Abstract
Liz Leach has written a practical guide to supporting people who are living with dementia. She is a highly experienced practitioner in health and social care whose work is based on the belief that the provision of care and support can be positive and uphold a person’s choices and wishes. The book is clearly laid out, easy and accessible to read with practical guidance throughout. The heart of the book is an in-depth explanation of current best practice in dementia care and support and how this can be achieved.
The book starts with a discussion of underpinning theories and frameworks such as person-centred care, the VIPS framework, relationship-centred care and the enriched care plan. Use of a dementia care triad + 1 throughout discussions in the book forefronts the relationships between professional workers, family and friends and the person living with dementia whilst also emphasising the importance of surrounding communities. Current UK social care and health models and current legislation are introduced as these impacts on what is available to a person, or family member.
Helpful advice is also given as to how to navigate through these systems. These models of care are also considered in terms of the power imbalances inherent within their structures.
Chapter 3 provides a good overview of the different types of dementia with a comprehensive section on assessment and diagnosis. Then goes on to discuss the dementia journey through early, mid and late stages with a consideration of advance care planning. Chapters 4 and 5 discuss the UK care act, personal budgets and personal health budgets. The implications for both the person living with dementia and carers are considered. Carer stress is acknowledged and discussed. Different care settings and eligibility are considered, and end of life care discussed.
For me as a clinician the heart of the book was in the practical skills and tools that are presented in chapters 6 and 7. Skills for personalised support are demonstrated through a number of ‘skills boxes’. Different skills are practically introduced that promote respect and dignity; skills to help with choices and person-centred planning. Supported by templates and web links in Appendix 2 the chapter presents tools such as All about Me profiles, doughnut sort, relationship mapping and circles of support. These skills and approaches are practically demonstrated in order to support achievement of personalisation in dementia care. These are not new tools, but an overview of those that have been used successfully for over 50 years.
Chapter 7 covers the important topic of communication and how to work alongside someone to reach an understanding of what a person is communicating. A comprehensive overview of strategies to understand communication as it changes through the course of dementia is undertaken and a discussion of how perceived behaviour needs interpretation as communication. Explorations of why a person’s behaviour may change with time are considered, with tips for effective communication and reflections to build on lessons learnt.
Each chapter is clearly summarised at the end with key lessons learnt, and questions to aid reflection help to embed the learning and make it practical. For many care settings, this book will be an aspirational goal of what good care can look like; for some settings, this level of person centred/person first care may already be in place – however, all settings would be able to take something practical and positive to work towards.
Although the underlying principles of this book are universal and are useful to practitioners, people living with dementia and students, it is clearly aimed at the UK market as evidenced by the social care and health models and legislation discussed within. This may limit its applicability to other health and social care systems.