Ambiance Advice

As the dementia progresses, many people develop behaviours that can be challenging. This includes restlessness and aggression. Aggression is not just about physical acts but can be shown in other ways, including verbal aggression. These behaviours can be distressing, both for the person and the carer. If a person with dementia becomes aggressive, it is important to remember that they are not ‘behaving badly’ and are not to blame.  Their behaviour may be a direct result of changes in their brain, or be caused by a general health problem, such as pain from an infection. These behaviours can also reflect problems related to the care the person is receiving, or their general environment or social interactions. In this case, the behaviour is best viewed as an attempt to communicate an unmet need, rather than as a direct symptom of dementia. If a person is being aggressive, they should be assessed by their GP in the first instance to identify any possible underlying causes.

Dementia affects people’s communication in different ways. Some people, particularly early on in their dementia, may have very few difficulties communicating. It may be enough to summarise regularly and provide assistance to keep people on track. Some people may have virtually no language at all. In these situations, the person will need a lot more help to communicate and you may need to use other forms of communication when interacting with them, for example gestures , facial expression and the tone of your voice. If someone is shouting and distressed, try to use a low soothing tone in our voice. If you match their energy you will likely escalate how they are feeling.

The term ‘sundowning’ refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can causes a range of behaviour, confusion, anxiety, aggression or ignoring direction. Sundowning can lead to pacing and wandering. The cause of this behaviour is unknown and may continue for several months often happening in the middle and later stages of dementia.

Poor appetite, cognitive impairment (problems with mental abilities), physical disabilities and sensory impairments (hearing and sight loss) can all cause the person with dementia to have problems eating and drinking.

Although eating and drinking difficulties are fairly common in people with dementia, each person’s difficulties will be unique to them and their situation. Because of this you should take into account the person’s preferences, beliefs, culture and life history. For example, their religious beliefs may mean they do not eat certain foods such as pork or shellfish, or they may be affected by the environment around them. You should tailor solutions to the person’s individual needs and preferences.

As dementia progresses, the person is likely to need more support to meet their needs.

The local authority (also known as local council) has a duty to assess the care needs of a person with dementia. The assessment will determine what care needs they have, and whether the local authority will contribute towards meeting them. Any person has a right to this assessment, even if they will end up paying for their own care.

The process is called a ‘care needs assessment’. The aim is to work out exactly what the person’s needs are, and the level and type of care and support required to meet these needs. It will also help the local authority to decide whether or not someone is eligible for care and support funded by the council. Social workers usually undertake the role of the assessor.

The Carer’s Assessment is a process where your Local Authority or Local Council Social Services assess your individual needs as a carer.

The Assessment will look at the impact that caring for a person with dementia is having upon you, and will then identify the type and level of support that you need to be able to carry out your role as a carer. This could include some respite care for the person with dementia, so that you have some time to yourself; or some training in safe ways to help a person with dementia move around, or some help coming to your home.

The Carer’s Assessment was established as part of the Care Act 2014, which sets out the legal rights of people with caring responsibilities to receive an assessment, and then receive support dependent upon their needs.

There are national rules about who has to pay for care and support, although these can vary locally. It mainly depends on the type of care and support that you need, where you live and what is available.

If you are living at home, you will usually pay for the costs of your own care and support. The local authority (council) may also contribute, but this depends on your income and your assets (such as savings or shares). You may be assessed by your local authority as having to pay for all your own care and support at home. This is sometimes called being a ‘self-funder’.

If you are receiving care and support in your own home, you are entitled to keep a basic level of income (money you receive regularly), however much your care costs. The Care Act states that charges for care must be ‘reasonable

Home care and residential care home charges

Upper savings threshold in England (above which the person has to pay all their costs) is £23,250

Lower savings threshold in England (below which a person’s savings are no longer taken into account, although all other income including benefits and pensions is still counted) is £14,250..

Personal expenses allowance for people in residential care is £24.50 a week

If you do not qualify for NHS continuing healthcare, you might still be able to receive NHS-funded nursing care contribution because you do have some level of nursing care need. This is only paid if you are assessed as needing nursing care in a care home registered to provide nursing care. The standard rate in England is £165.56 per week for 2020.