‘Unforgiveable’ abuse by some dementia carers
Expert issues warning over ‘unforgivable’ behaviour impacting on elderly patients
ELDERLY dementia patients are suffering abuse and neglect due to inadequate training for nurses and care workers, an expert has said.
Professor June Andrews, a former nurse and dementia expert, said that while the training of nurses had improved in leaps and bounds, in some cases staff were resorting to “unforgivable” behaviour due to poor training in managing the more challenging symptoms of dementia such as aggressive or agitated behaviour.
ELDERLY patients with dementia are suffering abuse and neglect because the training of nurses and care workers is “poorly resourced,” experts say.
Professor June Andrews, a former nurse and dementia expert, said it was disappointing that dementia care appeared so frequently in disciplinary hearings involving healthcare staff.
She said that while the training of nurses had improved in leaps and bounds, in some cases staff were resorting to “unforgivable” behaviour due to inadequate training in how to manage the more challenging symptoms of dementia such as aggressive or agitated behaviour.
In one recent hearing a senior care worker was struck off for a pattern of abuse directed towards one elderly patient suffering from dementia in a Glasgow care home.
Daniel Akers was found to have subjected the elderly woman to a pattern of psychological abuse at Rowandale Nursing Home in Glasgow ‘for his own gratification’.
The abuse included repeatedly asking her where the toilet was knowing she did not have the capacity to answer and repeatedly being told to wear her jacket indoors.
All nurses are now expected to have at least basic training in the care of patients with dementia.
However, around two per cent of registered nurses – and just three nurses who work in care homes – have gone through the Scottish Government’s Dementia Champions programme, led by the charity Alzheimer Scotland at the University of the West of Scotland.
Nursing leaders say hospital staff are often focussed on medical symptoms and don’t necessarily have the time or the resources to deal with cognitive symptoms, such as distress and agitation but say relatives should be prepared to step up an do more to help.
Professor Andrews said: “Of course it is disappointing that dementia crops up so often in disciplinary hearings. There are three reasons for this.
“One is that the numbers of people with dementia in hospital or care homes is very high, and they are there for a very long time, so they are more exposed to possibility of care.
“The second is that care is sometimes poorly resourced and staff not given enough education about the difficult things that people with dementia sometimes do, so they resort to doing unforgivable things because they don’t know any better and are not properly managed and supervised.
“The third reason is that as a whole in society we just don’t respect older people. It’s ageism.
“We are sentimental about older frail people, but faced with their need at the worst time of life, we fail to fund their care, or visit them in hospitals or care homes, or support their families. “Everyone can do something. It can’t just be left to the services.”
Professor Debbie Tolson, Director of the Alzheimer Scotland Dementia Centre at the University of the West of Scotland (UWS) and former Evening Times Scotswoman of the Year finalist says inadequate training can lead to “well intentioned but poorly informed care”.
She said: “It is shocking when cases of abuse hit the headlines, but everyday in under resourced
care facilities and hospitals there are numerous examples of advanced dementia care that falls short of best practice.
“The complexity of advanced dementia care, and emotional labour of caring makes it challenging for staff who lack knowledge and skills to consistently give appropriate care.
“Well intentioned but poorly informed care, can have detrimental consequences on a person living with such an advanced and progressive illness.
“Failure to deliver evidence informed care is unacceptable and sometimes there is a fine line between poor advanced dementia care and what might be interpreted as mistreatment or abuse.
“At UWS all our new nurse registrants are prepared to practice at a skilled level with dementia care. This is important for the future workforce and ability to provide good quality of care to people with advanced dementia.
“To date 944 Dementia Champions have been prepared. Of these 544 are qualified nurses, of whom 502 practice in the acute care sector. Just three nurses who work in care home have completed, and yet 40% of people with dementia will end there days in care homes.
“People trust nurses, and people with dementia, their family and friends have to trust that the nurses who support them understand their dementia related needs and will be there when they need them.”
Val Howatson is senior nursing lecturer at Glasgow Caledonian University, where all students are introduced to dementia training from the first module and all take part in an dementia simulation exercise which mimics the symptoms of the illness.
She said: “That’s very powerful. It’s quite an emotive part of the training.
“It’s about trying to prepare students as soon as possible with the knowledge to understand the illness and give them the skills that are required to deal with some of the challenges associated with the condition such as agitation.
“We give students the opportunity of specialising in working in the care of older adults. It’s not for everyone but the right people choose that.
“I remember when I was training there was a stigma in working in the care of older people but that is not the case anymore. There are really exciting opportunities with regard to career development.”
A Scottish Government spokesperson said: “All newly-trained nurses are at Dementia Skilled practice level and additional training is available as part of ongoing professional development. Training is also given for specialist dementia settings and for staff with specific and specialist dementia-related roles.
“By March next year we will have 1000 dementia champions – who play a vital role in cascading education to other staff – working in acute general hospitals and community hospitals.
“And the Scottish Government, in partnership with Alzheimer Scotland, also partfunds with individual Health Boards a nurse consultant in every Board who has a specific remit for staff training.”