National Preventive Mechanism
greater care needs and one-to-one interaction, as well as a particular culture of
communication with those affected. The situation is even more complicated for
some persons with dementia by the fact that, depending upon their background
and the duration of the illness, they may no longer be incorporated into social
networks. If social support is only available to a limited extent outside of the
facility, the other nursing home residents and professional carers are often the
only reference persons.
In the view of the NPM, the focus of treatment and care for persons with
dementia must be on maintaining subjective well-being and optimising
objective living conditions as a significant element of quality of life. The
NPM’s recommendations thus cover in particular both the provision of
person-focused care and the implementation of the principle of normalisation
within the structure of the day. The NPM centres its enquiries in this regard on
everyday orientation, biography work and milieu therapy. Validation, basal
stimulation, reminiscence therapy, work and movement are also particularly
significant forms of comprehensible communication and interaction. Sensory
and consensual experiences are enhanced by cooking and eating together.
Residents’ special preferences should also be taken into account, along with
food rich in calories and vitamins. The NPM views positively the usage of
Dementia Care Mapping (DCM) as an instrument for surveying both residents’
quality of life and quality of care.
Well-being and living
conditions
Gerontopsychiatric care proved to be inadequate in many facilities. With the
exception of Vorarlberg and the facilities of the Vienna Association of Medical
Institutions (Krankenanstaltverbund, KAV), it seems that it is not possible
to involve specialist neurologists and psychiatrists in order to diagnose and
treat long-term care residents suffering from gerontopsychiatric illnesses on a
comprehensive scale, often repeatedly throughout the year. There are districts
in Austria (e.g. Tamsweg/Lungau) in which still no psychiatrists work as
contractual partners of health insurance providers or as specialised medical
consultants in homes.
Inadequate gerontopsychiatric support
Inpatient care facilities for persons with dementia require comprehensive
barrier-free spatial and structural conditions to enable disoriented elderly
persons to move freely, as far as possible, without undermining their feeling
of security. Familiar, age-appropriate furniture and comfort zones create a
feeling of homeliness, which is largely lacking in hospital-like buildings of a
specified facility. Clearly visible aids to orientation, the avoidance of reflective
surfaces, attention to anti-glare and the use of low-contrast flooring reduce the
risk of elderly persons feeling irritated.
Structural conditions in
some cases not suited
to patients with
dementia
Even in facilities with outdoor areas and gardens, the commissions have
observed, that staff in many cases do not have time to accompany residents
outdoors. For the elderly, movement is an important aspect of care and support.
Last year the NPM reported that residents tend to receive too little mobility
support because nursing staff do not have sufficient resources for this (see NPM
Inadequate mobility
support and time spent
outdoors
101
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