Care in a dementia day care centre: a social worker explains

Jincy Shiju is a social worker at Dementia Day Care Centre, Bangalore (a service run by Nightingales Medical Trust).  Currently, the centre services six dementia patients for day-time care on weekdays. The activities of ARDSI Bangalore Chapter are also carried out through the Centre. [note]

Dementia Care Notes: Please describe the steps you follow to admit a patient for the day care facility.

Jincy: When a client’s relatives approach us for day care facility, we first ask them to get the client assessed by our doctor. During this assessment, our doctor checks the client’s current status and identifies which areas to focus on during rehabilitation and care. We next gather information about the client from the client’s family, using our “client social profile” format, and we sit with the family to get clarifications and additional data about the client.

At the end of this information-gathering, and before we take in the client for actual care, we are therefore well informed about the client’s personal and social history. For example, we know:

• Client’s personal history, such as preferred name, school/ education, occupation, cities lived in, languages known, family details (such as spouse, children, grandchildren and others), friends/ neighbours, pets.
• Special memories and anecdotes.
• Social involvement, such as whether the client likes to socialize, social activities enjoyed, etc.
• Emotional habits, such as how the client expresses emotions such as joy, sorrow, does the client like to be touched/ hugged, how the client expresses frustration.
• Religious beliefs and habits.
• Behavior challenges.
• Routine the client is used to.
• Food habits, likes and dislikes.
• Hobbies, activities that the client likes or may want to try.
• Whether the client likes intellectual activities.

Dementia Care Notes: How do you handle new patients when they are admitted?

Jincy: We use a gradual approach to help the client adjust to the day care facility and staff.

The first day, the client stays with us only for a few hours, and a relative remains present.

Over the next few days, we increase the hours of the client’s stay with us. The relative remains present at the facility but sits in a different room, not visible to the client. The client is handled by our staff without the help of the relative. We use this adjustment period to get more comfortable about the client’s habits and likes and dislikes, and ask the relative for more data as we need it. The client, too, starts adjusting to our staff and facility.

Usually, after a few days, we are able to care for the client from morning to evening, and the relative no longer needs to be available for consulting.

Dementia Care Notes: Do you provide food? Are the patients comfortable eating the food you provide?

Jincy: Some families send food with the clients, and we heat and serve it at mealtimes. Others are happy to let us provide food to the client.

Dementia Care Notes: How well do the patients adjust to the day care?

Jincy: Some clients show better behavior here as compared to the agitation they show at home. Others seem agitated and restless and keep saying they want to go home. We usually manage to engage the clients in various interesting activities, and distract them from restlessness.

Sometimes, we do face problems such as restless clients trying to wander, or clients getting angry and aggressive.

Dementia Care Notes: Are some clients reluctant to come for day care?

Jincy: Yes, some clients tell their families that they do not want to come. Sometimes they even refuse to get out of the car and enter the facility. We have to persuade them. But once they enter the facility, they seem happy enough and spend the day peacefully.

Dementia Care Notes: Can you give some examples of how you handle challenging behavior?

Jincy: One of the problems we face is of wandering. Clients get restless and want to go out.

We first try to calm the clients by talking to them. If they want to walk around, we stay close with them or follow them, or we take them for a walk in our garden or to the park nearby. We do not stop them from walking, but make sure they are accompanied. As soon as they seem calmer, we guide them back to the facility.

Sometimes, we also stop wandering by locking the main door, so that they can only wander within the facility. If asked, we pretend that we have misplaced the key, or that the key is with a staff member who is not present and will be back shortly. We then try to distract the client.

Some clients insist they want to go back home. We never refuse this need, but let them know that their family will take some time to come. We may pretend that we have called the family, and that the family members are taking time because of a traffic jam. Or that our van cannot drop the client home back right now because there is no petrol or the driver has gone for lunch. Often, reassuring the clients that they will soon be going back is enough to calm them down for some time. We also try to distract them by sending along a different staff member to talk to them.

On a few occasions, when clients seem extremely restless, we may have to request the family member to come. We once had a patient who tried to climb out of the facility and was extremely agitated. After the family member arrived, however, he was very calm and it was difficult to believe that he had been so agitated just a short while ago.

Dementia Care Notes: So, in some situations, you need to call the family during the day, to ask them to take the patient home?

Jincy: This may happen for medical reasons, or extreme behavior challenges, but is not common.

In case of medical problems, in addition to immediately informing the client’s family, we also call in doctors from the neighbouring hospital to assess the client’s problem and advise us. Sometimes, the client is too unwell to stay at the day care, for example, he/ she may be having a severe asthmatic attack. Then we ask the family to take them home or to a hospital.

Sometimes, when the client is very agitated and insists on family presence, and when we are not able to calm the patient, we inform the family and request some member to come. In such cases, the client usually calms down on seeing the family member, and the family member is able to then leave. Or the family member takes the client home for the day.

Dementia Care Notes: How often do you need to call in the family to ask them to come or take the patient away?

Jincy: We have six clients currently. We usually do not need to call any of their families for help more than once or twice a month.

Dementia Care Notes: How often do you communicate with the family regarding the patient’s status and activities?

Jincy: Every day. We have a register in which we note down the daily report for a client. This is shown to the family every day by the driver who drops the client home at the end. The family signs an acknowledgement for having read this, and also uses the same register to note their comments and to inform us of any change in the client’s status or of any other problem.

In addition to this, family members call us whenever they need to tell us anything, and we also call them in case we need more information, or are facing a problem.

Dementia Care Notes: You have patients from different regions of India. Is language a problem at times?

Jincy: Usually, we are able to understand the client’s language because we have staff members who know the language, or are able to guess the meaning by asking questions. Once in a while, we face problems with a particular word; in such a case, we call the family to find out.

One such incident was when a client kept saying “peshaab” and we did not know what it meant, and were unable to guess. The client seemed insistent and agitated, and soiled himself by the time we managed to contact the family and understand that peshaab means urine.

Usually, however, families inform us of the words the client will use and we are prepared for handling the client.

Dementia Care Notes: Under which situations do you refuse to accept a patient for daycare?

Jincy: Currently, we do not accept bed-ridden patients for day care. However, we have another facility, Nightingales Centre for Ageing and Alzheimer’s, that accepts bed-ridden patients for short and long stay.

Dementia Care Notes: Are some of the patients incontinent? Do you accept such patients? How do you handle incontinence?

Jincy: Most of our clients are able to tell us when they want to go to the toilet. We also keep watching them for any restlessness. In any case, we take them every hour or so, so that there is less chance of accidents.

In case of accidents, we clean the clients and change their clothes. We have extra sets of clothes for such accidents.

Some clients, who are more incontinent, use diapers.

Dementia Care Notes: What is the ratio of patient to nurses right now at the day care centre?

Jincy: The ratio is one nursing aide to 3 patients.  The nursing aides are trained staff who help them with various activities, and two social workers who provide training and guidance and make sure that the care is being given properly. There is also one housekeeper and one driver.

In addition to these persons, we also often have volunteers and counsellors who come in for additional support.

Dementia Care Notes: What sort of activities do the patients spend their time on?

Jincy: In addition to the normal activities like walking, going to the toilet, and eating, we have activities that clients enjoy, such as games. Our staff spends time talking to the clients if the client likes it. Sometimes, we arrange for programs like pet therapy and art therapy. We also take clients for outings. The type of activity and the time spent on it depends on the client’s ability and interest.

Thank you, Jincy!

The day care centre described above is no longer operational, you can check our city wise resource pages for what is currently available in various cities.

[This is part of the expert interviews on this site. View the list of all interviews of health care professionals and volunteers.]
Note. This is an interview of an expert/ volunteer. The views expressed and the suggestions given are those of the interviewed person, and not a recommendation being made by Dementia Care Notes. Suitability and applicability of the suggestions remain the responsibility of the reader. For professional advice suitable for your situation, please consult an appropriate professional.