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« Eldertopia and What Are Old People For? | Main | Dr. Bill Blogs as The TGB Geriatrician »

May 6, 2008 |Permalink |Comments (2)

Monkhouse Monday: Dementia, Diversity and Eldercare

[Editor's Note: (Below is this week's edition of 'Monkhouse Mondays', accidentally postponed to Tuesday -- Sorry Christa!)
Dr. Thomas has invited Eden Alternative's Europe Coordinator Christa Monkhouse to guest-post on a weekly basis from across the Big Pond. Christa is personally responsible for introducing the Eden Alternative to Europe, first in the UK, then Denmark, Austria, Germany, Switzerland and soon in Sweden, Finland and other European nations. Stay-tuned for regular updates on 'Monkhouse Mondays'.]

Persons with Dementia (PwD), do they need "Special Care“ or simply to be part of our "Cultural Diversity?“

Presenting the Eden Philosophy to varied audiences of professionals I am often asked: "Which model of care do you use for people with dementia?“, implying that surely they must be treated "specially“, given the proliferation of "special care units“.

My answer, informed by experience is: "Intentional and informed diversity-management.“

What do I mean by this? Some context: We know that people with dementia are overmedicated (see Al Power’s post on Antipsychotic Restraints), at conferences we hear about solutions for "wandering“, "aggression“, "unrest“ and "violence“. We keep PwD in "secure“ or "special care“ units. Research has shown that overmedication causes more deaths, that wandering is a normal and purposeful reaction to "feeling out of place“ in an institution, so are aggression, restlessness and violence. Secure units and chemical restraints keep people with dementia away from mainstream society. In Swiss law and medical ethical guidelines (www.samw.ch, english version/ethics/guidelines = coercive measures in medicine) a person can only be "secured“ for a short time if she is a danger to herself or others. Anecdotal evidence shows that people with dementia are actually very cautious, perceiving different colour flooring as "gaps“ and stopping in front of them. The question arises if "secure units“ are a severe infringement of human rights?

The answer? Why not educate the general public, schoolchildren in how to deal with PwD? How to serve them with attention and compassion at the supermarket checkout, the bus, the train, the cafe? If a person has "eloped“ from a care home, educated police will know what to do, normal, everyday business, calm, professional, warm. As there will be more and more people with dementia, they have the potential to add to the diversity of our society, visible at parties, restaurants, parks, hairdressers, beauty parlours, banks and hotels. They should not be marginalized, segregated and hidden. No, they can remind us how being, not just doing, is valuable in our lives and that tenderness and compassion can be practiced every day. This would be a true recovery approach to dementia care as outlined in Dr. T. Adams’ insightful and practical new book on Dementia care(p. 283). PwD would so re-cover the ground they have lost through the socially constructed segregation from mainstream society.

An empathic, practical and useful approach to dementia recovery on a personal level is the Spark of Life program developed by J. Verity, Eden Mentor for Scandinavia and Dementia-care pioneer from Australia. Watch the Demo-Video on YouTube and be moved (I was) to tears

--
Christa Monkhouse, www.eden-europe.net

Comments ( 2)

awe-inspiring video. truly.

Posted by Judith Shapiro [TypeKey Profile Page]
May 7, 2008 1:01 AM

Like most folks reading this blog I am appalled at how elders are treated in nursing homes, and the treatment of elders with dementia scares the heck out of me. But. Last night I was talking to a retired nurse with a lot of experience caring for people of many ages with a wide variety of disabilities. She pointed out that often restraints are used for the protection of the restrained person, so that they don't have accidents when no one is watching them. And nursing care is notoriously understaffed, we don't pay them enough and we don't hire enough of them because it just costs too darn much. As a mother of three I know how hard it is to keep your eyes on little ones every second, I am sure the same applies to nurses caring for elders. In North America we simply don't have the same ethic of putting care for people ahead of economics as they do in Europe.

From personal experience I'm not sure I agree entirely with the statement "wandering is a normal and purposeful reaction to 'feeling out of place' in an institution". I agree with purposeful but I don't think this is limited to institutions, I think the feeling of being out of place can happen to persons with dementia regardless of their circumstances, it's part of the 'disease'.

Posted by Anne
May 9, 2008 9:03 AM

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