“A small change can make a BIG difference”

An Interview with an AHP Dementia Champion

My name is Tracey Stronach and I’m an Occupational Therapist working in a large acute hospital in Edinburgh.

  1. What do you enjoy most about being an occupational therapist?

 

I’ve always enjoyed working with elderly people and for a number of years have specialised working with this group of people in both acute and rehabilitation hospital settings. When people ask me what I most enjoy about being an Occupational Therapist, I think it’s the difference I can make by identifying the impact of acute and chronic illness on function and safety  and by pro-actively trying to reduce or manage this impact.   My training has enabled me to always see the “bigger picture” and appreciate the effects of the environment and social situation as well as the physical and psychological impact of illness and disability.

  1. Why did you decide to become a dementia champion?

Within dementia care I particularly enjoy using my occupational therapy knowledge to support both the person in hospital and their families and carers at a time when admission to acute care can be distressing. This is especially relevant for a long term condition like dementia, where outcomes are improved with the right environment and a compassionate approach. My role involves identifying services, equipment and adaptations that will improve the quality of life for the person living with dementia and their carer too with the ultimate goal to enable the person to return home.

I was delighted to gain a place on the Dementia Champions programme in 2014, and thoroughly enjoyed my training with colleagues from all over Scotland. Before the course I had read stories of people with dementia who did not experience a good patient journey in acute hospital care.  Gaining skills to help improve the experience of such people was a main driver for me applying.  I was also keen to make sure I knew as much as possible about identifying, and helping reduce, stressed and distressed behaviour in the acute hospital environment.

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  1. What aspect of the dementia champion education did you enjoy the most?

As well as the taught sessions, I really enjoyed my community placement, where I joined an afternoon singing group in a local church. It was such a positive way to meet people living well with dementia and their families and carers.  The community setting was a real contrast to my work environment, where I tend to meet people in a crisis situation. It helped put things in perspective and reinforced the impact that the environment has on the person with dementia. This welcoming atmosphere was very respectful and the volunteers treated those attending in a very inclusive, caring and compassionate way. My assignments helped me to reflect on what I had learnt and identified what ideas and learning I could take back to my workplace.

  1. What has been your proudest moment integrating your new learning as a dementia champion in you day job?

At the same time as becoming a Dementia Champion I took part in a course focussing on learning skills to train others in Dementia Awareness.

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Working with other Occupational Therapists, and using the Dementia Skilled – Improving Practice resource, we have run some training sessions for the support staff in our occupational therapy department. The feedback has been very positive and the sessions have generated discussion, reflection and the sharing of ideas.  I think my proudest moments come when I can see that someone has used the information taught to make a positive change in caring for someone with dementia. This could be a practical skill; using more sensitive or up to date terminology; or altering a perception or belief.  The change needn’t be huge – even a small change can make a big difference!

  1. What would you say to your colleagues to encourage them to be a dementia champion too?

I feel very privileged to have completed two major programmes of learning in the field of dementia care. I would recommend anyone to take up the opportunity of training – the more Dementia Champions we have, the better care we can provide for people living with dementia – and their families and carers. I’m sure this is the highest priority for all those who work with people living with dementia.

Final thoughts……

I’d be interested to hear how other Dementia Champions are putting their training into practice.

  • What’s been working well?
  • How do we demonstrate we make a difference to the lives of those with dementia?

 

pic-1-ConvertImageTracey Stronach

Specialist Occupational Therapist – Mobile Medicine of the Elderly Team

@TherapyLimpet

I’m an Occupational Therapist working in a large acute hospital in Edinburgh. I’m part of a mobile Medicine of the Elderly team which involves working with people being treated on non-Medicine of the Elderly wards within our hospital. This brings equity of care to this often vulnerable group of people.

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Allied Health Professionals

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Who are they and how can they help you?

Allied health professionals are a group of various health professionals who can support you if you have dementia. They are often referred to as AHPs and are registered with the Health and Care Professionals Council (HCPC). http://www.hcpc-uk.org
Allied health professionals are experts in prevention and rehabilitation and will help you focus on your abilities and strengths so you can stay connected to your community and live in your own home for as long as possible. There are several different kinds of allied health professionals and we designed a leaflet about those AHP’s you are most likely to see in a community setting including:
Dieticians to help you to eat and drink well
Occupational therapists to help you to continue with the occupations (activities) that are important to you from getting dressed to hobbies or going to work
Physiotherapists who you to stay active
Podiatrist who you to look after your feet
Speech and language therapists who help you with your everyday conversations and any difficulties you have with swallowing food and fluids.
For other AHP’s (arts therapists, orthoptists, paramedics, prosthetist, orthotists and radiography) visit http://www.ahpf.org.uk
It is best to make early contact with an AHP if you are worried about your memory or if you or someone in your family has recently been diagnosed with dementia. That way you can get the information, advice and treatment that is right for you and your family as quickly as possible. Our leaflet describes how AHP’s can help and how to get in touch with them.

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5 things you should know about the AHP leaflet
1. We designed the leaflet in partnership with the allied health professional bodies, who endorsed and supported the content of the section about their profession
2. We worked with the Scottish Dementia Working Group (S_D_W_G) and the National Dementia Carers Action Network on the content and language use

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3. We will be updating the leaflet at the end of this year and welcome comments on how useful the leaflet. Tell us your idea and comment on this blog or email us at TalkingDementia@Alzscot.org. We will also ask you during Scotland’s Dementia Awareness week (30 May-5 June)
4. We have already shared over 3,000 of the leaflets so far since its launch last summer
5. You can receive a copy of the leaflet 6 ways
• online http://www.alzscot.org/assets/0001/7456/AHP_Leaflet_for_launch.pdf,
• from an Alzheimer Scotland link worker
• from your local Alzheimer Scotland dementia advisor
• at your local Alzheimer Scotland resource centre
• from your local NHS AHP
• email us at TalkingDementia@Alzscot.org and we will send you a copy.

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Thank you for reading this blog. We look forward to hearing your views and ideas on our allied health professional leaflet and this blog?

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Elaine HunterElaine Hunter
Allied Health Professional Consultant, Alzheimer Scotland
@elaineahpmh 

My remit in Alzheimer Scotland is to bring the skills of AHPs to the forefront of dementia practice and to share with them the principles and practice of working in a major charity that is dedicated to “making sure nobody faces dementia alone”. I am leading the delivery of commitment 4 of Scotland’s Dementia Strategy. In short, a great job working with great people.

Occupational Therapy Interns

To introduce ourselves:  We are Lynsey Robertson-Flannigan and Chris Cousins, 2 Occupational Therapy Students from Queen Margaret University in Edinburgh and we are currently completing a 3 month Occupational Therapy Internship based within Alzheimer Scotland in partnership with Santander Universities and Queen Margaret University.

This is what our 3 month internship provides: it gives us work experience within third sector focusing on dementia and AHP work. As there are two of us, we have joint projects we’re working on, a blog being one of them. We each also have our own individual projects that we will be working on throughout our time at Alzheimer Scotland and we’ll keep you updated on these at the blog.

We have put together a few video blogs on our work while we are here.  Please feel free to comment or ask questions.

 

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Christopher Cousins

Occupational Therapy Intern  

@ChrisGCousins

I am an Occupational Therapy Student from Queen Margaret University and am currently working in the role as Occupational Therapy Intern within Alzheimer Scotland working with The Scottish Dementia Working Group and using social media to promote what we are doing. I am in post for June, July and August 2015.

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Lynsey Robertson-Flannigan

Occupational Therapy Intern  

@LRFlanniganOTS

I am an Occupational Therapy Intern working within the policy team at Alzheimer Scotland. My internship has provided me with the excellent opportunity to work alongside the Scottish Dementia Working Group and support them with a project to share their ‘Top-Tips’ for living well with dementia. I am also completing a literature search on rights based practice to be used in the development of an MSc Dementia module being run at Queen Margaret University, Edinburgh.

“A blog a day blether” for #DAW2015

Allied Health Professionals Q&A

Day 3 “Ask an Occupational Therapist”

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Welcome to day three of our AHP Dementia blog posts.  I’m really pleased to answer some questions as an occupational therapist.  People often think of occupational therapists as the people who provide equipment and while this is an important aspect of the role we can also help in other ways.  It’s about what people need to do and want to do in their daily lives, the habits and routines that we have and the roles and responsibilities.  But without any further ado I will answer the questions….

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“My mum used to be very creative.  Painting, dressmaking, soft furnishings etc.  I have bought pastels and crayons to encourage her to draw/colour in, but she thinks these are childish activities.  What approaches would the OT recommend?” Catriona, carer

Thanks Catriona, that’s a great question.  Supporting people to be involved in activities is so important but it can be challenging at times to get that “just right fit”.  For an activity to be enjoyable for any of us we need to find it interesting and relevant to our lives and it needs to be something that is realistic for us to do but not so easy that we find it boring.  Here are some suggestions for approaches to try and hopefully you will find something that helps.

  • Sometimes people might comment that an activity is childish if it is too easy or if the materials appear child like. If your mum was not previously interested in colouring in she might consider this an activity for children.  However, colouring in for adults has become quite fashionable and there are a number of colouring books designed for adults that you could try.  There are a range of designs with some very intricate but some more simple and lots of themes from the animal kingdom, art deco, flowers and geometric patterns.
  • I’ve found when using art as an activity that the type of art materials used can make an activity more or less inviting for people. Some of the materials which have worked well in my experience are colouring pencils which you can then apply water to and they look like watercolour paints, having a sketch book rather than sheets of paper, a simple paint pallet with a good quality brush etc.
  • Sometimes people can find it challenging to get started with an activity and creating the right environment can be helpful. Setting up a spot at a table with good lighting and the required materials in clear view can be helpful.  Your mum might also find it helpful to have some inspiration to get started with painting.  In the past I’ve used a selection of photographs as a starting point e.g. a beautiful scene, a familiar place etc something to trace can even work.  Sometimes taking a sketch book and pencils/paints out for a drive and seeing if your mum is inspired to do some sketching of a view.
  • Sometimes having a goal or an end product that is going to be used can make an activity more inviting. Here are a few ideas I’ve used in the past:
    • Using blank greeting cards or postcards which can then be sent or given to mark an occasion.
    • Scanning the finished art work and it can then be used to make a calendar, magnet, integrated into a printed photo book etc.

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  • Sometimes we assume that people will want to continue with an interest or hobby from the past. This is often the case but people can find it less enjoyable as they might compare what they are able to do now with their previous abilities.  If you have a few examples of projects that your mum has completed in the past you could use these to prompt a discussion and get a sense of how she feels about these activities now.
  • If your mum is still interested in her creative hobbies but doesn’t want to paint or colour in you could try:
    • Joint projects can be a good way to involve the person
    • Having a box of fabrics, threads, yarn etc that your mum can enjoy looking through and sorting.
    • Looking at patterns, photographs, books related to the interests.
    • Going to an exhibition or group related to the interests. You might find a session for people with dementia e.g. the National Gallery of Scotland runs a Social Gallery event where people with dementia can visit the gallery to see the art, join in a practical art session and have tea and cake (https://www.nationalgalleries.org/education/gallery-social-programme/ )

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The last question in this blog has some other ideas about finding activities that you might find useful too.

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If you do not have a CPN, can you still get help in the community if you need aids and adaptations in your house?  Alison, living well with dementia

Thanks for your question Alison, you do not need a CPN to get access to aids and adaptations.  If you think you would benefit from a piece of equipment you should be able to refer yourself via your local social work department or you could ask your GP to make a referral on your behalf.  Many councils have a selection of simple equipment that you can access directly e.g. a grab rail or cutlery that’s easy to grip.  This information will probably be available on the council website.

If you aren’t sure what you need or if you think you need a bigger piece of equipment or adaptation to your home then you can ask for an occupational therapy assessment through your local social work department.  You can usually do this via a telephone call or some council web pages have a form you can complete on line.

The web site “ask sara”  is another place where you can find out more information about equipment.  You can select an aspect of your health, home or daily life that you are finding challenging e.g. your memory, the stairs or communicating and the website will ask you some simple questions which will guide its recommendations.  It may suggest some strategies, sources of help and advice as well as equipment that you might be able to borrow or purchase.

If economics & person centred care are behind the drive towards greater care in the community, who is looking at the provision of equipment in the home to enable carers to care at home for longer? (e.g. wet rooms, hoists, bed raisers, rise & recline chairs, hospital beds.  It seems to be getting harder not easier to obtain support as local funds are being tightened.  How can we rethink ways in which expensive equipment might be safely repurposed and recycled?  Kathryn, carer.

Thanks for your question Kathryn.  This is a challenge indeed and it is being looked at by the Scottish Government (information available here).  The west of Scotland has a service which decontaminates and recycles equipment and this has been shown to save a considerable amount of money.  We can all play a small part in helping to recycle equipment too.  If you or someone you know has been provided with a piece of equipment which is no longer required then you can contact your council and ask for it to be collected, I’ve often come across equipment when I’ve been out to visit someone as an OT that people hadn’t thought they could return.

My father can no longer follow TV programmes or read books and my family are concerned about him.  He’s never been very outgoing and refuses to go to day care or any clubs.  They want to know what they can do to keep him occupied during the day?

Thanks for your question, sometimes people can find activities that use lots of language harder to concentrate on so reading and watching television can become tiring and less enjoyable.  Everyone is different but here are a few ideas to find things for your dad to be involved with:

  • What other hobbies and interests has your dad had? Did he enjoy gardening, watching or playing sport, listening to music, walking, painting, going to the theatre or cinema, photography etc.       This can be a really great place to start.
  • Starting with a few ideas of things that have interested your dad in the past you can have a trip down memory lane and chat about these things and your dad’s memories. That might give you a sense of how he feels about trying these things again.       Sometimes it helps to have a few props to hand to help the conversation e.g. a few photographs.
  • If your dad identifies something he enjoyed and would like to do then its finding a way to help him to do the activity (you might find some ideas in the answers to the first question on this blog too).
  • Your dad might need a bit of help to get started with an activity – it might be as simple as getting the things he needs out and putting them all in the one place, making sure there is good lighting and inviting him to be involved.
  • Your dad might find it easier to do an activity jointly e.g. doing some gardening with another family member.
  • There are an increasing number of dementia friendly initiatives in the community as a recognition that not everyone with dementia wants to go to day care they might want to keep going to the theatre or football just as they did before. There are an increasing number of events which are being advertised as being dementia friendly e.g. relaxed theatre performances with less people in the audience, shorter performances that are more visual and less reliant on language. Have a look online to see what’s available in your local area.
  • Some people find listening to music a really good activity that can be relaxing, spark memories and even inspire people to get on their feet to have a dance.  The charity Playlist for Life  has lots of useful information about using music that’s personal to the individual.

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  • Another activity which I’ve found works for lots of people is making a life story. It can be a good family activity gathering some photographs and stories together in a photo album, scrap book or box and then this can be used as a conversation starter or just an enjoyable book/box to look through. There is some really helpful guidance on life story work in the Communication and Mealtimes Toolkit  if you would like some ideas to get started.
  • Other ideas might just be in finding ways to keep your dad involved in the daily routines at home e.g. getting out for a walk to buy milk, helping out with washing the dishes, meal preparation, washing the car etc.

Thanks to everyone who submitted a question and have a look tomorrow for answers from our Physiotherapist colleague, Lynne.

We welcome ideas and comments from our readers about this blog.

Tomorrow’s blog will be by Lynn – “Ask a Physiotherapist” Q & A.

Jenny ReidJenny Reid
AHP Dementia Consultant (NHS Lothian)
@JennyAHPDem

My role involves raising awareness of the contribution AHPs make to helping people with dementia, their families and carers live well and supporting AHP service development, education and evaluation.  The national remit of my role includes producing the Dementia AHPproaches newsletter, leading a national pilot of the Tailored Activity Programme and supporting AHPs in the development of early interventions and supported self management for people living with dementia, their families and carers.

Actualising work potential in dementia care

I am delighted to share with you in this blog, my work as an occupational therapist with a young man. This is only possible as I am working closely with his family and community partners.  The DVD is five minutes long and I hope you can see how work/vocational potential can be actualised with the right support, at the right time

My special interest is community connections.  During my last posting with NHS Lanarkshire, I was involved in designing an occupational therapy based leisure group in partnership with older adults and multi-agencies. This was open to ALL older adults and took place at the Time Capsule Leisure centre. It continues to attract around sixty older adults to the weekly group since 2009. Current leaders are looking into opening the group for an additional day as more older adults want to join in.  This leisure group was chosen as the platform to launch Scotland’s first National Dementia strategy.

I would now welcome your reflections around this filming and any further discussion points it raises within you.

Many thanks for taking the time to view this blog.

 

pasnaPasna Sallis- Occupational Therapist, Young Onset Dementia Team, NHS Greater Glasgow and Clyde

@pasna

My work involves timely occupational therapy input with the younger person with dementia and their family to live well within their community. In my current role I address self management issues within home, hospital, Care home settings, as well as within the wider community for example, work and/or leisure domain. I provide a consultancy role to OTs within our Board who are looking for specialist working knowledge in dementia care.

‘Pocket Ideas…for a moment in time’ a person centred approach in Acute Care

Pocket Ideas, what is it?

So if a person with dementia or carer wanted to know what to expect when being introduced to “pocket ideas” what would I say?

‘Pocket Ideas’ is a portable pocket sized book filled with prepared activities and inspirational quotes to help stimulate conversation. These conversations can take place whilst working with a patient in the ward, as the book is very portable, or in a group situation.

It’s an opportunity for us all to remember to see the person who has had many life experiences, skills and knowledge. It helps to build therapeutic relationships, reduce distress, reinforce the benefits of meaningful activity and person centred care. It’s a tool that anyone can use and anywhere, reminding us that every moment we have to offer older people in meaningful experiences is valuable, and essential in our professional practice. Enjoy the experience using it and the opportunity to reminisce, remember and even talk about new topics.

I would also tell them that this initiative won an award last year, in the category of “Best Acute Initiative” of Scotlands Dementia Awards 2014.

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5 Top Tips using ‘Pocket Ideas’

  1. Only takes 5 minutes to have a moment in time with an individual, and it reinforces the importance of meaningful activity.
  2. Simple prepared activities and inspirational pictures to stimulate a conversation.
  3. Encourages positive therapeutic relationships and reinforces the importance of humanity, compassion, person centred care and being actively engaged.
  4. Portable pocket sized tool and can be used anywhere by anyone.
  5. Enjoy using it, as a moment in time can bring back a memory, reduce stress, provide comfort and make you smile.

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5 things you need to know when designing a resource like this

  1. Understand what the problem is and creative ways to address it.
  2. Importance of engaging relevant staff members to support project ideas.
  3. Establish a working group to talk about ideas, set achievable goals and support each other to realise a possibility and make a difference.
  4. Create a prototype using creative ideas.
  5. Develop a means to measure the benefits of using the prototype and then pilot the project idea in the relevant area.

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My top recommendation to make something happen, surround yourself with a great team.

Our team picture includes; left to right Jean Knox, (Technical instructor), Gillian Agnew (Occupational therapists), me in the middle, Elaine Tizzard (Technical instructor) and Darrell Line (Technical instructor).

I would welcome any reflections on my blog post

I would also like to leave you with a question to consider and reflect on

How can we ensure, if you are living with dementia and require to go into an acute care setting that every contact with a health care professional is person centred and we ask you “what is important to you”

Andrea Boyd

Occupational Therapist, NHS Ayrshire and Arran

@AndreaBoydahpmh

I am currently on secondment and leading up the project ‘Pocket Ideas…for a moment in time’. I have been an Occupational Therapist for many years, but this is such an exciting opportunity to continue with the development of our person centred tool with the support of my ‘Activity Team’.

 

Three tips to creating an enabling home environment

As an allied health professional consultant and an occupational therapist, part of my role is to help people to keep doing the things they need and want to do in daily life.  This includes working with the person to understand their abilities and difficulties, habits and routines, likes and dislikes.  An important element of this process is considering all of these things in relation to the home environment.   For someone with dementia they might experience problems with their memory, with keeping track of the day and time of day, with finding items around the home and adapting to other age related changes.  By making a few changes at home people can minimise the impact of these problems making everyday life easier and less stressful.  Here are a few things that I have learned along the way.

  1. Let there be light….

Lighting is especially important for people living with dementia because of age related changes to our sight and the fact that dementia can change how we perceive what our eyes are seeing.  Here are a few things to think about in relation to lighting at home:

  • Are you getting as much natural light as possible?  Things like having your windows cleaned regularly, using tie backs for curtains to allow light in and keeping trees and plants near windows cut back can all help.
  • Do you have enough lights and are they bright enough? You might be able to use brighter bulbs in your existing light fittings or have an additional lamp beside your armchair or at the bedside.  Every little helps.

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 ….. and dark

Getting a good night’s sleep can be a problem and this can be due to lots of different reasons.  Keeping track of day and night so your body knows when it is time to go to bed and when its time to get up can be difficult.

  • Having a dark bedroom (with thick or black out curtains) can help you get to sleep and stay asleep especially in the summer months.
  • Shutting your curtains when it’s dark outside can also help as some people find the reflections on the window are distracting or even upsetting.

 

  1. Using contrast to help

Contrast can help to make important things more visible.  If you aren’t sure if there is a good contrast then try taking a black and white photograph and see if the object is clear in the picture.

Here are a few items to consider if the contrast is good enough:

  • Does the toilet seat or chair contrast with the floor?
  • Do your plates contrast with the table surface/table cloth?
  • Is the banister a contrasting colour to the wall?

You don’t always need to spend lots of money on increasing the contrast.

  • A replacement toilet seat in a different colour can be purchased at a reasonable cost
  • Rather than replacing all your plates, maybe a coloured table cloth or place mat would be a cheaper option.
  • A new chair or carpet would be expensive but a coloured throw could help without spending so much money.

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  1. “A place for everything and everything in its place”

I found the best solutions were usually personal to the individual and used existing habits and routines.  Here are just a few of the strategies that I have learned from people with dementia:

  • Keeping keys on a hook near the door and a sign on the inside of the door as a reminder.
  • Having an extendable key ring “clipped” onto your handbag so it is always attached.
  • Keeping a special bowl/box with “essential items” for tasks in that place e.g. a pair of glasses and the remote control next to where you watch television.
  • Using labels (might have a picture as well as the words) on cupboards or drawers where commonly used items are stored
  • Recognising that sometimes things will be misplaced so having a few spares (e.g. keys, reading glasses) to hand to reduce stress when this happens.

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This has just been a small selection of ideas.  It would be great to hear how other people have made changes at home to make living with dementia in daily life easier.

If you have any other hints and tips it would be great if you could share them in a comments section?

Jenny ReidJenny Reid
AHP Dementia Consultant (NHS Lothian)
@JennyAHPDem

My role involves raising awareness of the contribution AHPs make to helping people with dementia, their families and carers live well and supporting AHP service development, education and evaluation.  The national remit of my role includes producing the Dementia AHPproaches newsletter, leading a national pilot of the Tailored Activity Programme and supporting AHPs in the development of early interventions and supported self management for people living with dementia, their families and carers.

 

Useful links….

http://dementia.stir.ac.uk/design/virtual-environments/virtual-care-home

http://www.enablingenvironments.com.au/AdaptaHome.aspx

http://www.scie.org.uk/publications/dementia/dementia-friendly-environments/environment/index.asp

www.cih.org/resources/PDF/Scotland%2520general/Improving%2520the%2520design%2520of%2520housing%2520to%2520assist%2520people%2520with%2520dementia%2520-%2520FINAL.pdf