Transformative palliative care - Residential care
Background
Sylvia, an elderly woman with a history of low mood and depression, was admitted to a care home in 2023 under palliative care. Her health had significantly deteriorated at home, and she had stopped eating and drinking for about six weeks before admission. Sylvia was extremely frail, unable to move around, and needed full assistance with personal care, transfers, and continence. She was placed on end-of-life care with a prognosis of two to three weeks.
Initial assessment
When Sylvia was admitted she:
- was severely frail, unable to sit up on her own or move around
- was malnourished and refusing food and fluids
- had a history of depression and low mood
- needed two staff members for all personal and continence care
- needed one staff member to encourage her to eat, give her medication, and provide emotional support
Intervention
The care team took a person-centred approach, focusing on what Sylvia liked and her life history. Key interventions included:
- life story work: staff talked to Sylvia about her past, finding out her favourite foods and memories
- personalised nutrition: they discovered Sylvia loved a “99” Mr Whippy ice cream. The care home arranged for an ice cream van to visit on a warm day, creating a joyful and nostalgic experience for Sylvia
- emotional support: staff provided consistent companionship and reassurance, building trust and emotional connection
Outcomes
The impact of these interventions was amazing:
- Sylvia started eating again, gained weight, and her overall health improved
- her mood lifted significantly, and she became more engaged and communicative
- she went from being immobile to walking safely with a Zimmer frame
- two years later, Sylvia is largely independent, needing only a fifth of the care she initially required
- the need for one-to-one support reduced drastically, highlighting her incredible progress
Conclusion
Sylvia’s story shows the transformative power of compassionate, personalised care in a palliative setting. By focusing on emotional well-being, meaningful engagement, and individual preferences, the care team not only extended Sylvia’s life but significantly
enhanced its quality. This case highlights the importance of holistic, person-centred approaches in elderly and end-of-life care.
A person-centred approach to dementia care
Background
Ronald is a 79-year-old resident in a care home, living with dementia. A widower since his early 40s, he raised four children alone and had a successful career in engineering. Ballroom dancing was a lifelong passion and a key part of his identity.
Initial assessment
Ronald followed a consistent early morning routine, waking at 5.30 am and walking around the care home, often entering other residents’ rooms. At 8.00 am daily, he became distressed -shouting at others to 'get out' and raising his fists. This behaviour lasted around two hours and required one-to-one staff support to ensure safety. While this supervision was essential, it was reactive and focused on risk management rather than emotional support or prevention.
Intervention
During a dementia training session, the trainer asked the manager for permission to approach Ronald. Using a calm, open posture, she gently said, 'I can see you are very upset, but I am here for you. How can I help?' Ronald began to relax. When she complimented his blue eyes, he smiled and replied, 'That’s what all the lassies say when I am dancing with them.'
This moment of connection led to a spontaneous waltz. As they danced, Ronald expressed concern about not having food for his children. The trainer reassured him they were safe, continuing the dance and conversation. This one-to-one interaction was not only calming but also deeply validating, drawing on Ronald’s personal history and emotional needs.
Following this, the care team introduced a new morning routine. Ronald was brought to the lounge where ballroom music played. As others finished breakfast, those who wished to joined Ronald for a dance. He then had his breakfast in a quieter setting.
Outcomes
- Ronald no longer displayed distress in the mornings
- one-to-one support was transformed from a reactive safety measure into a proactive, therapeutic engagement
- Ronald’s emotional needs were met through meaningful connection
- other residents engaged socially, enhancing the home’s atmosphere
- staff gained confidence in using personalised approaches to de-escalate distress
Conclusion
This case highlights the power of positive, person-centred one-to-one support in dementia care. By shifting from supervision to connection, staff were able to transform Ronald’s daily distress into a joyful, shared experience. His identity as a dancer was honoured, and his emotional world was acknowledged - demonstrating how compassionate, tailored care can significantly improve quality of life for individuals living with dementia.
