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KATE BALZER IS THE CHAIR OF SIGDOM, A ROYAL COLLEGE OF SPEECH & LANGUAGE THERAPISTS SPECIAL INTEREST GROUP FOR SPEECH AND LANGUAGE THERAPISTS WORKING WITH ADULTS IN DOMICILIARY AND COMMUNITY SETTINGS (WWW.SIG-DOM.COM). IN JUNE 2010 THE GROUP HELD A STUDY DAY ON DEMENTIA IN THE COMMUNITY. THE RESOURCES AND IDEAS FOR WORKING WITH PEOPLE WITH DEMENTIA PRESENTED HERE CAME OUT OF ONE OF THE SESSIONS, A THERAPY SWAPSHOP.

1. SOCIAL NETWORKS A clients partner, family and friends are vital and need our support in order to understand their loved ones difficulties, make the most of communication, and enable safe eating and drinking. The importance of supporting carers, particularly in the early stages, is highlighted in the National Dementia Strategy (2009). Chatter Matters by Colin Barnes is a great resource for helping to talk through communication issues, and Care to Communicate: Helping the Older Person with Dementia by Jennie Powell is useful for carers (or therapists) who want to read about more ideas. Barnes, C.J. (2003) Chatter Matters: advice on communication for carers, Journal of Dementia Care 11(5), pp.19-21. Department of Health (2009) Living well with dementia: A National Dementia Strategy. Available at: http://www.dh.gov.uk/en/ Publicationsandstatistics/Publications/ PublicationsPolic yAndGuidance/ DH_094058 (Accessed 21 March 2011). Powell, J. (2000) Care to Communicate: Helping the Older Person with Dementia. London: Hawker Publications. 2. PRESENCE IN CARE HOMES Training and support for carers in care homes is vital to ensure safe eating and drinking and good communication, but there are a number of imaginative ways this can be achieved in addition to traditional classroom-style lectures. Some of us have special arrangements with individual care homes who allow us to be involved in handover or inservice programmes, while others have innovative ways to get people to attend the training (such as just turning up and starting a workshop in the lounge!) Getting this right can do wonders for our reputation, and we need to develop a presence and profile in order to be taken seriously. This doesnt however mean we have to do everything ourselves, and the nutrition companies can be very helpful. For example the dysphagia representatives at Fresenius are able to offer training to care homes, and Nutilis produces tear-off pads showing how many scoops of thickener are needed for each drink. Fresenius, www.fresenius-kabi.co.uk/ Nutilis, www.nutilis.com/ 3. COMMUNICATION BOOKS / MEMORY BOARD Communication books are not just books meant for communicating messages but chat books, scrap books, life books, memory

albums, eating / drinking guidelines, likes / dislikes, communication strategy sheets and even DVDs. These arent just for use in the home but are invaluable for taking to day centres, or if a client is admitted to hospital or moved to a care home, particularly in an emergency. A memory board is less involved and time consuming than a communication book, and could be as simple as a list of key people and issues for the client. 4. CONVERSATION STARTERS Another great idea is using communication cards with conversation starters to help get things going, such as Did you watch something on the telly this afternoon? or What did you do when Jane visited? You can buy and sort commercially available cards, but making your own will suit individual clients. 5. PERSONAL OBJECTS Clients often have personal objects that mean or represent something to them. We can use these - and pictures and symbols - to enable better understanding of a client as a person and to facilitate better communication with them. This is particularly useful for care home residents. Some care homes allow us to personalise doors with objects and pictures to represent the person whose room it is, for example a toy aeroplane on the door of a retired air-hostess with many a tale to tell. 6. TV GUIDES Simple pictorial or symbol based TV guides help clients participate in choosing what to watch. This can also facilitate the choice of better TV programmes for clients to enjoy with their partners. They might for example find it easier to engage with more straightforward programmes with less dialogue, such as a wildlife feature rather than a complex murder mystery. I use a grid for each day, with pictures of the major channel logos down the side, and 10 pictures across the top to represent the time of day from early morning to bedtime. I then add in pictures of programmes, which you can get readily from Google Images. You could also laminate a basic grid, then Velcro on pictures depending on the day, removing only the ones the client doesnt want to watch. 7. FREECYCLE Freecycle is an online forum where people give away unwanted goods. It can be a

marvellous resource for getting hold of useful items, particularly reminiscence materials. You sign up to your regional group (for free) and then post a message saying what you want, for example, wanted old adverts, ration books, vinyl records, etc. Then you just wait to see if a group member has what youre looking for. Freecycle, www.uk.freecycle.org/ 8. TALKING MATS Talking Mats is an evidence-based low tech communication framework using a mat with picture symbols attached. There is a specific dementia pack, and the tool can be great for identifying a clients preferences in all sorts of situations. When we get stuck for a suitable picture we use Google Images. Further information about Talking Mats & Dementia, including links to research papers on effectiveness and decision making, is at http://www.talkingmats.com/ Package-Dementia.htm. 9. INTERVENTION Most of us believe that there is a place for 1:1 therapy intervention in dementia. Between us weve tried things from other fields like errorless learning (often used in aphasia but gaining ground in the dementia literature), and Intensive Interaction, an approach to teaching pre-speech communication to children and adults with learning disabilities. Kessels, R.P. & Hensken, L.M. (2009) Effects of errorless skill learning in people with mildmoderate or severe dementia: a randomized controlled pilot study, NeuroRehabilitation 25(4), pp.307-312. For more on Intensive Interaction, see www.intensiveinteraction.co.uk 10. THE WIDER TEAM The multidisciplinary team and voluntary sector can be invaluable for joint training or joint input. Some of us have been involved in Occupational Therapy groups, and many of us have used the Alzheimers Society for their wealth of information and local support in various guises. This can include individual and group peer support for clients and families in the early, mid and late stages of dementia, Ageing Cafes, and resources and information giving for professionals. Alzheimers Society, www.alzheimers.org.uk