Jan Little on person-centred care

The issue of 'covert medication' in UK care homes has recently been highlighted in the press. Hiding medication, such as sedatives, in a person's food without their knowledge or consent raises many questions about human rights, as well as the motives of the staff.

Sadly, the reason for administering drugs in this way is often to ensure convenience for the organisation rather than for the best interests of the person.

Secret sedation can compromise an older person's quality of life, dignity and independence - so surely there is a better and kinder way to deal with older people whose behaviour we find challenging?

Care home workers are faced with difficult situations every day and this can be heightened if the older people they are caring for have dementia. Surveys have suggested that a staggering 70 per cent of care homes across the UK practice covert medication. This has prompted calls to clarify the law or even ban the practice.

Many professionals in the industry would agree that, in some instances, covert medication is necessary and can be the best way to manage the safety and well-being of the person concerned. However, I believe this should only be used as a final resort, after other methods of managing challenging behaviour have been thoroughly discussed and trialled.

Flexible care

Caring for people with dementia or challenging behaviour can feel like fighting a losing battle, but it is important to view the patient as an individual and not as a series of tasks that need to be carried out.

If people are comfortable and happy in their living environment and care is suited to their needs and routine, the incidence of frustration and any need to intervene can be reduced. If a person wants to get up at night to suit their routine, then who are we to change this? If they need to eat or sleep at a different time, we should accommodate their needs to secure their long-term comfort and happiness.

A pilot project was undertaken at Saffron Homes, one of Brunelcare's residential homes that specialises in the provision of dementia care, to establish whether or not person-centred care could minimise the use of medication. Positive changes were made to move away from task-based care and towards inclusive, personalised care.

Residents are now supported more by a person-centred approach and less by medication - increasing their control and independence in many small but significant ways. Brunelcare introduced person-centred care in all its homes two years ago and would certainly not want to look back.

Caring for people who are not orientated to time and place or display challenging behaviour is difficult and requires patience and understanding. Often, due to lack of staff or budget restraints, using covert medication is seen as a convenient way for carers to manage certain behaviours and prevent accidents. But this is not the answer and it is my belief that alternative options are available that prioritise the best interests of the person and not the convenience of the carer.

Addressing the issues of staffing and resources is essential to ensure covert medication is only used as a last resort and with the full support of the family and GP.