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CHW44-Supporting Individuals with Dementia Policy

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Supporting Individuals with Dementia Policy

1. Purpose

The purpose of this policy is to set out how {{org_field_name}} supports individuals living with dementia in a safe, lawful, compassionate, rights-based and person-centred way. The service will support each individual to maintain dignity, independence, identity, choice, communication, relationships, well-being and personal outcomes.

This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, the Welsh Government statutory guidance for service providers and responsible individuals, the Social Services and Well-being (Wales) Act 2014, the Mental Capacity Act 2005, Deprivation of Liberty Safeguards, the Equality Act 2010, the Wales Safeguarding Procedures, CIW requirements and relevant Social Care Wales codes, frameworks and guidance.

The service will ensure that dementia care is delivered in accordance with the Statement of Purpose, the individual’s care and support plan where applicable, provider assessment, personal plan, risk assessments, mental capacity assessments, communication needs, Welsh language needs, and any specialist health or therapeutic advice.

2. Scope

This policy applies to all staff, agency workers, volunteers, managers, the Responsible Individual and any person involved in providing, managing, monitoring or reviewing care and support for individuals living with dementia at {{org_field_name}}.

It applies to all stages of support, including pre-admission assessment, admission, provider assessment, personal planning, day-to-day care, communication, Welsh language and cultural needs, emotional well-being, positive behaviour support, risk management, safeguarding, mental capacity, deprivation of liberty, medicines, nutrition and hydration, continence, skin integrity, oral health, meaningful activity, family involvement, access to healthcare, environmental adaptations, end-of-life care, records, notifications, complaints, duty of candour, staff training, supervision, audit and quality assurance.

For the purposes of this policy, the term “individual” should be used instead of “resident” wherever possible, in line with Welsh regulatory language.

3. Principles of Dementia Care

Person-Centred Care: Each individual living with dementia will have an initial personal plan before care and support commences, unless the admission is urgent, in which case the initial personal plan will be completed within 24 hours. The personal plan will be informed by the individual’s care and support plan where available, provider assessment, health and specialist assessments, life history, communication needs, Welsh language needs, cultural and spiritual wishes, routines, preferences, strengths, risks and personal outcomes. The plan will explain how day-to-day care will be provided, how risks will be reduced, how positive risk-taking and independence will be supported, and how the individual will be supported to achieve what matters to them.

Personal Outcomes and What Matters: Staff will actively identify and record what matters to the individual, including their wishes, feelings, strengths, abilities, relationships, preferred routines, life history, occupation, cultural identity, faith, hobbies, communication preferences and personal goals. Dementia must not be used as a reason to exclude the individual from decision-making. The service will support the individual to participate as fully as possible in assessments, reviews, activities and day-to-day choices.

Dignity and Respect: Staff must always treat residents with dignity and respect, preserving their independence wherever possible. Personal care routines should be adapted to ensure the individual is comfortable and involved in decision-making.

Effective Communication: Staff must communicate in a calm, respectful, patient and reassuring way, using language, tone, pace, body language and non-verbal communication that the individual can understand. Staff must allow time for the individual to process information and respond. The individual’s communication needs, preferred language, Welsh language needs, sensory needs and any communication aids must be recorded in their personal plan. Where required, staff will use appropriate aids or approaches such as pictures, objects of reference, signs, gestures, hearing aids, glasses, communication passports, life story resources, Makaton, British Sign Language or other agreed communication methods. Information must be provided in a format the individual can understand, and advocacy support must be offered where needed.

Welsh Language and Active Offer: Where an individual’s first or preferred language is Welsh, the service will make reasonable steps to provide care, communication, activities, information and emotional support through the medium of Welsh. The service will not rely solely on the individual or their representative having to request Welsh language support. Welsh language needs and preferences will be identified during assessment, recorded in the personal plan, shared with staff, and reviewed as the individual’s communication needs change.

Consistency and Routine: Individuals with dementia benefit from structured daily routines that provide familiarity and reassurance. Staff must follow established care plans, ensuring that schedules for meals, personal care, and activities remain predictable and calming.

Promoting Independence and Engagement: Residents should be encouraged to participate in meaningful activities that align with their interests and abilities. Cognitive stimulation, music therapy, reminiscence activities, and physical exercises should be incorporated to enhance well-being and maintain skills for as long as possible.

Mental Capacity, Consent and Decision-Making: Individuals living with dementia must be presumed to have capacity unless a decision-specific assessment shows otherwise. Staff must support the individual to make their own decisions wherever possible, including by using accessible information, communication aids, familiar staff, appropriate timing and involvement of people who know the individual well. Capacity may fluctuate and must be considered for the specific decision at the specific time. Where an individual lacks capacity for a particular decision, any decision or act of care must be in the person’s best interests, lawful, necessary, proportionate, least restrictive and recorded in accordance with the Mental Capacity Act 2005 and the service’s Mental Capacity and Consent procedures. Where care arrangements may amount to a deprivation of liberty, the service must ensure that lawful authority is in place through the Deprivation of Liberty Safeguards or any successor legal framework.

Safeguarding and Risk Management: Dementia care must be provided in a way that keeps individuals safe and protects them from abuse, neglect, financial abuse, discrimination, improper treatment, unlawful restraint and inappropriate deprivation of liberty. Staff must follow CHW13 Safeguarding Adults from Abuse and Improper Treatment Policy, the Wales Safeguarding Procedures and local safeguarding arrangements. Any allegation, concern or evidence of abuse, neglect or improper treatment must be acted on immediately to protect the individual and others, reported to the manager, referred to the local authority safeguarding team and other relevant agencies where required, recorded clearly, and notified to CIW where this meets the notification requirements. Individuals and representatives must be informed about how to raise safeguarding concerns and how to access advocacy support.

4. Procedures for Supporting Individuals with Dementia

Initial Assessment, Provider Assessment and Personal Planning

Before agreeing to provide care and support, {{org_field_name}} will determine whether the service is suitable to meet the individual’s care and support needs and support the individual to achieve their personal outcomes. This decision will take account of the individual’s care and support plan where available, health and specialist assessments, the individual’s views, wishes and feelings, risks to the individual’s well-being, risks to others, reasonable adjustments, and the service’s Statement of Purpose.

An initial personal plan will be prepared before the individual starts receiving care and support. In an urgent admission, the initial personal plan will be prepared within 24 hours.

Within 7 days of the commencement of care and support, a provider assessment will be completed by a person with the appropriate skills, knowledge, competence and training. This assessment will consider how the individual’s needs can best be met, how their personal outcomes can be achieved, their wishes and feelings, communication needs, Welsh language needs, risks, mental capacity, health needs, emotional well-being, life history, routines and specialist support needs.

The personal plan will be reviewed and updated following the provider assessment and whenever the individual’s needs, risks, capacity, behaviour, communication, health or personal outcomes change. The personal plan will be formally reviewed at least every three months, or sooner where required. Reviews will involve the individual, their representative where appropriate, relevant professionals and the placing authority or commissioner where applicable.

Supporting Distress, Behavioural Communication and Emotional Well-being

Staff must understand that changes in behaviour may be a form of communication and may indicate unmet need, pain, fear, anxiety, infection, delirium, constipation, dehydration, hunger, loneliness, sensory overload, environmental distress, medication side effects or changes in mental health. Staff must seek to understand the reason for distress before responding.

Staff must use person-centred, non-pharmacological and least restrictive approaches first, including reassurance, validation, distraction, reminiscence, meaningful activity, sensory support, environmental adjustment, pain assessment, hydration, nutrition, rest, privacy, and involvement of staff or relatives who know the individual well.

Where distress or behaviour creates risk, the individual must have a person-centred positive behaviour support plan or equivalent guidance within their personal plan. This must identify triggers, early warning signs, preferred approaches, de-escalation strategies, communication needs, risks, agreed interventions, and when professional advice must be sought.

Restrictive practice, control or restraint must only be used where necessary to prevent a risk of harm and where it is proportionate, lawful and the least restrictive option. It must only be carried out by staff trained in the method used. Any use of control, restraint or restrictive practice must be recorded within 24 hours, reviewed by the manager, considered within the individual’s care review, and included in governance and quality monitoring.

Restrictive Practice, Control and Restraint

The service will actively work to prevent the need for restrictive practice through person-centred care, skilled communication, positive behaviour support, meaningful activity, environmental adaptation and early identification of unmet need.

Locked doors, keypad systems, sensor mats, bedrails, lap belts, low chairs, covert medication, continuous supervision, restrictions on leaving the building, restrictions on movement, or any other measure that restricts liberty or choice must be individually assessed, justified, recorded and reviewed. Such measures must never be used for staff convenience or as a blanket approach.

Where an individual lacks capacity to consent to restrictive arrangements, the service will follow the Mental Capacity Act 2005, best interests decision-making and DoLS requirements. Where a restriction may amount to a deprivation of liberty, the manager must ensure that a DoLS authorisation is applied for, monitored and reviewed.

Creating a Dementia-Friendly Environment

Signage and wayfinding aids should be clear, using both words and pictures to help residents navigate the environment.

Lighting and colour contrasts should be optimised to prevent visual confusion.

Safe, secure outdoor spaces should be provided to encourage mobility and connection with nature.

The environment will be assessed and reviewed to ensure it supports orientation, independence, dignity, privacy, safety and well-being. This includes appropriate signage, lighting, colour contrast, flooring, noise reduction, access to clocks and calendars, familiar objects, personalised bedroom doors where appropriate, safe access to toilets and communal areas, and safe access to outdoor space.

Any use of surveillance, monitoring technology, sensor equipment or assistive technology must be lawful, proportionate, clearly risk-assessed, recorded in the individual’s personal plan, and must respect privacy, dignity, confidentiality and mental capacity requirements. Blanket restrictions or blanket surveillance must not be used.

Nutrition and Hydration

Individuals living with dementia may have difficulty recognising food or drink, using cutlery, concentrating during meals, communicating hunger or thirst, swallowing safely, or maintaining adequate nutrition and hydration. Staff must provide dignified, respectful and individualised support.

The personal plan must record the individual’s food and drink preferences, cultural or religious dietary needs, allergies, swallowing needs, nutritional risk, hydration needs, preferred mealtime routines, level of assistance required, and any specialist advice.

Staff must promote independence through appropriate support, adapted utensils, finger foods, plate colour contrast, calm mealtime environments, verbal and visual prompts, and flexible meal choices.

Where there are concerns about weight loss, dehydration, choking, swallowing, recurrent chest infections, refusal of food or drink, or changes in eating patterns, staff must record and escalate concerns promptly and seek advice from appropriate professionals, such as the GP, dietitian, speech and language therapist, dentist or pharmacist.

Oral Health and Dental Care

Oral health is part of daily dementia care. Staff must support individuals to maintain oral hygiene in a way that protects dignity, choice and independence. The personal plan must record the individual’s oral care routine, dentures, dental appointments, oral health risks, level of support required and signs that may indicate dental pain or discomfort.

Staff must monitor for signs of oral pain, infection, loose dentures, refusal to eat, facial swelling, bleeding gums, bad breath, broken teeth or changes in behaviour that may indicate dental discomfort. Concerns must be reported promptly and support must be provided to access dental care.

Pain, Delirium and Changes in Presentation

Staff must recognise that individuals living with dementia may not be able to describe pain, illness, infection, delirium, constipation, dehydration or emotional distress verbally. Changes such as increased confusion, agitation, withdrawal, falls, refusal of care, reduced appetite, sleep disturbance or altered mobility must be treated as possible signs of unmet need or physical illness.

Staff must record concerns, use appropriate observation and pain recognition tools where available, escalate promptly to the nurse or manager, and seek medical advice when required. Any significant change must trigger a review of the personal plan, risk assessments and relevant health involvement.

Skin Integrity, Mobility and Continence

Individuals living with dementia who have reduced mobility, poor nutrition, dehydration, continence needs or difficulty communicating discomfort may be at increased risk of skin damage and pressure ulcers. Where required, skin integrity and pressure risk assessments must be completed, reviewed and acted upon.

Staff must support continence in a dignified and person-centred way, promoting independence wherever possible. The personal plan must record continence routines, preferred language, signs of discomfort, required aids, skin care, night-time needs, privacy preferences and when specialist advice is required.

Any deterioration in skin condition, continence, mobility or comfort must be recorded, escalated and reviewed.

Access to Healthcare and Specialist Support

The service will support individuals living with dementia to access timely healthcare and specialist advice, including GP, dentist, optometrist, pharmacist, community nursing, mental health services, speech and language therapy, dietetics, physiotherapy, occupational therapy, tissue viability, palliative care and other professionals as required.

Professional advice must be recorded, communicated to relevant staff and incorporated into the personal plan and risk assessments. Where more than one professional or agency is involved, roles and responsibilities must be clear.

Medicines and Covert Administration

Medicines for individuals living with dementia must be managed safely and in accordance with the Medication Policy. Staff must promote independence with medicines where safe and appropriate. Where an individual refuses medicine, staff must not assume refusal is due to dementia; they must consider capacity, communication, side effects, pain, fear, taste, timing and the individual’s wishes.

Covert administration must only be used where the individual lacks capacity to consent to the specific medicine, where it is assessed to be in the individual’s best interests, where less restrictive options have been considered, and where this has been agreed and recorded through the correct best interests process with relevant professionals, including pharmacy and prescriber input. Covert administration must be clearly recorded in the personal plan and reviewed regularly.

End-of-Life and Palliative Dementia Care

End-of-life care for individuals living with dementia must be planned sensitively, reviewed regularly and delivered in a way that promotes comfort, dignity, choice, family involvement and respect for the individual’s wishes, beliefs and values.

Where appropriate, the service will support advance care planning discussions with the individual and/or their representative, taking account of mental capacity, communication needs and the individual’s right to make decisions. The personal plan must record any known wishes, advance statements, advance decisions, Lasting Power of Attorney for health and welfare, DNACPR or treatment escalation plans where applicable, spiritual or cultural needs, preferred place of care and people to involve.

Staff must monitor for pain, distress, swallowing difficulties, dehydration, infection, pressure damage, anxiety and changes in consciousness. The service will work with GPs, community nurses, palliative care teams and families to ensure timely symptom control, emotional support and dignified care. Families and representatives will be communicated with sensitively and kept informed in accordance with the individual’s wishes, consent and best interests.

5. Staff Training and Responsibilities

All staff must receive induction, training, supervision and support appropriate to their role and responsibilities. Staff must complete dementia awareness training and any role-specific dementia training required to meet the needs of individuals using the service. Training will be informed by Social Care Wales resources, the All Wales Induction Framework for Health and Social Care, relevant dementia learning and development frameworks, and the needs identified in the Statement of Purpose and personal plans.

Staff training and competency checks will include, where relevant to role: person-centred dementia care, communication, Welsh language awareness and Active Offer, life story work, equality and human rights, safeguarding, Wales Safeguarding Procedures, Mental Capacity Act 2005, Deprivation of Liberty Safeguards, consent, advocacy, positive behaviour support, restrictive practice and restraint, duty of candour, nutrition and hydration, dysphagia awareness, oral health, continence, skin integrity, falls prevention, infection prevention and control, medicines, covert administration awareness, end-of-life care, record keeping, confidentiality, complaints and whistleblowing.

Staff must be able to recognise that behaviour may be communication and must know how to identify and respond to pain, distress, delirium, infection, dehydration, hunger, sensory impairment, loneliness, fear or environmental triggers.

Staff must receive supervision at least quarterly, an annual appraisal, and additional support where practice concerns, incidents, safeguarding issues, complaints or changes in individuals’ needs identify learning needs.

Agency staff and volunteers must receive an introduction to the service, including the Statement of Purpose, key policies, safeguarding procedures, emergency procedures, communication needs of individuals and any dementia-specific risks relevant to the people they support.

6. Duty of Candour, Complaints and Learning

{{org_field_name}} will promote a culture of openness, honesty and learning. Where something goes wrong in the care or support of an individual living with dementia, the service will act openly and transparently with the individual and/or their representative, in accordance with the duty of candour, confidentiality, consent and best interests requirements.

The service will explain what happened, provide information about any investigation or review, offer an apology where appropriate, and explain what action will be taken to reduce the risk of recurrence.

Individuals living with dementia and their representatives will be supported to raise concerns or complaints in a way they can understand and use. Information about complaints, advocacy and escalation routes will be made accessible. Complaints, safeguarding concerns, incidents, restrictive practice records, falls, medication issues, hospital admissions, feedback and compliments will be reviewed to identify learning and improve dementia care.

7. Related Policies

8. CIW Inspection, Ratings and Evidence

The service will maintain evidence to demonstrate that dementia care is safe, effective, person-centred, rights-based and outcome-focused. Evidence may include personal plans, provider assessments, care reviews, staff training records, supervision records, competency assessments, quality audits, feedback, incident analysis, safeguarding records, DoLS records, restrictive practice reviews, healthcare records, activity records and improvement plans.

The service will use CIW inspection findings, ratings, recommendations and areas for improvement to strengthen dementia care and update this policy where required.

9. Monitoring, Audit and Review

The Registered Manager and Responsible Individual will monitor the implementation and effectiveness of this policy through supervision, direct observation, care plan audits, provider assessment audits, personal plan reviews, medication audits, safeguarding audits, complaints analysis, incident and accident reviews, restrictive practice reviews, DoLS monitoring, training records, staff competency checks, feedback from individuals and representatives, and quality assurance systems.

Dementia care audits will include whether personal plans contain sufficient information about life history, personal outcomes, communication, Welsh language needs, mental capacity, DoLS, nutrition and hydration, oral health, pain, continence, skin integrity, mobility, distress, positive behaviour support, meaningful activity, family involvement, end-of-life wishes and specialist professional advice.

The service will seek and act on feedback from individuals living with dementia, representatives, staff, visiting professionals and commissioners. Feedback methods will be adapted to the individual’s communication needs and level of understanding.

Findings from audits, incidents, complaints, safeguarding concerns, CIW inspections, staff feedback and quality-of-care reviews will be used to improve dementia care. Actions will be recorded, allocated to responsible persons, given timescales and reviewed until completed.

This policy will be reviewed at least annually, or sooner if there are changes in legislation, Welsh Government guidance, CIW requirements, Social Care Wales guidance, dementia best practice, the Statement of Purpose, or the needs of individuals using the service.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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