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Introduction
Person-centred care is a holistic and integrative approach where health and care professionals work
collaboratively with individuals using their services and their communities to maintain wellbeing and
quality of life for individuals with dementia, including the elements of care, the individual, carers and
family. This is because, it is important to recognise the uniqueness and individuality of a person who has
dementia, particularly, it recognises that there are unmet needs for example isolation, that may be the
basis of behavioural symptoms in individuals with dementia. It was developed by Carl Rogers, a
humanist, to therapy as he felt that the client was the one who should say what it wrong, find ways of
improving and determine the conclusion of the therapy. Rogers stated that, in order to be effective, the
therapist or carer must have three special qualities: Congruence –being honest with the service user
without lying to them about their condition, Empathy - understand how they feel after knowing that
they have dementia, Unconditional positive regard – accept and respect for what they are and not try to
change them. The person-centred approach enables health care providers to understand and provide
support for the unmet needs of the individual with dementia. It has been concluded that person-centred
care interventions were shown to reduce agitation, neuropsychiatric symptoms such as depression and
anxiety and to improve the quality of life in individuals with dementia in a care home. (NCBI, 2017) By
following the nursing process, which is a method of delivering a high standard nursing care assessing
needs, planning and implementing care, evaluating whether the care delivered has been affective, it is
important to regularly review the usefulness of the care individuals receive from nurses, so that support
can be increased in line with their needs. (Aldworth et al, 2016) Additionally, it is important that the care
worker has the responsibility of the safety of the individual under the low to protect and promote the
rights and wellbeing of them. Therefore, safeguarding in care is key to the quality of care delivered.
Dignity, privacy and respect are fundamental to all care provision and care workers should be sensitive
to the needs of the individual with dementia. In late stage dementia, individuals’ symptoms are
worsened so they will not complain if they receive care that is below standard, making them more
vulnerable to abuse and neglect. For example, they may take care for the individuals rather than with
them which means that they do not include the individual in decisions. They may not fully meet the
individual’s needs as they do not consider the individual’s preferences, thoughts, feelings, opinions,
beliefs, and values in the care plan. Therefore, to prevent this type of practice, the staff should report
any concerns to their manager and document any incidents, accidents using appropriate paperwork for
their workplace. (Aldworth et al, 2016) However, the care worker should be trained in manual handling,
first aid, food hygiene and challenging-behaviour management in dementia care. For example, if an
individual with dementia are shouting, wandering, biting or throwing objects, it is important to protect
the individual as well as the other individuals who are present as this behaviour can be distressing for
them too, considering to be mindful of the impact the care worker’s interventions have on their sense of
personal identity. In this situation, they should use fewer mechanical restraints which may reduce
serious injuries in nursing home residents, reduce the use of antipsychotic drugs and improving job
satisfaction in staff. (NCBI, 2006) Also, they can engage the individuals in certain types of activities,
including activities of personal interest. Therefore, it would seem logical that the benefits of therapy in
dementia could be improved with the use of Person-Centred Care approaches, which include personal
preference and interests. (NCBI, 2017)
Independence, rights and empowerment should be promoted for the affected individuals as part of their
advocates job, especially as their disease progresses and their capacity to apply their rights without
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support diminishes. This can benefit the individual not only on a personal level for them, but it also
encourages them to take part in decisions. For example, the workers must allow individuals to choose
what type of care they prefer to receive according to their interests, beliefs and abilities. This can make
them feel that they are in control over some aspects of their life, giving them the confidence and ability
to look after themselves with less input from the care worker. Also, workers should respect and not
dismiss of the simple choices individuals make. For example, if the individual with dementia may want to
make a certain dish for the third time in a week, the care worker should respect that and allow them to
do so as, they may not remember of making it in the previous days. The care worker could take this time
as an opportunity to talk about the reason behind the dish and the memories the individual may have of
the past. By upholding their independence will build mutual respect and trust which will make the
situation easier for both sides. However, the care providers should make sure that there is a safe,
enabling/empowering environment for the individuals to live safely. This is because many individuals
with dementia can be affected by their balance and special perception, which means they may have
weak muscles and may trip over on the staircase, so it is important to consider the safety of their living
environment. They should also check that the floor of the toilets is not wet to avoid any unnecessary trip
hazards and falls. As individuals move into a care home, they may not feel like home and therefore to
help them feel calm and comfortable in the environment, the care workers can play music that they
remember because, their long-term memory lasts longer so the music selected can be from their
childhood. This can help them reduce anxiety, irritability and restlessness. (Aldworth et al, 2016)
Recognition of cultural and religious differences and requirements. Every individual should be given the
opportunity to participate in all cultural events such as Easter which one important event in the UK and
some individuals celebrate this day however, considering to be sensitive to the cultural events of all
other individuals for example, some individuals who practice Islam may be fasting and praying because
of Ramadan. Therefore, inclusion, which is being part of an institution, even or culture, promotes a
sense of belonging which is important for individuals with early or middle stage dementia who are still
aware of their cultural norms and who may feel detached or excluded from what is going on around
them because of their confusion or the loss of ability to communicate effectively. (Aldworth et al, 2016)
The Care Quality Commission (CQC) expects the manager to collect information about the ethnic origin
and religions of the staff team and service users so that they can use this information to think about how
they might plan events in their activity calendar, encouraging everyone to join. For example, the
manager can get the staff and service users to help celebrate Diwali with traditional music, lights,
fireworks and traditional sweets. This can bring a positive atmosphere in the care setting where every
service user, including from other religions, may enjoy the day. (Social Care Institute for Excellence,
2015) Additionally, it is important that the workers are sensitive to the cultural needs of their service
users and that they are aware of any restrictions this may include. For example, an individual celebrating
Ramadan is not allowed to eat food, drink liquids, smoking and it is wise to consult them and find out
about what might be appropriate or inappropriate things to do to mark those periods of time. This is
because, an individual with dementia may forget that they should not drink water during the day and
may try to drink and their family may be upset that the person’s cultural norms are not being observed.
Therefore, the care worker should be calm and respectful in explaining why they are not allowed to
drink water throughout the day. If the problem is persistent, then the family should be made aware of
the issue and he steps the care worker have taken but the individual is choosing to drink water.
However, it is important to recognise and respect all cultures, different traditions, religions and the
festivals that are part of individuals. The care workers’ opinions of a particular race, religion, culture or
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belief system should not have an impact on the quality of care that they deliver. For example, the staff
should not have discriminatory behaviour towards the individuals due to their culture, religion or
tradition, instead, they need to be aware of the principles and restrictions that part of different cultural
and religious teachings and support individuals’ needs respectively. (Aldworth et al, 2016)
Entitlement to advocacy. When an individual is living with dementia, an advocate can ensure they are
listened to and represent the individual’s views and interests. As individuals’ dementia progresses, they
will lose their ability to ask for what they need or what they deserve, and it is the responsibility of an
advocate is to provide appropriate treatment, correct diet and even the benefits they are entitled to.
For example, a person with Frontotemporal lobe dementia will be affected by their speech and
language, which causes them to not be able to communicate effectively about their needs and
preferences. Therefore, a person may often find themselves in the position of advocate for these
individuals, and this is a position of trust. However, there should be awareness of representation and
advocacy as it is not enough to just acknowledge that the individual is vulnerable, the care worker needs
to be vigilant in promoting and upholding their rights to safety, dignity and independence as part of
their advocacy duties. Care worker needs to be aware of whether the individual has made any advanced
decisions about their future care, and also if they have nominated someone to have a lasting power of
attorney as their disease progresses and become unable to manage their finances. (Aldworth et al, 2016)
Patient Centred Care
Isobel Blake is 65 years and has frontotemporal lobe dementia, which is an uncommon type of dementia
that causes problems with behaviour and language. Frontotemporal dementia affects the frontal and
temporal lobes of the brain and, areas that are generally associated with personality, behaviour and
language, and portions of these lobes shrink. This type of dementia mainly affects behaviour and
personality such as compulsive behaviours like hoarding, compulsive cleaning, or repetitive movements
and wandering. Some develop a binge eating habit where it can lead to weight problems and other
health issues. FTD also affects communication as it affects the ability to speak, use and understand
language however, sometimes it can affect movement similar to Parkinson’s disease. As these symptoms
progress, Isobel’s health can be affected as she will not be able to communicate about her needs and
concerns, also she will start having different preferences, thoughts and needs than she had when
planning her care. This is because, her behaviour and personality will change, and staff should not
change her but, accept and respect her. Also, as her mobility will worsen, she will need advanced care
and may fear of losing dignity and privacy as a staff member will have to take her to the toilet and help
her. She and her family should be counselled about vigilance and practical safeguards such as controlling
or changing access to accounts and credit. Her family or staff members should also be counselled to seek
advice from an elder law attorney about securing belongings and planning for their financial future.
Additionally, driving issues in FTD usually arise later therefore, she may not be allowed to drive again for
her safety however, repeated cognitive tests can be done to see if she can drive in order to promote
independence and empowerment.
As for now, she has lost some of her inhibitions and often speak bluntly, also she struggles with
organisation. Isobel has difficulty swallowing food and her medicines. In terms of her emotional state,
she becomes frustrated and has lost her ability to empathise therefore, she laughs at other residents
