Leah Bisiani is a self-styled crusader for dementia care, who runs regular workshops and training sessions, and addressed the prestigious 25th Annual Gerontology Assoication Conference in Canada last year (2006). She spoke to Sue Cartledge about the importance of ‘true person-centred care’.
She outlined her approach to dementia care and the initiatives she has introduced as manager of Thornbury Aged Care Hostel, Primelife Medina Manor in Melbourne.
Sue Cartledge: What are the key messages that aged care providers need to understand about dementia?
Leah Bisiani: The key point is to ensure that the resident’s quality of life is maximised. And in order to do that, we need to first resolve any depression the person may be suffering from. Over 50 per cent of people with dementia, especially Alzheimer’s, have undiagnosed depression. This is a massive area that is currently totally neglected in dementia care, even though it destroys the resident’s quality of life and exacerbates every symptom of dementia and makes caring for them more difficult.
Depression is not part of dementia and it can be resolved. This is an area that needs to be addressed in AC facilities across the country.
The next key is sensory stimulation. Because people living with dementia have no short-term memory, nor can they think about the future, they live in the present moment. If we can make that moment happy and enjoyable for them, they will be happy. While their cognitive facilities degenerate with the disease, their senses don’t, or at least, only to the degree of normal ageing. So, lots of activities that involve touch – patting animals, massage, holding hands, activities like gardening or cooking, lots of tactile objects and wall hangings with different textures to feel.
Music, dancing, talking, singing. Aromatherapy, scented plants, cooking smells – all stimulate the senses and make the residents happy.
Colour is very important, especially bright, strong colours. Most people with dementia have impaired eyesight, so they can’t distinguish pastels. Cheerful colours lead to positive emotions, where greys and creams and neutral tones don’t stimulate them and make them feel low. Green is calming, blue is peaceful; orange and red are stimulating; yellow just makes everyone feel like smiling.
A lack of sensory stimulation makes residents feel depressed, anxious and agitated.
Thirdly, care must be provided in a holistic framework that meets the resident’s needs. We need to see the world through their eyes, enter their reality because they can’t understand the way we think and operate. So routines and preferences must be ones that the resident chooses and that they’re happy with. If we try to enforce our routines on them, it makes them feel they are not important, and this leads to agitation and unfortunate behaviours. This is their home, and we have to help them create a lifestyle that makes them happy, — that makes their final years their ‘golden years.’
What are the best methods of training carers?
Education is very important and I have written several papers on different aspects of dementia care. It’s such a specialised area and there is so much to learn. Too many AC providers don’t really understand dementia. My latest paper is on depression and dementia, and my papers are used as references by Victoria University.
However, theory is not enough. You need to have practical experience of working with people with dementia to understand that you are dealing with individuals, and dementia affects each person in their own individual way.
Most of the people I teach are already working with people with dementia. I show them video footage of how we work at Medina Manor, how staff interactive with the residents, the strategies we use and how effective they are. Our residents dance and sing and talk together and form friendships – you can see it working!
Because most of the personal carers are only at Certificate III level, it’s a lot for them to learn. I give them a two-hour training session each week to reinforce what they’ve already learned and to teach them new strategies and tools. Everyone is audited for competencies each year, and also sits a multiple-choice exam. We’re benchmarking dementia care. Our standards have impressed the Alzheimer’s Association and Standards Australia
What sort of resources do you need for this approach?
When we started, we had exactly the same resources as everyone else, including a tight staffing budget. What the person-centred approach takes is a lot more work, so you need passion and total commitment and dedication and imagination and creativity in truly caring for your residents and creating a wonderful lifestyle for them. Management here has been really supportive. This approach must be driven by management.
Medina Manor has a mixed population ethnically – mainly Greek, Italian and Arabic backgrounds, and so religious and cultural holidays are very important to the residents.
“We celebrate all the holidays,” Bisiani says, as well occasions like Melbourne Cup Day or Valentine’s Day. “They’re all ways of creating stimulating and fun activities, and generally they involve special food and dressing up as well.”
Just before Christmas, Medina Manor held a ‘Flower Power’ Open Day. The facility was open to relatives and families, service providers and local ACAT teams. Residents and staff dressed up in hippie style, with flowers in their hair, and there was a psychodelic theme to the colourful decorations.
Leah Bisiani and a resident enjoying ‘Flower Power’ Day
The food also played on the theme of ‘peace and love’ with angelfood cake and peace cake, and everyone was entertained with music, dancing and aromatherapy hand and neck massages.