Dementia Care Models
A ‘model of care’ can be loosely defined as something which provides “the best practice care and services to an individual as they progress through the stages of a condition, injury or event”. In simplistic terms, the aim of any care model is to ensure that a person receives “the right care at the right time, delivered by the right people in the right place”.
Many illnesses and conditions follow a predictable path to which a relatively unvarying care model can be effectively applied. For dementia, however, there is no ‘one size fits all’ model of care. This is because the symptoms associated with dementia can be attributed to many different causes such Alzheimer’s disease, stroke, severe head injury or the emergence of protein deposits, known as Lewy bodies, in the brain.
Consequently, dementia affects different people in different ways according to a variety of factors including the individual’s age, the area of the brain affected and the underlying cause of the condition.
Therefore, any dementia care model must take an holistic and person-centred approach to caring for people with this condition.
Examining the psychosocial approach to dementia reminds us that a person with dementia is no less a person than anyone else and efforts should be made to maintain and improve quality of life by respecting and preserving the individual’s personhood. To develop this further means that we take the perspective of how the person with dementia views their life rather than our perspective of how they should lead their life. Dementia care pioneer Tom Kitwood argued the ‘dementia’ is not the problem; the problem is ‘our’ (individual, carer, professional, society) inability to accommodate ‘their’ view of the world (Kitwood 1997). Therefore there is a danger of creating/maintaining a ‘them’ and ‘us’ dialectic tension that has become reinforced over the years by the socially constructed and devalued status of someone who is ‘dementing’.
At the heart of Kitwood’s (1997) conception of person-centred care was ‘personhood’:
‘Personhood: it is a standing or status that is bestowed upon one human being, by others, in the context of relationships and social being. It implies recognition, respect and trust.’
(Kitwood 1997 p. 8)
Personhood is a recognition of the value of all human beings (regardless of race, sex, disability, age or cognitive ability) and is a status that one individual bestows upon another. In upholding personhood many societal factors are involved, such as culture, availability of support and services and, unfortunately, the negative attitudes that many professionals hold towards dementia may also diminish personhood. Personhood can be supported by a variety of different methods and interventions.
Building on the work of Kitwood, Naomi Feil’s (2002) approach of ‘validation’ recognises the subjective experience of a person’s experience. By recognising who the person is and that in order to offer individual and empathic care we need to properly acknowledge and understand the various elements that make a person unique. We also draw upon the evidence base for Reminiscence and life story work. Pam Schweitzer (1998) stresses that family carers might find revising the past improves their current relationship with the person they care for. Homecare workers may find reminiscence similarly helpful when caring for a person with dementia to assist with developing a relationship and understand of the persons feelings. Approaches such as life review, creating life history boxes or books, going out to visit memorable places, discussion groups, looking at family photo albums or listening to favourite music all would fit under the umbrella of reminiscence.
The Good Care Group’s holistic approach encompasses a clinical pathway that promotes physical, emotional and lifestyle needs and aims to enhance overall health and wellbeing (Alzheimer’s Society 2011). Our highly personalised and fully-managed dementia care services are designed to enable people with dementia to enjoy the best possible quality of life whilst receiving the care they need in the comforting and familiar surroundings of their own home. You can find out more about our one-to-one dementia care services here. Alternatively, to speak to someone about your dementia care requirements please call 0203 728 7577.