Unit of competency details

Descriptor 

This unit describes the knowledge and skills required to provide support to clients with dementia in a variety of settings including family homes, community day settings and residential care

Application 

This unit applies to workers in a range of aged and community services contexts working with people with dementia

Employability Skills 

This unit contains Employability Skills

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in italics are elaborated in the Range Statement.

ELEMENT 

PERFORMANCE CRITERIA 

1. Provide support to those affected by dementia

1.1 Work with a basic understanding of dementia 

1.2 Support individual needs of people with dementia using a person-centred approach to care and address individual needs for a stable familiar environment

1.3 Work with awareness of the impact of physical, social and emotional aspects of the environment on the person with dementia

1.4 Work with awareness of the impacts that dementia may have on family , carers and significant others 

1.5 Recognise witnessed signs consistent with financial, physical or emotional abuse or neglect of the client and report to an appropriate person

2. Use communication strategies which take account of the progressive and variable nature of dementia

2.1 Use a range of communication strategies to maximise engagement of the person with dementia such as eye contact, gentle touch (where appropriate), short simple statements

2.2 Gain cooperation and provide reassurance as appropriate to individual clients by using reality orientation including:

• reminders of the day, the time, relationships, occasions
• reassuring words, phrases and body language

2.3 Use a range of validation strategies to relieve distress and agitation in clients such as:

• Empathy
• Acceptance of the person's reality
• Acknowledgment
• Allowing expressions of distress
• Providing verbal and/or physical reassurance
• Use reminiscences frequently to connect with clients

3. Provide appropriate activities  to maintain dignity, skills and health of client at optimum level

3.1 Provide activities  which aim to maintain independence, using familiar routines and existing skills

3.2 Provide activities that are appropriate to the individual, reflecting their cultural likes and dislikes, in order to bring back pleasurable memories

3.3 Ensure all activities provided focus on ensuring the safety and comfort  of the client balanced with autonomy and risk taking

3.4 Use purposeful and meaningful activity to enhance self-esteem and pleasure in life, to minimise boredom and to distract from or eliminate behavioural and psychological symptoms of dementia

3.5 Use family carers and significant others  as a resource, where appropriate, to assist in developing appropriate activities by accessing information about client reminiscences and routines

3.6 Provide support and guidance to family carers and significant others where appropriate to assist them to understand the disease, its impact on the person and some approaches to providing care

4. Implement strategies which minimise the impact of behaviours of concern

4.1 Identify behaviours of concern 

4.2 Identify potential triggers for behaviours of concern for specific individuals

4.3 Contribute to team discussion on care planning and care plan review to minimise behaviours

4.4 Implement strategies to minimise the likelihood of and reduce the impact of behaviours on the person and others

4.5 Regularly review strategies that are implemented to ensure maximum effectiveness and reflect changes in the care plan

5. Implement self care strategies

5.6 Monitor own stress level in relation to working with people with dementia

5.7 Use appropriate self care strategies and seek support if required

REQUIRED SKILLS AND KNOWLEDGE 

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge :

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

These include foundation knowledge of:

• Dementia as a progressive neurological condition
• Common indicators and symptoms of dementia
• Progression of dementia and potential impact on the person with dementia, their family and significant others
• Relationship between brain changes and behaviour in people with dementia
• Specific impacts of dementia related to cultural, personal and historical background
• Indications of neglect or abuse
• Current research on dementia
• Principles of person-centred approach to care
• Support services available
• Plan of care for the clients
• Organisation protocols and policies related to own area of work
• The importance of the physical, social and emotional environment for people with dementia
• Importance of relevant activities and communication when working with people with dementia
• Limitations and legal ramifications of physical, chemical and psychological restraint
• The range of appropriate strategies to be implemented when working with people with dementia
• The social model of disability
• The impact of social devaluation on an individual's quality of life
• Competency and image enhancement as a means of addressing devaluation

Essential skills :

It is critical that the candidate demonstrate the ability to:

• Communicate effectively with clients with dementia
• Utilise creative, least restrictive approaches to behaviours of clients with dementia

In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

These include the ability to:

• Demonstrate a broad range of communication approaches e.g. reminiscences
• Establish and maintain a relationship that takes into account client and family individual differences (e.g. cognitive abilities, cultural background, language skills)
• Apply verbal communication skills (language skills) and non-verbal communication skills (e.g. touch, smiling, gestures) necessary to develop a trusting relationship with a person who has dementia and their family
• Use communication techniques to enhance communication and facilitate client's interaction within their environment
• Adapt activities to meet individual needs
• Provide opportunities for enjoyment
• Demonstrate cultural sensitivity
• Undertake observation and analysis of client needs
• Respond appropriately to indications of neglect or abuse
• Facilitate self-monitoring and self care
• Facilitate cooperative behaviour

EVIDENCE GUIDE 

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this unit of competency :

• The individual being assessed must provide evidence of specified essential knowledge as well as skills
• This unit is most appropriately assessed in the workplace under the normal range of workplace conditions but partial assessment could be undertaken under simulated conditions
• Assessment may include observations, questioning and evidence gathered from the workplace on more than one occasion
• Where, for reasons of safety, space, or access to equipment and resources, assessment takes place away from the workplace, the assessment environment should represent workplace conditions as closely as possible

Access and equity considerations :

• All workers in community services should be aware of access, equity and human rights issues in relation to their own area of work
• All workers should develop their ability to work in a culturally diverse environment
• In recognition of particular issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on Aboriginal and Torres Strait Islander people
• Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on Aboriginal and/or Torres Strait Islander clients and communities

Context of and specific resources for assessment :

• This unit can be assessed independently, however holistic assessment practice with other community services units of competency is encouraged
• Resources required for assessment include:

• access to appropriate workplace where assessment can take place

Method of assessment :

• In cases where the learner does not have the opportunity to cover all relevant aspects in the work environment, the remainder should be assessed through realistic simulations, projects, previous relevant experience or oral questioning on 'What if?' scenarios
• Assessment of this unit of competence will usually include observation of processes and procedures, oral and/or written questioning on Essential knowledge and skills and consideration of required attitudes
• Where performance is not directly observed and/or is required to be demonstrated over a 'period of time' and/or in a 'number of locations', any evidence should be authenticated by colleagues, supervisors, clients or other appropriate persons

RANGE STATEMENT 

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Understanding of dementia may include :

• Knowledge of different manifestations of dementia, including:

• Alzheimer's disease
• Huntington's disease
• Pick's disease
• Vascular dementia

• Basic understanding of pathological features, including:

• Amyloid plaques
• Neurofibrillary tangles
• Loss of connection between cells and cell death

Impacts that dementia may have on family carers and significant others may include :

• Depression
• Loss and grieving
• Anger
• Despair
• Social embarrassment a family member might feel
• Isolation
• Financial burden on the family

Impacts of dementia on the wider community may include :

• Inappropriate behaviour
• Anxiety
• Dependence on others
• Disorientation

Significant others may include :

• Spouse
• Family
• Friends

Strategies to respond to behaviours of concern include :

• Distraction
• Current events
• Reminiscences
• Music, dancing
• Walking
• Talking reassuringly about familiar and favourite topics
• Behaviour modification (if appropriate)
• Addressing physical triggers to behaviour including pain
• Alternative therapies

Activities include :

• Daily living activities such as:

• maintaining personal safety
• communication (speech, writing, non-verbal communication)
• eating and drinking
• mobilising and transferring (moving from place to place and position to position)
• attending to personal hygiene (bathing, laundering personal linen)
• dressing and undressing
• attending own spiritual needs
• grooming
• expressing sexuality

Instrumental activities such as :

• Accessing financial resources and allowances
• Paying bills and regular outgoings
• Shopping
• Preparing meals
• Climbing stairs
• Maintaining household (cleaning, laundry, décor, repairs)
• Travelling by private and public transport
• Interacting with others and socialising
• Accessing leisure, recreational and sporting activities
• Recreational and sporting activities
• Craft and creative activities
• Socialising
• Reminiscing activities
• Spiritual activities

Ensuring the safety and comfort of client while addressing the risks associated with :

• Ability to find their own way
• Ability to negotiate traffic
• Wandering or other behaviours relating to agitation
• Behaviours relating to psychotic experiences or mood disorders
• Ability to safely prepare, cook and store food and drink
• Ability to control temperature of water
• Ability to use home appliances
• Ability to maintain personal and home security
• Ability to manage own finances
• Ability to recognise dangers in their environment
• Ability to recognise the safety of others

Environmental strategies may include :

• Orientation to day, date, time of day, place, person, carer, family relationships, weather
• Adequate lighting to decrease risk of misinterpreting their environment
• Manipulate stimuli such as activity, noise, music, lighting, decor
• Provision of space (to pace, wander)
• Provision of individual's own belongings such as photos, books, clothes
• Security
• Safe storage of toxic chemicals

Behaviours of concern :

Refer to:

• Changed behaviour or BPSD (Behavioural and Psychological Symptoms of Dementia)

And may include but are not limited to:

• Physical aggression
• Social withdrawal
• Verbal disruption
• Repetitive actions or questions
• Resistance to personal care
• Sexually inappropriate behaviour
• Refusal to accept services
• Problems associated with eating
• Socially inappropriate behaviour
• Wandering or intrusiveness
• Sleep disturbances