South Tees NHS Foundation Trust · People with dementia feel empowered and enabled to exercise...

1 Written and compiled by Helen Robinson-Clinical Educator Dementia

Approved by the skilled and effective workforce work stream Review date July 2014

South Tees Hospitals NHS Foundation Trust

Excellence in dementia care across general hospital and community settings.

Competency framework 2013-2018



Contents Page 3 Introduction Page 4-8 Structure of the framework Page 9 The W.A.S.P. competency framework explained Page 10-12 Level 1 dementia care. Essential practice level. Page 13-34 Level 2 dementia care. Skilled practice level including W.A.S.P. competency

framework. Page 35-63 Level 3 dementia care. Enhanced practice level including W.A.S.P.

competency framework



Introduction At South Tees Hospitals Foundation Trust (STHFT) we strive to consistently deliver high quality care that meets the needs of our patients and their families in our hospitals and community services. Our organisational values place the patient central to everything we do and for those with dementia we recognise that care is often complex and admissions to hospital can be life changing. It is therefore vital that we all become dementia aware. For those who have clinical contact with patients with dementia it is essential that they have the right skills and knowledge to care competently and compassionately while promoting the individuals personhood. The principles of good dementia care should maximise each individual’s person rights, choices and health and wellbeing. South Tees Hospitals NHS Foundation Trust “Excellence in dementia care across general hospital and community settings competency framework 2013-2018” applies to all health staff that have contact with, and or provide support, care, treatment and services for people who have dementia, and their families and carers. Our framework is an amalgam of the Scottish Government’s “Promoting excellence: a framework for all health and social services staff working with people with dementia, their families and carers”(1) and the “South West dementia partnership dementia competency framework”(2). Embedded within this framework is the common core principles for supporting people with dementia: A guide for training the social care and health workforce (3). The development of the framework was informed by:

Evidence, best practice guidance and literature reviews;

Reviews of existing competency frameworks;

Links being made with wider UK dementia work programmes; and

Listening to what people with dementia, their friends, families and carers have said locally and nationally.

(1) Scottish Government (2011) Promoting Excellence: A Framework For All Health And Social Services Staff Working With People With dementia, Their Families And Carers. Scottish Government. (You may re-use this information (excluding logos and images) free of charge in any format or medium, under the terms of the Open Government Licence). (2) South West dementia Partnership (2011) dementia Competency Framework. South West dementia Partnership. Employers can use this framework for; Identifying training needs, Developing job descriptions, Commissioning, designing and delivering training, Informing supervision and appraisal, Informing service redesign, Demonstrating skill mix and competence within a performance framework, Demonstrating competence and competence levels in practice. (3) DOH (2011) Common Core Principles For Supporting People With dementia: A Guide For Training The Social Care And Health Workforce. London. HMSO. Copies of this work may be made for non-commercial distribution to aid social care workforce development



The structure of the framework. The dementia competency framework is an incremental 1, 2, 3 approach; moving from essential skills through enhanced skills, to specialist skills in dementia care. You must be proficient in Level 1 dementia care before you can move onto level 2. Again, you must be proficient in level 1 and level 2 dementia care before you can move onto level 3. Level 1 dementia care. Essential practice level - This looks at the basic awareness and training required in all areas of health and social care. Level 2 dementia care. Skilled practice level- This builds on the knowledge gained from the level 1 essential practice level. The focus of this level is the competencies required for staff working regularly with people with dementia, their relatives and carers. Level 3 dementia care. Enhanced practice level- This level builds on the knowledge gained from the level 1 essential practice level and the level 2 skilled practice level. The level 3 enhanced practice level is relevant to staff working more intensely with people with dementia, their relatives and carers. These levels are based on the knowledge and skills specific to the worker’s role, rather than to their position within an organisation or profession, in relation to dementia. Level 1 dementia care is, as the name suggests, essential to all staff within South Tees NHS Foundation Trust. With Level 2 and Level 3 dementia care, it is up to the individual staff member and their employer to ensure they cover the competencies and training required for their own role in relation to working with people with dementia, their families and carers.



The dementia competency framework.

The framework should be used at a personal, service provider and organisational level in a number of ways, and for a range of purposes:

By all staff members who are required to have a basic knowledge of dementia and the impact it has on the lives of those living with dementia, their family and carers. This would allow them to fulfil their responsibilities in delivering excellence in dementia care;

By individual staff members, alongside their managers or supervisors, to identify strengths and areas from improvement required by staff working regularly with people with dementia, their relatives and carers.

By wards and department managers, to ensure their staff have the correct level of dementia awareness and training to meet the needs of the people they serve, their family and carers.

The South Tees Hospitals NHS Foundation Trust “Excellence in dementia care across general hospital and community settings competency framework 2013-2018” uses seven outcomes to cover the fundamental areas of dementia care. These are supported with evidence from a vast range of sources, as shown below: Outcome one- The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect.

People with dementia feel empowered and enabled to exercise rights and choice, maintain their identity and to be treated with dignity and equality (1).

Objective 12: Improved end of life care for people with dementia (7).

Objective 13: An informed and effective workplace for people with dementia (7).

Recommendation 9. Begin to change the approach to care for people with dementia to one of dignity and respect (9).

I have personal choice and control or influence over decisions about me (10).

Statement 5. People with dementia, while they have capacity, have the opportunity to discuss and make decisions, together with their carer/s, about the use of advance statements, advance decisions to refuse treatment, lasting power of attorney, and preferred priorities of care (11).

G13. Consent to examination and treatment policy (12).

G34i. Covert medication (adults) policy (12).

G56. Advance decisions (living wills policy) (12).

G62. Safeguarding vulnerable adults policy (12).

G112. Privacy and dignity policy (12). (1) Scottish Government (2011) Promoting Excellence: A Framework For All Health And Social Services Staff Working With People With dementia, Their Families And Carers. Scottish Government. (You may re-use this information (excluding logos and images) free of charge in any format or medium, under the terms of the Open Government Licence). (7) DOH (2009) Living Well With dementia: The National dementia Strategy. (9) Alzheimer’s Society (2009) Counting the cost. Caring for people with dementia on hospital wards. (10) DOH (2010) Quality Outcomes for people with dementia: Building On The Work Of The National dementia Strategy. (11) NICE (2010) Dementia Quality Standard 2010. (12) South Tees NHS Foundation Trust. Various Policies.



Outcome Two- The person with dementia has access to good quality early diagnosis and intervention.

People with dementia have access to a timely and accurate diagnosis of dementia (1).

Objective 2: Good-quality early diagnosis and intervention for all (7).

Principle 1 Know the early signs of dementia (2).

Principle 2 Early diagnosis of dementia helps people receive information, support and treatment at the earliest possible stage (2).

I live in an enabling and supportive environment where I feel valued and understood (10).

Statement 2. People with suspected dementia are referred to a memory assessment service specialising in the diagnosis and initial management of dementia (11).

Statement 3. People newly diagnosed with dementia and/or their carers receive written and verbal information about their condition, treatment and the support options in their local area (11).

Outcome Three- The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing.

People with dementia maintain their best level of physical, mental, social and emotional wellbeing (1).

Principle 3 Communicate sensitively to support meaningful interaction (2).

Principle 4 Promote independence and encourage activity (2).

Principle 5 Recognise the signs of distress resulting from confusion and respond by diffusing a person’s anxiety and supporting their understanding of the events they experience (2).

Recommendation 8. Make sure that people with dementia have enough to eat and drink (9).

Statement 7. People with dementia who develop non-cognitive symptoms that cause them significant distress, or who develop behaviour that challenges, are offered an assessment at an early opportunity to establish generating and aggravating factors. Interventions to improve such behaviour or distress should be recorded in their care plan (11).

G61. Mental capacity act 2005 and deprivation of liberty safeguards policy (12).

G62. Safeguarding vulnerable adults policy (12).

G65. Protected mealtimes policy and guidance for assisted feeding (12).

G102. Pain management in inpatient adults policy (12).

G141. Mental health act (12). (1) Scottish Government (2011) Promoting Excellence: A Framework For All Health And Social Services Staff Working With People With dementia, Their Families And Carers. Scottish Government. (You may re-use this information (excluding logos and images) free of charge in any format or medium, under the terms of the Open Government Licence). (2) Common Core Principles For Supporting People With dementia: A Guide For Training The Social Care And Health Workforce (DOH, 2011). Copies of this work may be made for non-commercial distribution to aid social care workforce development (7) DOH (2009) Living Well With dementia: The National dementia Strategy. (9) Alzheimer’s Society (2009) Counting the cost. Caring for people with dementia on hospital wards. (10) DOH (2010) Quality Outcomes for people with dementia: Building On The Work Of The National dementia Strategy. (11) NICE (2010) Dementia Quality Standard 2010.



Outcome Four- The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities.

People with dementia are able to maintain valued relationships and networks, and have the opportunity to develop new ones both personal and professional (1).

Objective 1: Improving public and professional awareness and understanding of dementia (7).


I have a sense of belonging and of being a valued part of family, community and civic life (10). Outcome Five- The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers.

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 (1).

People with dementia have access to quality services and can continue to participate in community life and valued activities (1).

Principle 8 Work as part of a multi-agency team to support the person with dementia (2).

Objective 6: Improved community personal support services (7).


Recommendation 5. Ensure that there is an informed and effective acute care workforce in hospitals for people with dementia (9).

I know that services are designed around me and my needs (10).

G130. Clinical handover of care policy (12). (1) Scottish Government (2011) Promoting Excellence: A Framework For All Health And Social Services Staff Working With People With dementia, Their Families And Carers. Scottish Government. (You may re-use this information (excluding logos and images) free of charge in any format or medium, under the terms of the Open Government Licence). (2) Common Core Principles For Supporting People With dementia: A Guide For Training The Social Care And Health Workforce (DOH, 2011). Copies of this work may be made for non-commercial distribution to aid social care workforce development (7) DOH (2009) Living Well With dementia: The National dementia Strategy. (9) Alzheimer’s Society (2009) Counting the cost. Caring for people with dementia on hospital wards. (10) DOH (2010) Quality Outcomes for people with dementia: Building On The Work Of The National dementia Strategy. (12) South Tees NHS Foundation Trust. Various Policies.



Outcome Six- The person with dementia feels safe, in a supportive environment, and is enabled to be to be as independent as possible.

People with dementia feel safe and secure and are able to be as independent as possible (1).

Principle 4 Promote independence and encourage activity (2).

Objective 8: Improved quality of care for people with dementia in general hospitals (7).

Objective 9: Improved intermediate care for people with dementia (7).

Objective 10: Considering the potential for housing support, housing-related services and telecare to support people with dementia and their carers (7).

Objective 11: Living well with dementia in care homes (7).

Recommendation 7. Involve people with dementia, carers, family and friends in the care of people with dementia to improve person-centred care (9).

I live in an enabling and supportive environment where I feel valued and understood (10).

G30. Clinical falls prevention and management policy (12). Outcome Seven- The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need.

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 (1).

Principle 6 Family members and other carers are valued, respected and supported just like those they care for and are helped to gain access to dementia care advice (2).

Objective 3: Good-quality information for those with diagnosed dementia and their carers (7).

Objective 4: Enabling easy access to care, support and advice following diagnosis (7).

Objective 7: Implementing the Carer’s Strategy (7).

Recommendation 7. Involve people with dementia, carers, family and friends in the care of people with dementia to improve person-centred care (9).

I have support that helps me live my life (10).

I have the knowledge and know-how to get what I need (10).

Statement 6. Carers of people with dementia are offered an assessment of emotional, psychological and social needs and, if accepted, receive tailored interventions identified by a care plan to address those needs (11).

Statement 10. Carers of people with dementia have access to a comprehensive range of respite/short-break services that meet the needs of both the carer and the person with dementia (11).

(1) Scottish Government (2011) Promoting Excellence: A Framework For All Health And Social Services Staff Working With People With dementia, Their Families And Carers. Scottish Government. (You may re-use this information (excluding logos and images) free of charge in any format or medium, under the terms of the Open Government Licence). (2) Common Core Principles For Supporting People With dementia: A Guide For Training The Social Care And Health Workforce (DOH, 2011). Copies of this work may be made for non-commercial distribution to aid social care workforce development (7) DOH (2009) Living Well With dementia: The National dementia Strategy. (9) Alzheimer’s Society (2009) Counting the cost. Caring for people with dementia on hospital wards. (10) DOH (2010) Quality Outcomes for people with dementia: Building On The Work Of The National dementia Strategy. (11) NICE (2010) Dementia Quality Standard 2010. (12) South Tees NHS Foundation Trust. Various Policies.



W.A.S.P. framework structure In order to assist in the assessment of skills, the W.A.S.P. (Witnessed, Assimilated, Supervised, and Proficient) framework will be used. The W.A.S.P. Framework is divided into four sections; i) action, ii) rationale, iii) W.A.S.P. assessment and iv) comments and progress record. The W.A.S.P. assessment (see table below) is used for each competency and contains a scoring process which is used to assess progress.

W Witnessed Observe or witness the competency. It is considered good practice that the learner will have had the opportunity to observe an assessment prior to being supervised.

A Assimilated Understand the elements of the competency. Three essential elements, theory, practice and professional approach. Demonstrate sound knowledge base for the competency element, including relevant Trust Policies, and Professional and Legal issues relating to it. Assimilation of knowledge can be assessed through observation of practice, or through questioning/discussion/simulation of situations relating to the competency element if these particular situations have not arisen.

S Supervised Practice under supervision to demonstrate understanding. Score as follows: 1 needs further practice; 2 shows aptitude; 2 proficient.

P Proficient Competent in knowledge and skill elements of the competency.



Level 1 dementia care. Essential practice level



Level 1 dementia care. Essential practice level

Level 1 dementia care. Essential practice level Basic/fundamental awareness and training required in all areas of the Trust. Level 1 dementia care. Essential practice level is basic knowledge about dementia and the impact it has on the lives of those living with dementia, their family and carers. Content includes the signs and symptoms of dementia and their effects on the person, person-centred care, communication issues, environmental issues, awareness of relevant legislation and support for the person with dementia, their families and carers. Outcome One- The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect.

Quality of life;

Person-centeredness;

Choice and control;

Supporting strengths;

Understanding about the risk of neglect, harm and abuse. Outcome Two- The person with dementia has access to good quality early diagnosis and intervention.

How to access information and services;

Common signs and symptoms;

Communication methods. Outcome Three- The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing.

Hazards;

Effects of symptoms;

Responding to distress. Outcome Four. The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities

Support;

Engagement in activities;

Spiritual and cultural needs;

Environment. Outcome Five- The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers. Not applicable at Level 1. Outcome Six- The person with dementia feels safe, in a supportive environment, and is enabled to be as independent as possible.

Stigma;

Social Isolation.



Outcome Seven- The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need. Not applicable at Level 1.

**At present Level 1 dementia care. Essential practice level is an interactive taught session with the Clinical

Educators and is not included within a W.A.S.P. framework**



Level 2 dementia care. Skilled practice level



Level 2 dementia care. Skilled practice level Level 2 dementia care. Skilled practice level Builds on the knowledge gained from the level 1 dementia care. Essential practice level. The focus of this level is on the competencies required for staff working regularly with people with dementia, their relatives and carers. This could be on the ward, in outpatient areas, in the community, and even in people’s own homes. It is expected than anyone undertaking level 2 dementia care. Skilled practice level will have already undertaken level 1 dementia care. Essential practice level, as this level builds on the knowledge already obtained from this. Content includes key legislation, risk assessment, health and wellbeing and anticipatory care planning. Outcome One- The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect.

Health behaviours;

Key legislation. Outcome Two- The person with dementia has access to good quality early diagnosis and intervention. No expansion from skills and knowledge gained in level 1 dementia care. Essential practice level. Outcome Three- The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing.

Life story;

Specific health conditions associated with dementia;

Interventions that can support good nutrition, skin care continence and pain management;

Distress caused by changes in routine;

Communication. Outcome Four- The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities.

Engagement in activities;

Current networks and introduction to third sector agencies for peer and group support;

Independence;

Spiritual and cultural needs;

Environment;

Need for involvement;

Capacity;

Challenges faced by the person with dementia, their family and carers. Outcome Five- The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers.

Types of dementia;

Community based support;

Voluntary services.



Outcome Six- The person with dementia feels safe, in a supportive environment, and is enabled to be as independent as possible.

Services available to the person with dementia, their family and carers;

Assistive technology;

Aids and adaptations used;

Stigma and social isolation;

Care approaches used. Outcome Seven. The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need.

Safety and wellbeing;

Early diagnosis and its importance;

Stages of the dementia journey;

Cognitive stimulation.



Level 2 dementia care. Skilled practice level. Outcome One.

Competency Standard Statement The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect.

W WITNESSED Observe or witness the competency – it is considered good practice that the healthcare professional will have had the opportunity to observe the procedure prior to being supervised.

A

ASSIMILATED Understands the underpinning knowledge associated with each element of the competency 1 = DEMONSTRATES FUNDAMENTAL KNOWLEDGE AND UNDERSTANDING 2 = DEMONSTRATES BROAD KNOWLEDGE AND UNDERSTANDING 3 = DEMONSTRATES IN DEPTH KNOWLEDGE AND UNDERSTANDING

S

SUPERVISED Practice under supervision to demonstrate understanding: score as follows: 1 = NEEDS FURTHER PRACTICE 2 = SHOWS APTITUDE 3 = DEMONSTRATES SKILLED AND PROFESSIONAL PRACTICE

P PROFICIENT Competent in both knowledge and skill elements of the Competency.

ACTION RATIONALE W A (Score) S (Score) P

Demonstrate knowledge of health behaviours that may affect the person with dementia. Work in a way which promotes choice, well-being and protection of all individuals.

To enable individuals with dementia to make informed choices concerning their health and wellbeing.

Be aware of the key provisions of:

Mental Health Act (1983);

The Human Rights Act (1998);

Mental Capacity Act (2005); and

The Equalities Act (2010).

To support the person with dementia. To assess risk in relation to capacity. To allow previously expressed wishes to be taken into account.



Be aware of how to contact the local Safeguarding Team (South Tees Hospitals NHS Foundation Trust Policy G62. Safeguarding Vulnerable Adults Policy).

To contribute to the assessment of people at risk of abuse.

Involve the person with dementia in all decisions and respect the decisions that they make. Consider the need for an advocate or independent mental capacity advocate in various stages of the dementia journey.

To support the person with dementia and to aid them in exercising their rights and choices.

Staff Member (Signature)

Trainer (Signature)

Competency Achieved

Yes/No

Date



Reflection on learning in practice.

Describe the learning activity?

How many hours was the session?

What have you learnt?

How will this influence your practice?

What further learning needs has this identified?



Level 2 dementia care. Skilled practice level. Outcome Two.

Competency Standard Statement The person with dementia has access to good quality early diagnosis and intervention.

*** No expansion from skills and knowledge gained in Level 1 dementia care. Essential Practice Level ***



Level 2 dementia care. Skilled practice level. Outcome Three.

Competency Standard Statement The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing.


A


S



ACTION RATIONALE

W A (Score) S (Score) P

Recognise and respect the spiritual, cultural and personal beliefs of the person with dementia. Provide information or signpost to services.

To enable support of the spiritual, cultural and personal wellbeing of individuals.

Assist with maintaining the physical comfort of the person with dementia.

To allow for physical comfort.

Assist the patient with dementia to mobilise (within the learner’s professional responsibility).

To allow for maintenance of mobility.

Manage the person with dementia’s physical, mental, social and emotional needs (within the learner’s professional responsibility). Support individuals during activities to improve

To maintain their best level of physical, mental, social and emotional wellbeing.



their physical health and wellbeing. Support individuals during activities to improve their social wellbeing. Understand the need to assess mental, alongside physical, wellbeing.

Use life story and ’patient passports’ to support meaningful engagement of the patient with dementia.

To understand the person with dementia’s history and support their individuality.

Understand that the person with dementia may not be able communicate physical illness, pain or mental distress.

To ensure that the person with dementia is cared for holistically, taking into account their own ability to communicate need.

Contribute, as appropriate to your role, to the palliative and end of life care of the person with dementia.

To allow for the maintenance of dignity and to enable the person with dementia to have a good death.


Trainer (Signature)

Competency Achieved

Yes/No

Date



Level 2 dementia care. Skilled practice level. Outcome Four.

Competency Standard Statement The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities.


A


S




Establish a therapeutic relationship with the person with dementia, their family and carers. Maintain a therapeutic relationship for the required duration and appropriately disengage from the therapeutic relationship as appropriate.

To allow for a sense of belonging and empowerment.

Support the person with dementia to develop and maintain relationships with others.

To allow for a sense of belonging.

Understand that it is important for the person with dementia, their family and carers to have the opportunity to be a valued part of the local community.

To allow for a sense of belonging, empowerment and independence.



Understand that the person with dementia must be encouraged to continue with their work, chosen activities, social and community life, as appropriate to the individual.


Assist the person with dementia and their family and carers to contact local support.

To allow for a sense of empowerment.

Understand that environmental adjustments may be required to help the person with dementia maintain valued relationships and networks.

To aid access and to allow participation in all stages of the dementia journey.

Understand that there may be challenges to maintaining valued relationships and networks as the dementia progresses. Understand the person with dementia, their friends and family may need additional support at various stages, including counselling and psychological therapies, and know how to access or to signpost to these.



Trainer (Signature)

Competency Achieved

Yes/No

Date



Level 2 dementia care. Skilled practice level. Outcome Five.

Competency Standard Statement The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers.


A


S




Have knowledge of the four main types of dementia:

Alzheimer’s Disease;

Vascular dementia;

Front temporal dementia; and

Dementia with Lewy bodies.

To allow an awareness of the range of challenges encountered by the person with each type of dementia.

Be aware of local specialist memory services available.

To support the person with memory impairment to access appropriate services.



Have knowledge of support services available (such as professional, specialist and voluntary services) for the person with dementia, their family and carers.

To refer or signpost the person with dementia, their family and carers; To empower the person with dementia and to allow them to maintain their independence.

Assist in the movement of the patient between services (such as community, social, hospital, and specialist) and support as appropriate.

To refer or signpost the person with dementia, their family and carers.

Contribute to effective multidisciplinary team working.

To ensure services are used appropriately; with the individual at the centre of the decision making.


Trainer (Signature)

Competency Achieved

Yes/No

Date



Level 2 dementia care. Skilled practice level. Outcome Six.

Competency Standard Statement The person with dementia feels safe, in a supportive environment, and is enabled to be as independent as possible.


A


S




Recognise that environmental factors can affect the person with dementia and, wherever possible, be aware of adaptations that can be made. Monitor any changes in physical and mental health and ensure these are addressed, as appropriate to your role.

To support the person with dementia to be as independent as possible.

Work with other members of the multidisciplinary team to ensure the person with dementia has a full assessment of their home environment, allowing for adaptations to be made, as appropriate.

To allow the person with dementia to feel safe and secure.



Provide information and signposting to services for risk enablement, such as telecare.

To ensure the maintenance of independence for as long as possible.

Provide support and encouragement, with activities of daily living, appropriate to your role.

To support the person with dementia to maintain good physical health.

Have knowledge of some of the equipment available to aid with diet, fluids and continence, appropriate to your role.

To allow the person with dementia to remain independent and to maintain their dignity at all times.

Recognise when the person with dementia is at risk of falls and react appropriately; Understand the impact of visual and auditory problems on the risk of falls.

To maintain the safety and dignity of the person with dementia.

Understand that admission to hospital can have a dramatic detrimental effect on the person with dementia.

To promote the use of anticipatory and preventative measures that can be put in place to prevent admission, or readmission, to the acute setting.


Trainer (Signature)

Competency Achieved

Yes/No

Date

31







32

Level 2 dementia care. Skilled practice level. Outcome Seven.

Competency Standard Statement The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need.


A


S




Respond with compassion to the person with dementia, and their families and carers, when they show signs of frustration and distress.

To enable a sense of empowerment and independence.

Be aware of the needs of families and carers and enable a Carer’s Assessment to take place.

To ensure the health and wellbeing of those close to the person with dementia.

Build a therapeutic relationship with the person with dementia, their family and carers.

To ensure that the needs of the person with dementia are at the centre of all decision making.

Be able to give information on or signpost to Carer’s Associations, specialist services, benefits advice and support agencies.

To ensure the person with dementia, their families and carers have the knowledge and support they need.

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Include families and carers, where appropriate, in honest discussions about the progression of dementia and the terminal nature of the disease.

To enable the person with dementia, their family and carer to make informed choices about their own care.


Trainer (Signature)

Competency Achieved

Yes/No

Date

34







35

Level 3 dementia care. Enhanced practice level.

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Level 3 dementia care. Enhanced practice level. Level 3 dementia care. Enhanced practice level. Builds on the knowledge gained from the level 1 dementia care. Essential practice level and the level 2 dementia care. Skilled practice level. The enhanced practice level is relevant to staff working more intensely with people with dementia, their relatives and carers. This could be within dementia clinics, memory clinics, dementia advisory services, and EMI care homes. It is expected than anyone undertaking Level 3 dementia care. Enhanced practice level will have already undertaken level 1 and level 2 dementia care, as this level builds on the knowledge already obtained from these. Content includes a much more in-depth overview of dementia; how this affects the person, their family, friends and carers, using an evidence-based approach. Outcome One- The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect.

Human and legal rights;

Safeguarding;

Knowledge of principles and key provision of legislation;

Future planning and the potential for distress;

Creating a life story;

Complexity of disease progression;

Keeping family and carers informed;

Advocacy;

Remaining up to date with dementia care. Outcome Two- The person with dementia has access to good quality early diagnosis and intervention.

Evidence based health behaviours;

Detailed knowledge of dementia and the need for support;

Evidence based screening tools;

Delirium, depression and dementia and knowing how to differentiate. Outcome Three- The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing.

Health promotion;

Causes and signs of distress;

Sensitive approach to the person with dementia through all stages in their dementia journey;

Specialist services;

Self-management and self-help;

Quality of life;

Carer’s assessments;

Understanding pain, nutritional needs, physical wellbeing and cultural and spiritual support services available at end of life;

Psychological and emotional effects of dying affecting the person with dementia, family and carers;

Bereavement support;

Physical conditions associated with different types of dementia.

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Outcome Four- The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities

Local services offering assessment and advice on memory problems;

Impact of diagnosis;

Younger onset dementia;

Personalisation of care;

Enablement;

Social inclusion and quality of life;

Understanding behaviours shown in distress;

Balancing dependence and interdependence; and

Helping the person with dementia to communicate their decisions. Outcome Five -The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers.

Problem solving with regard to what the person with dementia perceives as important;

Pharmacological interventions;

Guidance in the use of medication for people with dementia;

Supporting the person with dementia, their family and carers in times of distress;

Range of interventions that can support good nutrition, skin care, continence and pain management;

Specialist services available. Outcome Six- The person with dementia feels safe, in a supportive environment, and is enabled to be as independent as possible.

Quality of life;

Independent living;

Risk enablement;

Respite and short breaks for the patient and their carer;

Neglect and abuse;

Informed consent, confidentiality and advance planning and the implications of such;

Communication. Outcome Seven- The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need.

The role of families, friends and carers and their rights;

Determining capacity;

Communication and tools available.

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Level 3 dementia care. Skilled practice level. Outcome One.

Competency Standard Statement The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect.


A


S




Have a detailed knowledge of the key provisions of:

The Mental Health Act (1983);

The Human Rights Act (1998);

Mental Capacity Act (2005);

The Equalities Act (2010).

To support the person with dementia. To assess risk in relation to capacity. To empower the person with dementia and to allow previously expressed wishes to be taken into account.

Be able to provide clinical information on dementia to the person with dementia, their family and carers.

To enable the person with dementia to make well informed choices concerning their health and wellbeing.

Have an in-depth understanding of person centred care.

To empower the person with dementia.

Be aware of the signs and symptoms of elder abuse.

To contribute to the assessment of people at risk of abuse.

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Be aware of how and when to make an Adult Safeguarding Referral (South Tees Hospitals NHS Foundation Trust Policy G62. Safeguarding Vulnerable Adults Policy) and encourage others to do the same.

Involve the person with dementia in all decisions and respect the decisions that they make. Be aware of how and when to refer the person with dementia to an advocate or independent mental capacity advocate in various stages of the dementia journey.


Be aware of risk taking and enable to person with dementia to take risks in the context of their own lives.


Enable the person with dementia, their family and carers to discuss sensitive areas such as Advanced Planning, Power Of Attorney, Advance Directives and progression of the disease. Sensitively and empathetically support the person with dementia to make plans and identify their priorities for the future. Be aware when Advanced Planning has taken place, whether or not this has been recorded, and whether this knowledge has been used to deliver patient centred care.

To enable the person with dementia to make well informed choices concerning their health and wellbeing, and to aid them in exercising their rights and choices.

If no Advanced Planning is in place, work with family, carers or patient advocates, to ensure the choices of the person with dementia are met to the best possible knowledge.


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Be aware that there can be conflicts of interests between the person with dementia, their family and carers and deal with this in a sensitive manner.


Provide on-going support, appropriate to your role, guidance and advice for family and carers after the death of the person with dementia.

To allow for the family and carers to feel supported and to show respect for the choices the person with dementia may have made on matters of end of life care.


Trainer (Signature)

Competency Achieved

Yes/No

Date

41







42

Level 3 dementia care. Skilled practice level. Outcome Two.

Competency Standard Statement The person with dementia has access to good quality early diagnosis and intervention.


A


S




Good knowledge of approved assessment tools used in the diagnosis of dementia. Knowledge of how to refer the person to general practitioner and memory clinic services.

To support the person with memory impairment to access appropriate services.

Support the person, their family and carers through the screening process. Work with others, where appropriate to your role, to establish a diagnosis of the person’s health condition. Be aware of the impact of diagnostic errors to the person, their family and carers. Be aware of the personal needs of the person with a suspected dementia.

To allow for informed choices to be made and to support the person with memory impairment, their family and carers in the diagnosis of a possible dementia.

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Understand the needs of hard to reach groups of people with a suspected dementia:

Learning disabilities;

Younger people;

People with communication difficulties.

To allow people in hard to reach groups to access the same quality early diagnosis and intervention as others with a suspected dementia.

Excellent knowledge of communication skills, methods of interaction and approaches to communication needed for person centred care.

To ensure tactful and timely interventions.


Trainer (Signature)

Competency Achieved

Yes/No

Date

44







45

Level 3 dementia care. Skilled practice level. Outcome Three.

Competency Standard Statement The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing.


A


S


P PROFICIENT Competent in both knowledge and skill elements of the competency.


Demonstrate detailed knowledge of the spiritual, cultural and personal beliefs of the person with dementia, their family and carers. Provide information or signpost to services.

To enable support of the spiritual, cultural and personal wellbeing of individuals.

Demonstrate detailed knowledge of health promotion and understand how this can impact on each of the stages of dementia.

To enable the person with dementia to maintain their best level of physical, mental, social, emotional and spiritual wellbeing.

Have knowledge of a range of physical conditions that can be associated with different types of dementia (visual difficulties, vascular conditions, auditory difficulties).

To allow for physical and emotional wellbeing.

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Knowledge of local services that provide specialist physical health assessments, treatments and services for people with dementia.

To allow for physical wellbeing.

Support and enable the person with dementia to remain active and mobile.

To allow the person with dementia to maintain their best level of physical wellbeing.

Be able to recognise the common physical health problems of the person with dementia, their family and carers and make referrals to specialists where necessary.


Understand the need to assess pain thoroughly, how to distinguish between chronic and acute pain and that dementia impairs the person’s ability to articulate their pain.

To allow for physical, emotional and mental wellbeing.

Be aware of when to seek specialist help from other services (social services, mental health services, dietetic services) and be able to refer to services when required.


Knowledge of local services that provide specialist psychological interventions and therapies.

To enable the person with dementia to maintain their best level of mental, emotional and spiritual wellbeing.

Be able to recognise the common mental health problems (such as depression, anxiety, delirium) of the person with dementia, their family and carers and make referrals to specialists where necessary. Respond sensitively and empathetically to non-verbal cues from the person with dementia, their family and carers that may indicate they are in

To enable the person with dementia to maintain their best level of mental, emotional and spiritual wellbeing; To enable the family and carers of the person with dementia to maintain their best level of mental, emotional and spiritual wellbeing; allowing them to continue caring at their best.

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psychological distress.

Understand the impact and potential losses associated with a diagnosis of dementia and the range of possible reactions, including emotional distress. Understand that changes in behaviour are often a sign that the person with dementia is trying to communicate a need, and respond with appropriate interventions based on knowledge of the person with dementia.

To enable the person with dementia to maintain their best level of mental, emotional and spiritual wellbeing.

Have knowledge of medications used to delay dementia signs and symptoms. Have knowledge of antipsychotic medications and the risk factors associated with them. Be able to discuss the uses of medications in a sensitive manner with the person with dementia, their family and carers. Understand the specific pharmacological issues relating to people with dementia in responding to both physical and psychological needs, including poly-pharmacy and covert medication. Where medication use is indicated ensure it adheres to national and local guidance relevant to people with dementia.

To allow for physical and mental wellbeing.

Implement, where appropriate to role, individual or group therapeutic activities.

To allow the person with dementia to maintain their best level of physical, mental, social, emotional and spiritual wellbeing.

Be aware of the need to promote the person with To allow for physical and mental wellbeing.

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dementia’s strengths and maximise their ability to engage in self-management.

Knowledge of the similarities and differences between dementia, delirium and depression and the appropriate treatment options and responses required for both.

To allow for physical and mental wellbeing.

Knowledge of the complexity associated with the progression of dementia and the signs and symptoms associated with the end of life. Best practice knowledge and a range of approaches to gathering information from people with dementia, their family and carers at the end of life.

To allow the person with dementia to maintain their best level of physical, mental, social, emotional and spiritual wellbeing to the end of life.

Knowledge and understanding of the legal and policy position regarding resuscitation in relation to people with dementia.

To allow for the recognition of the wishes of the person with dementia.


Trainer (Signature)

Competency Achieved

Yes/No

Date

49







50

Level 3 dementia care. Skilled practice level. Outcome Four.

Competency Standard Statement The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities.


A


S




Assist in the assessment of need for, and provision of, social support in the community. Refer to the most appropriate service as needed.

The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities.

Assist in helping the person with dementia, their family and carers evaluate and contact support services available. Enable the person with dementia, their family and carers to access support networks and respite services.

To allow access to the best quality services available and to enable to carers to continue caring to the best of their health and ability.

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Promote the benefit of staying active and of the participation in valued activities as the dementia progresses. Have good knowledge of self-directed support and how this can be enabled and maximised to support the person with dementia.

To allow for a sense of empowerment.

Have a detailed knowledge of services available within the community for example:

Memory devices;

Dementia support services;

Carers support;

Assistive technology;

Assisted living.

To gain the best support for the person with dementia, empowering them to maintain valued relationships and networks.

Understand the increased risk of those with a learning disability developing dementia.

To allow for the early implementation of plans to empower the person with dementia and to allow them to access the most appropriate services for their needs.

Understand the importance of maintaining roles, relationships and community endeavors to the person with dementia, their family and carers. Understand the impact a diagnosis of dementia may have on people from :

A range of ethnic and cultural groups;

Those with learning disabilities;

Younger people.

To allow for a sense of belonging and empowerment and an opportunity to maintain and develop relationships. To enable the most appropriate care and advice to be given with regard to the person’s personal beliefs.

Have good knowledge of how dementia can change the dynamics of relationships with friends, family and carers and how these changes can be supported.

To allow for the implementation of plans that supports the person with dementia, their family and carers.

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Actively promote dignity and respect for the person with dementia and challenge any discriminatory practices that may compromise the person’s right to dignity, safety and respect.


Work with the person with dementia, their family and carers to use a range of psychological, environmental and social interventions to empower the person with dementia so they can participate in community life and valued activities.

Empowering the person with dementia to remain an active participant in community life.

Knowledge of how to sensitively support a person in the creation of a life story which forms the basis for understanding their cultural, spiritual and personal history, and supports the implementation of their present and future wishes and choices.

To allow for the development of new relationships and networks; both personal and professional.

Understand the potential risk of social isolation that can follow a diagnosis of dementia. Work to maximise social inclusion by supporting people with dementia, family and carers, to access community organisations and supports.

To give the person with dementia a sense of belonging and an opportunity to maintain valued relationships.


Trainer (Signature)

Competency Achieved

Yes/No

Date

53







54

Level 3 dementia care. Skilled practice level. Outcome Five.

Competency Standard Statement The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers.


A


S




Be actively involved, where appropriate to role, in the evaluation of services for people with dementia in your own area.

To ensure the person has access to the best quality services for their needs.

Have an in-depth knowledge of the four main types of dementia:

Alzheimer’s Disease;

Vascular dementia;

Frontotemporal dementia; and

dementia With Lewy bodies; as well as an awareness of other rarer types of dementia.

To allow an awareness of the range of challenges encountered by the person with each type of dementia.

Know how to refer, and actively do so according to role, to specialist memory services, support services and voluntary services for the person with dementia, their family and carers.

The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers.

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Be aware of CQUIN targets specific to dementia.

To show awareness of government targets for the improvement of services for the person with dementia, their family and carers.

Be aware of dementia care mapping and its use within the Trust.

To show awareness of how services are being continually improved for the person with dementia, their family and carers.


Trainer (Signature)

Competency Achieved

Yes/No

Date

56







57

Level 3 dementia care. Skilled practice level. Outcome Six.

Competency Standard Statement The person with dementia feels safe, in a supportive environment, and is enabled to be as independent as possible.


A


S




Have a full and comprehensive knowledge of environmental factors and the impact adaptation and the use of colour can have. Monitor any changes in physical and mental health and ensure these are addressed, as appropriate to your role.

To allow for an appropriate and safe environment for the person with dementia; allowing them to stay as independent as possible for the greatest amount of time.

Actively support the person with dementia to retain their skills, and develop new ways of adapting to the environment, as the disease progresses.

To allow the person with dementia to feel safe and supported, whilst retaining their independence.

Be involved, where appropriate to role, in the development of action plans which assist in the improvement of environments.

To create a safe and supportive environment for the person with dementia.

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Monitor and review changes in environments.

To maintain a safe and supportive environment for the person with dementia.

Refer to services that allow for risk enablement, such as telecare. Support people with dementia in risk enablement through involvement in risk assessment and management.

To allow the person with dementia to feel safe, in a supportive environment, and enable them to be as independent as possible.


Trainer (Signature)

Competency Achieved

Yes/No

Date

59







60

Level 3 dementia care. Skilled practice level. Outcome Seven.

Competency Standard Statement The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need.


A


S




Support the person with dementia, their family and carers to exercise their rights, entitlements and choices.

To enable them to live how they wish.

Engage with the person with dementia, their family and carers as equal and expert partners in care.

To show respect and to ensure you understand what they choices mean to them.

Have good knowledge of the outcomes of assessments of the person with dementia, including referrals to specialists, self-directed support and carer’s assessments.

To ensure the person with dementia, their family and friends have all information required to feel supported and able to make informed decisions.


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Trainer (Signature)

Competency Achieved

Yes/No

Date

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South Tees NHS Foundation Trust · People with dementia feel empowered and enabled to exercise...

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