What Is The Social Model Of Dementia Care?

Question

Answer

The Social Model of Dementia Care has the following characteristics.

• “The social model of care seeks to understand the emotions and behaviors of the person with dementia by placing him or her within the context of his or her social circumstances and biography.”
• By learning about each person with dementia as an individual, with his or her own history and background, care and support can be designed to be more appropriate to the needs of the individual
• Without this background knowledge and understanding, behaviors may lead to misunderstanding and incorrect labeling of the individual.
• Other intrinsic factors, such as the cultural or ethnic identity of the person with dementia, must inform how needs are assessed and care is delivered.
• The social model of care asserts that dementia is more than, but inclusive of, the clinical damage to the brain.

(Marshall, 2004; NICE Guideline 42, 2007)

The social model of dementia care is what underlines my approach. In fact, it underlined my approach before I even understood what it was. When I found it, I thought, "This is what I am already doing." Basically, you are trying to understand the emotions and the behaviors of that person by placing them within their context, either via their social circumstances and/or their biography. Who is this person? How are they feeling? How do they perceive themselves now? How is their environment impacting that? When we learn about each person as an individual and hear their history/background, we can more aptly program their care and provide the support they need. Without that knowledge, their behaviors and how they are reacting to things are misunderstood by caregivers. They are often labeled as having a behavioral disturbance or inappropriate behavior. Instead, their needs are not being met or understood. We have to consider some other factors too, like their culture and ethnic identity. This is also going to inform us of how their needs can be met and their care delivered. I love this. "The Social Model of Care asserts that dementia is more than, but inclusive of, the clinical damage to the brain." We are not just looking at what functions and what does not. We have to get in there and see the person who is still there. 

• From the social model perspective, people with dementia may have an impairment (perhaps of cognitive function), but their disability results from the way they are treated by, or excluded from, society.
• For people with dementia, this model carries important implications, for example:
• The condition is not the ‘fault’ of the individual
• The focus is on the skills and abilities of the person rather than losses
• The individual can be fully understood (his or her history, likes/dislikes, and so on)
• Create an enabling or supportive environment
• Appropriate communication with the individual with dementia is key
• Opportunities should be taken for rehabilitation or re-enablement

(Marshall, 2004; NICE Guideline 42, 2007)

From this perspective, people may have an impairment, obviously decreased cognitive function with some physical impairment, but their disability results from the way they are treated by or excluded from society. This is so true, and I cannot stress this enough. As a society, we are not very inclusive of people with disabilities, period. I think this is especially true with cognitive disabilities as you cannot see them. You can see if someone cannot get out of a chair or has trouble walking, but you cannot see that it takes someone longer to process, so it is very misunderstood.

This model carries some significant implications that I live by these and try to teach care partners. First, it is not the fault of the individual, but it is their condition. They have not done something wrong. We have to focus on their skills and abilities and what they can do rather than what they have lost.

The individual can be fully understood. You can get their history, their likes, and their dislikes. I am not going to say it is easy, but you can do it. We want to create an environment that enables the person to do what is meaningful and supports them. Appropriate communication is key. We will get to that more at the end. Then, we want to take every opportunity to rehabilitate or re-enable these people to participate more fully in life.