Supporting the
homecare workforce
working with people
with dementia
The Presenters
Area officer 1
Area officer 2
Chapter 1
Supporting new staff into the
homecare sector and addressing
misconceptions about dementia
1. Only old people get dementia
2. There is no treatment for dementia
3. Nothing can be done for people with
dementia
4. There is no point visiting people with
dementia – they won’t remember me
5. People with dementia are aggressive and/or
violent
6. There is nothing I can do to lower my risk of
getting dementia
Dementia - Misconceptions
1. Make dementia awareness training part of every
new employee’s induction process
2. Do not overwhelm new workers with huge
amounts of statistics – provide information in bite
size chunks
3. When training more than one new worker,
understand that they will have different learning
needs/learning styles
Top Tips
4. Provide continuity of care for the
person with dementia, this will enable
new workers to build a solid foundation
with them
5. Incorporate different training techniques,
ranging from group training sessions to
on the job training
Top Tips
What’s your learning style?
Activity
What dementia training do you
provide for new workers?
How do you cater for
different learning styles?
Group discussion
• Common Induction standards
• Common Core Principles Self Care,
Dementia, EofLC, Dignity
• Supporting People in the Advanced
Stages of Dementia
• SCIE Dementia Gateway
• Alzheimer’s Society website/factsheets
• Dementia Friends campaign
Resources
Chapter 2
Motivation of homecare workers who
support people with dementia
• Top tips for managers from the Good Care
Group
• Staff motivation – why it’s important and
what the challenges are
• Resources and best practice guidance to
support the top tips
• Discussion – considering what else your
organisation could do to motivate staff
Introduction
• Base recruitment on values and competences.
• Ensure employees have the expertise, support and tools they need.
• Understand situations from the worker’s perspective.
• Treat homecare workers as professional experts and support their career development.
• Have clear and achievable goals so that success can be verified and celebrated
Top Tips
• Motivated workers deliver higher quality care
because they care about what they are doing
• They often learn faster and have more ideas
and are less likely to make mistakes
• Motivated homecare workers are enthusiastic,
patient and encouraging to others. This impacts
on the care they deliver to individuals and
families
• Direct links between high motivation and high
retention rates
•
Importance of staff
motivation
• Lone working
• Varied hours / zero-hour contracts
• Complex work
• Poor integration across health & social care
services
• Funding
• Levels of pay
Motivation of homecare staff
- challenges
• Turnover in the domiciliary care sector in England is
currently 28.2% (NMDS-SC)
• Ensuring the ‘right’ people for the role are selected is
the first step towards developing a motivated workforce
• New skills and knowledge can be taught, but attitudes
are more difficult to change
• Cavendish Review: “Organisations that recruit people
for their values and commitment to caring…know that it
improves care and staff engagement which in turn
reduces attrition rates and the cost of hiring”
Values Based Recruitment
• 15FQ+ Personality Questionnaire: www.15fq.com/
• Value Based Recruitment Toolkit:
http://profiles4care.com/participate/
• A Question of Care: www.aquestionofcare.org.uk
• Finders, Keepers
• Culture Toolkit: www.skillsforcare.org.uk/culture
• Social Care Commitment:
www.thesocialcarecommitment.org.uk
Values Based Recruitment
Resources
• Training in dementia care skills and related
topics – CIS/Care Cert; Diplomas; Awards &
Certificates; e-learning; Apprenticeships
• Having support 24/7: It is important for
homecare workers to know that there is
someone out there offering support
• Clear lines of escalation: definition of roles,
responsibilities and professional boundaries is
critical in homecare
Ensuring people have the
things they need
• Seeking feedback and acting upon it – use of
employee surveys, opportunities for group
verbal feedback, annual appraisals and
supervisions (‘Providing Effective Supervision’
resource)
• Fostering a culture where feedback is always
received as a gift is vital
• Having a robust process for when a worker
raises a concern, grievance or resigns
Understanding the workers
perspective
• Offering CPD opportunities (‘Keeping up the
good work’ resource)
• Empowering workers – involvement in the
development of creative solutions to support
clients
• Ensuring employment packages reflect the
professional status of the homecare worker’s role
Professional
experts/CPD
• Understanding what good looks like: CCPs, NICE
guidelines
• Celebrating and publicly recognising success:
Accolades
• Care Planning meetings – ensure all goals are
SMART
Clear goals
1) What you currently do to motivate your
staff
2) Anything you might do differently after
hearing the presentation today
3) How you can make this happen
Discuss in groups
Chapter 3
The importance of a flexible
workforce and continuing
professional development
• This section was developed by Ann Tuplin Care Services in North Lincolnshire (Scunthorpe)
• This is a Home Care service who are providing support to people with dementia who want to remain at home and live as independently as possible for as long as possible…
Introduction
• Because individual’s needs can change rapidly
• The support delivered often needs to change as the person’s needs change
Support in the person’s
home is challenging
A workforce that is:
• Able to respond to the individual’s need at that moment in time
• Able to adapt to the ever changing needs of an individual
Flexible workforce means?
• Staff need to have skills and confidence in themselves
• Staff need to have confidence in their line managers
• Staff need to be involved in the process of delivering support
• Line managers need to have confidence in their staff
This means that…
• The consistency and continuity that contracted staff can offer, only using ‘bank’, casual workers when there is a compelling reason.
• Ensuring that staff do not work excessively long shifts.
• Responsive rotas based on person centred plans.
Clear systems
As Managers, what kinds of
things are in place to support your workforce deliver quality
services?
Discussion
• Regular 1-1 / supervision sessions – how frequent? Are they recorded?
• Appraisals – do they take place each year? Are they recorded?
• Does each member of staff have a Personal Development Plan?
Supporting the workforce
• What kinds of learning and development activity do staff have access to? How is information recorded?
• Shadowing / observations?
• Taught sessions?
• Peer discussions?
• Own research?
• Internal / external meetings / events?
Supporting the workforce
1. Continuity is as important for staff as it is for people who need care and support
2. Support and supervision for staff is essential 3. Ensure company ethos is sympathetic and
encouraging for staff learning requirements 4. Involve staff in planning their own learning and
development 5. Match staff to work, taking into account capability
and interest
Top Tips
Information for Leaders and Managers https://www.nsasocialcare.co.uk/about-us/leadership-qualities-framework http://www.skillsforcare.org.uk/Document-library/Standards/Manager-Induction-Standards/Manager-Induction-Standards.pdf
Resources
Chapter 4
Supporting workers providing care
for people whose behaviour may
challenge, in their own homes
What behaviours do you
consider are ‘challenging’?
Question
Aggression Agitation Restless
Being sexually inappropriate
Repeated questioning Repetitive actions
Clinging & following Losing things
Delusions or hallucinations
Behaviours
Discuss these behaviours
and share techniques to
deal with them
Group discussion
http://www.scie.org.uk/socialcaretv/video-player.asp?guid=bce0a383-9d9e-45bd-8593-e9c4fe6318ed
Des video sent to link officers by Karen S
Video
• Try not to see the behaviour in the same
way you might from a ‘well’ person
• If possible, remove what’s causing the
problem
• Stay calm, don’t shout or argue
• Give the person some space
• Reflect on the situation
Supporting staff to manage
behaviour they may find
challenging
1. Leadership: be clear on your leadership influences and translate
these into your business plan. Have a clear vision of what
services you want to provide, and include workers, people who
need care and support and their carers in shaping your services.
2. Developing and supporting workers is a sharing process; assist
workers to be accountable for communicating difficulties and the
changing needs of the people they are supporting.
3. Dig deeper when faced with labels such as “challenging
behaviour”; often the person who needs support is trying to
communicate.
Top Tips
4.Person-centred care is challenging to get into
every day care; attention to detail on support plans
and their formulation process is key to working this
way.
5.Look at the lines of communication open to
workers, people who need care and support and
their carers and let them witness the effectiveness
of communicating. Highlight changes that have
taken place due to their input.
Top Tips
• A Positive & Proactive Workforce
• Supporting staff working with people
who challenge services
• Domiciliary Care Lone Worker Safety
guide
• Effective supervision
• Carers resources
Resources
Chapter 5
Enhancing quality of life through
activity-based support
Benefits: • Improved independence
• Maintain skills
• Learn new skills
• Mitigate dementia symptoms
• Improved wellbeing
• Improved health
• Communication
Enhancing life quality
through activities
1. Always have a dementia link worker at
meetings
2. Find out something new each week about the
person living with dementia
3. Know what is going on in your area
4. Empower your dementia link workers to work
in partnership with other agencies, family,
friends, etc.
5. Use the Kitwood equation
Top Tips
• Read the case study provided
• Working in groups devise an activity for one or more of the following visit times: – 15 minutes
– 30 minutes
– 1 hour
– 3 hours
• How can the workforce be supported to undertake activities / meaningful moments?
Activity
• Activities handbook
• Local activity champion groups
• Community mapping
• Assistive technologies
• Skills around the person
• Alzheimer's Society
• College of Occupational Therapists / NAPA
• Qualifications
Other tools/resources
Chapter 6
Co-production between the social
care workforce and carers
• Skills for Care resources
• Working alongside carers to support
co-production
• Case study – Home Instead
• Top tips for working with carers
Introduction
• Dementia: Carers and workers
resources – guide book and
information resource
• Carers matter, everybody’s business
Resources
What are some of the benefits and some of the challenges of working alongside family carers of people with dementia in their own homes?
5 mins - Discuss and feedback as a group.
Discussion
• Train staff to be trainers
• These staff train carers locally on dementia for free
• In addition others sectors are supported to learn more about dementia
• Supports working together
Case Study – Home Instead
How might we need to support staff working alongside family carers of people with dementia in their own homes?
5 mins - Discuss and feedback as a group.
Discussion
“The worker came bustling in and
turned the radio off. It had taken me
ages to settle Dad with the soft music
he likes so much. The worker said it
was boring, but Dad soon got restless
when he couldn’t hear the music.”
Carer perspective
• Find out as much as you can before you visit
• Treat the home as you would want a visitor to treat
your home
• Build a supportive, respectful relationship with the
carer
• Notice anything that is changing, including the carer
seeming stressed
• Find ways to complement the carer’s role and make
their life easier
• Don’t forget the needs of carers who lives elsewhere
Top tips from carers guide
and Home Instead
Chapter 7
Using assistive technology to
increase the uptake of personal
budgets and self-directed support for
people with dementia
• Background about HomeCareDirect
• Assistive technology – definition and
use
• Benefits of using assistive technology
• Key messages
• Ways of embedding practice in your
setting
Introduction
• National provider of support services
• Key outcome focus on managing
individual’s care team
• Developed an iCareBuddy app
• Created an online tool to create and
amend the rotas
HomeCareDirect
“any device or system that allows an
individual to perform a task that they
would otherwise be unable to do, or
increase the ease and safety with which
the task can be performed”
Royal commission of long term care 1999
Assistive Technology
• Using existing devices
• Individual and family members
• Adult social care workers - Logging of
information
• Organisational - Use information
Benefits of using icare
buddy app
• Can be used by anyone with a secure
log in
• Can be accessed 24 hours a day
internationally
• View information
• Coupled with iCareBuddy app, alert to
on call service
• Provides peace of mind
Benefits of using online
tool
• Wide range of similar tools available
• Website www.atdementia.org.uk
• Having dementia friends within the
service
• Skills for Care assistive technology
framework
• Skills for Care ALT resource hub
• Digital learning strategy
Resources
• What other examples can you share ?
• What are the potential challenges of
using assistive technology?
• What other benefits can you highlight
for
1. Individuals with dementia
2. Adult social care workers
3. Organisation
Thinking and sharing time
Chapter 8
Supporting workers to deliver end of
life care to people with dementia in
their own homes
Introduction
• Top Tips for Managers as developed by Cherish Care
• Signpost to resources to support each top tip
• Consider own service and workforce development
Top Tips
• Build a strong, qualified team to support people at End-of-Life
• Train all your staff to be "Carer Aware" - carers may need as much support as the person diagnosed
• Plan as early as possible; leaving it till later means you may not know the wishes of the person
• Research and use the excellent resources and training materials available
• Work closely with the other partners in the person's care - see "A Triangle of Care"
Build a strong & qualified team
• As part of their “Living Well at End of Life with Dementia” – workforce plan to include:
– Use of Common Core Principles
– Support development of champions, coaches within staff Workforce Development Innovations Fund
– Qualification Credit Framework (QCF) – team were developed using mini qualifications and units covering end of life care and dementia
– Workforce Development Funding to support on-going attainment of QCF
Train all your staff to be "Carer Aware"
• Gather information
– “Little Things Mean a Lot”
– Good Day / Bad Day looks like
– Like and admire
• Carers Matter, Everybody's Business
• Carers are provided with places on in-house training sessions and some ex- carers are now volunteers with the service
Plan as early as possible
• Make sure individuals wishes are understood
• Good resources for staff to use
– “Planning for Your Future Care”
– Difficult Conversations for Dementia
• Locally agreed Advanced Care Plan
Resources
• E-learning via National Minimum Data Set – Social Care
• Social Care Institute for Excellence
• Conversations for Life
• Improving end of life care - Yorkshire and the Humber
• Skills for Care End of Life Care skills development page
Workforce development
• Induction & Team meetings
• Dementia Friends training as a whole
• Supervision & reflective learning logs
• Materials stored online for access “out of hours”
Work closely with the other partners
• Triangle of Care A guide to best practice for dementia care including a self assessment checklist
• Dementia Friendly Communities work
Consider what you would do
• In pairs identify one thing that you could do to develop staff to support end of life care and dementia within your service.
• Write this on a ‘post it note’ and place on the poster
Chapter 9
Supporting workforce integration
across health and social care -
Preventing hospital admissions
• Top Tips for Managers as
developed by Meritum Independent
Living
• Signpost to resources to support
each top tip
• Consider workforce plan to support
integrated development
Introduction
• Train staff well
• Work in harmony with health and
social services.
• Agreed aims and objectives are
important
• Consistency of care workers is
essential
• Develop a flexible workforce
Top Tips
• Good grounding – dementia Qualification Credit Framework (QCF) level 2 or 3
• Extended with in-house scheme covering:
– What is dementia – building on current understanding and
sharing experiences
– Understanding what is meant by ‘crisis’
– The pressures on carers and families dealing with memory loss
– The impact environment has on behaviour
– The principles of enablement and occupational therapy
– ensuring that they are working to support others who may be
involved in care and support,
– Dealing with dementia crises - Assessment and reassessment of
the crisis situation, recognising and supporting resolution of the
crisis
Train Staff Well
• Members of team encouraged to present case studies
• Used as part of on-going assessment and support – what going well, risk and what can learn for similar situations in future?
• What successful outcomes would be for the person and the service.
Case study discussions
Think about an area of service
development that will involve working
in a more integrated way.
Using the template start to design a
training plan covering some key areas
for development and how this will
happen.
Activity
Template
• Workforce Capacity Planning Model
• Guide to Workforce Planning
• Health & social care case studies – many have a dementia focus and include:
• Reducing avoidable hospital admissions
• Reablement and timely hospital discharges
• Smoother transitions
• Better use of resources
Resources
• Aim to open a discussion on what we mean by workforce integration and help us to think through and act to make it happen.
• For staff working in any role in social care, health or housing and for anyone whose work interacts with care and support - leisure, transport, retail, etc.
• Six principles (listed on next slide)
Title
Resources
1) Focus on better outcomes for people who need care and support
2) Involves the whole system
3) Acknowledge and overcome resistance to change and transition.
4) A confident, engaged, motivated, knowledgeable and properly skilled workforce
5) Process matters- it gives messages, creates opportunities, and demonstrates the way in which the workforce is valued
6) Successful workforce integration creates new relationships, networks and ways of working.
Principles of workforce
integration
Chapter 10
Partnership working between the
homecare workforce and other people
working in health and social care
• Skills for Care resources
• Discussion points
• Case Study – Cardinal
• Top tips
Introduction
Skills for Care and other
resources
• Link up: http://www.skillsforcare.org.uk/Finding-and-
keeping-workers/Practical-toolkits/Link-Up.aspx
• Skills for Care resources around integration
• Dementia resources on Skills for Care website
What might be some of the
challenges in working in an
integrated way particularly with
healthcare colleagues? 5 mins
Discussion Points
What are some of the way we can
encourage our teams to become
more integrated with colleagues in
healthcare? 5 mins
Discussion Points
• Partnership working focussed on how care pathways
would be optimised, whilst at the same time being
responsive to the specialist needs of individuals to
assist with avoidable hospital admissions, hospital bed
blocking and integrated discharge planning.
• Weekly multidisciplinary team meetings attended by
hospital consultants, social workers, hospital discharge
planning together with the Cardinal team, all working
together to ensure rapid hospital discharges and re-
ablement care.
Case Study - Cardinal
• GPs referring directly to cardinal to avoid acute
admissions
• Employing staff with specialist skills, not
normally seen in a community care service
including occupational therapist and
physiotherapists
• Dementia coaches deliver a number of training
sessions to all the team which has shown
alternative ways to deal with difficult situations
• Staff carry out life story work with relatives
Case Study - Cardinal
• GPs referring directly to cardinal to avoid acute
admissions
• Employing staff with specialist skills, not
normally seen in a community care service
including occupational therapist and
physiotherapists
• Dementia coaches deliver a number of training
sessions to all the team which has shown
alternative ways to deal with difficult situations
• Staff carry out life story work with relatives
Case Study - Cardinal
• Be Courageous - really listen to what’s important for
successful integration from acute to community settings
and visa versa then provide a unique flexible service
• Create a workforce culture embracing positive social
interactions – establishing a true relationship centred
service
• Aim for continuity of care to develop a bond with the
person and their family and to gain trust in exploring
different ways to achieve daily living tasks.
Top Tips
• Comprehensive training and particularly
the effective use of in-house dementia
coaches is one very effective way of
achieving this.
• Ensure an on-going commitment to
support staff and relatives in practical
ways to tailor care delivery to each
person’s individual needs - each day is
different!
Top Tips
Chapter 11
Adapting home environments for
people with dementia
Kitchen
Bathroom
Living room
Bedroom
Outside space
Activity
• Open shelving
• Label hot / cold taps
• Plain floor coverings
• Reminder notes / post its
• Use labels or photographs
• Cooking and baking smells
• Glass jars for tea and coffee
• Monitors – very hot or very cold
Kitchen
• Door signs on toilets
• Open shelving
• Cover or remove mirrors
• Contrasting colours for toilet seats etc
• Set thermostats to avoid scalding
• Bath plug that allows water to drain away /
flood detectors*
• Shower doors/panels could be reflective
Bathroom
• Avoid low coffee tables
• Keep clutter to a minimum
• Keep things within reach
• Have a drawer for rummaging
• Display photos, ornaments etc
• Try and keep the room as familiar as possible
• Use open cupboards/shelves for storage
• Can get confused if there is not enough light
Living Room
• Night / day clocks
• Sign, pictures or photos
• Cover or remove mirrors
• Personal items can be reassuring
• Ensure access to the bed from both sides
• Bed covers should contrast from carpet
• Pictures on wardrobes and drawers
• Contrasting colour for bedroom door
Bedroom
• Provide seating
• Avoid poisonous plants
• Avoid paths with patterns
• Should be safe and secure
• Can help with feeling of well being
• Pets provide interest and activity
• Sensory stimulation – colours, smells
Outside/Garden
http://www.scie.org.uk/socialcaretv/video-
player.asp?v=dementiaenvironmentathome
Video
1. Enhance quality of life and help reduce
behaviours that happen in Dementia by
adapting a home environment to suit the
changes in a person with Dementia
2. Provide opportunities for more involvement
in all daily living activities
Top Tips
3. Give workers the opportunity to be involved in adapting a
person’s home they are supporting by undertaking these
activities with the person with Dementia.
4. Don’t be frightened of asking for physical changes to
happen to the person’s home giving explanations of why you
feel it would work better for the person you are supporting.
5. Be sensitive to changes that happen in Dementia, what’s
worked one week may not work the next. Don’t be put off by
this “get more creative”
Top Tips
• The University of Sterling
• Alzheimer’s Society
• SCIE Dementia Gateway & Social
Care TV
Resources
Thank you for listening
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