Describe how to ensure an individual with dementia, carers and others feel able to complain without fear of retribution

Complaint procedures must be easy to use and readily available to all. We must acknowledge all forms of complaints as soon as we receive and handle strictly with confidentiality. We must provide written instructions of complaints procedure before commencing the service. We should also encourage individuals, carers and others to make complaint when such a situation arises. We must explain to them about their rights and available internal and external support. We must provide full assistance if individuals are unable to write and forward complaints. Feedback or comments about the service from service users are the other way to aware of any potential complaints about the service.

 Md Foisal Miah Talukdar

Describe how a conflict of interest can be addressed between the carer and an individual with dementia whilst balancing rights, choices and risk

Conflict of interests may arise between carer and individual with dementia from time to time. There is also dilemma may arise while you working with an individual with dementia. In those situations, carers or individuals may need counselling, advice and guidance from senior care worker or manager. As a carer, you must always be aware of your role, purpose of your role and professional boundaries. Persuading and compromising behaviour are keys to address this sort of issue. A group training session including possible scenario will definitely be helpful to address this kind of issue at workplace.

Md Foisal Miah Talukdar

Describe how the ability of an individual with dementia to make decisions may fluctuate

Dementia is a set of symptoms and different types of dementia affects individual’s ability differently. Individual with dementia may be able to make decisions about everyday choices and preferences, but an individual may find very hard to making any complex decision, as they may not be able to understand and retain the information to make right decision. However, ability of an individual depends on types and stages of dementia.

Individuals with vascular dementia may suffer from memory problems (such as recalling recent or past events) and problems concentrating due to slower thought. They may not be able to speak very fluent or not be able to speak at all. Giving consent and taking decision may become very difficult for them. In early onset of the symptoms they may be able to make decisions without any interruption.

Individuals with fronto-temporal dementia can exhibit inappropriate behaviour or ruthless comments to others. Due to their behaviour and lack of empathy to others, decisions taken by them may not be legible for the purpose.

Individuals suffering from dementia with lewy-bodies may have disorganised speech or struggle with planning and decision making.

It is very important to understand that at the beginning of the symptoms of dementia, an individual can make own decisions and plan for their own care ahead even with little help and support. At later stage, it is almost impossible for them to make any decision or contribute to it at all.

Md Foisal Miah Talukdar

Demonstrate that the best interests of an individual with dementia are considered when planning and delivering care and support

One of the legal requirement for delivering care and support is person centred care. Therefore, all providers must create a person centred care plan for each individual they provide care and support. It must meet individual’s choices and preferences and be planned with the individual. However, when we create person centred care plan for an individual with dementia, it is not always possible to determine or establish their choices and preferences due to their memory impairment, poor mobility, medical conditions, poor judgement and inability to retain information and take decision. If choices and preferences of an individual with dementia cannot be readily established then we must take decision considering individual’s best interests. Best interests decisions are usually taken in the presence of various professionals (depending on the specific decision), individual and family members after assessing all the available information.

Example: One of the individual with dementia would like to go out himself for shopping. Due to individual’s forgetfulness and other associate behaviour, it is not suggested to let him go for shopping on his own.

Best interests decision: After reviewing all the available information and taking into account of individual’s and public’s health and safety, it is being decided that we can introduce online shopping to the individual. If it still does not fulfil individual’s preferences then one carer can escort him to do the shopping.

Md Foisal Miah Talukdar

Explain how and when personal information may be shared with carers and others, taking into account legislative frameworks and agreed ways of working

Data protection act 1998 states that individuals’ personal and sensitive information must be kept safe and secure and we must not share personal information without individuals’ consent. Therefore, we must obtain individuals’ consent prior to sharing their personal information. Internal policies and procedures put restrictions on who we can share with and what information we can share which can refer to legislation wording ‘need to know’ and ‘right to know’.

In any emergency situation where individuals’ life is at risk, we can share personal information with the appropriate authority that need to know such information to save individuals lives. An organisation has express powers and obligations to share information with only named organisation for certain purpose. You can share individual’s personal information with carers and other professionals such as GP, hospitals, physiotherapists, nurses, mental health nurse, social service, only to improve the individual’s health and wellbeing. The personal data can be shared only with other agreed professionals in order to improve individual’s health and wellbeing. Data also can be shared to prevent crime and identifying criminals with appropriate authority and we do not need to obtain consent for that.

In order to share individual’s personal data we must follow organisation’s policies and procedures on how to share such information. Few standards are described below –

·         Make sure person seeking information has right to know

·         Determine the purpose (it must be beneficial to the individual)

·         Make sure person seeking information is a real and right person

·         Ask the person to make a written request

·         Use encrypted mail server to exchange personal data    
·         In the event of any doubt, you must contact organisation's information security officer

Md Foisal Miah Talukdar

Evaluate agreed ways of working that relate to rights and choices of an individual with dementia

One of the agreed ways of working is safeguarding adults which relates to rights and choices of an individual with dementia. Every individual has right to be safe from harm and abuse regardless their physical and mental conditions. Therefore, we require to record and report any concern or abuse we observe or come across. Individual with dementia can be subject of abuse or become an abuser very easily as they have lack of mental capacity, poor judgement, poor mobility, disorientation and anger. Therefore, we must take reasonable action according to policies and procedures to promote and maintain rights and choices of an individual with dementia. An example is given below for you to understand better -

Example:

An individual with dementia always choose not to have any personal care. It is the individual’s choice which must be respected. Similarly, you have to consider your duty of care. Your duty of care is what action have you taken or technique you have approached to persuade the individual to maintain personal care. Recording individual’s refusal in provided form is not enough to prevent individual from being self-neglect. You must record what you have done to persuade or to make agree the individual including different time, different person, family meetings or involvement, who did you report and what is the outcome. 

 Md Foisal Miah Talukdar

Explain the impact of key legislation that relates to fulfilment of rights and choices and the minimising of risk of harm for an individual with dementia

Key legislation:

                Human Rights Act 1998 

        Health and Social Care Act 2008 Regulations 2014 

                Mental Capacity Act 2005 

                Adults with Incapacity (Scotland) Act 2000 

                Mental Health Act 2007 

                The Disability Discrimination Act 1995 

                Safeguarding Vulnerable Groups Act 2006 

                Carers (Equal opportunities) Act 2004

An individual with dementia may become deprived of their liberty, rights and choices. They are also at greater risk of harm and abuse. Therefore, government put various legislations in place to protect individual with dementia from harm and abuse and promote their rights. The basic principles of Human rights act 1998 and the disability discrimination act 1995 are no one should be treated unfairly, due to their age, race, gender, disability. belief and sexual orientation. Everyone should be treated equally. These pieces of legislation support the rights of an individual with dementia. The health and social care act 2008 (regulated activity) Regulation 2014 emphasized on ‘Person-centred care’ which promotes rights and choices of individual with dementia. This legislation states that ‘The care and treatment of service users must – be appropriate, meet their needs and reflect their preferences’. Mental capacity act 2005 impose rule about deprivation of liberty for individuals with dementia and other mental illness. It also stated that if it is established any individual does not have mental capacity, then service provider or designated person must act on individual’s best interest. In order to minimise the risks of harm and abuse to individuals with dementia, Safeguarding vulnerable group act 2006 put rules of vigorous screening system for the worker prior to coming in contact with vulnerable adults.

All of these legislations must be maintained in practical work environment by service provider. Violating or non-compliance of these legislations can be heavily consequence such as operation closure, license provoked, reprimand and imprisonment. 

Md Foisal Miah Talukdar