This week is Dementia Awareness Week; a time to reflect on the huge numbers of people with this illness who are living in care homes which have nothing to offer their residents beyond the most basic of care. I have visited too many of these sorts of “homes” and been shocked to see elderly residents, suffering from dementia, left to sit in the same chair from morning until night, with no attempt being made to encourage them to join in with any activities. If, indeed, the home offers any, other than a box of crayons and a colouring book.

On one occasion I visited a relative who I found, as usual, sitting alongside a widescreen television, with the sound blaring in her ear. Her chair faced the same way as the television, which meant she could not see the screen – even if she wanted to watch a programme. Happily, she is now in a Care Home with staff who provide companionship, stimulation and kindness. She is surrounded by jigsaw puzzles, duplo and other activities. A “Memory Lane” reminds her of times gone by; appropriate songs are sung and played; visiting musicians entertain and she is treated as a person in her own right. Her medication has been quartered, she speaks again and can weight-bear – all in the space of a month.

According to figures provided by The Alzheimer’s Society, over 80 per cent of people in care homes have dementia. There are 800,000 adults – some aged as young as 40 – living with dementia, but fewer than half of those have been diagnosed. Try as I might, I could not persuade either of the GPs who looked after my mother-in-law that a diagnosis would be helpful. Rather like some doctors who still seem under the impression that breast cancer is just one illness, there are too many who wave their hands in the air and say “Well, it’s dementia, isn’t it?” and prescribe mood-altering medication which can be administered at will by untrained carers in care homes.

Would it not be so much better to ensure that all staff in care homes are trained properly in dementia care? Would it not be better to use non-pharmacological approaches? Should we not ensure that medication is not handed out purely to keep the dementia patients quiet?

The Care Quality Commission calls for “better identification of dementia and comprehensive training for staff”. Shouldn’t care homes which can no longer cope and have slowly spiralled downwards under the weight of more dementia patients than is possible to manage be subjected to much more careful scrutiny by the CQC? It is all too easy to make these statements, but it is the responsibility of the CQC to implement their duty of care to such vulnerable members of the community.

I fear that nothing very much is changing in many Care Homes. Yet there are possibilities on offer which would create a calm, secure and mentally comfortable environment for those living with dementia. Richard Ernest – who I have mentioned before – produces RemPods, which are “pop-up” rooms decorated and furnished authentically in the period. His 1950s living room is particularly popular and, recently, he emailed to tell me that he has unveiled his “pop-up” shop and pub, complete with smells and sounds. Wandering through these sets allows the dementia patient to relax in familiar surroundings and unlock memories – vital for carers and nurses who need to learn more about their patients in order to communicate with them effectively and create the best care plan.

I have a great interest in the Montessori education system for children and have suggested before that it could so easily be adapted for dementia patients. Over the past year I have discovered that this work is not exclusive to the United States.

Initially – having written a couple of blog posts on the subject last year – I was contacted by Tom and Karen Brenner (from Brenner Pathways). Tom and Karen are gerontologists, researchers, consultants, trainers and writers working in the USA. They work with dementia patients using the Montessori method which is described in their new book: You Say Goodbye and We Say Hello: The Montessori Method for positive dementia care. I think it should be compulsory reading for anyone working with dementia patients. Muscle memory still works in dementia patients – so arranging flowers, sorting objects and singing well-known songs can re-establish a sense of great achievement in a task completed. I only wish I had thought of this when my mother was diagnosed with vascular dementia. She would have benefited hugely from exactly those activities. The Montessori method offers a way of reducing the sense of isolation, anger and frustration which accompanies the different forms of dementia.

Another good book is Montessori based activities for persons with dementia. Vol 1, written by Dr. Cameron Camp from the Myers Research Institute in Ohio. The institute has been researching the use of the Montessori system in its dementia programming for over 10 years and has proved that, by using the system, there is an increase in levels of engagement and participation in persons with dementia.

Now I discover that the UK is slowly catching up with the acceptance of the Montessori method. Dementia Works – run by Fiona Fowler and Alistair Richardson – provides training for carers and nurses, “utilising the approach of Montessori principles when working with people with dementia”. Fiona was the Consultant for the Channel 4/Clarity Productions Losing Myself in the Three Minute Wonders series, which explored the lives of people living with dementia.

At the University of Salford, Natalie Yates-Bolton is the co-lead of the Dementia Design Group. Despite being diagnosed with breast cancer, Natalie won a Florence Nightingale Foundation travel scholarship to the USA, to study non-pharmacological approaches to improving the quality of life for people with dementia. She believes that up to two thirds of antipsychotic prescriptions could be avoided if appropriate support was available to people with dementia, their carers and other staff. She believes firmly that “activities should not be used merely to fill the time”.

The UK has too few trained dementia nurses – the best known being Admiral Nurses, provided by Dementia UK. The charity has had a big rethink and, in future, will concentrate only on these nurses. There will be investment in the Admiral Nursing Academy – which supports research and practice development – with the objective of expanding the number of Admiral Nurses. Dementia UK will be recruiting a Chief Admiral Nurse and I hope sincerely that he or she will include the Montessori method in the Admiral Nurses’ training course.

http://blogs.telegraph.co.uk/news/judithpotts/100217659/