Dionne’s social prescribing story : Building rapport for clients with dementia

Dionne’s social prescribing story : Building rapport with clients with dementia

Dionne is a social prescribing link worker partly funded by a large city in the West Midlands council and partly by a national third sector organisation. She shares her experience of building rapport with clients with dementia.
Dionne feels strongly that communication and language are key tools to empower the client in the decision-making process and to build rapport:

“From the first topic of discussion, which is reason of referral, it is important to hear from their side whether they agree with what the GP has brought to my attention. It may not be correct, or it may not be what they actually want to prioritise. And so, discussing if they think that’s the primary kind of reason is empowering for clients”.

When social prescribers use inclusive and accessible language, discussions and decisions around support needs can also be empowering for clients. Dionne suggests:

“Clearly explaining to clients that it is their decision on questions like – How do you want this to progress? Are you happy for us to have a chat today? Would you like to set up another telephone appointment? Would you like to see your face to face? We can do that. Surgery. Home, community, whatever feels better for you. Listening to them is the ethos of social prescribing”.

Dionne cannot emphasise enough that social prescribing is by nature person-centred and therefore it is key to place the client with dementia at the core of communication and support, even fighting one’s preconceptions about abilities and skills of those who experience cognitive deterioration:

“One thing that I see not just in social prescribing, but on a wider spectrum is that oftentimes we see dementia clients as – oh you know they’re vulnerable, they’re not in the space to be able to be at the centre of their own support – I think one thing that could be reinforced to social prescribers is try to put the patient back in the centre of the support. Social prescribing is meant to be patient-led”.

In Dionne’s experience, empowering clients will not always prove easy, as dementia decreases their confidence and motivation, in Dionne’s words:

“The attitude of – I’ve been there, tried that, it did not help”.

Motivational interviewing can sometimes help to give clients back a vision:

“With them, it’s trying to do that in a really slow and motivational way. It’s about exploring how long ago did you try? And it was a few years ago. Okay. So, what’s different now? And would you be against trying that again? Let’s have a little look at amending that, adapting it, adapting it slightly. OK, you can’t do XY you said, but could you do a B&C. What does that look like? And let’s have a look and try”.

It can also help to instil a sense of empowerment back in clients that struggle:

“I often find myself saying – we can either sit on that and not do anything, or we can be proactive. If we’re proactive, and we start to look at what are the options you’re in charge of making those decisions – And that puts the person in much more control”.

Ultimately, it is about trying to give them a vision of the changes that social prescribing could bring in their lives:

“What would that give them? What would their life look like if they had lost weight, and they were fitter? What would their family and friends see? And then what would the difference be? What would they say about them? What would they observe if everything was different and how they wanted it to be? Or how would it benefit our relationship? So, I think it’s just finding some common ground with people”.

Sometimes, involving family members in these discussions can help. However, this needs to be done with caution, as family members could take over conversations and away decisional power from the client. Dionne finds that the greatest barrier to developing rapport with and gaining clients’ trust is by excluding them in the process of developing their own support package, by listening only to the views of family members:

“The most difficult situation I had was when I met the person with dementia and their relative and the relative was adamant that they wanted them to do something. And the person with dementia kept saying – I don’t want to, please don’t make me – and that’s just horrible”.

In order to navigate these challenging scenarios sensitively, Dionne found it helpful to:

“Remember who the client is. Try to direct only some questions to those who can fill in the gap. Explain that anything that you’re doing is in the best interests of both of them really and try and get them both on board, but try and convince the caregiver that, they’re also going to benefit from this other person deciding what it is that they want out of it”.