This Publicly Available Specification (PAS) provides a guide to the principles and recommendations for the use of Dementia Care Mapping (DCM) by care providers where the intention is to improve the quality of person-centred care (PCC) for persons living with dementia.
It is for use by people with responsibility for implementing, delivering and managing standards of care, quality assurance and improvement processes within health and social care.
PAS 800 is for use by providers of care homes, nursing homes, hospital wards, day care and interim care services where significant numbers of service users are living with moderate to severe dementia.
Dementia Care Mapping (DCM) is a set of observational tools that have been used in formal dementia care settings such as hospital wards, care homes and day care facilities in the UK since 1991.
It has been used both as an instrument for developing person-centred care (PCC) practice, and as a tool in research. It developed from the pioneering work of the late Professor Tom Kitwood on PCC.
In his final book, Dementia Reconsidered, Kitwood described DCM as:
“a serious attempt to take the standpoint of the person with dementia, using a combination of empathy and observational skill”.
DCM is both a tool and a process. The tool is the observations and the coding frames. This is the intensive in-depth, real time observations over a number of hours of people with dementia living in formal care settings.
The process is the use of DCM as a driver for the development of PCC practice, including careful preparation of staff and management teams, feedback of the results of the map, action-planning by the staff team on the basis of this feedback, the monitoring of progress over time, and then the cycle of re-mapping commences.
During a DCM evaluation, a trained observer (a mapper) may focus on one person or track a small number of people with dementia (participants) typically up to five. This occurs continuously over a representative time period. For ethical reasons mapping only takes place in communal areas of care facilities.
After each-five minute period (a time frame); two types of codes are used to record what has happened to each individual. The Behaviour Category Code (BCC) describes one of 23 different domains of participant behaviour that has occurred. BCCs are subdivided into those behaviours that are thought to have high potential for well-being and those with low potential.
The mapper also makes a decision for each time frame, based on behavioural indicators, about the relative state of mood and engagement experienced by the participant with dementia. This is called a mood/ engagement value (ME value). ME values are averaged over the mapping period to arrive at a well and ill-being score (WIB score). This provides an index of relative well-being for a particular time period for an individual or a group.
Personal detractions (PDs) and personal enhancers (PEs) are recorded whenever they occur. PDs are staff behaviours that have the potential to undermine the personhood of those with dementia. These are described and coded according to type and severity.
PEs are staff behaviours that are thought to enhance personhood. These are described and coded according to type and the degree to which it is thought they enhance personhood.
What does DCM tool provide?
The DMC tool gives a great deal of in depth-detail about the following:
How individual and group care facility levels of well-being and ill-being vary within group care facilities across the day.
It identifies which participants have relatively high well-being and who has low well-being and whether there are significant changes in this over time.
How people with dementia spend their time and how this is linked to their relative well and ill-being.
Staff behaviour that promotes PCC and staff behaviours that will undermine PCC. DCM tells us about how the quality of care impacts on the quality of life of those living with dementia in communal care settings. Within Kitwood’s writing was the assumption that well-being for people with dementia is strongly influenced by the quality of relationships they enjoy with those around them.
The interdependency between the quality of the care environment to the relative quality of life experienced by people with dementia is central to PCC practice.
DCM was originally developed in formal care services for people living with dementia. Over the years it has also been used in services for people with learning disabilities; on general elderly care wards and with people with Huntington’s disease.
Being placed in the taxonomy of measures of both quality of life and quality of care, DCM can throw light on specific elements of both. The BCCs and MEs, provide detailed information about relative well-being, mood, engagement and occupation, which are important elements of quality of life. Through PDs and PEs, DCM records the quality of care practice as it promotes or undermines the personhood of those being mapped.
DCM can provide an indicator of where a care setting is within the “old culture – new culture” care continuum which can be seen as a journey from task-centred to PCC [6]. DCM is also a complex and powerful tool dealing in human well-being that needs to be used expertly and responsibly. This is why training in DCM needs to be delivered and monitored to a consistently high standard. This must be delivered by licensed trainers who undergo a rigorous preparation for their role and who use standardized training methods.
Training in DCM can have a profound impact on course participants. Staff trained in DCM report that the training in itself has a positive influence on their practice generally. It can provide those trained with a new framework or a way of viewing people with dementia and the care practices they are part of, or observe in their daily practice.
DCM is not an easy or trivial process. DCM is not a short-term solution to all the challenges of providing formal care for people with dementia. It is a powerful tool that can bring about significant change. Staff and management teams often need help to engage with this and consider their purpose and their own resources carefully prior to deciding to use DCM.
DCM is unlikely to have a positive impact unless staff have the necessary knowledge, skills and support to use the information generated. DCM works through helping staff teams reflect on their practice to bring about quality improvements and so mechanisms such as supervision, mentoring, governance and quality assurance groups need to be established at an organizational level for DCM to work effectively over a sustained period of time.
Bringing DCM into an organization as a driver for PCC practice is a major undertaking. It requires clear strategic and operational planning if there is to be a maximum return on investment. Many organizations spend over a year planning and ensuring they are prepared before embarking on their first DCM evaluation. Time spent undertaking effective planning can help avoid expensive mistakes later. The impetus for this Publicly Available Specification (PAS 800) is to ensure that care provider organizations have comprehensive guidance to assist them in this process.
Contents of PAS 800 the Code of Practice for Dementia Care Mapping (PAS 800) include:
Scope
Terms and definitions
Organizational strategy for DCM
Knowledge and skills framework to deliver the DCM strategy
DCM staff briefing, conducting mapping and staff feedback
Using DCM data to achieve improvements in PCC
Example of using DCM to improve a care plan
Example of using DCM to improve care at a group level
Example of using DCM to improve care at a care provider organization level
DCM codes
Bibliography
Example group behaviour category profile
Example group WIB profile
Checklist for a care provider organization DCM strategy
DCM data and what it indicates about the delivery of PCC
DCM data and how it helps track change in care quality over time
List of behaviour category codes
List of mood and engagement codes
List of personal detraction and personal enhancer codes
This Publicly Available Specification, PAS 800, was sponsored by the University of Bradford and its development was facilitated by the British Standards Institution (BSI).
The following organizations were involved in the development of this Publicly Available Specification:
Alzheimer’s Society
Anchor Trust for dementia
Four Seasons Health Care
Norfolk and Waveney Mental Health NHS Foundation Trust
Norwich Special Interest Group
Somerset Care
St Andrew’s Healthcare – Townsend
University of Worcester
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