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Care Talk – June 2012 “Coping with Dementia the SPECAL way”

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Doris finds a locked door and starts hammering on it and swearing. She becomes even more agitated when asked if she’d like to come away and have a cup of tea. She then starts to kick the door, calling out that she’s a prisoner.

We know this. We know it to be the challenging behaviour of a person with dementia. To a large and frankly depressing degree, we don’t really know how to help her. Recently, however, I read about the SPECAL (specialised early care for Alzheimer’s) method and resolved to know more…

Zoë Elkins, Head of Care Strategy at The Good Care Group, explains that it came about 25 years ago when Penny Garner, a Cotswolds housewife, looked after her mother, who had Alzheimer’s. Through their journey, Penny found she was able to understand her mum and keep her in a really good place when others weren’t so able to. She went on to use the experience to devise a simple methodology she could teach to others.

Chancing upon Penny at a conference, Zoë became a convert: “I’d been in the sector for 10 years and had never come across a model that had a practical solution I could give to care staff. People tell you to sympathise when you have this awful challenging behaviour, but no one offers a practical way of making the client happier and therefore reducing the challenging behaviour.”

So what is the SPECAL method?

It is essentially based around three day-to-day golden rules:

• Never contradict
• Don’t ask questions
• Learn from the expert (the person with dementia)

And it works.

Zoë told me the story of John, who was being cared for at home by his wife. John’s behaviour was challenging, and aggressive if his wife left his sight for barely a moment. During his life, he had been a professional rugby player – now an Alpha male on a cocktail of anti-psychotic drugs coping with dementia. Finally, The Good Care Group stepped in…

“It’s vital to spend a lot of time gathering information about the person and organising it into a care profile. Once you have that, anyone could deliver it,” Zoë said. After much time with John, the carer began to recognise the triggers to his anxiety and would return him to a good place by throwing him a rugby ball and triggering stories about the games he so enjoyed. Eventually it became easier to cue him into what she called his ‘glory stories’. After an intensive six months, John was finally able to come off the drugs and his wife went on holiday to France for two weeks.

When introduced to The Good Care Group’s Nadia Fierstone, my first question is how she deals with the job’s intensity.

“I focus on information gathering with my clients, which allows me to detach from merely coping to solution finding. There’s a purpose to the questions dementia clients will ask, even though they may not make sense initially, and by monitoring those questions and finding answers that seem acceptable, then I’m not really caught up in this loop of, ‘why do they keep asking these same questions? Why can’t I seem to reduce the anxiety?’”

For Nadia, her job is about creating good feelings rather than just seeing it as a detrimental situation; the method gives her practical ways of dealing with scenarios.

“For example, I wouldn’t ask a client if they wanted to wear their pink glasses. I would say – those pink specs look terrific on you, maybe you should put them on. Direct questions lead to a loop, and anxiety. Use statements and hints, then they don’t feel under pressure to fact find for lost information. It’s a simple approach but it works.”

And what might be the benefits to carers working with this method?

“It’s difficult for carers because you could see it as permanent decline,” Zoë explains. “But SPECAL’s enabled our staff to turn that concept on its head and look at the quality of life improvement and the end experience.”

Nadia adds: “The job is all about making someone feel good, and if that person feels good, then anxiety is reduced and the result is a happier, calmer environment for both the client and the carer.”

As for Doris, Zoë Elkins happened to be passing by, and placing herself in Doris’s reality, she too kicked the door. Relieved to have found an ally, Doris was
quickly returned to a good place and able to enjoy that cup of tea – thanks to SPECAL.

Top Tips

  • Never contradict
  • Don’t ask questions
  • Learn from the expert (the person with dementia)
  • Invest time in observing the individual
  • Identify triggers to anxiety
  • Identify solutions to restore calmness
Practice Nursing – June 2012 “An improved experience for dementia patients” Primary Care Today – February/March 2012 “Can home based dementia care succeed?”
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