CHCAC319A Provide support to people living with dementia

CHCAC319A Provide support to people living with dementia

Assessor is to use this cover sheet to record the results of all the assessments in these units.

Assessment Tasks Outcome

Unit:	CHCAC319A Provide support to people living with dementia
Student ID:
Student’s Name:

Assessor’s Feedback

Assessors: Please return this cover sheet to the student, along with assessment results and feedback. A copy must be supplied to the office and kept in the student’s file with the evidence. Please complete the table above.

Tasks included in this assessment:

Assessment Tasks	Title	Satisfactory/ Not yet satisfactory	Assessor’s Signature	Date	Re-submission Satisfactory/ Not yet satisfactory
Short-answer questions	Assessment 1
True/False questions	Assessment 1
Multiple Choice questions	Assessment 1
Case Study 1	Assessment 2
Case Study 2	Assessment 2
Case Study 3	Assessment 2
Case Study 4	Assessment 2
Case Study 5	Assessment 2
Assessor’s Feedback

Assessor’s name & signature…………………………………………………………..

Assessments

This unit is recommended to be assessed in conjunction with the following related units.

To achieve a competent result for this unit, you must satisfactorily complete all the assessment requirements listed below. Your trainer/assessor will give you the timelines when these assessments need to be submitted.

Assessments for this unit are as follows:

Assessment Number	Type of Assessment	Description and location
Assessment  1	Short Questions /Multiple Choice Questions/True-False questions	These questions are found in this booklet. Answer all of the questions.
Assessment 2	Case studies	There are five case studies in this booklet. You are required to answer the questions that follow the case study.
Assessment 3	Personal journal	Each student is to keep a journal of their daily activities while on clinical placements.
Assessment 4	Workplace observation	Each student will be expected to cover some aspects of this course at the workplace. Your assessor will give you more details.
Assessment 5	Third-party observation	Each student will be expected to cover some aspects of this course at the workplace and to get a report from the supervisor.

Assessment 1 –  Short questions

Instructions to the student

Please read all the information given to you before you answer. If you do not understand any of the questions, please ask your trainer/assessor for assistance.

You must answer ALL the questions in your own words.

1. What does ‘dementia’ mean?

2. According to current research on dementia, it is important to remember that dementia is not a disease but rather a variety of symptoms that may accompany certain diseases or conditions. List the two most common forms of dementia and what causes these.

3. When caring for someone with dementia, it is important that you practice a ‘person-centred approach’. What does this approach mean and why would this be important?

4.  Dementia can have an impact not only on the person, but also on the family members, as well as the carers. List three impacts of caring for a person with dementia.

5. What might a person with dementia be feeling in the initial stages of the disease? Give two answers.

6.      Looking at the Appendix A for this unit titled ‘Compulsory Reporting Guidelines for Approved Providers of Residential Aged Care’, answer the following:

a.         What is a ‘reportable offence’?

b.        Must a worker report abuse that is ‘suspected’ and not ‘witnessed’?

c.         When is there a special circumstance put in place that allows the provider not to report abuse?

7.      When communicating with people who have dementia, it is important to remember that it can be frustrating and upsetting for the person not to be able to tell you what they want. They may even find it hard to process lots of information at one time. 

List six common strategies that you might use in communicating with a person with dementia in your work as a carer.

8.      Name three strategies that carers can use to gain residents’ trust and can be used to relieve stress and agitation in residents.

9.      How do you find out what activities and routines are going to be meaningful and appropriate for the person you are caring for? Who might you ask and why?

10.   Read the following scenario and answer the question that follows.

Mrs Lee is an elderly lady living in the dementia unit of an aged care facility. The staffs are at their wit’s end, as they cannot seem to get Mrs Lee to eat. Mrs Lee refuses to sit at the dining room table for lunch, but wanders around, hanging around the kitchen area. Before the onset of dementia, every mealtime, Mrs Lee used to eat her meals in the kitchen from a small bowl using chopsticks, while Mr Lee and her children sat at the table to eat. She would then set about washing the dishes and preparing for the next meal. Mrs Lee would always have a radio on to listen to the music in Chinese. Listening to music from her homeland would bring her comfort.

What could you do to encourage Mrs Lee to eat?

11.   When working with people who have dementia, it is often necessary to ‘enter the person’s reality’ with them. What do you think does this mean? Can you think of an example of when you might have to do this?

12.   Sometimes, family members and friends can get upset when their loved one cannot remember who they are, or remember past experiences.

a.        Give an example of how you might provide support and guidance to assist them in understanding how the dementia is impacting their loved one.

b.        Give two examples of how you might help them to provide care using strategies you have learned about.

13.   When working with clients who have dementia, you will come across many behaviours of concern. List six of these.

14.   For every behaviour, there is a purpose (a reason that it happens) and a trigger (something that causes it to happen). List five triggers and behaviours that you may see in a person with dementia.

15.   Being a carer can be a stressful job.

a.      Give two ways you can manage your stress.  

b.      Who might you turn to for support if you could not manage the stress on your own?

16.    

a.      List the three stages of dementia. 

b.      Give two features of each of the stages of dementia.

17.   Briefly explain what the limitations and legal consequences of physical, chemical and psychological restraint are. (Use Appendix C – Decision Making Tool: Responding to issues of restraint - Summary). 

18.    

a.      How do you prevent and respond to behaviours of concern?

b.      In a facility, the department you are working in has a client who is exhibiting a behaviour of concern. You have tried different strategies but these are not working. You have been called to a meeting by your team leader to discuss this.

1)      Who will be involved in this meeting?

2)        Name two documents that will be used and reviewed in this meeting.

3)        It is expected that in the outcome of this review there will be some changes in the care plan to ensure the client is given optimum care. True or False

              

19.   Look at the fact sheet titled ‘Alzheimer’s Disease’ in Appendix D and answer the following multiple choice questions. Mark the correct answer.

a.      The main features of Alzheimer’s disease are:

                                           1)        Plaques and tangles

                                           2)        Cats and dogs

                                           3)        Hearts and lungs

                                           4)        Obesity and food

b.      As more neurons die in the brain:

1)        your hair will grow faster

2)        your hair will fall out

3)        your head will increase in size

4)        affected regions of the brain will shrink

20.   People with dementia, just like you and I, have the need to participate in ‘meaningful activities’. List three reasons that it is important to provide the person with meaningful activities. 

21.   Name three activities that you may be involved in when dealing with a person suffering from dementia to improve their quality of life.

22.   List three activities of daily living (ADLs) for a client who has dementia.

23.   Name two support services in your area that you could refer a dementia client to.

24.   It is important to acknowledge that with dementia the brain changes and behaviour is affected. TRUE or FALSE

25.   It is important to provide activities that are appropriate to the individual, reflecting their cultural likes and dislikes, in order to bring back pleasurable memories. TRUE or FALSE

26.   When providing activities for a client, these activities must:

a.      have nothing to do with the client

b.      focus on ensuring safety  and comfort

c.      be focused on what the carer wants to do that’s important

d.      be purposeful and meaningful

e.      enhance self-esteem and pleasure and minimise boredom

27.    

a.      List three indicators of abuse.

b.      Who would you report signs of abuse to?

28.   Give two policies and procedures relating to maintaining client’s confidentiality.

29.   Explain your understanding of the ‘Social Model of Disability’.

30.    

a.      What is ‘social devaluation’?

b.       How does social devaluation affect the quality of life of a person living with dementia?

Self-study task Strategies for improving communication
CHCAC319A Provide support to people living with dementia 1. Provide support to those affected by dementia 2. Use communication strategies which take account of the progressive and variable nature of dementia 4. Implement strategies which minimise the impact of behaviours of concern
Learn about different strategies for enhancing communication with clients who have dementia, how to use these strategies and the benefits they bring to clients and care workers including help to avoid behaviours of concern. 1. Reality orientation What it is When to use it What areas to cover Benefits 2. Validation strategies What they are When to use them Benefits 3. Reminiscence What it is When to use it What areas to cover Benefits 4. Distraction What it is When to use it Benefits
	True/False Self-Study Task Communication techniques
	CHCAC319A Provide support to people living with dementia 2. Use communication strategies which take account of the progressive and variable nature of dementia 4. Implement strategies which minimise the impact of behaviours of concern
	Communication with other people becomes increasingly difficult as dementia progresses. Difficulty understanding others and being understood causes frustration, agitation and distress. Carers need to be aware of a range of communication strategies that may assist clients including body language, reality orientation and validation. Select the correct answer.
		True	False
	Clients may substitute words they remember for those they have forgotten.	True	False
	If the client’s speech is fluent, it will always make sense.	True	False
	Emotions may not always match the words spoken.	True	False
	Clients are easily distracted by activities in the environment.	True	False
	Say everything you want to say as quickly as possible before the client’s attention wanders.	True	False
	Clients born overseas may revert to their first language as dementia progresses.	True	False
	Clients do not generally bother about whether others understand them.	True	False
	Clients with dementia may often forget their glasses and hearing aids.	True	False
	Poor memory and concentration affect communication.	True	False
	The major part of communication is the words we speak.	True	False
	The minor part of communication is our body language.	True	False
	It is easier for a person with dementia to interpret our body language than our speech.	True	False
	If words and body language don’t match, it doesn’t matter as the clients are confused anyway.	True	False
	Clients with dementia will not pick up on the tone of voice.	True	False
	Using a person’s preferred name will help gain their attention.	True	False
	Using closed questions helps understanding.	True	False
	Negatives are good commands for clients with dementia.	True	False
	If a client does not reply immediately, you are not getting a response, so move on.	True	False
	You can finish sentences for clients to assist them.	True	False
	Initiate conversations with clients as they may have trouble getting started.	True	False
	Reflect your interpretation of what the client has said back to them.	True	False
	If the environment is noisy, go to a quieter spot to talk to your client.	True	False
	Activity in the environment will not interfere with communication, just noise.	True	False
	Reality orientation is generally used in late stages of dementia when clients are very confused.	True	False
	Reality orientation reminds clients what is happening in the present time.	True	False
	If a client does not accept reality, then do not argue.	True	False
	Non-verbal prompts such as signage are not useful for dementia clients, even at early stages.	True	False
	A comforting touch is a welcome means of communication for many clients.	True	False
	Validation strategies can help a client feel accepted and reduce agitation.	True	False
	Reminiscences generally upset clients as they remind them of what is lost.	True	False
	Try to empathise with clients who are struggling to communicate.	True	False
	If a client is distressed by their inability to communicate, it is best to ignore it.	True	False
	Distraction is one of the best ways of relieving agitation when a client cannot communicate.	True	False
	It is not a carer’s role to reminisce about the past with clients; it should be left to the family.	True	False
	Communication with dementia clients has little point as they do not remember it.	True	False

Multiple Choice: Circle the correct answer.

1. Dementia is a result of changes that take place in the brain and affects a person's: a. memory b. mood c. behaviour d. all of the above 2. A person with mid-stage dementia may have the ability to: a. remember recent events b. remember the past c. remember what day it is d. all of the above 3. A person's behaviour can be affected by: a. their environment b. the people they interact with c. their physical wellbeing d. all of the above 4. You can discover the trigger to a behaviour of concern by: a. trialling a variety of triggers b. observing the client in the environment when the behaviour occurs c. asking the client what causes the behaviour d. all of the above 5. It is important to report a change in a client’s behaviour because: a. change is of interest to all b. the family of the person will ask about it  c. it may be a treatable medical condition d. all of the above 6. The major part of communication is: a. words b. body language c. tone of voice d. loudness of voice 7. Alzheimer’s disease is: a. a progressive neurological condition b. caused by a virus c. a normal part of ageing d. an illness all elderly people develop 8. People with Alzheimer’s are at risk of abuse because: a. they are vulnerable due to confusion and memory loss b. carers can become very stressed and worn out c. they can exhibit aggression which is difficult to cope with d. all of the above 9. The social model of disability: a. looks at the medical problems of the disability b. could not be applied to dementia c. looks at the social/environmental problems of the disability d. all of the above 10. Good communication techniques are very important with dementia clients as: a. they can help soothe agitation b. they can help orient the client to the environment c. they can help validate a client’s reality d. all of the above 11. Activities that meet people’s needs are important in dementia care as: a. they provide pleasure and a feeling of success b. they keep clients out of the way of nurses c. families expect their relative to have entertainment d. they improve the client’s medical condition 12.  A carer should monitor their stress levels because: a. care work is a stressful job b. stress affects performance at work c. stress affects home life and relationships d. all of the above

True or False: True False Dementia is not curable. True False Early symptoms of dementia are mainly incontinence and difficulty swallowing. True False Dementia is always caused by a neurological condition. True False Other diseases may have the same symptoms as dementia but are treatable. True False Dementia clients are generally easy to care for. True False As dementia progresses, clients demonstrate increasing numbers of symptoms. True False Poor recent memory and confusion is an early sign of dementia. True False All cultures view dementia in the same way. True False People from CALD backgrounds may report later for diagnosis of dementia. True False People from CALD backgrounds often have difficulty accessing dementia care services. True False Physical abuse is the only sort of abuse that matters to a health care worker. True False A health care worker does not have a duty to report witnessed signs of abuse. True False Person-centred care is not a suitable method of care for a confused person. True False Person-centred care treats every person as unique and tries to empower them. True False It is important that support services for dementia care publish materials in different languages. True False Body language does not matter in communication in dementia care as clients are confused. True False Aged care facilities do not generally have policies on handling behaviours of concern. True False Aged care facilities do generally have polices on restraint management True False Legal procedures must be observed if using physical, chemical or psychological restraints. True False Raising the sides of the bed is a form of restraint and should not be generally used True False It is good to provide long activities for clients to keep them occupied for a long period. True False It is good to repeat short activities as this suits dementia clients. True False Dementia clients respond well to a familiar and home-like environment. True False A plan of care for dementia clients does not need regular review as the condition does not change. True False Every dementia client should be treated with respect even though they may be confused. True False It is useless to provide enjoyable activities for dementia clients as they do not remember them. True False It is important for care workers to monitor their own health. as care work is stressful True False A care worker should not be ashamed of suffering from stress True False Research shows some of the commonest behaviours that are difficult to control are verbal abuse and repetition True False Research shows aggression in dementia clients does not concern health workers greatly True False

Assessment 2 – Case studies

Case Study 1

Read the following case study and answer the questions that follow.

Mavis is 83 years old and has mild dementia. She has been a widow for 15 years and still lives in her own home. Because of Mavis’ forgetfulness, she has been getting increasingly agitated as she often forgets the most routine tasks that she has been doing all her life. Recently her family has decided that she needs some extra care with some household activities to help Mavis maintain her dignity, skills and health. Her family is worried about her personal safety in operating electrical appliances and the oven, especially since she once left the oven on all night.

Mavis has always loved to cook and wants to continue to bake for her family, neighbors and when the church has their fundraising fairs. However, the last three times she has attempted to bake a cake, she has forgotten how to do it and has difficulty following the recipes.

·       You are required to outline the steps you would take to support Mavis. You must include the following in your answer to cover the relevant performance criteria:

a)      What activities would you help Mavis take part in to maintain her independence using familiar routines and existing skills?

b)     How would you ensure these activities are appropriate to Mavis?

c)      How would you ensure the activities focus on making sure Mavis is safe and comfortable, balanced with maintaining existing skills and a level of independence?

d)     Give two strategies you would use to minimise boredom and to distract from or eliminate the symptoms of dementia, especially when Mavis realises she has forgotten to do something and feels like a failure.

e) How would you involve the family and significant others in planning activities for Mavis?

Case Study 2

Read the following case study and answer the questions that follow.

John is an 89-year-old man who has dementia. You have been caring for him for the past two weeks and you notice that he is often confused and wanders aimlessly around the garden and corridors, asking what time it is. You still have not found a strategy that works to help with his confusion, and his constant asking the time is beginning to get on other residents’ nerves. You decide to ring his daughter, Sally, and ask her if she has any information that might help you. Sally tells you that John and his wife (her mother), Gladys, were very much sticklers for a routine in their life. Everything they did was at a ‘certain’ time; for example, Gladys would get up and make John breakfast at 7am sharp. They both would sit down to have a cup of tea at 10am sharp, and Gladys always made sure lunch was ready on the table for John at 12 noon. Again, their dinner time was 5.30pm on the dot. Gladys would set a small alarm clock near the back door to remind John, who usually worked in the garden,  that it was time to come in for dinner. This was their routine for as long as Sally could remember. This gives you some ideas to try. Firstly you let staff know of John’s routine, so that everyone knows to remind him of the time for breakfast, cup of tea, lunch and dinner. You also find a small alarm clock to set, so that John can hear the alarm and this will remind him to come in for dinner. After the first day of ‘reminding’ John of the time, his confusion and wandering behaviour seemed to be lessening. After a week, John had settled into this new ‘routine’ and the episodes of wandering and confusion only seemed to occur when new staff were working and were not aware of these strategies.

1. What was the trigger for John’s wandering and confusion?

2. What resources did you use to help find a strategy that worked?

3. What were the strategies that staff used to minimise John’s wandering and confusion?

4. How would you inform others of these strategies and where would this be documented?

5. When might you have to review these strategies and how might this happen?

Case Study 3

Read the following case study and answer the questions that follow.

Stephen has dementia. You are caring for him, assisting with showering and toileting among other needs. As you take him to the toilet this morning, you notice suspicious bruising on his upper left arm. It looks like a “firm grip” injury and looks like it could hurt. Stephen cannot tell you what happened to him clearly. He mutters incomprehensible explanations but is obviously distressed. He says something to the effect that his money is missing. Upon returning to his room after toileting, he reaches out for his wallet on the bed and shakes it. Only two 20-cent coins fall to the floor. He is almost teary but you cannot quite clearly tell what happened. From his increased level of distress as you ask him what happened, you can only conclude he is not happy with what happened. You suspect that someone took his money and then reached out for his arm, threatening him if he said what happened. This is only a guess, however.

1.           What kind of abuses do you think Stephen may have suffered and what will you do?

Abuse:

What to do:

Abuse:

What to do:

Self-study tasks -SS05-Pearson Article I.                 Impact of dementia on carers

CHCAC319A Provide support to people living with dementia 1. Provide support to those affected by dementia

The impact of caring for someone with dementia includes the emotional effects of prolonged stress and anxiety, distress at changes in a loved one, financial and planning worries and the physical impact of the caring role. Many carers are elderly and not in good health themselves, which makes the task even more difficult.

Case Study 4 – Diagnosis of dementia Jane’s mother Sylvia lives on her own in a retirement village on the coast. Jane is single, lives and works in the city, and spends many weekends on the coast with her mother. She has noticed Sylvia is getting more forgetful and seems a little confused at times. After talking to her brother the other day on the phone, Sylvia asked Jane who it was when she hung up. Jane was puzzled but Sylvia then said she was joking. One day the doctor rings Jane and tells her that Sylvia has early stage Alzheimer’s disease, diagnosed after she was found wandering at night and seemingly confused. Sylvia had asked him to break the news to Jane. Jane is stunned as she had never even thought of it, but the doctor says her mother, although upset, had expected it. Jane panics, leaves work and rushes up to see Sylvia. Sylvia is very cross with her when she arrives as Jane keeps crying and making a fuss and upsetting her. After a day, Jane calms a little. At the moment, her mother says she can still manage, but Jane decides she will move to the coast and care for her mother as soon as she can arrange it. Jane makes a list of things for them to do whilst her mother is still able to make decisions. Her mother then chases her back to her work; Jane returns but keeps bursting into tears and feels dreadful at leaving her mum alone.

1. Why hadn’t Jane considered her mum might have dementia? 2. How did Jane feel after the diagnosis? 3. How did Sylvia feel after the diagnosis? 4. What might be on Jane’s list of things to do? 5. What sort of information might Jane seek and where might she find it?

Case Study 5 – Caring for the carer Jack‘s wife Norah was diagnosed with Alzheimer’s disease five years ago. Since then, Jack has borne the burden of care as his children all live long distances away. They wanted him to move close to them but he felt Norah was better to stay in her own home. He is very devoted to Norah, but she is very difficult to manage now. They are both 84 years old, and although fit, Jack’s mobility has deteriorated due to arthritis and he is constantly tired and feels depressed, lonely and anxious about the future. Norah only occasionally recognises him and has lately become quite aggressive, particularly if he cannot meet her demands very quickly which is often the case. She has lately also become incontinent and there are large amounts of washing to do which he cannot manage. He gets help with house work and a neighbour comes in to sit with Norah once a week so he can shop but otherwise he has given up his social life and few friends visit now. His family visits every few months but Norah does not recognise them and generally they upset Jack more than they help.

1. What may Jack be experiencing? 2. What assistance might Jack seek in order to relieve some of the pressure, stress and anxiety of his situation? 3. If Jack wishes to consider residential care, where can he go for information? 4. If Jack is considering residential aged care, how might he be feeling?