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Helping care homes use person-centred programmes to reduce residents' distress

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Is there still a perception that care homes continue to be ‘left behind’ in the NHS, particularly in relation to dementia care? asks Caroline Baker

Having worked for both the NHS and the independent care sector, I recently chose to return to the independent sector.

My decision was sparked by the shelving of the innovative and award-winning programmes we had developed at the primary care trust to enhance dementia care back between 2001 and 2005 and the disbanding of the team to allow our funding to be transferred into the primary care sector.

A decade ago, before we’d developed these programmes, excellence in dementia care in the PCT was considered (I quote from a psychiatric consultant at the time) a “peripheral luxury”.

”Nurses were generally not considered to be leaders or innovators”

Nurses were generally not considered to be leaders or innovators in my experience but were there to be led and directed by our medical colleagues. Things appear to have improved significantly since then and I now come across many articles about the NHS introducing innovative practice in dementia care.

Returning to the independent sector gave me and my team a whole new opportunity to create a programme that already in its early findings appears to be enhancing the lives of people living with dementia in our care homes.

The project

For the past few months, we have been carrying out a pilot programme within 11 of our care homes within Barchester across the UK.

“The project has been designed to enhance person-centred approaches and therefore reduce elements of distress”

The ”10-60-6 Project” has been designed and developed to enhance the wellbeing of residents living with dementia in care homes. In essence, the project has been designed to enhance person-centred approaches and therefore reduce elements of distress that people may otherwise experience, which in turn will help not only our residents, but their relatives and our staff.

The project consists of a blend of four levels of training and evidenced and researched based interventions that will be implemented over a nine-month period with support from an experienced dementia care specialist. The pilot completed at the end of June when all homes have received an unannounced accreditation.


Initial analysis of the data we have collected has shown that there has been on average a 34% reduction in distressed reactions among the residents within the pilot homes along with improvements in wellbeing scores, increases in weight and reductions in the use of medications such as hypnotics and anxiolytics.

What is interesting, however, is that levels of anti-psychotic medications were much lower at baseline than a previous programme I was involved with (Baker, 2015), indicating that the work of the Department of Health in 2009 and 2016 (DH, 2009; 2016) appears to be reaching far and wide.

Within his book, Powers (2014) states that perhaps the greatest argument for offering alternatives to drug therapy is the multitude of cases in which a person’s distress is solved through other approaches.

This second programme, although vastly different to the first programme that we worked on at the PCT (Baker 2015), appears to be yielding similar positive outcomes. This leads me to question whether it is the interventions that we ask people to introduce that are responsible for the positive outcomes, or the training, support and advice that we deliver, or even a combination of the two. Or are the findings simply a result of asking the home to provide a focus on what they are currently delivering and how they might improve it further?

”Our team have come up with some outstanding ideas, tools and methods”

Powers (2014) further elucidates that every time we see such a success, we should wonder how many other people’s needs could be met without drugs if we could better identify the root causes.

Using Power’s theories to underpin our programme, we are aiming to do exactly that, focusing not only on the seven domains of well-being that he describes but on making a determined effort to identify the ‘root cause’ through life story work, specialist assessment tools and timely, appropriate and evidence or research based interventions.

So, are we behind the NHS? We don’t think so!

Our team have come up with some outstanding ideas, tools and methods of implementation as well as drawing on the latest evidence and research-based interventions to improve dementia care in practice with some outstanding results. Perhaps most importantly, we have been given both the autonomy and the funding by our line manager, Professor Trish Morris-Thompson, to make this happen because our board believed that we could (and would) make a significant difference in dementia care.

A full report should be available on the Company website by the end of August 2016.

Caroline Baker


Baker C (2015)Developing Excellent Care for People Living with Dementia in Care Homes. Jessica Kingsley Publishers, London

DOH (2009) – The use of anti-psychotic medication for people with dementia: Time for Action – A report for the Minister of State for Care Services by Professor Sube Banerjee. Department of Health, London

DOH (2016) - Prime Minister’s Challenge on Dementia 2020: Implementation Plan. Department of Health, London

Powers G A (2014)Dementia Beyond Disease: Enhancing Well-Being. Health Professions Press, Baltimore.




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