high demand on SCU beds and the difficulties involved in their making decisions about who might and might not most benefit from such placements and the need in some cases to discharge residents with final-admission, the high demand on SCU beds and the difficulties involved in their making decisions about who might and might not most benefit from such placements and the need in some cases to discharge residents with final-stage dementia from the SCU to free up beds.stage dementia from the SCU to free up beds.3) Easing into the SCU3) Easing into the SCU – Front-line staff stated that new residents tended to settle into the SCU in their own individual way. This phase was generally described as a gradual process of getting to know each other. Staff spent – Front-line staff stated that new residents tended to settle into the SCU in their own individual way. This phase was generally described as a gradual process of getting to know each other. Staff spent considerable time facilitating the new resident to settle into the SCU environment. Some front-line staff saw respite care as an important conduit, or entrconsiderable time facilitating the new resident to settle into the SCU environment. Some front-line staff saw respite care as an important conduit, or entrée into long-term care; it helped to prepare residents gradually for long-term ée into long-term care; it helped to prepare residents gradually for long-term care admission.care admission.4) Supporting and being supported4) Supporting and being supported – Front-line staff used a range of practical and psychological supports to assist residents and family caregivers, during and immediately following admission. Useful initiatives and supports – Front-line staff used a range of practical and psychological supports to assist residents and family caregivers, during and immediately following admission. Useful initiatives and supports included, (i) inviting family caregivers to visit the SCU prior to admission, (ii) reassuring family caregivers about the physical setting and informing them about the Unit’s philosophy of care, (iii) collecting information about the included, (i) inviting family caregivers to visit the SCU prior to admission, (ii) reassuring family caregivers about the physical setting and informing them about the Unit’s philosophy of care, (iii) collecting information about the resident including his or her life story and sharing this information with all staff members before admission, (v) taking the time to get to know the new resident after admission and (vi) subsequently responding to the new resident resident including his or her life story and sharing this information with all staff members before admission, (v) taking the time to get to know the new resident after admission and (vi) subsequently responding to the new resident in a person-centered flexible and individualized manner.in a person-centered flexible and individualized manner.5) Experiencing positive changes following admission5) Experiencing positive changes following admission – Front-line staff identified positive changes in their residents’ behaviour and mood over the first weeks following admission. Some reported reduced levels of anxiety, – Front-line staff identified positive changes in their residents’ behaviour and mood over the first weeks following admission. Some reported reduced levels of anxiety, improved self-esteem, better interactions, and increased independence in activities of daily living. In addition, in some cases, new residents helped to motivate other residents to share their hobbies. This helped to inform the improved self-esteem, better interactions, and increased independence in activities of daily living. In addition, in some cases, new residents helped to motivate other residents to share their hobbies. This helped to inform the design and delivery of SCUs’ activity programmes.design and delivery of SCUs’ activity programmes.
DiscussionDiscussionPreliminary findings from this study reveal the type of strain experienced by staff conscious of long wait lists and being obliged to make important admission and discharge decisions affecting many peoples’ lives. The admissionPreliminary findings from this study reveal the type of strain experienced by staff conscious of long wait lists and being obliged to make important admission and discharge decisions affecting many peoples’ lives. The admissionof new residents to a SCU is a complex and on-going process which requires good organisational and communication skills on the part of front-line professional staff. There is a need for better recognition of the choices,of new residents to a SCU is a complex and on-going process which requires good organisational and communication skills on the part of front-line professional staff. There is a need for better recognition of the choices,dilemmas and strains these health care professionals working in dementia care experience during this period. Training programmes should pay particular attention to modules which further up-skill staff on topics such as SCU dilemmas and strains these health care professionals working in dementia care experience during this period. Training programmes should pay particular attention to modules which further up-skill staff on topics such as SCU admission assessment protocols, ways of helping family caregivers adjust to home care relinquishment and mechanisms for helping new residents settle into more purpose-built environments. Some family members were admission assessment protocols, ways of helping family caregivers adjust to home care relinquishment and mechanisms for helping new residents settle into more purpose-built environments. Some family members were disappointed that their relatives failed to meet the eligibility criteria for SCU admission and front-line staff reported feeling pressurised about having to communicate and defend such decisions. There is need for improved public disappointed that their relatives failed to meet the eligibility criteria for SCU admission and front-line staff reported feeling pressurised about having to communicate and defend such decisions. There is need for improved public awareness about the type of individual with dementia best suited for accommodation in SCUs. The short-term benefits of placement in a SCU for persons with dementia in this small qualitative study, included reduced anxiety, awareness about the type of individual with dementia best suited for accommodation in SCUs. The short-term benefits of placement in a SCU for persons with dementia in this small qualitative study, included reduced anxiety, improved self-esteem and better interactions. There is a need for more quantitative studies to be undertaken to estimate the real effectiveness of SCUs both in the short term and more long term. To avoid having to transfer improved self-esteem and better interactions. There is a need for more quantitative studies to be undertaken to estimate the real effectiveness of SCUs both in the short term and more long term. To avoid having to transfer people with end-stage dementia to other facilities, existing SCUs need to consider extending their facilities to include areas for those terminally ill with dementia.people with end-stage dementia to other facilities, existing SCUs need to consider extending their facilities to include areas for those terminally ill with dementia.
AcknowledgementsAcknowledgementsThis PhD studentship is part of the Living With Dementia Research Programme and is funded by The Atlantic Philanthropies. This PhD studentship is part of the Living With Dementia Research Programme and is funded by The Atlantic Philanthropies.
LiteratureLiteratureCioffi, J. M., Fleming, A., Wilkes, L., Sinfield, M. & Le Miere, J. (2007). The effect of environmental change on residents with dementia: The perceptions of relatives and staff. Cioffi, J. M., Fleming, A., Wilkes, L., Sinfield, M. & Le Miere, J. (2007). The effect of environmental change on residents with dementia: The perceptions of relatives and staff. Dementia 6 (2),Dementia 6 (2), 215-231. 215-231.O’Shea, E. (2007). O’Shea, E. (2007). Implementing policy for dementia care in Ireland.Implementing policy for dementia care in Ireland. The Alzheimer Society of Ireland (Electronic Resource). The Alzheimer Society of Ireland (Electronic Resource). Shaw, R. L. (2009). Shaw, R. L. (2009). An introduction to Interpretative Phenomenological AnalysisAn introduction to Interpretative Phenomenological Analysis (Course materials). Aston University. (Course materials). Aston University.Teresi, J. A., Holmes, D. & Ory, M. G. (2000). The therapeutic design of environments for people with dementia: Further reflections and recent findings from the National Institute on Aging Collaborative Studies of Dementia Teresi, J. A., Holmes, D. & Ory, M. G. (2000). The therapeutic design of environments for people with dementia: Further reflections and recent findings from the National Institute on Aging Collaborative Studies of Dementia
Specialist Care Units. Specialist Care Units. Gerontologist 40 (4),Gerontologist 40 (4), 417-421. 417-421.
