‘We can’t offer our service to people who may not be able to follow the agreed programme.’
‘People with dementia may forget to do the activities we and they agreed.’
I hear this quite often, talking to social prescribing and falls support services.
Social prescribing involves talking about what matters to a person, what they would be interested in trying, what would help them get started again in their lives, keep engaged, get a job…
And the motivational discussion leads to an agreed plan of action.
Like going swimming, or walking, or to a library. Or trying out a lunch club at a local pub. Or a peer support group.
Trying the local WI or bowls group. Or reading a daily paper. Or learning a new skill like typing or how to use a tablet (IT type of course).
It’s all about getting going again, or meeting people, getting out of the house or flat or bedsit…activity.
And exercise groups like those for people at risk of falls – usually those who have already fallen! – similarly expect people who attend to go away and remember and follow the exercises they have been shown and may have learned.
So where does that leave people with impaired memory?
People living with dementia often have deteriorating balance. They also often develop perceptual difficulties and have frequent trips and slips.
Especially where floors and pavements are uneven or change colour and pattern.
These people need to keep as strong as possible so they can withstand the wobbles and balance upsets they experience. They need core strength.
Yet they may be the people who do not or cannot get to exercise groups. Or whom social prescribers may pass over because of their forgetfulness.
When I ask providers about this issue I invariably get the same response.
Along with…well what can we do about that? We cannot provide that support and help when we are not there.
Very seemingly reasonable.
And very predictable.
And another example of people loving with dementia being written off because ‘we don’t know really know what to do about that’.
And we cannot be bothered to work it out!
People with dementia matter. They are not ‘too difficult to care for’. They are not as good as dead so what is the point.
We need to find ways of providing the support that is needed.
We do it for people in wheelchairs, or with cancer, or special needs. Why not for people with brain disease?
That is the issue. Too difficult.
Or too expensive.
So what should we do?
Well, if a person needs support or help or care in order to do the specific activities that will help keep them safe they have a right to that support.
And identifying that as a need identifies what is needed!
It might be using a little Echo for reminders. (£35)
It might be going into a person’s home and writing reminders around the rooms.
It might be making phone calls each day to remind them.
It might be visiting them each day or other day to do the exercises with them.
Shouldn’t the person living with dementia, if they have this need, also have a support plan? And a personal budget for support?
Who is going to make this happen?
A Dementia Companion. An Admiral Nurse? A social prescriber? A GP?
Do we not all have basic human rights? (which are not optional!)
Is there not an Equalities Act?
We must not give in to the ‘too difficult’ excuse.
And we must not leave people with cognitive difficulties brought on by brain disease to just give up and die.
I will never accept the commissioners’ arguments that they have no money. Or that they have no evidence.
Of course there is bloody evidence. Social prescribing works. Exercise works. Activity works. Nature works.
This is proven.
And there is money in the system. Because if you provide the support I am talking about you will save shedloads through reduced hospital admissions and broken bones, and delayed or avoided admissions to care and nursing homes. And family carer breakdown.
Cost of hip or pelvis repair, plus extended stay, plus rehab…say £10,000.
And what about wellbeing? And quality of life? Which are what social prescribing and activity are all about.
It is NOT too difficult.
It just needs determination, vision, innovation, imagination, and