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Enhanced dementia practice for inspectors

Promoting and protecting peoples' rights - developing your practice

Watch the film clip of Annabel and Scott below and consider the questions at the bottom of the page.

Annabel is the manager of a small residential care home. She was recently promoted from her supervisor post which she held for six years. Annabel leads a team of social care workers, and as the home does not provide nursing support they work in partnership with local community nurses who visit regularly.
Scott is a local care inspector based in the older adults team. He has previously worked as a mental health officer and enjoys good relationships with local services.

Video: Developing your practice

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Video transcript: Developing your practice

Scott - Okay so I would like to talk to Mrs McGregor now. Jean McGregor.

Annabel - Okay.

Scott - Jean has been here for 2 weeks now and I can see from her care plan that under the instruction from the district nurse (who she saw two days ago?) that she is no longer allowed to go out of the care home on her own. Could you tell me more about that?

Annabel - Yes, We asked the district nurse to see Jean; there were a few things we needed to discuss. After she saw her, the district nurse said that she wasn't to be allowed out anymore in case she gets lost.

Scott - Okay, Does the district nurse know Jean?

Annabel - No I don't think so.

Scott - So who else was involved in the decision to stop her from going outside?

Annabel - No one I don't think. The district nurse just said she was to be kept in in case she gets lost or she has a fall outside when no one was with her so we put that into her care plan.

Scott - And what does Jean think about that?

Annabel - She's okay mostly but unsettled at times. Especially when she wants to go out and we've had to tell her she can't go out by herself. We take her into the garden but she wants to go into the village. She's lived here all her life. She knows everyone. I think she misses the walk and the chat with the people she meets.

Scott - So what does her family think about the fact that she's no longer allowed going out on her own?

Annabel - Well her daughter is NOT happy about it. She thinks it's better for her mum to get out and that keeping her in is doing her more harm than good. Jean can't walk very far so she's not going to get terribly lost. Everyone knows her too.

Scott - So what do you think's best for Jean?

Annabel - Well that's difficult because the district nurse has told us what to do.

Scott - Well let's think about Jean for a moment and how we can help her. What would happen if she got lost?

Annabel - Well there's a danger of her getting lost a little bit in the village. There's a risk of her falling but as I've said before she's lived here all her life. Most people know her. Someone would help her home but the district nurse has told us no.

Scott - But whose decision is this to make? I mean we have to consider Jeans rights in this.

Annabel - Okay well we could have a review meeting with jean and her family and the district nurse and talk about what Jean wants and what's in her best interests.

Scott - So you look into that. Remember Jean's rights and if there's anything else that you need, let me know!

Annabel - Okay thank you.

Questions

  1. Which of Mrs Macgregor's human and legal rights are influencing this discussion between an inspector and a care home manager?
  2. In this interaction, the care home manager informs the inspector that the community nurse was involved in the decision of Mrs Macgregor not being able to go out unsupported. What concerns or queries do you think Scott has as an inspector?
  3. The decision to restrict Mrs Macgregor's freedoms will impact significantly on how she wants to live her life. How would you have expected the service to involve Mrs Macgregor in any decisions about her life and her support?
  4. Who else should be involved in any support planning decisions or conflicts that will affect how a person with dementia wants to live their life? Describe the roles and responsibilities of particular agents in these decisions (referencing applicable legislation), which could include carers and family members, social workers, social care workers, and mental health nurses.
  5. Describe elements of good practice in supporting people with dementia to communicate decisions in their preferred way, using their preferred media and language. How can you support services to implement this good practice?
  6. As an inspector, how can you support services to make changes which recognise and uphold legal and organisational requirements on equality, diversity, discrimination, rights, confidentiality and sharing of information for people with dementia?
  7. Describe your role, as an inspector, in managing some of the specific ethical dilemmas and conflicts that may appear when working with services which provide support to people with dementia and their carers. Who else would you work with if you were not able to reach a solution?

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