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Swimming against the current: how can we work to enable people living with dementia?

29 February 2016

Imogen BloodImogen Blood is an independent researcher and the author of RiPfA’s new publication Enablement in dementia: Practice Tool – a resource which aims to help professionals understand enabling approaches to working with and supporting people with dementia.

There’s a lot of interest at the moment in ‘strengths-based practice’, not least because the Care Act 2014 requires us to ‘consider the person’s own strengths and capabilities, and what support might be available from their wider support network or within the community to help’. This is applicable across a range of settings, from working with people who experience multiple needs and exclusions, to those living with dementia.

However, trying to apply this approach to people with dementia – particularly in the advanced stages – can leave us swimming against the tide: seeking out and nurturing ‘capabilities’ when others are focusing on how much has been lost; trying to re-establish connections with the wider community, when the norm has been to segregate; taking positive risks when much of the feedback around us is telling us to play it safe.

This publication follows on from my earlier Key Issue on the topic of Dementia and enablement, along with a webinar I gave in October 2015. It recognises that, if we are going to enable (rather than disable) people with dementia through our assessments, we must:

  • Start with the person (rather than the form) and make a real effort to understand them and the person they used to be.
  • Support the relationships and connections they have (and used to have) to other people.
  • Identify the skills which may have been overlooked and the behaviours which have enabled them to survive this far (both in life and in their diagnosis).

Having mapped out ‘their world’ with them, we are then in a position to start working together to help them reconnect with the great passions and the little pleasures that make life worth living. This is particularly important for those of us working in residential care, extra care housing or long-stay hospital wards. Switching on the television so someone can watch the football may be a valued starting point, but for too many this is as far as it goes.

It is only when we have a true sense of a person in this way that we can begin to do some ‘positive risk-taking’ with them. In other words, we can begin to properly weigh up the risks of doing something (which we tend to be preoccupied with) with the risks of not doing it (which are easily overlooked).

In the resource, we meet Fred (a care home resident with fairly advanced dementia) and his wife, Mary (who is a regular visitor to the home and is herself in the early stages of dementia). The couple would like to go out for a walk and a pint: should we and can we support them to do this?

The tool reminds us of the principles of the Mental Capacity Act 2005 and the fact that, in case law, the courts tend to go for the least restrictive option: if we can enable someone with dementia to do something which it seems to be in their interests to do, then we should. Yet research has shown that it is so much easier to do this when we collaborate with others and share the responsibility: where we act alone, we tend to fear blame and play safe. To support professionals working in this area who want to adopt more enabling approaches, I have developed a set of questions within the tool that guides the ‘key players’ through a more balanced and defensible (rather than a defensive) approach to risk.

I hope that this resource will help you to feel confident that the decisions you’re making around enablement are rooted in evidence of good practice, and will help you to swim boldly against the tide as you seek to protect identity, meaning and purpose in life.

Read the resource:

Enablement in dementia: Practice Tool

Related resources:

Risk enablement: Frontline Briefing

Involving and engaging people with dementia: Practice Tool

Enablement in dementia: Key Issue

Maximising independence for people with dementia: Strategic briefing

How can we enable people living with dementia to live independent and fulfilled lives? Knowledge Exchange Webinar

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