Behavioural support


Specialist behavioural support services within dementia care


Dr Zoe Lucock and Dr Emma Williams, co-directors of Positive Ageing Consultancy & Training, explain how incorporating behavioural analysis as part of a multidisciplinary approach to dementia care can have a profoundly positive impact on the support that a person living with dementia receives


Before we delve into the exciting details of behavioural support, let us look at the case of Mildred. Mildred is one of many older adults living with dementia in a care home. The perspectives of each individual involved with her case show the importance of a behaviour analyst in performing specialist assessments and consolidating data to create a person-centred bespoke coaching programme for her caregivers.


The resident: Mildred When I was younger, I could recall details about my life and memories like they were the most exquisite glass in front of me, every detail was clear and crisp. Now, I don’t even know where I live or what I’m doing here. This scares the living daylights out of me! I look in the mirror and sometimes it’s my face I see, and other times I see a ghastly wrinkled old woman staring at me. I’m sure she’s a ghost haunting me for something that I did years ago.


In this place that I can’t seem to escape


from, I make sure to laugh and smile when people talk at me so that they can’t see that their words are passing through my brain like wispy smoke. Most of the time when people talk at me, I manage to keep the pleasantries going, but sometimes the cheeky upstarts that appear to run the place seem to enjoy putting me through some kind of torture! Every day without fail, they make me get out of bed because they say I need to wash. I’ve


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started giving them a bit of a bash now when they come in to boss me around. I used to just shout at them and tell them to go away and leave me alone, but they didn’t listen to that. I’ve never liked showering; I’ve always


preferred a bath. Far nicer to relax and enjoy the water rather than to jump in and out too fast. I hate the noise and the way the water spikes my skin like needles when it falls down from the roof. I’ve tried telling them that I don’t like it, but they look at me as if I am speaking a foreign language. When they get their own way and put me in the shower it doesn’t feel like a shower. Something feels wrong.


The care home manager Mildred has lived in our home for about nine months. She came to us after her dementia


Behaviour analysts work within multi-disciplinary teams and collaborate with all professionals involved in someone’s care


progressed and she could no longer manage at home. Before she came, she almost set her house on fire, so it’s a good job we could take her in at short notice. When she first came here, she settled in


well and the staff seemed to get on with her. The last six months have been a completely different story! My staff have begun to report more and more frequently that Mildred hits them when it’s time for her shower. Things got so bad that two members of staff had to be taken off her care plan because they threatened to leave if she hit them one more time. I’ve only got two other members of staff available to help out with her, but what are we meant to do when they’re off? My staff have told me that they speak


calmly and try to reason with her and tell her that she needs to wash or she’s going to get poorly, but this doesn’t work and only seems to make her more angry. We’ve tried all the tips and tricks that


have worked with other residents over the years and the recommendations from other professionals. Now we are at the end of the road. I think she would be better off living somewhere a bit more secure, where they can control her a bit better. Maybe she needs


www.thecarehomeenvironment.com January 2024


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