A Discussion of Consultation in Person-Centered Care and Dementia Care Mapping

As seasoned adult day services providers and consultants to long term care facilities, we have over twenty years combined dementia care experience. Having completed the dementia care mapping (DCM) training, it has forever changed how we look at care by challenging some fundamental beliefs which we will explore in this series of articles. We approached the DCM training thinking it would enhance our ability to provide care within our practice settings. It has been a watershed event in our development as care providers creating a whole new perspective on dementia care. So just what is dementia care mapping? Let us explain further.

As noted by the Heather Hills Institute (Associates and Licensees of the Bradford Dementia Group), "dementia care mapping is a new method for evaluating and improving the care that is given to persons with dementia in day centers, residential homes, psychogeriatric wards or any other formal care settings. DCM can deliver clear and reliable information which will be of value to all those concerned with quality assurance and with improving dementia care. DCM goes to the real heart of caring by striving to assess care from the point of view of the person with dementia. It involves making detailed observations and recordings in dementia care settings. The result is a dementia care "map" which shows in summary how each client fared, how care was distributed among the group, and notable characteristics of the style of care, as well as an overall index of the general quality of care. The method may also be used to compare different schemes, or to look at a particular scheme at different points in time. After the data are analyzed, immediate feedback can be given to the direct care staff so that existing practices can be improved. DCM is the first systematic method to have been devised for looking at the details of the care process. Thus, it supplements standard approaches which focus mainly on the care structure." This fundamental difference in approach to evaluation of dementia care is of major significance as, to quote Tom Kitwood, founder of the method, "The erosion of speech, language and comprehension in a deepening dementia render the conventional methods of questionnaires and interview as unreliable." (Kitwood, DCM Manual, 7th Ed., 1997)

The DCM process began in 1989 when Tom Kitwood and Kathleen Bredin were commissioned to evaluate the quality of dementia care in a local care setting in their homeland, England. They developed their first edition of dementia care mapping from their observations, and concluded that DCM uniquely evaluates well being from the perspective of the person experiencing the disease. Since then, the DCM method has been developed extensively with the work of Kitwood until his death in 1998, and the Bradford Dementia Group he formed within the School of Health Studies, University of Bradford, Bradford, England. DCM-and dementia care itself--have evolved,our expectations for quality of care have increased and the knowledge of possibilities of well being for individuals with dementia has changed. "DCM is the most thoroughly empirical method in existence for evaluating and improving the quality of dementia care in formal settings, if empirical is taken in its original sense, meaning "based on knowledge derived from direct experience"". (Kitwood, Preface to Evaluating Dementia Care The DCM Method, 7th Ed., 1997). The currently used seventh edition of DCM represents thousands of hours of collaboration of DCM practitioners and researchers.

The DCM method challenges our traditional culture of care, which currently looks only at whether a care setting is clean and well equipped, and that its residents are quiet, obedient and well managed. The underlying philosophy embraces person-centered care which truly forces us to look at individualizing care and getting away from the "herd mentality" of care. This new culture of care redefines expectations of good quality care, which is not driven by the expectations, desires and needs of the caregiver, but rather by the perspective of the needs and desires of the care receivers. Adult day services places much emphasis on individualized care which makes these settings a perfect fit for use of the DCM method.

"Dementia care mapping is not simply a technique for collecting data. It is intended as a contribution to the removal of that terrible suffering that is inflicted on human beings when personhood is denied; and to the promotion of that peace and well-being that arise when personhood is respected and maintained. The issues here are not simply to do with good dementia care; they relate to the fundamental basis of our human life." (Kitwood, 1997).

Jensen & Hartle welcome the opportunity to discuss how these techniques can be utilized in developing your staff for greater aptitude and productivity

Glossary of terms:

Dementia Care Mapping: A formal, systematic method of tracking the state of personhood of individuals with dementia.

Person-centered care: "Care is envisaged as being much more than that of meeting basic physical needs; it is a matter of attending to the whole person, of enabling each individual to make the fullest possible use of his or her abilities and to remain a social being." (Kitwood, 1997)

Personhood: " The so-called cognitive abilities are only a part of the totality of our human functioning...Personhood, in the full sense, involves a great deal besides cognition, for example: feelings, action, belonging, attachments to other persons, and identity." (Kitwood, 1997)

Well and Ill-Being: A person's psychological state with indicators of well being: Assertiveness; bodily relaxation; sensitivity to the emotional needs of others; humor; creative self-expression; helpfulness; initiating social contact; affection; self-respect' expressing a full range of emotions; acceptance of others who also have dementia. Indicators of ill-being are: unattended sadness or grief; sustained anger; anxiety; boredom; apathy and withdrawal; despair; physical discomfort of pain.

Old culture of care: Sees dementia care as issues of safety and maintenance, suited to staff with few abilities, inspirations or qualifications. "The view of degenerative dementias is seen as devastating illnesses in which personality and identity are progressively dismantled." (Kitwood, 1997) 

New culture of care: Sees dementia care as one of the richest care fields, demanding resourcefulness, knowledge, flexibility and an ability on the part of the caregivers to be comfortable with themselves and others. Dementia is seen as a form of disability and the quality of care is crucial to how a person with the disease fares.