1: Understand key legislation and agreed ways of working that support the fulfilment of rights and choices of individuals with dementia while minimising risk of harm 1.1 What is the impact of the Mental Health Act, and the Mental Incapacity Act (Deprivation of Liberty Safeguards) on individuals who are living with the experience of dementia; with regards to minimising the risks of harm whilst at the same time enabling rights and choices for the individual?
These acts and safe guards are put in place to prevent vulnerable adults with dementia from being subjected to any harmful situation or risk, The impact of the mental health act and mental incapacity act is to help carers and dementia sufferers face issues of discrimination, infringement of their human rights and choices. Poor quality of care and support breaches the right of dignity and respect. Mental health and mental incapacity act is a system that also helps carers to evaluate a service users rights and choices, enabling them to make the right decision and not putting themselves or others at risk or harm. 1.2 Evaluate whether the systems and procedures you have at your disposal in your place of work ensure that individuals with dementia are still accorded rights and choices?
Systems and procedures at my disposal in my work place to ensure that individuals in my care who have dementia are still accorded rights and choices are: HUMAN RIGHTS ACT 1998
MENTAL CAPACITY ACT 2005
ADULTS WITH INCAPACITY ACT 2000
MENTAL HEALTH ACT 2007
Within the company we also have policies and procedures of equal opertunities, confidentiality policy, Whistle blowing policy, Company legislations on having regular and up to date training. All of these acts and legislations help me to form the rights and choices of the residents in my care and to make sure these rights and choices are carried out as the individual with dementia declines in health and does not have the capacity to make their own choices as they once could. Whilst the individual still has the capacity to make decisions regarding their care we have what is called an advanced care plan which we use to ask individuals of when they become too ill as the dementia progresses how they would like to be cared for, e.g. how they would like personal hygiene to be carried out, what foods they dislike and like, what they would like to talk about or regularly be reminded of.
Also further on in the decline of their health preferences for end of life care, funeral arrangements, etc. 1.3 Give three examples of when, and to whom you might share personal information about an individual who is living with the experience of dementia whilst remaining within your policies and guidelines and requirements under the Data Protection Act.
Sharing personal information about an individual who is living with dementia is illegal unless you have good reason too for example:
1. If the individual in your care is at risk of harm or harmful to others, You would have to share personal information with the police, social services or any professional involvement that needs specific information on an individual.
2. If an individual with dementia is very ill you would share information with a Doctor/GP to help with health issues.
3. Change of shifts between a colleague and yourself (a handover) you may need to share some personal information on an individual who may be very ill, end of life or even behaviour problems.
Three examples all used whilst remaining within policies and guidelines of the data protection act.
2: Be able to maximise the rights and choices of individuals with dementia. 2.3 Explain why it is important in both legal terms and personal terms, not to assume that an individual with dementia cannot make their own decisions.
There are different stages of dementia, in the early stages of being diagnosed an individual still can make their own decisions and choices. No matter what stage an individual living with dementia is at its always important to give choices and never assume. If an individual is confused and low in mood it may well be that they are feeling unwell, not that because they suffer with dementia they cannot make a decision or choices for themselves. Assumption is also discrimination of their ability, capacity and human right.
Legal terms equality and diversity, key legislations, rights and choices, minimising the risk of harm, dignity, ability, mental capacity act 2005, human rights act 1998, discrimination act 1995, together these legislations form the fundamental rights and freedom of an individual, as long as the individual with dementia has legal capacity, the ability to understand and appreciate the consequences of their actions and decisions, they should seek legal advice and planning. Such as: Appoint a named power of attorney
Written documents seen/signed by lawyer/solicitor
Chose a care plan, from being diagnosed with dementia to severe decline in health, and how you would like things to be done at each stage of dementia from personal care to palliative/end of life. I.e. DNR, after life, funeral arrangements. Never assume an individual who has dementia can’t make a decision because long after they are very ill with a care plan in place, they are still making their own decisions and choices.
2.4 Explain why it is important not to assume that a person living with dementia who cannot seem to make a decision one day should not be able to make the same decision on any other day, and the reasons why their ability to make a decision might fluctuate.
Living with dementia can be overwhelming, stressful and emotional. There is a lot to take in, appointments and assessments to attend, sorting out what support you are entitled to, care preparation, wishes and preferences. Every day is different and brings a new challenge, depending on how the dementia sufferer is feeling that day, they could be angry, still in shock of the diagnoses, sleep or food deprivation causes fatigue and hunger. Their routine or activities for that day may have been slightly changed causing upset and frustration, e.g. new nurses, GP or carers.
There are many types of dementia, causing many different symptoms and treatments, it may take time to find the appropriate treatment/medication to suit the individual. When all the legal stuff is done, help/support is in place you find the individual to be relieved, coping a little better, quality of life is better due to eating and sleeping more. All of these reasons might make a person with dementia fluctuate on day to day decisions.
3: Be able to involve carers and others in supporting individuals with dementia 3.2 Give an example of where you have balanced the rights and choices requested by an individual living with the experience of dementia to resolve a conflict.
My own experience of resolving a conflict whilst balancing the rights and choices of an individual living with dementia was when I had just come on shift at 8am and I could hear a resident screaming and shouting at the top of their voice. I went straight to the room and there a resident was trying to hit a career from night shift with their walking aid. I immediately called for assistance from another carer and sent the night staff to nurse in charge to make a statement of what happened. I calmly asked the resident what was upsetting them so much to which they replied that all they wanted was to go back to bed as they was very tired and had not slept very much. I then noticed that the residents night clothes was soaking wet as was their bed. The nurse in charge came to the room to inform me that the night carer was trying to explain to the resident that they had had an accident and needed to be washed, changed and clean bedding put on.
Having dementia the resident had not realised they were wet and just thought the night carer was getting her up to be washed and dressed. Legally I knew the resident could not be left to go back to sleep in their own urine no matter how much they insisted that no assistance was needed. I struck up a conversation with the resident explaining the consequences of lying in a wet bed and clothes, I promised that when we changed the bedding gave them a wash and fresh night clothes they could go back to bed and sleep. Whilst I was chatting the nurse had already gathered warm soapy water in a wash bowl, flannels, towels, clean bedding and night clothes, the resident agreed to have the personal care they needed to be dry, comfortable and get back to bed to have the much needed sleep they deserved. Therefore resolving a conflict whilst maintaining the rights and choices of the individual. 3.3 Describe how your home ensures that an individual with dementia, their carers, and any others feel able to complain without fear of retribution
Reassuring a resident or individual with dementia, advocate, relatives and everyone who works within the health care setting knows the correct procedures to follow if they need to or want to complain. It’s important especially for a resident to know that they can talk to their carer or another member of staff if the complaint is about their carer. Reassure residents that their complaints will be dealt with confidentially in the correct way, explain policies and procedures of the complaint route and that all staff must adhere to these procedures, this will gain the trust and confidence of individuals and relatives promoting contact and interaction.
4. Be able to maintain the privacy, dignity and respect of individuals with dementia whilst promoting rights and choices 4.1 Describe how to maintain privacy and dignity when providing personal support for intimate care to an individual with dementia
Residents with dementia in your care will have a care plan in place for you to follow with their wishes and preferences on intimate care, bathing etc. At each stage of dementia and what they have chosen to happen in that care plan should be followed maintaining their rights and choices. Suffering with dementia or not it’s a basic human right to have privacy and dignity. When supporting individual with personal hygiene/intimate care to maintain privacy, keep doors, blinds/curtains and windows closed. Most elderly find it embarrassing that a nurse/carer is supporting/assisting with a task that
they have managed till now with, for most of their lives, maintain dignity by allocating one carer for personal/intimate care. Where this is not possible, a second career is allocated keeping within guidelines of continuity of care.