Page 1 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

Page 2 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

DEM 313 - Equality, Diversity and Inclusion in dementia care practice

Page 3 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet. Task 1 - Understand that each individual’s experience of dementia is unique

1.1 Explain why it is important to recognise and respect an individual’s heritage

1.2 Compare the experience of dementia for an individual who has acquired it as an older person with the experience of an individual who has acquired it as a younger person

1.3 Describe how the experience of dementia may be different for individuals; who have a learning disability; who are from different ethnic backgrounds; who are at the end of life

1.4 Describe how the experience of an individual’s dementia may impact on carers

Task 2 - Understand the importance of diversity, equality and inclusion in dementia care and support

2.1 Describe how current legislation, government policy and agreed ways of working support inclusive practice for dementia care and support

2.2 Describe the ways in which an individual with dementia may be subjected to discrimination and oppression

2.3 Explain the potential impact of discrimination on an individual with dementia

2.4 Analyse how diversity, equality and inclusion are addressed in dementia care and support

Page 4 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet. Task 3 - Be able to work in a person centred manner to ensure inclusivity of the individual with dementia

3.1 Demonstrate how to identify an individual’s uniqueness (See report by NVQ3 trainer)

3.2 Demonstrate how to use life experiences and circumstances of an individual who has dementia to ensure their inclusion (See report by NVQ3 trainer)

3.3 Demonstrate practical ways of helping an individual with dementia to maintain their dignity (See report by NVQ3 trainer)

3.4 Demonstrate how to engage and include an individual with dementia in daily life (See report by NVQ3 trainer)

Task 4 - Be able to work with others to encourage support for diversity and equality

4.1 Work with others to promote diversity and equality for individuals with dementia (See report by NVQ3 trainer)

4.2 Demonstrate how to share the individual’s preferences and interests with others (See report by NVQ3 trainer)

4.3 Explain how to challenge discrimination and oppressive practice of others when working with an individual with dementia

Page 5 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

Exemplification – DEM 313 An individual is someone requiring care or support Heritage refers to an individual’s culture, history and personal experiences and is unique to them Others may include; Care workers; Colleague; Manager; Social Worker; Occupational Therapist; GP; Speech & Language Therapist; Physiotherapist; Pharmacist; Nurse; Psychologist; Admiral Nurses; Independent Mental Capacity Advocate; Community Psychiatric Nurse; Dementia Care Advisors; Advocate; Support groups

Page 6 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

Assignment task – DEM313 Answers Task 1 - Understand that each individual’s experience of dementia is unique

What is Dementia?

Dementia is a term used to describe the deterioration of brain function that results in loss of memory, reduced language skills, impaired reasoning and loss of daily living skills. This is the dementia syndrome; however, as the individuals try to live with their dementia they may display behavioural and emotional problems. There are over 100 different types of dementia. The most common types are Alzheimer’s disease, vascular dementia and dementia with Lewy bodies. An individual may have a combination of different causes of dementia; in particular Alzheimer’s disease and vascular dementia. Each of these diseases tends to affect particular areas of the brain and will cause different changes in an individual’s behaviour. Within the health and social care setting for individuals living with Dementia, staff often describe Dementia as; the less of everything You know; the less of the You day after day. Individuals living with Dementia have the same rights as others. The Human rights do not stop when Dementia comes.

Page 7 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

1.1 Explain why it is important to recognise and respect an individual’s heritage (12 pages to answer the question – Page 7 to 18)

What is Heritage?

Heritage is the full range of our inherited traditions, monuments, objects, and culture. Most important, it is the range of contemporary activities, meanings, and behaviours that we draw from them. Heritage includes, but is much more than preserving, excavating, displaying, or restoring a collection of old things. It is both tangible and intangible, in the sense that ideas and memories of songs, recipes, language, dances, and many other elements of who we are and how we identify ourselves are as important as historical buildings and archaeological sites. Heritage is, or should be, the subject of active public reflection, debate, and discussion. What is worth saving? What can we, or should we, forget? What memories can we enjoy, regret, or learn from? Who owns the past? Who is entitled to speak for past generations? Active public discussion about material and intangible heritage of individuals, groups, communities, and nations is a valuable facet of public life in our multicultural world. Heritage is a contemporary activity with far reaching effects. It can be an element of far sighted urban and regional planning. It can be the platform for political recognition, a medium for intercultural dialogue, a means of ethical reflection, and the potential basis for local economic development. It is simultaneously local and particular, global and shared. Heritage is an essential part of the present we live in and of the future we will build.

Page 8 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

I am working as a senior care assistant. Within my health and social care setting for individuals living with Dementia, duty of staff to understand the importance to recognise and respect an individual’s heritage; means staff to understand the importance of recognising e.g. diversity (see page 9), inclusion (see page 10) and interaction, and respect heritage including the individual’s unique culture, personal history and personal experiences; means staff to understand the legal and organisational requirements around equality (see page 11), diversity, discrimination (see page 12), and rights (see page 13); means staff to promote active support (see page 14) and place the preferences, and best interest of individuals at the centre of provision e.g. care planning includes choice and preferences of food, clothing, beliefs, lifestyle, and preferred means of communication, wishes as well as need and support; means staff to promote person centred approaches (see page 14) that put the individual at the heart of own care planning to meet the importance to recognise and respect an individual’s heritage; means staff to understand the importance of how and why person centred values (see page 15) e.g. individuality, rights, choice, privacy, independence, dignity, respect, and partnership must influence all aspects of health and social care work; means staff to work with the individual and others to find out the individual’s history, preferences, wishes and needs; means staff to demonstrate ways to put person centred values into practice in a complex or sensitive situation e.g. distressing or traumatic, threatening or frightening, likely to have serious implications or consequences, of a personal nature, and involving complex communication or cognitive needs, that are directly related to an individual; means staff to adapt actions and approaches in response to an individual’s changing needs or preferences according to the individual’s heritage; means staff to promote active participation (see page 16) to meet the holistic needs e.g. physical, emotional, and spiritual of an individual in relation of the individual’s heritage; means staff to understand the links between identity, self-image and self-esteem, and to support an individual in a way that promotes their sense of identity, self-image and self-esteem; means staff to understand factors that contribute to the wellbeing (see page 16) of individuals, and to contribute to environments that promote wellbeing (see page 17) for individuals; means staff to understand the model of diversity (see page 18).

Page 9 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is Diversity?

Diversity means; being different, diverse, or variety; means understanding that each individual is unique, and recognizing our individual differences. These can be along the dimensions of race, ethnicity, nationality, culture, gender, sexual orientation, socio-economic status, age, physical abilities, religious beliefs, political beliefs, ability, or other ideologies.

Diversity in my health and social care workplace for individuals living with early dementia means that, there are male residents and female residents of different ages from different background regarding their lives and experiences. They all have their own personal preferences regarding their likes and dislikes when eating and drinking, regarding their participation when involved in activities. My residents are all different in the way they behave when socialising with the other residents or with staff. Also their beliefs, mental health condition and physical health are different. All these difference is what make diversity.

Page 10 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is Inclusion?

Inclusion is a term used by people with disabilities and other disability rights advocates for the idea that all people should freely, openly and without pity accommodate any person with a disability without restrictions or limitations of any kind. Inclusion means promoting equality of access, inclusion and participation for individuals regardless of their differences. It’s a requirement for all social care workers to adopt an approach that ensures service users are placed at the centre of the planning and decision making process as far as possible, e.g. by using the person centred approach and by promoting active participation. Care workers must respect the values, beliefs and preferences of service users ensuring the same life opportunities are provided regardless of their diverse needs and differences.

Inclusion in my health and social care workplace for individuals living with early dementia means that, to provide cares in a centred person approach, putting the resident in the centre of the care planning process, according to the resident's mental capacity.

Page 11 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is Equality?

Equality is ensuring individuals or groups of individuals are treated fairly and equally and no less favourably, specific to their needs, including areas of race, gender, disability, religion or belief, sexual orientation and age. Promoting equality should remove discrimination in all of the aforementioned areas. Equality ensures everyone, regardless of their difference and ability has their right to be treated with respect and to be provided the same opportunities to access services as everyone else. When explaining equality to consider the following; individual rights; giving and respecting choices; tailored services that better meet the diverse and individual needs. Negative discriminatory behaviours typically seen in care practices are the following; direct discrimination and indirect discrimination; harassment and bullying; victimisation; power and control; inappropriate language; oppression and lack of equality of opportunity; excluding people and groups from activities; blanket care approach, not personalised, all treated the same.

Equality in my health and social care workplace for individuals living with early dementia means that, to care for all the residents in a fair and equal way, regarding their care needs, without making difference in regards of the colour of the skins or religions.

Page 12 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is Discrimination?

The definition of discrimination is the act of prejudice against a person because they have a certain set of characteristics. Discrimination is to treat a person less favourably than another person is, or would be, treated in the same or similar circumstances. Discrimination is treating someone differently because of some ascribed difference. Usually negative. Discrimination is to treat people unequally, some favoured more than others - is often an expression of prejudice. Discrimination can take many forms but in many countries around the world there are laws prohibiting any form of discrimination. Discrimination can be on the grounds of sex and sexual orientation, race, disability, mental health, age, ethnic background, religion, gender and gender reassignment, learning ability, life style and outlook. This is not acceptable. Discrimination can be based on the assumptions people make about other e.g. people with mental health issues are dangerous. Discrimination is also linked with; stereotyping (grouping a person or group under one usually negative characteristic or feature); labelling (a general classifying name, term or category applied to a person); oppression (the experience of being treated as an inferior person or group, having their basic human rights and needs ignored and being treated in an unjust way); prejudice (a preconceived opinion, like or dislike often based upon stereotypical beliefs and fears). Discrimination can be direct or indirect. Direct discrimination happens when a person treats another less favourably than someone else because of one of the following reasons. Gender, marriage or civil partnership, pregnancy and maternity leave, sexual orientation, disability, race and colour of the skin, religion or belief, and age. For example, it would now be regarded as direct discrimination if a driving job was only open to male applicants. Indirect discrimination is where certain conditions or rules apply that disadvantage a particular person or group of people more than another. For example, saying that applicants for a job must be clean shaven puts members of some religious groups at a disadvantage. Indirect discrimination is unlawful, whether or not it is intended. It is only allowed if it is necessary for the way a service works, and there is no other way of achieving it. For example, the condition that applicants must be male might be justified if the vacancy was intended to create a chance balance a staff group where there are male receivers of care.

Page 13 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What are Rights?

Within my health and social care setting, Rights mean the following; the right to make choices underpin the importance of individual empowerment; universal declaration of Human Rights; independence and autonomy of individuals; importance of impartiality, being aware of own attitudes, values and beliefs, not allowing personal views to influence an individual's decision making; awareness of relevant legislation and agreed ways of working that influence individual's rights e.g. equality and human rights, disability discrimination.

The Universal Declaration of Human Rights, legitimate descendant of Jesus Christ's Sermon on the Mount The Universal Declaration of Human Rights (UDHR) is a declaration adopted by the United Nations General Assembly on 10 December 1948 at the Palais de Chaillot, Paris. Jesus Christ's Sermon on the Mount is the very first and significant contributor to Human Rights. Jesus Christ's Sermon on the Mount, Matthew 5:1-12 Seeing the crowds, Jesus went up on the mountain, and when he sat down his disciples came to him. And he opened his mouth and taught them, saying: “Blessed are the poor in spirit, for theirs is the kingdom of heaven. Blessed are those who mourn, for they shall be comforted. Blessed are the meek, for they shall inherit the earth. Blessed are those who hunger and thirst for righteousness, for they shall be satisfied. Blessed are the merciful, for they shall obtain mercy. Blessed are the pure in heart, for they shall see God. Blessed are the peacemakers, for they shall be called sons of God. Blessed are those who are persecuted for righteousness’ sake for theirs is the kingdom of heaven. Blessed are you when men revile you and persecute you and utter all kinds of evil against you falsely on my account. Rejoice and be glad, for your reward is great in heaven, for so men persecuted the prophets who were before you” This section of teaching, recorded in Matthew, chapters 5 to 7, is the longest piece of teaching from Jesus in the gospels. The Meaning of the Sermon on the Mount is intended; to identify the ways in which the followers of Jesus should behave in living a life of acceptance of God’s gracious invitation to enter the kingdom of heaven; to remind to the human race that they are a creation of love by God, and they are never alone in the love of Jesus, son of God. “Thou shalt love thy neighbour as thyself” is the most important commandment, because the first Human Right is to be loved.

Page 14 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is Active Support?

Active Support is a proven model of care that enables and empowers people with intellectual disabilities to participate in all aspects of their lives.

What is Person Centred Approach?

Person Centred Approach is a way of working developed from the work of the psychologist Dr Carl Rogers (1902 – 1987). In health and social care settings, the person centred approach is a way of working that put the individual at the heart of the care planning process. This will provide a framework for the individual to plan and set a direction of their care planning process according to the individual's physical and psychological needs, spiritual beliefs, culture, likes and dislikes, family and friends. The person centred approach method is linked with the active participation method, which is a way of working that recognises an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient (See below - Graphic of Dementia Person Centred Approach needs).

Page 15 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What are Person Centred Values?

The eight Person Centred Values, also called the 8 Core Care Values, are an agreed set of principles that are believed to be the foundation of all good care practice and provide care workers with an agreed set of principles and standards by which care workers benchmark their practice which ensures they conduct themselves in a way that embraces these principles. The 8 Core Care Values were intended to guide and inform the approach and practice required of all care workers. The 8 Core Care Values not only apply to the relationships developed with the individuals who require care or support within a care home, families and friends but to the working relationships with team members and colleagues; other professionals; advocates or others who are important to individuals. The 8 Core Care Values provides a set of principles that help to develop a better understanding of what constitutes good care practice which supports the continued care, safety and wellbeing of the individuals within a care home. These values and principles are now embedded in the General Social Care Council (GSCC) Codes of practice for social care workers, and must be adhered to at by all social care workers. The 8 Core Care Values are the following: individuality; rights; choice; privacy; independence; dignity; respect; partnership. Individuals have a right to be treated as an individual; to be treated equally and not be discriminated against; to be respected; to have privacy; to be treated in a dignified way; to be protected from danger and harm; to be supported and cared for in a way that meets their needs, takes account of their choices and also protects them; to communicate using their preferred methods of communication and language; to access information about themselves.

Page 16 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is Active Participation?

Active Participation is a way of working that recognises an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient.

What are the factors that contribute to the wellbeing of an individual?

Factors that contribute to the wellbeing of an individual are the following; emotional; relational; physical; financial; intellectual; environmental; vocational; career; spiritual. Other factors that contribute to the wellbeing of an individual living within a health and social care sector may include aspects that are; cultural e.g. staff to respect and to promote the individual's likes and dislikes, choices and preferences; religious e.g. individuals going to the Church, means relationships with other individuals sharing the same religion, belief, faith; social e.g. staff to promote inclusion through group activities with other individuals; political e.g. individuals voting for elections; emotional e.g. individuals having close bonds with own family and friends, sharing good memories, looking at photos. Others values that underpin within my work setting and contribute to the wellbeing of individuals through the rights; to be treated as an individual; to be treated equally and not be discriminated against; to be respected; to have privacy; to be treated in a dignified way; to be protected from danger and harm; to be supported and cared for in a way that meets their needs, takes account of their choices and also protects them; to communicate using their preferred methods of communication and language; to access information about themselves.

Page 17 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What are the environments that promote wellbeing for an individual?

Environments that promote wellbeing for an individual are the following: physical, people, and environmental. Environmental factors play an important part in an individual's wellbeing, and much more for an individual at the end of life. For example, personalised the individual's room is very important for the individual's wellbeing. This can include simple things such as rearranging furniture in the room of the individual with the personal furniture of the individual, that help to make feel the individual like home, with the personal clock, the personal and favourite painting, objects such as personal books, personal perfume, a TV, a radio to listen a relaxing music, some personal pictures, religious pictures and objects according to the individual's religion. This also include, moving an armchair or a bed in front of a window to enable the individual to gain a view and stimulate their senses. Simple environmental factors such as a vase of flowers, softer lighting or relaxing music to achieve a pleasant atmosphere, helps in all ways, to maintain the wellbeing of the individual as good as possible. For an individual at the end of life, it is very important to know the date and time, and to feel the outside elements, such as wind; for example moving the bed closer the window and to open the window allow the individual at the end of life to feel the wind, that help to stay in contact with the outside world. A positive moral for an individual at the end of life is crucial, and give the boost needed for the individual to eat, to drink, and to fight for life.

Page 18 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is Model of Diversity?

The social model of disability says that disability is caused and made worse by societies’ attitudes and how it is organised, rather than by a person’s own impairment or difference. It looks at ways of removing barriers that restrict life choices for disabled individuals. When barriers are removed, disabled individuals can become more independent and equal in society, with real choices and control over their own lives. Disabled individuals themselves developed the social model of disability because the traditional model did not explain their personal experience of disability or help to develop more inclusive ways of living. Traditional model of disability shows problems born of assumptions, stereotypes and labels e.g. special schools, charity, sympathy, special transports, doctors, medical treatment, educational psychologists, social workers, rehabilitation centres, occupational therapists, speech therapists, physiotherapists, sheltered workshops. The social model of disability shows barriers born of ignorance, fear, stigma, lack of education and knowledge, inflexible employment, underestimated/devalued, inaccessible information, inaccessible transport, inaccessible facilities, lack of employment, inflexible employment, sheltered workshops, segregated services, medicalised, overprotected/hidden in homes by families, lack of social network.

Page 19 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

1.2 Compare the experience of dementia for an individual who has acquired it as an older person with the experience of an individual who has acquired it as a younger person (1 page to answer the question – Page 19)

Below is a table that compares the experience of Dementia for an individual who has acquired it as an older person with the experience of Dementia for an individual who has acquired it as a younger person:

Availability of support Availability of services

Experience of

Experience of

Dementia for an

Dementia for an

individual who has

individual who has

acquired it as an

acquired it as a

older person

younger person

Dementia care settings offer great support

Struggle to access appropriate care and support;

and encouragement for an older person

May be left without support; Support should

living with Dementia that experiences

include not only health and social care services,

loneliness and isolation regarding

but also wider services that promote wellbeing

combination of sight and memory loss that

such as financial advice and support; Others to

lead to restricted participation in hobbies

have the relevant skills, training and support to

and social groups, impacting on wellbeing.

recognise early stages/symptoms of Dementia.

Dementia services are well designed to

Dementia services may not be appropriate to the

meet the needs for an older person living

needs of a younger person who are more likely

with Dementia that lacks sight loss, which

to work, have family and financial commitments

leads to a profound sense of disorientation

and rarer forms of dementia; Excluded from

and sense of isolation; Increased

Dementia services with a minimum age criterion;

coordination between Dementia services

Forced to travel considerable distances to

and sight loss services help in identifying

access appropriate services; Importance for

an older person abilities and needs

younger persons with Dementia to have access

regarding support.

to a range of specialist services that address their particular needs and enable them to live well with Dementia.

Recognition of individual needs

The experience of joint sight loss and

May face discrimination; May be forced to give

Dementia create a profound sense of

up work; Dementia strategies and plans in

disorientation in an older person, leading

England (2009), Northern Ireland (2011) and

to great difficulty regarding the time and

Wales (2011) and in National Institute for Clinical

the surroundings, despite using visual

Excellence (NICE) guidance has recognised the

cues - this often provoked distress, which

specific needs for a younger person; Recognition

leads occasionally to agitated and

from Alzheimer's Society; More tailored needs to

aggressive behaviour.

overcome the chronic shortage of specialist services.

Page 20 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

1.3 Describe how the experience of dementia may be different for individuals; who have a learning disability; who are from different ethnic backgrounds; who are at the end of life (4 pages to answer the question – Page 20 to 23)

Within the health and social care setting, the experience of Dementia may be different for individuals who have a learning disability, who are from different ethnic backgrounds, and who are at the end of life; means staff to understand the differences between the availability of support and services, and the recognition of individual needs. Experiences of Dementia for individuals who have a learning disability means; services and support available for individuals with learning disabilities and Dementia; delay in diagnosis for individuals with learning disabilities; variety of learning disabilities e.g. link between Down’s syndrome and Alzheimer’s disease; link between learning disabilities and Dementia. Experiences of Dementia for individuals who are from different ethnic backgrounds means; recognition of individual needs; services and support available for individuals from different ethnic backgrounds; increasing incidence of Dementia in young individuals from ethnic minorities. Experiences of Dementia for individuals who are at the end of life means; services and support for those with Dementia at the end of life; CG42 Dementia: A NICE-SCIE Guideline on supporting individuals with Dementia and their care givers in health and social care. As seen on page 19, the experiences of Dementia for a young individual means; availability of services - Alzheimer's Society supports the recommendation made by the All Party Parliamentary Group (APPGs) on Dementia that all health and social care staff must be equipped with the skills and knowledge to support all individuals with Dementia, including young people. Alzheimer’s Society calls for all Clinical Commissioning Groups (CCGs) to appoint a Dementia Lead, with specific responsibility for delivering services for all individuals with Dementia and identifying, and assessing the needs of, young people with Dementia when planning and commissioning services. Local authorities and CCGs should also commission Dementia Advisers to help a young person with Dementia access specialist services; means recognition of individual needs - Personal budgets for a younger person with Dementia. There are clear benefits to individuals with dementia and carers using direct payments. This is likely to be particularly beneficial to a younger person given the lack of appropriate services. The Care Act offers new opportunities for individuals with Dementia to access personal budgets. However, barriers to uptake remain, including the attitudes of clinicians, the complexity of the system and funding. Duty of employers to adopt good employment practices that support people with dementia and carers. Following a diagnosis, there should be a discussion of a variety of options to support the person to stay in work. Employers should also provide information, advice and guidance about finishing work to people with dementia and carers who are unable, or no longer wish to, continue working.

Page 21 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What are the factors that may influence the type and level of care or support to be provided?

Within the health and social care work setting, factors that may influence the type and level of care or support to be provided may include; Feasibility of aspirations; Beliefs, values and preferences of the individual; Risks associated with achieving outcomes; Availability of services and other support options; Gender e.g. it may be difficult for female individuals to approach male care staff for certain problems; Physical factors; Mental health factors; Beliefs factors; Religious factors; Cultural factors such are western culture or orthodox models of health care, with their emphasis on medication (Page 22 Graphic that shows the founders of Western Culture) in contradiction of traditional ways of treating health problems e.g. illness is ascribed to angry gods or bad spirits, this approach may not be perceived as effective and individuals will be unlikely to seek western culture or orthodox models of health care but indigenous healers or religious leaders may be consulted instead; Social environments; Education and literacy e.g. individual with no understanding of factors that may influence own type and level of care or support needed; Institutional preferences e.g. staff holding diplomas, having experiences on the care setting, who are perceived as wise, or likely to have the required information, may be trusted by most individuals; Institutional factors e.g. different codes of practice between different care settings; Care setting effectivity e.g. good communication between health care services will lead to better care; Individual personal health practices and coping skills; Factors affecting end of life care e.g. environmental factors, non-medical interventions, use of equipment and aids, alternative therapies; Factors that may influence mental wellbeing and mental health across the life span e.g. biological factors, social factors, psychological factors; Risk factors including inequalities, poor quality social relationships; Individual previous employment/working conditions; Individual social support networks; Individual financial and social status; Protective factors including socially valued roles, social support and contact; Healthy child development e.g. factors arising from individuals’ early lives may influence their wellbeing as adults and the potential impact of levels of wellbeing in adulthood their wellbeing in later life (individual’s personal history); Cognitive impairments e.g. individual living with Alzheimer dementia; Individual's mobility e.g. the use of a wheelchair or Zimmer frame; Others factors that may influence the type and level of care or support to be provided are in relation with support requirements and preferences for an individual which means additional plan of care as seen on page 23; Others support to take into account are factors related to complex or sensitive situations e.g. situations which are distressing or traumatic for the individual such are bereavement, loss, deprivation e.g. situations which are threatening or frightening such are potentially violent e.g. situations which are likely to have serious implications or consequences such are individual that show challenging behaviours within the care home e.g. situations which are of a personal nature such are involving confidential information e.g. situations which are involving complex communication or cognitive needs such are individuals with communication or learning disabilities that have preferred methods of communication such are communication album or books with large pictures.

Page 22 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

Page 23 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What additional plan of care within My Day My Life centred person approach care plan?

Within My Day My Life centred person approach care plan, support requirements and preferences for an individual will be found in an additional plan of care, regarding the following; D.O.L.S (Deprivation of Liberty Safeguards) e.g. individual with dementia that is at risk of self-neglect will be referred from senior care staff to the Dementia Team/Best Interest People (when the resident's next of kin come to visit the resident for the first time, I ask the resident's next of kin to sign the consent to access care documentation if the resident does not have capacity to consent, is on D.O.L.S); Type 2 Diabetes e.g. individual visited by District Nurse regarding insulin injection, individual that needs medications free of sugar, Blood glucose monitoring from senior care staff; Anticoagulant medication such as Warfarin e.g. individual visited by Pharmacist once or twice a week regarding the International Normalisation Ratio (INR) that will determines the Warfarin dose; Zimmer frame e.g. individuals with poor mobility and at risk at falls will be referred from senior care staff to the Physiotherapist (staff duty to maintain the individual's mobility as long as possible by ensuring the care setting is free of hazards such as broken glass and wet floor) to maintain their mobility; pressure cushion and pressure mattress e.g. individual with pressure sore that requires frequent change regarding position when sitting or lying on the bed; smoking e.g. individual that likes to smoke, staff to ensure safety regarding other individuals within the care setting; C.O.P.D (Chronic Obstructive Pulmonary Disease), Asthma e.g. staff to check the individual's inhalers are working properly; swallowing difficulties e.g. individuals on pureed meal/soft diet are at risk of shocking, staff to ensure they are not sitting on the same dining table with other residents that are free of swallowing difficulties; medication allergies e.g. Penicillin, staff to refer to the GP of the individual; individuals that are not safe being self-medicated e.g. individuals living with Alzheimer Dementia; decreased appetite e.g. individual losing weight, staff to refer the individual to the dietitian if the individual is losing weight, staff to take action by prescribing with the accord of the GP nutritional drinks such as Energy drink, Energy yogurt; individual's map of life e.g. staff to ask to the individual, Friends and relatives, N.O.K to fill out the individual's map of life that will give me precious information regarding the individual's favourite food and drink, hobbies and interests, favourite childhood memories, favourite places lived, favourite job, to ensure effective communication with the individual according to the individual's preferred method of communication; individual’s changing needs or preferences regarding the individual senses and communication e.g. the individual might need new glasses; choices and decisions over care e.g. the individual's dementia become worst; lifestyle e.g. the individual refuses to participate in any activities, refused to be include in activities, prefers one on one specific activity rather than group activity, asks to attend Church; medications e.g. the individual refuses taking his medications; safety e.g. the individual might become aggressive towards staff and other residents; mobility e.g. the individual cannot walk and need wheelchair; skin care e.g. the individual had a fall and one of the shoulder is showing bruises; washing and dressing e.g. the individual might change his preferences towards personal hygiene, for example an individual was having no preferences of male or female staff and now refuse male staff when being assisted with personal cares; personal hygiene e.g. the individual might become incontinent; eating and drinking e.g. the individual is losing weight; breathing and circulation e.g. the individual is showing problems when breathing; mental health and wellbeing e.g. the individual mental capacity is getting worst due of living with Alzheimer Dementia; future decisions e.g. the individual change of opinion regarding resuscitation in case of emergency.

Page 24 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

1.4 Describe how the experience of an individual’s dementia may impact on carers (4 pages to answer the question – Page 24 to 27)

Within the health and social care setting, the experience of an individual’s Dementia may impact on carers; means positive impact enabling carers to understand the most common cause of Dementia (see page 25 to 27) and develop skills to care for individuals with Dementia; means negative impact such as physical demands of the role on ageing partners, inability to step out of carer role, need for care becomes constant; means physical, social, emotional, financial impact on dependants.

Page 25 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is Alzheimer’s disease?

Alzheimer’s disease is the most common cause of Dementia in the elderly. During the course of the disease, the chemistry and structure of the brain changes, leading to the death of brain cells. The signs and symptoms of Alzheimer’s disease are caused by damage and the death of brain cells. The main features of this type of Dementia are; Memory Impairment; Loss of Language Skills; Failure to Recognise People; Impaired Movement; Personality Changes; Lack of Insight; Disrupted Sleep Patterns; Impaired Planning Skills; Hallucinations. These signs and symptoms are progressive and so they worsen over time.

Alzheimer’s disease affects how individuals think, remember, behave, perceive and communicate. Alzheimer's disease is a degenerative brain disease that causes chemical and structural changes to the brain which destroys the ability to remember and to reason. Individuals living with Alzheimer's disease experience memory loss and the increasing inability to understand language. This means that an individual with Alzheimer's disease may lose empathetic feelings and may not recognise carers and others from one day to the next. Alzheimer's disease can affect speech and language. An individual living with Alzheimer's disease may lose words gradually or get the order of their words muddled which makes conversation very difficult.

Page 26 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

How Alzheimer’s disease affects the different parts of the brain?

Alzheimer’s disease affects; the Frontal Lobe of the brain regarding the intelligence, judgement and behaviour of the individual; the Temporal Lobe of the brain regarding the memory of the individual; the Parietal Lobe of the brain regarding the language of the individual.

Page 27 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What are the risk factors for Alzheimer’s disease?

Research has revealed that there are certain risk factors which increase the risk of an individual developing the Alzheimer’s disease. Risk factors are usually classified as genetic or environmental. Genetic risk factors for Alzheimer’s disease have been found due to research into disease concordance, how often a disease occurs in twins and family members. Having a family history of Alzheimer’s is an important risk factor for developing the disease, and so far twin studies show about 40% concordance between identical twins. This means that in twins where one twin has Alzheimer’s, 40% of the second twins also have the disease. Environmental risk factors are events that happen in an individual’s life which is not determined by genetics e.g. History of Head Trauma; Smoking, Diabetes; Reduced Physical or Cognitive Activity; Circulatory Risk Factors; Increasing Age. Sadly, another risk factor is loneliness, a condition that is all too prevalent in our society, especially amongst the elderly.

Alzheimer’s disease is caused by the build-up of a protein called Beta-Amyloid Peptide in certain areas of the brain, which forms tangles within brain cells. Beta-Amyloid Peptide is a by-product of a cell membrane protein called Amyloid Precursor Protein (APP). Enzymatic Reaction is due of a split effect from the Amyloid Precursor Protein (APP), which forms a smaller beta-amyloid peptide, and as beta-amyloid peptide build up in the brain they cause progressive damage to the brain cells and ultimately cause them to death, affecting cell signalling and communication, which is affecting the individual's speech.

Page 28 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet. Task 2 - Understand the importance of diversity, equality and inclusion in dementia care and support

2.1 Describe how current legislation, government policy and agreed ways of working support inclusive practice for dementia care and support (6 pages to answer the question – Page 28 to 33)

What is inclusive practice for Dementia care and support?

Within the health and social care setting, inclusive practice for Dementia care and support means staff to promote equality and diversity in a ways of working that include individuals from different areas of race, gender, disability, religion or belief, sexual orientation and age. Therefore it supports diversity (see page 9) as it includes everyone. As everyone is included, everyone is on an equal level, with no judgement passed on areas of race, gender, disability, religion or belief, sexual orientation and age. Therefore this promotes equality (see page 11).

Within the health and social care setting, current legislation, government policy and agreed ways of working support inclusive practice for Dementia care and support means; Legislations e.g. The Human Rights Act 1998 (see page 29); The Mental Capacity Act 2005 and The Deprivation of Liberty Safeguards (DoLS) (see page 29); The Adults with Incapacity (Scotland) Act 2000 (see page 30); The Mental Health Act 2007 (see page 30); The Disability Discrimination Act 1995 (see page 30); The Safeguarding Vulnerable Groups Act 2006 (see page 31); The Carers (Equal Opportunities) Act 2004 (see page 31); The Equality Act 2010 (see page 31); Policy e.g. Putting People First – the personalisation agenda; Living Well With Dementia - a national dementia strategy; Agreed ways of working e.g. Active Support (see page 14), Person Centred Approach (see page 14), Person Centred Values (see page 15), Active Participation (see page 16), Model of Disability (see page 18), Dementia Care Mapping (see page 32), Rementia – challenging the limit of Dementia care (see page 33).

Page 29 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is The Human Rights Act 1998?

The Human Rights Act is a UK law passed in 1998. It means that you can defend your rights in the UK courts and that public organisations (including the Government, the Police and local councils) must treat everyone equally, with fairness, dignity and respect.

What are The Mental Capacity Act 2005 and The Deprivation of Liberty Safeguards?

The main function of The Mental Capacity Act 2005 is to provide a statutory framework to empower and protect vulnerable people who are not able to make their own decisions e.g. individuals living with dementia that lack mental capacity. It makes it clear who can take decisions, in which situations and how they should go about this. It enables people to plan ahead for a time when they may lose capacity. Human rights don’t stop when dementia comes. Guidance on the Act will be provided in a Code of Practice. People who are placed under a duty to have regard to the Code include those working in a professional capacity e.g. doctors and social workers. The 5 principles that are contained within the Mental Capacity Act 2005 are; A presumption of capacity – every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise; The right for individuals to be supported to make their own decisions – people must be given all appropriate help before anyone concludes that they cannot make their own decisions: That individuals must retain the right to make what might be seen as eccentric or unwise decisions; Best interests – anything done for or on behalf of people without capacity must be in their best interests; Least restrictive intervention – anything done for or on behalf of people without capacity should be the least restrictive of their basic right and freedoms. DOLS stands for Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DOLS) is part of The Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that a care home or hospital only deprives someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. In my workplace setting, I am working as a senior care assistant for older people living with early dementia; some of my residents are on DOLS. That mean their live under Deprivation of Liberty Safeguards because they are no longer able to make decisions regarding their care planning process due of living with advanced dementia. DOLS act in their best interests.

Page 30 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is The Adults with Incapacity (Scotland) Act 2000?

The Adults with Incapacity (Scotland) Act 2000 provides a framework for safeguarding the welfare and managing the finances of adults (people aged 16 or over) who lack capacity due to mental illness, learning disability or a related condition, or an inability to communicate.

What is The Mental Health Act 2007?

The Mental Health Act 2007 introduced a number of significant changes to the Mental Health Act 1983, with farreaching implications for mental health service users and their families and carers. Starting with the 2000 White Paper and continuing through the 2002 and 2004 draft Mental Health Bills, which were subsequently dropped and replaced by the 2006 Mental Health Bill, the Mental Health Alliance campaigned vociferously for truly rights-based legislation that would ensure people with mental health problems were not discriminated against in comparison with people needing treatment for physical illnesses.

What is The Disability Discrimination Act 1995?

The Disability Discrimination Act came into effect in 1995. It has been amended a number of times since by regulations implemented in Northern Ireland. Anyone with a disability is protected by The Disability Discrimination Act 1995. The Disability Discrimination Act 1995 defines disability as "a physical or mental impairment which has a substantial and longterm adverse effect on a person’s ability to carry out normal day-to-day activities". This includes significant sight loss. The types of discrimination it can help you challenge are the following; direct discrimination (such as a ban on employing blind people); disability related discrimination (e.g. a taxi driver refusing to take a blind passenger because they have a guide dog); failure by an organisation to make a reasonable adjustment to allow you access to goods, facilities and services; victimisation; harassment. In 2010, The Disability Discrimination Act 1995 was replaced with The Equality Act 2010 (see page 31) in England, Scotland and Wales. The information on this page now only relates to Northern Ireland.

Page 31 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is The Safeguarding Vulnerable Groups Act 2006?

The following link http://aspecmaps.free.fr/NVQ3/The_Safeguarding_Vulnerable_Groups_Act_2006.pdf explains the background to the Act and some of the details within the Act. More information regarding the full Act and its Explanatory Notes on the Office of Public Sector Information website at www.opsi.gov.uk

What is The Carers (Equal Opportunities) Act 2004?

The Carers (Equal Opportunities) Act 2004 is an Act of the Parliament of the United Kingdom aimed at helping carers to achieve fair access to training, work and leisure opportunities. The Carers (Equal Opportunities) Act 2004 requires assessments to be offered to carers, to consider the needs of carers in relation to leisure, education, training and work. Not all carers will wish to pursue all of these opportunities but practitioners completing assessments with the carer should be able to signpost carers to other relevant agencies.

What is The Equality Act 2010?

The Equality Act 2010 legally protects people from discrimination in the workplace and in wider society. It replaced previous anti-discrimination laws with a single Act, making the law easier to understand and strengthening protection in some situations.

Page 32 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is Dementia Care Mapping?

Dementia Care Mapping is an established approach to achieving and embedding person-centred care for individuals living with Dementia. Dementia Care Mapping is used by care practitioners to improve quality of life for individuals living with Dementia in a range of care settings, including care homes and hospitals. Dementia Care Mapping prepares staff to take the perspective of the individual living with Dementia in assessing the quality of the care they provide. It empowers staff teams to engage in evidence-based critical reflection in order to improve the quality of care for individuals living with Dementia. The Dementia Care Mapping cycle provides an ongoing evidence base for developing person-centred practice and achieving practice change and includes the following phases:

Dementia Care Mapping can be used for different purposes including; quality monitoring and improvement; individual assessment and care planning; review of key times of the day; staff development and training needs analysis. It has been used as part of a developmental, supervisory framework for staff that is supporting individuals living with Dementia in their own homes, and with other vulnerable groups of individuals who have communication difficulties.

Page 33 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

What is Rementia – challenging the limit of Dementia care? Dementia is conventionally defined in terms of neurological changes in the brain and an inevitable and progressive decline in the individual's cognitive powers and functional ability. However, this biomedical model fails to recognize other important factors within the dementing process, such as the social and care context within which the dementing individual lives. It is argued that appropriate care interventions can have a considerable impact on the progress of Dementia. Data from an evaluation of three experimental homes for the elderly mentally ill show that some degree of rementia, the regaining of lost cognitive and functional abilities is possible for some individuals. This evidence is used to argue for a more positive approach to Dementia care.

Page 34 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet.

2.2 Describe the ways in which an individual with dementia may be subjected to discrimination and oppression (1/3 of page to answer the question – Page 34)

Within the health and social care setting, the ways in which an individual with Dementia may be subjected to discrimination and oppression, are the following; stigma and prejudice; stereotyping; social isolation; denial of services e.g. support for people with Dementia is aimed at older people, with little support for younger people with Dementia (see page 19 table that compares the experience of Dementia for an individual who has acquired it as an older person with the experience of Dementia for an individual who has acquired it as a younger person).

2.3 Explain the potential impact of discrimination on an individual with dementia (1/3 of page to answer the question – Page 34)

Within the health and social care setting, the potential impact of discrimination on an individual with dementia, means; denial of services e.g. lack of specific end-of-life care for individuals living with Dementia; social isolation; lack of support for carers; abuse; neglect.

2.4 Analyse how diversity, equality and inclusion are addressed in dementia care and support (1/3 of page to answer the question – Page 34)

Within the health and social care setting, how diversity, equality and inclusion are addressed in Dementia care and support, are the following; early intervention to enable the individual to stay in their own home for longer; seamless integrated working to provide transition from domiciliary care, day care and eventually if needed to residential care; equality policy; care planning process; person-centred care, Dementia Care Mapping, rementia; policies such as CG42 Dementia: A NICE-SCIE Guideline on supporting people with dementia and their care givers in health and social care.

Page 35 of 35 aspecmaps.free.fr/NVQ3/DEM313.pdf Equality, diversity and inclusion in dementia care practice by Gaël Romanet. Task 4 - Be able to work with others to encourage support for diversity and equality

4. 3 Explain how to challenge discrimination and oppressive practice of others when working with an individual with dementia (1 page to answer the question – Page 35)

Within the health and social care setting, how to challenge discrimination and oppressive practice of others (that may include; Care workers; Colleague; Manager; Social Worker; Occupational Therapist; GP; Speech & Language Therapist; Physiotherapist; Pharmacist; Nurse; Psychologist; Admiral Nurses; Independent Mental Capacity Advocate; Community Psychiatric Nurse; Dementia Care Advisors; Advocate; Support groups) when working with an individual with Dementia, are the following; recognising signs and symptoms of danger, harm and abuse and using the organisation’s systems and procedures to report these; developing relationships in which individuals are able to express their fears, anxieties, feelings and concerns without worry of ridicule, rejection or retribution; supporting individuals and key people to understand own responsibilities to pass on information about actual and likely danger, harm and abuse and protect them and others from danger, harm and abuse; using supervision and support to cope with own thoughts and feelings about any suspected and/or disclosed danger, harm and abuse; complete accurate timed and dated records and reports, on suspicions of danger, harm and abuse within confidentiality agreements, according to legal and organisational requirements and that avoid statements that could adversely affect the use of evidence in future investigations. In a general manner, the importance of staff to understand and to promote a holistic view which means that we are interested in engaging and developing the whole person taking into account different levels, physical, emotional, mental and spiritual. It's the concept that the human being is multi-dimensional. We have conscious and unconscious aspects, rational and irrational aspects. An individual living with Dementia is still an human being with the same rights as others.