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Unit 313. Equality, Diversity and Inclusion in Dementia Care and Practice.

Unit 313. Equality, Diversity and Inclusion in Dementia Care and Practice.

PERFORMANCE EVIDENCE RECORD QCF Unit …313…………………………………………………………………. Candidate Name ………………………………………………………… Use this form to record details of activities (tick as appropriate) Observed by your assessor(Work product( Seen by Expert Witness( APL( Seen by witness(Simulation( Self-reflective account(Projects/Assignment( Unit |Assessment |Performance Evidence | | |criteria | | | | | | | | | | | | | | | | |Unit 313.

Equality, diversity and inclusion in dementia care and practice. | | | | | | | |Q1(1. 1) Explain why it is important to recognise and respect an individual’s heritage. | | | | | | |It is important to recognise and respect an individual’s heritage, because a heritage is the past life history| | | |of each individual, if we learn more about the heritage of a person, we can identify the person’s character, | | | |likes and dislikes and habits.

It helps to find out their actual needs. Especially in the case of a demented | | | |person, he may very confused and he doesn’t know what to do and what is his actual needs, so if we know about | | | |his culture and heritage we can make him very comfortable with all his needs. | | |Individual human beings, their different common and individual activities as a potential power in society, and| | | |different cultural, social, political, economic and legal contexts for cultural heritage activities are very | | | |important. Individual human beings and everyday life is the ground for all selected and protected cultural | | | |heritage, and the commercial, political and societal use of it.

The power of national and international laws | | | |and conventions are remarkable. On the contrary, the power of individuals is often invisible, and it is not | | | |always obvious to take it into consideration in connection to cultural heritage and the use of it. | | | | | | | |Q2(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. | | | | | | | | | | | | | | |There are over 16,000 younger people with dementia in the UK.

However, this number is likely to be an under | | | |estimate and the true figure may be up | | | |to three times higher. Data on the numbers of young onset cases are based on referrals to services, which | | | |significantly underestimates the numbers, because not all those with young onset dementia seek help early in | | | |the disease course. | | |There are often long delays in younger people with dementia receiving a diagnosis. Improved diagnostic | | | |services would help people get access to care more quickly and easily. | | | |It is important that younger people with dementia have access to a range of specialised services that address | | | |their particular needs. There is currently a lack of specialised services to meet the needs of people with | | | |dementia under 65. | | |Services must be age inclusive, they should be based on need, not age. It is essential that commissioners of | | | |services recognise the needs of younger people with dementia, as well as older people. | | | | | | | |Younger people with dementia may have different needs to people aged over 65 requiring a different type of | | | |service or a response appropriate to their age.

In general, younger people with dementia are more likely to: | | | |Be in work at the time of diagnosis | | | |Have dependent children  | | | |Have heavy financial commitments such as paying a mortgage  | | | |Have a rarer form of dementia with which professionals are less familiar  | | | |Find it difficult to rationalise losing skills at such a young age  | | | |Find it more difficult to access appropriate information and support. | | | | | | | |Once diagnosed, younger people with dementia all too often find it difficult to access suitable support and | | | |services. Dementia care services are usually designed for older people. Some dementia services have a minimum | | | |age criteria of 65 and even if dementia services accept younger users, the type f care they provide may not | | | |be appropriate. This means people are required to travel considerable distances to access appropriate services| | | |or may be left without the support they need. | | | | | | | |Q3 (1. 3) Describe how the experience of dementia may be different for individual’s | | | |Who has a learning disability? | | | |Who are from different ethnic backgrounds? | | | |Who are at the end of life? | | | | | | | | | | | | | | |a) Advances in medical and social care have led to a significant increase in the life expectancy of people | | | |with learning disabilities. The effect of ageing on people with learning disabilities ? including the | | | |increased risk of developing dementia ? has become an increasingly important issue. | | | |The causes of learning disability are varied.

They include genetic | | | |disorders, such as Down’s syndrome, pre- or post-natal infections, brain | | | |injury, and general individual differences. Dementia is a general term used to describe a group of diseases | | | |that affect the brain. Alzheimer’s disease is the most common form of dementia. The damage caused by all types| | | |of dementia leads to a progressive loss of brain tissue. As brain tissue cannot be replaced, symptoms become | | | |worse over time. Symptoms may include: | | | |loss of memory | | |difficulty concentrating | | | |difficulty finding the right words or understanding what other people are saying | | | |a poor sense of time and place | | | |difficulty completing self-care and domestic tasks | | | |difficulty solving minor problems | | | |mood changes | | | |Changes in behaviour. | | | |There is no evidence that dementia affects people with learning disabilities differently to how it affects | | | |other people. However, the early stages are more likely to be missed or misinterpreted – particularly if | | | |several professionals are involved in the person’s care.

The person may find it hard to express how they feel | | | |their abilities have deteriorated, and problems with communication may make it more difficult for others to | | | |assess change. | | | |It is vital that people who understand the person’s usual methods of communication are involved when a | | | |diagnosis is being explored – particularly where the person involved does not use words to communicate. | | | | | | | |b) The people with dementia and those who are from different ethnic background should have some different | | | |problems.

They all might have some problem with their language and also their cultural backgrounds are very | | | |different. Because of their mental condition they might have some problem with their memory, so they can’t | | | |realise what they have to eat or drink, they can’t make any decision. So we need to learn more about their | | | |cultural heritage, their eating habits. Eg. For Arabic-speaking communities who are Catholics, religion is | | | |important for comfort. It is separate from everyday life and does not have an impact on decisions relating to | | | |illness.

In some cases the priest may visit the family and act as a counsellor to help ease the stress on the | | | |family. For those who practice Islam, dementia | | | | | | | | | | | |is God’s will and should be accepted. However, this does not prevent the community from seeking treatment, | | | |because they believe that God enabled us to create treatment so we should use it. | | | | | | |c) During the later stages of dementia most people will become increasingly frail due to the progress of the | | | |illness. They will also gradually become totally dependent on others for all their care. | | | |Knowing what to expect can help everyone to prepare, and can enable | | | |the person to write an informed advance decision before | | | |they reach this stage so they can have some say over how they will be cared for. | | |Symptoms in the later stages | | | |Each person with dementia experiences their illness in their own individual way. The symptoms described below | | | |do not necessarily indicate that a person is in the later stages of the disease, as several of them can also | | | |be experienced in the earlier stages. However, these symptoms are very likely to occur in the later stages. | | | | | | | |Memory loss | | | |Memory loss is likely to be very severe in the later stages of dementia.

People may be unable to recognise | | | |those close to them or even their own reflection. They may no longer be able to find their way around familiar| | | |surroundings or identify everyday objects. However, they may occasionally experience sudden flashes of | | | |recognition. | | | |The person may believe that they are living in a time from their past, and may search for someone or something| | | |from that time. It can be helpful for those around them to use this as an opportunity to talk about the past | | | |and try to reassure the person. | | |Even if a person has severe memory loss, they may still be able to appreciate or respond to outside stimuli | | | |such as music, scent and touch. | | | | | | | |Communication | | | |The person with dementia will experience increasing problems understanding what is being said to them and what| | | |is going on around them.

They are likely to find it difficult to communicate with other people. They may | | | |gradually lose their speech, or they may repeat a few words or cry out from time to time. However, verbal | | | |language is only one way of communicating. The person’s expression and body language may give clues about how | | | |they are feeling. | | | |Those around the person should continue talking to them as though they understand. This helps to preserve | | | |their dignity. There may still be moments when the person seems to make an appropriate response. | | | | | | | | | | | | | | | | | | |Loss of mobility | | | |Many people with dementia gradually lose their ability to walk and to perform everyday tasks unaided. One of | | | |the first signs of this is that they shuffle or walk unsteadily. They may also seem slow or clumsy and be more| | | |likely to bump into things, drop objects or fall. A stroke, arthritis or the effects of a fall may also affect| | | |a person’s mobility. | | | | | | |Q4 (1. 4) Describe how the experience of an individual’s dementia may impact on carers. | | | |Dementia is a progressive disease and those who suffer with dementia gradually lose the ability to live | | | |independently without the assistance of | | | |others. The majority of patients are cared for by family caregivers and these individuals are placed in a | | | |situation of escalating personal demands. | | |Caring for an elderly person with dementia is a major life challenge and it entails emotional, physical, | | | |social and financial burden. It also has been described as one of the most difficult situations encountered by| | | |caregivers. Caregivers of dementia patients can experience various emotional problems during the course of the| | | |illness. One such disorder, that is frequently overlooked and not treated, is carer’s depression. It is well | | | |documented that family caregivers of persons with dementia have significantly more depressive symptoms than | | | |age and gender-matched non caregivers.

Caregivers of persons with dementia report more emotional strain and | | | |depressive symptoms than caregivers of persons who are not demented. Prevalence rates for depressive symptoms | | | |among caregivers of persons with dementia are reported to range from 28% to 55%. Prevalence of depression | | | |among caregivers of people with dementia has been estimated at between 40 and 60% which contrasts sharply with| | | |8% reported in non-caregivers of similar age. Recognition of risk factors or characteristics that may | | | |facilitate or are associated with the disease process is therefore crucial. | | |Risks for carer depression are related to gender, age, health status, ethnic and cultural affiliation, lack of| | | |social support, as well as certain other characteristics related to the caregiver. As caregivers depression | | | |while caring for a person with dementia increase the risk of abuse within a care giving relationship. | | | |Caregivers themselves may face verbal or physical abuse directed at them by | | | |the patient with dementia. In some cases, Alzheimer’s disease or other forms of  | | | |dementia may cause the patient to be uncharacteristically aggressive.

In other | | | |cases, verbal abuse or physical violence may have been typical of family | | | | | | | | | | | |interactions before the illness, and may be exacerbated | | | | | | | |Q5 (2. 1) Describe how current legislation government policy and agreed ways of working support inclusive | | | |practice. | | | | | | |Mental Capacity Act 2005 | | | |The Mental Capacity Act 2005 (MCA) provides a statutory framework for people who may not be able to make their| | | |own decisions. The Act creates a new role of Independent Mental Capacity Advocate (IMCA) whose purpose is to | | | |help vulnerable people who lack capacity and are facing important decisions made (on their behalf) by the NHS | | | |and Local Authorities.

The Act introduced a duty on the NHS and local authorities in England and Wales to | | | |involve an Independent Mental Capacity Advocate (IMCA) in certain circumstances. This is to ensure that if a | | | |person lacks capacity to make decisions for him/her self, and has no suitable family or friends who can speak | | | |for them, they have the right to be represented by a person who is independent of the service providers | | | |(an IMCA). A person only has a right to an IMCA, however, in circumstances relating to serious medical | | | |treatment or when a move into accommodation arranged by the local authority or NHS body is being considered. | | |Mental Health Act 2007 | | | |The Mental Health Act 2007 received Royal Assent on 19th July 2007 and the main provisions were implemented in| | | |October 2008. Section 130, relating to advocacy provision in England, comes into force in April 2009, for | | | |Wales in October 2008. The Act introduces a statutory framework for an Independent Mental Health Advocate | | | |(IMHA) to be made available to anyone who is being treated under the powers of the Mental Health Act. The | | | |Department of Health is committed to improving services for detained patients by ensuring that patients have | | | |access to high quality advocacy support. | | |PALS and ICAS | | | |The Independent Complaints Advocacy Service (ICAS)  | | | |PALS act on behalf of their service users when handling patient and family concerns. They liaise with staff, | | | |managers and, where appropriate, other relevant organisations, to negotiate speedy solutions and to help bring| | | |about changes to the way that health services are delivered.

PALS will also refer patients and families to | | | |local or national-based support agencies (such as locally based independent advocacy organisations) as | | | |appropriate. | | | |ICAS is the agency that supports individuals complaining about the National Health Service (NHS). All | | | |services provided by the NHS will come under the NHS complaints procedure and this would include GPs, | | | |hospitals, pharmacies, opticians, dentists. ICAS focuses on helping individuals who choose to pursue | | | |complaints about the NHS. | | | | | | | | | | |Disability Rights Commission Act | | | |The Disability Rights Commission Act 1999 led to the establishment of the Disability Rights Commission (DRC) | | | |in April 2000. This Act sets out the DRC’s statutory duties. | | | |Equality Act 2010 | | | |The Equality Act 2010 brings together nine separate pieces of legislation into one single Act, simplifying the| | | |law and strengthening it in important ways to help tackle discrimination and inequality. | | |Human Rights Act | | | |The Human Rights Act became law in Britain on 2nd October 2000 and its articles and protocols gave all people | | | |constitutional rights that were intended to prevent discrimination and unfair treatment, again echoing the | | | |ideals of advocacy: | | | | | | | |Q6 (2. 2) Describe the ways in which an individual with dementia may be subjected to discrimination and | | | |oppression. | | | | | | | |The biggest example of discrimination is in the provision of community services.

Local authorities and the NHS| | | |will put in place large packages of | | | |care for younger people with disabilities to support them to live in their own homes, which are, on average | | | |way in excess of levels of support that will be offered to older people. We regularly hear about social | | | |services deciding to move someone with dementia into a care home with little consideration being given to how | | | |a small amount of additional support at home could help someone to maintain their independence in the | | | |community for far longer. | | | | | | | |For people in care homes access to primary care services can be problematic.

Given the range of conditions | | | |which people in care homes typically experience it would seem sensible for residents to have regular check | | | |ups. However, this is often not the norm. The inadequacy of community chiropody, physiotherapy, optometry and | | | |dentistry are of particular concern. For example, chiropody can help people remain mobile and prevent falls | | | |and broken hips. Eye tests can alert people to the need for new glasses and of cataracts. For someone with | | | |dementia, these symptoms can be developing, without the person requesting help. Proactive screening needs to | | | |take place to pick up symptoms early.

Unfortunately we regularly hear about people in care homes developing | | | |very serious symptoms and conditions, such as cancers that could have been picked up and treated far earlier. | | | |Dementia gradually robs people of their ability to speak out about abuse, neglect and discrimination. This | | | |makes people with dementia especially susceptible to abuse. If someone with dementia is sitting in soiled | | | |clothes, hasn’t eaten for 24 hours and has been handled roughly to get them out of bed, they may not tell | | | |anyone about it. | | | | | | | | | | |Reporting of distress is far more likely to happen if the person with dementia has someone such as an | | | |articulate relative who can speak out for them and when the care providers encourage feedback. | | | |Very often people will act as grateful recipients of services and as such don’t feel in a position to question| | | |or request additional or different help.

It is very common for people to respond that they ‘don’t want to | | | |complain because they know that the home or the ward is short staffed and that they are all doing their best’. | | | |It is also clear that people do not have enough information to be clear about the standards of care that they | | | |should be entitled to expect. | | | |Fear | | | |People with dementia and their families can be fearful of complaining because of the ramifications that it can| | | |have. An Alzheimer’s Society outreach worker was recently supporting a family that had requested that bedding | | | |be changed more frequently.

The response from the care home manager was that “if they didn’t like it, they | | | |could find somewhere else”. | | | | | | | |Q7 (2. 3) Explain the potential impact of discrimination on an individual with dementia. | | | |The physical effects are: headaches, poor appetite, a change in eating habits, sleeplessness, and loss/gain of| | | |weight, deterioration of health, bruises, and ulcers, lack of personal hygiene and lack of energy. | | |The emotional effects are: low self esteem, lack of confidence, feeling unwanted, insecurity, becoming | | | |withdrawn, depression/stress, anxiety, sudden change in behaviour, lack of co-operation and learned | | | |helplessness. | | | |The social effects: isolation, lack of friends, becoming withdrawn, unrecognized as an individual, feel like a| | | |stranger and inability to build relationships. | | | |The intellectual effects: restricted access to education, lack of achievements, poor job prospects, lack of | | | |skills, self-fulfilling prophecy, loss of motivation, lack of interest in anything and absence from work. | | | | | | |The long term effects could include: | | | |loss of motivation | | | |reduced individual rights | | | |restricted opportunities | | | | | | | | | | | |limited access to services | | | |mental illness caused by stress | | | | | | | |Q8 (2. 4) Analyse how diversity, equality and inclusion are addressed in dementia care and support. | | | | | | | |Fundamental to a person centred approach are the concepts of equality, diversity and inclusion. It is | | | |important to understand that each person’s experience of dementia is unique. | | |It is essential to recognise and respect a person’s individual history, in particular: | | | |the experience of dementia for a younger person may be very different to the experience of an older person | | | | | | | |The experience of dementia may be different for individuals, | | | |who have a learning disability; | | | |who are from a Black or minority ethnic background; | | | |who are lesbian, gay, bisexual or transgendered; | | | |Who are approaching the end of their life. | | | | | | | |Q9(4. 3) Explain how to challenge discrimination and oppressive practice of others when working with an | | | |individual with dementia. | | | | | | |If we find out any discrimination between the service users, we need to stop that as soon as possible, for | | | |that we have to explain them the consequences of discrimination, and ask their problems that led to the | | | |situation, and solve it. If it is happening between a service user and a member of staff, we have to inform to| | | |our manager immediately. It is not easy to stop the discrimination in dementia case, because they are very | | | |confused, they don’t realise what they said, and some times it might be some discriminative words or behaviour| | | |towards another clients or staffs. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |Candidate Signature………………………………………………………….. Date.. …………………. | | | | | | |Assessor Signature……………………………………………………………Date…………………… | | | | | | | |Internal Verifier Signature and Date (if sampled) …………………………………………………… | | | |(photocopy as required) | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Performance Evidence Record (continued) Unit |Assessment |Performance Evidence | | |criteria | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | ———————– Evidence ref: Unit numbers: ———————– V2-01/08