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... ly the deficits, damages and problem behaviours, we need to see a person as a whole. This does not mean denying that there is a depending illness but alternatively setting it in a social rather than a medical context. Kitwood (1993) states that an understanding of a persons dementia should be the result of a complex interaction between their personality, their social psychology (social relationships), their physical health, their biography of life, and their neurological impairment. He argues that all these factors go together to make a person who they are, and that to focus on only one of these factors is to treat a person as less than whole. (Kitwood 1993). Kitwood and Bredin (1992) state that there is evidence to show that some individuals have shown signs of reversal or 'rement ia' when their social relationships and their conditions of life have changed.
They do, however, acknowledge that this evidence is purely anecdotal in type, nevertheless, they maintain that there seems no reason to doubt it and that in some cases they have actually met the individuals concerned. A second line of evidence concerns a study that confirms the productiveness of seeing a person as a whole. This study compared two groups of people who were comparable in their degree of dementia. The first group was given a programme of activities that occupied about 40 hours a week, plus a medical and psychiatric check-up weekly. Whereas the second group received a traditional amount of care which provided activities for around 3 to 5 hours per week and a monthly medical check-up. After one year only two of the first group showed signs of further deterioration, as oppose to 9 of the second group.
The findings of this study was encouraging because those in the first group were slightly younger that those in the second group and it is customary for an accelerated decline for those with early onset dementia. A third line of evidence came from an experiment carried out on 'geriatric' rats. Some of the rats were placed alone in impoverished environments and as they aged their brains deteriorated (Confirmed by post-mortem study). Some the rats were then placed in new environments with plenty of activities and the company of other rats. The experiment showed that the rats declining brain underwent substantial neurological development and were revived solely as a result of a change in their environment.
Kitwood and Bredin, (1992) concluded that comparable neurological development can also occur in the human brain, since the nature of the grey matter in rats and humans are similar. They also state that: "If some degree of 'repenting' can be brought about purely through human interaction; if some sufferers do stabilize when provided with a care environment that fosters activity and cooperation; if the ageing and damaged brain is capable of some structural regeneration, then there is ground for looking on dementia care in a positive way." (Kitwood and Bredin, 1992: 280). To what extent does policies reflect the normalisation / personhood approaches? The history and future developments of more independent services.
The traditional treatment of people with mental and physical disabilities was in large hospitals built on the outskirts of most towns. Once patients went into such hospitals they rarely came out. Living their lives within institutions led to people becoming institutionalised, dependent on the routines of the hospital to a point were they could no longer function outside of its walls. (Young 1995). Concerns over these issues led to a search for alternatives. Arguments for community care were strengthened by sociological critiques of institutional life. (Gothman, 1968). The Griffith report 'Community Care: Agenda for Action' was published in 1988.
This report recommended that the Local Authority Social Service Departments should be responsible for assessing individuals needs and arranging the purchase of whatever services they required. For example, domiciliary, day, and residential care. However, it was not is recommendation that the local authorities should provide the services. Griffith recommendations for the separation of purchaser / provider functions were one of the report's most influential proposals.
From this the term 'enabling authority' was coined and identified a direction in which local authorities provided an environment that enabled consumers to exercise choice and encourage the development of service provision within the private and voluntary sectors. The Griffith report became the blueprint for the white paper 'caring for people' which followed. Many of the reforms proposed by Griffith were later enacted in the NHS and Community Care Act. (Griffith, 1988). The Social Services Inspectorate 'At Home With Dementia's tates that: "Community care policy for older people with dementia, as for all user groups is underpinned by the concepts of promoting choice and fostering independence" (DOH, 1997). This report acknowledged many implications with regards to service delivery for people with dementia.
It stated that it was difficult to ensure their active participation in assessment and care management processes, thus, it was difficult to know if they are ever presented with and exercise real choices. The report also stated that gender needs were poorly served by home care services because there was not enough male staff available when required. It was also acknowledged in the report that specialist services were only available to people whom lived in defined catchment areas. However this may be rectified by the governments recent proposals in the modernising social services document to impose national standards.
This report also acknowledges that independence can carry a great deal of risk in respect of people with dementia and the challenges this can pose on social and health care agencies. A recent government publication, 'No Secrets: The Protection of vulnerable adults has laid down specific guidelines that statutory agencies must follow to ensure that vulnerable adults are protected from risk of abuse. The guidance gives a clear definition of what is considered to be a vulnerable adult. This includes older people with disabilities or impairment, particularly when their situation is complicated by additional factors such as "physical frailty or chronic illness, and sensory impairment." (p 7). The guidance also itemizes the different forms of abuse that can take place, for example: &# 61623; Physical abuse: this includes such things as hitting, restraint, misuse of medication, etc. &# 61623; Psychological abuse: this includes such things as deprivation of contact, controlling, isolation or withdrawal from supportive networks, intimidation etc. &# 61623; Financial abuse: this includes theft, exploitation, pressure in connection with wills, &# 61623; Neglect: this includes ignoring medical or physical care needs, failure to provide access to health and social care services, etc. The guidance has also incorporated the concept of 'significant harm' introduced by the Children Act and suggests that 'harm's hold be taken to include "the impairment of, or avoidable deterioration in, physical or mental health; and the impairment of physical, intellectual, emotional, social or behavioural development." (p 9).
The Government's response to the Health Committee's Report on Long Term Care. The government states that it is committed to improving the quality of life of older people and to preventing or delaying the onset of dependence through various initiatives. The report also states that they will give an extra 140 million to local authorities over a three-year period to provide a wider range of support services to carers. They also intend to extend direct payments to people over 65 to allow them to exercise further choice in service provision. (DOH, 1999).
In conclusion the values of normalisation appears to have come a long way in enabling society to recognise that all people have potential for growth when they are accorded the opportunity to do so. How far these ideals can be stretched to practice in respect of people suffering from dementia remains to be seen in the light of the implications that surrounds dementia care. However, the author believes that we should strive at all levels to increase the knowledge of dementia in respect of the possibility of 'rement ia'. Recent policies seem to recognise more now than ever before that people suffering from dementia deserve to have a the right to independence, a choice in the provision of care that they receive, and that they deserve the same respect that is accorded to all. The essence in supporting people and making a connection with a person based on mutual respect and trust requires firstly knowing yourself and (not only as a professional) and secondly, learning who the person is.
This is by no means easy to sustain in the formal human services. It takes real effort in a service system to maintain a connection with a person and to learn who that person is. Perhaps the essence of quality in a service also lies in simplicity and informality Bibliography: BIBLIOGRAPHY Baxter, C. Poonia, K.
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