Health Care Assistants: Do They Really Care?

This isn't a comprehensive guide to what dementia is and how it manifests in people, it's not meant to be. If you want that, go read somewhere else. What I want to write about is why I love working with people changed by Dementia and to also show the skill set you need to be able to do the job of a Health Care Assistant.

You have to start with the person before you explore dementia because as a carer, that's who you are dealing with at work, the person not the dementia first. That's really important and many people forget that and don't put the individual first.

The person can be affected mildly, completely and anywhere inbetween, by dementia, depending on the progression of their condition and what type of dementia with which they have been diagnosed. Even within the diagnosis, there will be a whole variety of changes depending on the personality and character of that individual.

So, to know the person and their life, character, values and idiosyncracies is key in understanding how their dementia is affecting them.

So after initially getting to know the person and listening to their family about who they have been all their life up until now, you then look at what type of dementia this person has been diagnosed with.
Vascular Dementia, Alzheimers, Dementia with Lewy Bodies, Creutzfeldt Jakobs Disease, Parkinsons Dementia, Korsakoff Syndrom...etc and many other more rare forms too. Within each one of these catagories are subcatagories of what type of Vascular, Alzheimers, Lewys Bodies...etc, does the person have, depending on what part of the brain has been damaged and from what underlying cause. All of these variations have an impact on the challenges faced by the person themselves and those caring for them.

So it's like the hardest puzzle to solve or like someone is lost in the middle of a really complex maze and you have to go find them. I love that challenge and that smile of recognition from the individual, when you finally begin to understand their behaviour enough to communicate with them successfully and can then pass on that information to other care staff in the hope of improving that individual's general care. It feels amazing! The change in that individual when they realise they're understood is one of the most satisfying outcomes because you know you made a real difference to that person and the relaxation of their family.

'George' used to ask me if anyone was coming to visit him today because he was feeling lonely. What came out of his mouth though was a jumble of words that didn't make any sense in a regular way, even though it might have done to him. He used to say...

"It could be up on the speak the....you know......the visit or down because it's down."

So, to begin to understand George, I had to rely on other clues like body language. I knew it was a question from his tone of voice and inflection, the way his head moved and expression around his eyes. There were some words that did make sense such as "visit" "up" "speak" "on the" and "it's down" which sounded like a definite statement. Piecing things together it seemed like he wanted to speak on the phone about a visit because someone was coming up to see him. I eventually settled on a question and asked him if he was feeling lonely and he replied "YES" and sighed as he said it but also smiled. Then we went to the admin office to phone his family so he could connect with a familiar voice and sort out a visit. He was satisfied and I knew a little bit more about how he communicated.

You might be thinking, 'Well done Sherlock that was a bit obvious'...but not so fast because the one thing you can't do is ask an individual challenged by dementia, too many questions. Sometimes two is even too many! They may often (as was the case with George) become frustrated and then aggressive or become depressed and have a fall because they might be aware that they're not making sense or might be annoyed that they are not being understood. So sometimes, you only get one shot at a simple question and you have to be accurate and clear.

And that was just one question! In any given day George had several. There are 24 other residents too, who all have several questions or statements.

Then you have simple instructions that you have to communicate to someone suffering from dementia. It's lunchtime. Do you need the toilet? Let's go and have a shower. Can I help you change your shirt as you've spilled something on it? Often they either don't understand or they might not want to go, especially for a shower or bath, which as you can appreciate, is quite a crucial hurdle. All of this during the course of one day has to be smoothly communicated in a very relaxed and calm way often in very tricky circumstances what with other residents around doing their thing too.

It's a challenge and often simple things like misunderstanding a question can have devastating consequences if you're not skilled at your job. A frustrated depressed person with dementia will not eat properly, drink enough and they will often fall. All of which can increase deterioration of their condition in the worst way possible and cause a most horrible demise. Fortunately, care workers are trained well and very skillful so are used to balancing all the relevant information about the person and their condition.

Throw on top of all that the usual things we can all communicate easily such as headaches they can't tell us they have, tooth pain which we have to watch out for signs of, bad night sleep woke up with neck pain, belly ache, upset stomach, too hot or cold and can't express that, urinary tract infections which are unfortunately common in those who find it hard to drink enough fluids and last but not least, foods they usually like but don't fancy today and find it hard to tell you that. All of these regular enough variables can impact on a person and their usual way of being.

People are complex enough, then you have dementia!

Some day this job will be professionalised and the whole entire industry will be much better for it.

Sure there are some carers who don't care, not interested in the people, sleep through training, don't remember anything they're told, just want to do their shift with the least amount of effort and collect their salary but they don't last long in the job. The challenge of the job makes it hard for them to be slack and there are more good staff than bad who will hate on them until they leave.

It's a wonderful job. Hard work but a total privelidge to spend time with someone and get to know them during this confusing time, for the months and weeks up until their finally day on this earth.