Creating a Personalised Care Plan for Dementia Patients

A personalised care plan for dementia patients is essential for ensuring their needs are met, but also that structure and routine is provided that enables those caring for them to meet their needs. Additionally, the process of creating a care plan for those with dementia ensures that areas that have been forgotten or overlooked can be addressed.

The concept of a personalised care plan for dementia

With dementia, it’s fair to say that it’s sometimes difficult to truly see the individual. Instead, often people see the disease. As such, they miss who this individual was in the past, who they are now, and the future they have ahead of them. Yet, we firmly believe that it is only through considering the dementia patient as an individual that we can fully care for them, helping them gain meaning and contentment in daily life.

For us, there is no one-size-fits-all approach that works when creating a care plan for the individual with dementia. There cannot be a single set of routines to apply! Instead, this person, their needs, and their past and future, need to be considered. That’s the essence of a personalised care plan.

What does a care plan for an individual with dementia cover?

A care plan inevitably involves an aspect of everyone involved in the care of the individual coming together and considering each of the different aspects. We suggest splitting it into three parts: activities of daily living; physical and cognitive impairments, and; social and emotional wellbeing.

Factoring in Activities of Daily Living into a Dementia Care Plan

·         Household tasks

Consider the household tasks that need to be done regularly and whether the individual has the capacity to do them or not. These include basic cleaning and changing bedding.

·         Food preparation

Look at whether the individual can organise, shop for, prepare and cook healthy nutritious meals that meet their needs, reliably and regularly.

·         Eating and mealtimes

Assess if the individual eats and drinks appropriately and safely, or whether they need supervision, aids, support and encouragement.

·         Personal care

Can the individual with dementia bathe and dress safely and appropriately? Are they able to perform their toileting needs reliably? Do they have incontinence issues?

Remember to not only consider if the individual can do the tasks, but also whether they will remember to and whether they can do them safely. Consider what level of supervision is required.

Physical and cognitive impairment

·         Mobility

It is very common for those with dementia to also have mobility difficulties. Their personalised care plan should account for their unique needs.

·         Safety

Consider the individual’s physical safety and their ability to determine danger and judge risk.

·         Cognitive impairment

Dementia is not a uniform disease; it affects sufferers differently and in different ways at different stages. The care plan should seek to determine the exact cognitive impairments that affect this individual e.g. language and communication.

·         Behaviour

How does dementia affect this individual’s behaviour? What are triggers for specific difficult behaviour?

·         Physicality and exercise

How can the individual be encouraged to be as active as possible whilst remaining safe?

Social and Emotional Wellbeing Within a Dementia Care Plan

·         Socialisation

Loneliness and isolation is a notable problem in those living with dementia. Consider how social needs will be met and addressed.

·         Creativity

At Eastleigh, there are music workshops through to craft activities galore. We do this because we know the value of fostering creative opportunities for those with dementia.

·         Reminiscence

For those with dementia, being able to reminisce is invaluable. It can allow the individual to feel themselves again and trust their memory. The scaffolding of reminiscence must be factored into all care plans for dementia.

·         Intellectual

Keeping an active mind is essential with dementia. Appropriate to the individual, intellectual stimulation should be factored into the care plan e.g. reading, puzzles or board games.

·         Spiritual

Caregivers should never overlook the spiritual needs of individuals living with dementia. An understanding of what was important to the individual, spiritually, before their decline, is essential to meeting their current care needs.

Within all of the areas above, there should be included how the individual currently functions, and any notable difficulties and needs. There should also be objectives set for each and then correlated planned interventions to meet those care needs.

The individual

In addition to all of the elements above, we really encourage those creating care plans for those with dementia to really focus on creating an understanding of the individual. It can be incredibly valuable to include the following elements:

·         The individual’s biography

What’s the story of this individual’s life? Did they have a career? Did they always live in this area? What were their achievements? What were their passions and hobbies?

·         Their family and friends

List the individual’s family and their important relationships. How involved are different family members now? Who are or were the individual’s best friends. Were they active in their community?

·         Likes and dislikes

One of the most difficult elements of dementia is its ability to rob the individual of the power of communication. By including known likes and dislikes in their care plan, it can really help the individual to feel secure.

Creating a daily routine and plan

From the overall care plan, the goal should be to create a daily routine and plan which meets all of the individual’s needs. It should outline responsibilities. A daily routine is essential for people with dementia as it provides structure and security, as well as space for meaning and enjoyment.

The objective isn’t to create a jam-packed list – there needs to be plenty of ‘unscheduled’ time within the day. However, it should provide a framework for the everyday. Structuring the day around mealtimes, waking and bed times will help.

An example care plan, just for the very first part of the morning, may look something like this:

• Encourage [NAME] to wash and brush teeth.
• Ask what they would like for breakfast today.
• Discuss chosen clothes for the day, get them out. Leave them to get dressed, having reminded them of the order to put their clothes on.
• Welcome [NAME] to their breakfast which has been prepared for them.
• Sit with [NAME] as they eat, encouraging them to drink their fruit juice.
• Discuss the plans for the morning before giving them the newspaper to read.
• Whilst they read the newspaper, prepare the craft activity to do together.

Care plans benefit both the individual and the carer

With a personalised care plan for dementia in place, the individual’s needs are met safely and reliably. Additionally, with a care plan, those caring for the individual know exactly what is involved in caring for the individual and why.

A care plan is needed for anyone living with dementia, from the early to advanced stages, whether they live at home or in residential care. It will change over time and should be reviewed regularly.