Experiences of relocation in dementia care from the perspective of six care workers.

BACKGROUND: Relocation of persons with dementia might be considered when quality of care cannot be sustained due to increasing needs. Relocation has been studied from the aspects of mortality and morbidity. AIM. To explore the thoughts and experiences of care workers when relocating a person with dementia within municipal sheltered housing. METHOD: This qualitative study was conducted in Sweden and based on interviews with six care workers involved in the relocation of two persons with dementia. Latent content analysis was applied. RESULTS: The findings of one narrative are summarised in the theme 'Walking the tightrope: trying to balance conflicting needs'. In the other narrative the theme 'Balancing closeness and distance' emerged. Eight sub-themes were identified illustrating the relocation time-line. CONCLUSION: Relocation from the care workers' perspective is a complex process with conflicting values and practical issues that hinder the provision of good care and security. IMPLICATIONS FOR PRACTICE: Supporting next of kin in the relocation decision-making process presupposes time for reflection in dialogue with staff. The risk of moral distress should be observed and support for care workers could be provided in the form of supervision, ethical consultations and local guidelines.

Demanding behaviours and workload in elderly care in Sweden: occurrence at two time points within a decade.

The aim of this study was to investigate the occurrence of demanding behaviours in persons >or=65 years receiving home care or living in sheltered accommodation at two points in time, 1993 and 2002. Another aim was to investigate whether the perceived workload in staff had changed during this period. All persons >or=65 years living at home and utilizing home care services or those who lived in some form of sheltered housing were included and assessed by staff using a three-part questionnaire, in two cross-sectional studies. The study group comprised 1187 and 1017 participants which equals 77% and 99% respectively. Symptoms and degree of behavioural and psychiatric symptoms common in dementia that were assessed with a subscale in The Gottfries-Bråne-Steen Scale, demonstrated an all over increase from 1993 to 2002. Items from The Multi Dimensional Dementia Assessment Scale (MDDAS) measured a decrease in 'daily' occurrences of dementia symptoms but an increase in 'sometimes per week'. A mixed pattern was seen concerning behaviours where increases as well as decreases were found. The behaviours 'constantly seeking attention' and 'shrieking continuously' increased significantly. The number of individuals showing restless, aggressive or shrieking behaviours increased significantly over the decade. Two items from the MDDAS were used to measure the workload. The physical workload increased significantly over the decade whereas the rising tendencies of the psychological workload were not statistically significant. The mean age over the decade had increased from 83 to 86 years, which together with the findings make the recipients of home care and sheltered housing a very vulnerable group. The demanding problems place considerable pressure on staff.

Patterns of and reasons for relocation in dementia care.

Because dementia is a progressive disease, the need for care in municipal shelter accommodations might change over time, raising the crucial question whether to relocate an individual. The aim of the study was to investigate the number of relocations between municipal dementia housing units and to examine the patterns and reasons for relocation, together with the various municipal prerequisites for carrying out relocation. Thirty-three managers of 101 dementia care units in 12 municipalities in Sweden were interviewed, and records of persons who had moved into or out of the dementia care units during the year 2002 were reviewed retrospectively. The results showed that turnover occurred in 35% of the 865 rooms during the year. Of those relocations, 78 (9%) were persons who moved to another accommodation-either into (59), between (13), or out of (6) a dementia care unit. This finding indicates that there are situations in which remaining in place was considered less appropriate than relocating a single individual with dementia to other accommodations with or without dementia specialization. The most common reason for relocation within the municipal shelters was an increased need for care.