Mrs C came to Aranlaw House when the care home she had been living in closed down. Mrs C had complex heath problems and these had been the focus of her care in her previous home; her dementia seemed to have been seen as part of her overall ‘frailty’ and no dementia specific care had been given to her. Mrs C was doubly incontinent and although she could weight bear she was unable to walk more than a step or two when being transferred with two staff. In the Home she had previously lived in Mrs C had been cared for in bed for most of the time as staff had felt she just wanted to sleep and was more comfortable in bed. Mrs C had lost a considerable amount of weight and was prescribed dietary supplements to drink to increase her calorie intake.
Mrs C spoke only a few words and would often sit for long periods humming to herself or singing the same line of a song over and over again as she pleated the hem of her skirt or repeatedly ran her hand over the table as if wiping it clean. As staff approached Mrs C to offer her help or bring her food or drinks she would often appear startled; not appearing to see them until they were right in front of her. Sometimes Mrs C could eat independently but more often than not she needed carers to assist her to eat and drink, she seemed to take no pleasure from eating and almost always declined to drink the supplements she had been prescribed.
We quickly realised that many of the needs that Mrs C had had been incorrectly attributed to her physical health problems. She was in fact exhibiting behaviours and visuo-perceptual and communication difficulties that indicated she had dementia at Stage 3. At this stage of the illness it is important to provide stimuli that is within the person’s visual field, which may be greatly reduced as the result of poor peripheral vision, loss of acuity and ability to see colour, as well as the person no longer being able to turn or raise their head easily to see in front of them or to look at what may be next to them. Social stimulation and activity at this stage is critical to prevent the person slipping prematurely into Stage 4.
Our staff now approached Mrs C more slowly; always from the front and gently spoke her name as they approached. When close to her staff crouched down to her level and used touch to confirm they were there and focusing on her. Gradually Mrs C stopped jumping as we approached and her eye contact with staff increased. We gave Mrs C a brightly coloured duster and she would often pick this up and wipe at the table as she had previously with her hand but she would attempt to fold the duster up and put it tidily on the table. Staff thanked Mrs C for helping to clear up and she would smile in response.