b'DEMENTIA CAREscale. Dr. Power warned this was not something the industry can build our way out of with more locked"There is no riskfree choice and no riskfree or specialized units, as there will not be enough workers to staff them, letenvironment. Trying to remove all risk will alone staff them well. The good news is that a large proportion of peoplealways come at the expense of wellbeing. with dementia are already living in integrated settings today, providingPeople will be safer, yes, but they will alsoevidence that the more labour- and resource-intensive segregated modelsbe less human, less autonomous, andmay not be needed in the future. more distressed."For Dr. Power, perhaps the most compelling argument against Dr. Allen Powersegregation is that locked units are not so much a clinical issue as arights issue. built on seven factors, referringabout bells, cameras or sensors. Pathways to inclusionto the framework of The EdenIts about the assumptions we From the outset of his presentation,Alternative Domains of Well-Being:make about what people can and Dr. Power assured attendees thatIdentity, Connectedness, Security,cannot do, and whether we design his intent was to explore difficultAutonomy, Meaning, Growth andenvironments that respect their conversations with a caring,Joy. All people need all seven capabilities rather than try tocompassionate sector. And givento live well, he explained. control them.his faith in the sectors ability toWhen one or two of those are reflect and evolve, he dedicated themissing, distress is a very normal5 - Negotiate risk, dont eliminate it:remainder of his time to focusing onhuman response. Dr. Power suggested reframing how the long-term care communitysafety as a shared, values-based can build stronger pathways to more3 - Leverage collective capacitydecision, not a technical exercise inclusive dementia care. through dialogue: Dementia carein eliminating danger. There is no is too complex for top-down rules.risk-free choice and no risk-free 1 - Reframe dementia: Long-termInstead, Dr. Power said, it requiresenvironment. Trying to removecare professionals understand thatshared thinking from the wholeall risk will always come at the dementia is more than a medicalcare team. When complexityexpense of well-being. People will condition; it is a life-alteringis present, you need dialogue,be safer, yes, but they will also be change in experience. Dr. Powernot directives. You need to bringless human, less autonomous, underscored the importance ofpeople together to think, to shareand more distressed. To that keeping this in mind as it reframesperspectives, and to make senseend, he urged long-term care the concept of dementia careof whats happening in real time.professionals to weigh action from control to accommodation:He emphasized that permanent,and inaction equally, and to We build wheelchair ramps, butconsistent staffing enables thisengage residents, families and we dont build cognitive ramps.dialogue, allowing teams to buildstaff in open dialogue about We take people whose brains arecollective insight and respond withvalues, dignity and acceptable changing and force them to livenuance rather than control. trade-offs. These collaborative in a world based on our rules, ourinsights are key designing supports schedules, our rhythms. We need4 - Create enabling environments.and environments that balance cognitive ramps, not locked doors. Living spaces for people withfreedom and safety rather than dementia should foster freedomdefaulting to confinement. 2 - A stronger focus on well-being:rather than mask confinement: IfIn reframing dementia, Dr.you can never leave, it will neverIn long-term care, difficult Power argued that its importantfeel like home, Dr. Power quotedconversations come with the to shift attention away fromEmi Kiyota as saying. No matterterritory. By applying an objective managing behaviours andhow pretty the wallpaper is or howlens to current practices, Dr. Powers toward understanding unmetcleverly you disguise the hallways,presentation offered long-term care human needs. A lack of well- its not a home if people cantprofessionals much to consider as being, not dementia, is muchmake choices about where they continue their good work. LTCTmore the root cause of distress,they go.he said. Dementia affects your reaction to the world, but it is notThe same concept applies to Matthew Bradford is a freelance the cause of the distress itself.restrictive technologies, he added:writer with Long Term Care Today. True well-being, he continued, isIts not about the gadgets. Its not www.oltca.com LONG TERM CARE TODAY 41'