Medical Care |

Medical Care

##SEVER##

/d/datarich.info1.html

Datarich.info


Your guide to dementia
services in Richmond
April 2012

Foreword
Patients, relatives and carers often see their GP as the first port of call when seeking advice
about various aspects of dementia care. Issues that arise are rarely solved by medical school knowledge alone. They are often complex and require a holistic approach. Navigating the maze of agencies involved in dementia care can add to confusion not just for patients and carers but also for their GP.
This guide is a very helpful tool in exploring who is involved, what their responsibilities are and what help they can offer a person with dementia. It is simple to use for patients and carers and a great resource for GPs to signpost, so that everyone gets the support they need as easily and as quickly as possible.
Dr Stavroula Lees GP Mental Health Lead, NHS South West London, Richmond Borough Team Recent publicity around dementia and the impact of the National dementia strategy (009) has played a large part in increasing public awareness. We, in Richmond, are together bringing this to ground level, having formed a joint older people's Mental Health Strategy Group where all the stakeholders in dementia care are across the table together. This is probably one of the most useful publications you will need to understand the network of local dementia services from one resource. It is as much a helpful reference guide to someone who has just been diagnosed with Dementia or their carer, as it is to social care professionals. Alzheimer's Society Richmond office are to be commended for producing this excellent guide for people in Richmond Borough. Dr Malar Baheerathan Teddington, Twickenham and Hampton Community Mental Health Team for Older People I am grateful to the Society for producing this resource. For many years the Richmond CMHT has enjoyed and continues to enjoy collaboration with the Society, and greatly value its contribution to the local dementia care provision through information, education and befriending. I am sure this resource will be of great interest and practical use to our service users and their carers, and can only praise the work and dedication that has gone into preparing it. I commend in particular the clarity of service signposting and the use of un-complicated and accessible language to reach out to a wide client-based and multidisciplinary local audience. Dr Robert M Lawrence, Consultant in Psychiatry of Old Age & Neuropsychiatry Richmond Community Mental Health Team for Older People Your guide to dementia services
in Richmond - April 2012
 Introduction .05  What is dementia? .07  After diagnosis .9 5 Living day to day .5 6 Community support services for people with dementia in Richmond .0 7 Carer support in the community . 8 Getting the help you need: Paying for care .5 9 Residential and nursing care .57 0 End of life care .6  Guide to Health and Social Care professionals and directory .6  Directory: Richmond local services .7  Directory: National resources .87  Safeguarding adults .9


1 Introduction
This guide provides information about dementia and its effects on people and their carers, and the journey that they will be taking. It outlines support services that are available to people living within the London Borough of Richmond-upon-Thames who are concerned about their memory and people who have been diagnosed with dementia, their carers and family.
Dementia affects people in different ways. It can be very frightening for someone when they notice changes in their ability to look after themselves and it can be difficult to know when and who to ask for help. It can be equally difficult for a person's family and friends to understand how they may help and support their friend or family member who has dementia.
Dementia does not automatically mean that someone cannot continue with all their daily activities. A person experiencing dementia may need more help and support. Helping someone to retain some control over their life in order that they can continue to fulfil their needs is essential.
It is important not to wait until crisis or breaking point before seeking information, help and support. While this guide has been written for carers of people who have, or may have, dementia, it may also be helpful to those people who believe they may have dementia themselves. If you think that you, or someone you know, may have dementia, then this guide The publication of the National dementia strategy in February 009 by the Department of Health has been welcomed as a landmark document and the first of its kind. It aims to increase awareness of dementia, ensure early diagnosis and intervention and improve the quality of care for people with dementia and their families and carers.
The National dementia strategy sets out 7 recommendations including the employment of Dementia Advisers, so that each person with dementia and their carer can have a named contact for information on local services and support.
It also calls for the development of local memory services for people presenting with dementia symptoms to receive specialist assessment, early diagnosis and appropriate intervention. It also sets out the importance of avoiding social isolation and recommends increased peer support through the development of Dementia Cafés and more support groups. This guide has been produced by Alzheimer's Society's South West London office (T: 00 8877 00) in association with NHS South West London Richmond Borough Team.
2 What is dementia?
The term ‘dementia' describes a set of symptoms, which include loss of memory, mood changes, and problems with communication and reasoning. These symptoms occur when the brain is damaged by certain diseases, including Alzheimer's disease and damage caused by a series of small strokes (Vascular dementia). Dementia is progressive, which means the symptoms will gradually get worse. How fast dementia progresses will depend on the individual person and the type of dementia they have. Each person is unique and will experience dementia in their own way.
What causes dementia?
There are several diseases and conditions that result in dementia. • Alzheimer's disease − the most common cause of dementia. During the course of the disease the chemistry and structure of the brain changes, leading to the death of brain cells. Problems of short-term memory are usually the first noticeable sign.
• Vascular dementia − if the oxygen supply to the brain fails due to vascular disease, brain cells are likely to die and this can cause the symptoms of vascular dementia. These symptoms can occur either suddenly, following a stroke, or over time through a series of small strokes.
• Dementia with Lewy bodies (DLB) − this is a form of dementia which shares characteristics with both Alzheimer's and Parkinson's disease. It gets its name from tiny abnormal structures that develop inside nerve cells. Their presence in the brain leads to the degeneration of brain tissue. Symptoms can include disorientation and hallucinations, as well as problems with planning, reasoning and problem solving. Memory may be affected to a lesser degree. Lewy bodies are also found in the brains of people with Parkinson's disease, a progressive neurological disease that affects movement. Many people who are initially diagnosed with Parkinson's disease later go on to develop a dementia that closely resembles DLB • Fronto-temporal dementia (including Pick's disease) − in fronto- temporal dementia, damage is usually focused in the front part of the brain. At first, personality and behaviour changes are the most obvious signs.
Rarer causes of dementia
There are many other rarer diseases that may lead to dementia, including progressive supranuclear palsy, Korsakoff's syndrome, Binswanger's disease, HIV/AIDS, and Creutzfeldt−Jakob disease (CJD). Some people with multiple sclerosis, motor neurone disease, Parkinson's disease and Huntington's disease may also develop dementia as a result of disease Other causes of dementia-like symptoms
Dementia-like symptoms can be caused by other conditions, including depression, urinary tract infections and vitamin deficiencies. Other possible causes of dementia-like symptoms could include poor hearing or sight, severe emotional upsets (e.g. bereavement) or the side effects of certain drugs or combinations of drugs. Mild cognitive impairment
Some individuals may have noticed problems with their memory, but a doctor may feel that the symptoms are not severe enough to warrant a diagnosis of Alzheimer's disease or another type of dementia, particularly if a person is still managing well. When this occurs, some doctors will use the term ‘mild cognitive impairment' (MCI).
For further information on different types of dementia, rarer causes of dementia and mild cognitive impairment see Alzheimer's Society's factsheets, What is dementia? What
is Alzheimer's disease? And Am I at risk of developing dementia? which are free to
download from alzheimers.org.uk/factsheets, or order them from Alzheimer Society's South West London office on 00 8877 00.
Risk factors
Researchers have highlighted some important factors that affect a person's risk of developing dementia. Most now believe that developing dementia depends upon a combination of genetic and environmental factors. A person who has some of the risk factors for dementia will not necessarily go on to develop the condition, and avoiding risk factors does not guarantee that you will be healthy − although it does make it more • There are about 750,000 people in the UK with dementia.
• Dementia mainly affects people over the age of 65 and the likelihood increases with age. However, it can affect younger people: there are over 6,000 people in the UK under the age of 65 who have dementia.
• Dementia can affect men and women.
Age is the most significant known risk factor for dementia. It is possible to develop dementia early in life, but the chances of developing it increase significantly as a person gets older. One in 50 people between the ages of 65 and 70 has some form of dementia, compared to one in five people over the age of 80. The role of genetics in the development of dementia is still not fully understood, but researchers have made some important advances in recent years. There are some families in which there seems to be a very clear inheritance of dementia from one generation to the next. This is usually in families where the disease appears relatively early in life. Certain genes can affect a person's risk of developing Alzheimer's disease but having a parent or other relative with later onset Alzheimer's disease only makes your own chances of developing it a little higher than if there were no cases of dementia in the family at all.
Medical history
Specific medical conditions can increase a person's chances of developing dementia. These include multiple sclerosis, Huntington's disease and HIV. Conditions that affect the heart, arteries or blood circulation can particularly affect a person's chances of developing vascular dementia. Mid-life obesity can also increase a person's risk of developing dementia in later life. People who suffer severe or repeated head injuries are at a three- to-four-fold increased risk of developing dementia. People who have learning disabilities have a higher risk of developing dementia than the general population. At present, we do not know why this is and further research is needed. Genetic factors may be involved, or a particular type of brain damage associated with a learning disability may be implicated.
People with Down's Syndrome are at particular risk of developing dementia. Studies have also shown that virtually all people with Down's Syndrome develop the plaques and tangles in the brain associated with Alzheimer's disease, although not all develop the symptoms. The reason for this has not been fully explained. However, research has shown that amyloid protein found in these plaques and tangles is linked to a gene on chromosome . People with Down's syndrome have an extra copy of chromosome , which may explain their increased risk.
Environment and lifestyle factors
• Diet can affect a person's risk of developing many types of illness, including dementia. A healthy and balanced diet that enables a person to maintain a normal body weight is likely to reduce the likelihood of developing high blood pressure or heart disease, both of which put a person at greater risk of developing • Smoking has an extremely harmful effect on the heart, lungs and vascular system, including the blood vessels in the brain. This increases the risk of developing vascular dementia. • Alcohol − people who drink excessive amounts of alcohol over a long period of time increase their risk of developing a form of dementia called Korsakoff's syndrome. • Physical exercise and good level of physical health helps to protect against many conditions, including dementia.


How can I tell if I have dementia?
Many people fear they have dementia, particularly if they think that their memory is getting worse or if they have known someone who has had the illness. Becoming forgetful does not necessarily mean that you have dementia. If you are worried about yourself, or someone close to you, it is worth discussing your concerns with your GP.
Dementia affects everyone in different ways, but you should seek help if your memory is not as good as it used to be and you: • struggle to remember recent events, although you can easily recall things that happened in the past • find it hard to follow conversations or programmes on TV • forget the names of friends or everyday objects • cannot recall things you have heard, seen or read • notice that you repeat yourself or lose the thread of what you are saying • have problems thinking and reasoning • feel anxious, depressed or angry about your forgetfulness • find that other people start to comment on your forgetfulness • feel confused even when in a familiar environment.
Is treatment possible?
Dementia is a progressive illness. There are currently no drug treatments available that can provide a cure. However, medicines have been developed that can improve symptoms, or temporarily slow down their progression in some people who have Alzheimer's disease. Research has shown that the brains of people with Alzheimer's disease show a loss of nerve cells that use a chemical called acetylcholine as a chemical messenger. The loss of these nerve cells is related to the severity of symptoms that people experience.
There are two main types of medication used to treat Alzheimer's disease – cholinesterase inhibitors and NMDA receptor antagonists – which work in different ways. Cholinesterase inhibitors include Aricept (donepezil hydrochloride), Exelon (rivastigmine) and Reminyl (galantamine). The NMDA receptor antagonist is Ebixa (memantine). Aricept was the first drug to be licensed in the UK specifically for Alzheimer's disease and Ebixa is the newest of the Alzheimer's drugs.
Aricept, Exelon and Reminyl prevent an enzyme known as acetylcholinesterase from breaking down acetylcholine in the brain. Increased concentrations of acetylcholine lead to increased communication between the nerve cells that use acetylcholine as a chemical messenger, which may in turn temporarily improve or stabilize the symptoms of Alzheimer's disease.
All three cholinesterase inhibitors work in a similar way, but one might suit an individual better than another, particularly in terms of side-effects experienced. Current guidance for NHS treatment is that the cheapest of these drugs is generally tried first. The action of Ebixa is quite different from, and more complex than, that of Aricept, Exelon and Reminyl. Ebixa blocks a messenger chemical known as glutamate. Glutamate is released in excessive amounts when brain cells are damaged by Alzheimer's disease and this causes the brain cells to be damaged further. Ebixa can protect brain cells by blocking these effects of excess glutamate.
The acetylcholinesterase inhibitors were developed specifically to treat Alzheimer's disease. We do not yet know whether they can be helpful for people with other forms of dementia, although there is evidence that they may be effective in dementia with Lewy bodies and dementia related to Parkinson's disease, for which Exelon is licensed. NICE guidelines allow acetylcholinesterase inhibitors to be offered to people with Lewy body or Parkinson's disease dementia if they have distressing symptoms.
There are several trials examining cholinesterase inhibitors for the treatment of vascular dementia, but the benefits are very modest, except in the individuals with a combination of both Alzheimer's disease and Vascular dementia. Cholinesterase inhibitors are not licensed for the treatment of Vascular dementia. Are these drugs effective for everyone with Alzheimer's disease? The latest (0) guidance from the National Institute for Health and Clinical Excellence (NICE) recommends that Aricept, Exelon and Reminyl are available as part of NHS care for people with mild-to-moderate Alzheimer's disease. There are also now several studies − including work supported by Alzheimer's Society – which suggest that cholinesterase inhibitors may also help people with more severe Alzheimer's disease. However, these drugs are not licensed in the UK for the treatment of severe Alzheimer's disease.
Between 0 and 70 per cent of people with Alzheimer's disease benefit from cholinesterase inhibitor treatment, but it is not effective for everyone and may improve symptoms only temporarily, between 6 and  months in most cases. According to an Alzheimer's Society survey of ,000 people, those using these treatments often experience improvements in motivation, anxiety levels and confidence, in addition to daily living, memory and thinking.
Ebixa is licensed for the treatment of moderate-to-severe Alzheimer's disease. It can temporarily slow down the progression of symptoms, including everyday function, in people in the middle and later stages The 0 NICE guidance recommends use of Ebixa as part of NHS care for severe Alzheimer's disease and for patients with moderate disease who cannot take the cholinesterase inhibitor drugs.
Drug treatments for other symptoms There are also drugs available to help treat depression and behavioural and psychological symptoms. However, the Alzheimer's Society is dedicated to improving the treatment and care of people with dementia to help reduce the use of antipsychotic drugs. Drugs should not be given to a person with dementia without close discussion and monitoring from The maintenance of general good health is certainly important and people with dementia often respond well to ‘psychological' techniques such as reminiscence therapy, music, art and occupational therapy. Cognitive stimulation therapy has also shown to be beneficial to some people with early to moderate stage dementia. People with vascular dementia may be able to reduce the risk of further strokes through changes in lifestyle, such as a healthier diet and regular exercise. Diet and exercise cannot only help reduce their risk of further stroke but may also help prevent depression. Maintaining good health, good blood pressure and ensuring timely treatment of any acute infections, e.g. urinary tract infections, is For further information about dementia and drug treatments for dementia, see Alzheimer's Society's factsheets Drug treatments for Alzheimer's disease and Dementia: Drugs
used to relieve depression and behavioural symptoms which can be downloaded from
alzheimers.org.uk/factsheets Or you can order them through your local Dementia Adviser or Alzheimer's Society's South West London office on 00 8877 00.


3 Diagnosis
Why is getting a diagnosis important?
A proper diagnosis of dementia is essential in order to: • rule out other conditions that may have symptoms similar to dementia and that may be treatable • rule out other possible causes of confusion • access advice, information and support from social services, voluntary agencies and support groups • allow the person to plan and make arrangements for the future.
As drugs for treating different conditions become available (see Section : What is dementia? page 7) it is becoming increasingly important to identify which type of dementia the person has. For example, drugs are already available to treat some people with Alzheimer's disease and some people with dementia with Lewy bodies, but these drugs are ineffective in the treatment of Pick's disease (another form of dementia), and may actually worsen symptoms. How is a diagnosis made?
Making a diagnosis of dementia is often difficult, particularly in the early stages. The time it takes to make a diagnosis can vary. If scans and other investigations are required, it could take – weeks, depending on waiting lists. If the person is in the early stages of dementia, a 6– month period of monitoring may be required before a diagnosis can be Step : Assessment by a GP If you are concerned that you, or someone close to you, may have dementia, the first person to consult is the GP. They will spend some time talking to you and (if you are accompanying someone) the person you are concerned about, to try to establish some of the symptoms. The GP will look at the person's medical history and that of other family members. They may carry out a physical examination and may perform a number of tests, such as blood and urine tests, to identify other conditions that may be causing confusion. The GP will also ask a series of questions designed to test thinking and memory.
At the end of the assessment, the GP should communicate their findings and discuss what action needs to be taken. They may feel able to make a diagnosis, or they may perform further assessments to make sure. In some cases they may want to refer the person to a memory clinic or other specialist service for a fuller assessment. In Richmond there are two memory assessment clinics serving different parts of the Borough (see section 6: Community support services for people with dementia, page 0).
Step : Referral to a specialist The GP is the usual person to make a referral to a specialist. If you feel that a referral would be helpful and the GP does not suggest it, do press for it. You are entitled to ask for a referral to a memory clinic or other specialist service for a second opinion or for support, and access to services that the referral may give. A consultant will have more specialised knowledge and experience of dementia than the GP, and will have access to more specialised investigations, such as brain scans and memory testing.
Step : Assessment Assessment may take place in the home, in an outpatients department, in a day centre over several weeks or, very occasionally, as a hospital inpatient. The specialist will carry out their assessment through: • Analysis of background information − likely to include time talking to the person being diagnosed and those close to them.
• Physical examinations and tests − will be undertaken if they have not already been carried out by the GP.
• Memory assessment – the person being diagnosed may see a clinical psychologist or neuropsychologist for a more detailed assessment of memory and other thinking processes. These tests will look at things like memory, verbal and non-verbal abilities.
• Scans − the person might be given a brain scan. Scans may show brain shrinkage (atrophy). A scan that shows no unexpected changes in the brain does not rule out conditions such as Alzheimer's disease because in the early stages of the disease the changes can be difficult to distinguish from normal ageing.
Step : Explaining the diagnosis Doctors may differ in their views on what to tell their patients about a diagnosis of dementia. The person with dementia has the right to be told of their diagnosis − particularly if this gives them the opportunity to put their affairs in order. However, in some circumstances a professional may • they should only offer the diagnosis of dementia if the patient asks, or seems to want to know • the knowledge that they have dementia will be too much for the person to cope with • it is better to use a term such as ‘memory problems' if this may be more easily understood or seems more appropriate.
Most doctors will inform those close to the person concerned of the diagnosis of dementia or possible dementia. In some cases it may be left to the relatives or friends to decide whether to tell the person that they have dementia. This will depend on the kind of relationship they have with the person and what they feel the person would want to know.
If dementia is diagnosed, the person with dementia and their family or carers will be given information about the condition and about the range of local services, which can help to meet their needs. It is at this point that the person with dementia may also be referred to their local Dementia Adviser who will support and accompany them through their journey with dementia by being a named contact for them to reach and discuss issues. The Dementia Adviser can be contacted through the Memory Service or by contacting Alzheimer's Society's South West London office on 00 8877 00.
For further information, see Alzheimer's Society's factsheets Diagnosis and assessment,
and How the GP can help, at alzheimers.org.uk/factsheets or contact Alzheimer's Society's
South West London office on 00 8877 00.
4 After diagnosis
Talking things over and planning ahead
Once you or someone you are close to receives a diagnosis of dementia, it is important to consider what to do next. When someone is diagnosed with dementia, they should be encouraged to remain as independent as possible, and continue to enjoy their usual activities and occupations but it is also important to talk about and plan for the future.
If family and friends do not already know, try to tell them as soon as possible. Ideally, the person with dementia should decide when to tell people. The person with dementia might want to talk about their plans and wishes for the future with their family and friends.
General health
If someone has dementia, they should always see their GP if they feel unwell or if there are any concerns about their health. This is because even minor complaints can make a difference to their well-being and ability to cope. Many conditions, such as infected leg ulcers, constipation or chest infections, can cause additional confusion and distress that usually diminish once treated. They should also see the GP if there are any sudden and inexplicable changes in their behaviour. Depression is very common in early-stage dementia, and it is important to tell the GP if this is suspected. Some common symptoms of depression include: a sad, hopeless or irritable mood for much of the times; increased anxiety; a loss of pleasure or interest in activities; feelings of low self-esteem, worthlessness or undue guilt; feelings of isolation; sleep disturbance; problems with remembering, concentrating or making simple decisions; slowing down of mind and body, increased agitation and restlessness; eating too much or too little; aches and pains that appear to have no cause; thoughts of suicide and death. If the condition persists, there are a range of treatments that the GP could suggest. The main treatments include psychological therapies (i.e. having someone to talk to about your feelings), support group's and keeping active: see Section 5: Living day to day (page 5) to help improve mood and well-being. The person with dementia should have regular sight, hearing and dental check-ups. Problems with sight can exacerbate confusion, while hearing difficulties can increase feelings of isolation. Problems with teeth, gums or dentures can result in discomfort and distress.
If the person with dementia is still working and is experiencing any difficulties in their job, they should talk to their employer or get advice as soon as possible. Advice is available from a range of sources, including: • their human resources department • ACAS (Advisory, Conciliation and Arbitration Service) • a trade union • the Citizens Advice Bureau • the disability employment adviser at the local job centre.
The employer may be able to make some reasonable adjustments to help the person continue to work. If the person decides to stop working, they should get advice about their pension from their employer or pension A person with a diagnosis of dementia does not necessarily have to stop driving immediately, but it is important to ensure that they are still driving safely. As with all changes to a person's health that may affect their driving, they must inform the Driver and Vehicle Licensing Authority (DVLA) of their diagnosis. They should also inform their insurance company, or their insurance may become invalid.


The DVLA will ask for medical reports and possibly a driving assessment (this is not the same as a driving licence test) in order to decide whether the person is able to continue driving. It will then either issue a new, limited licence (which will need to be regularly reviewed), or will revoke the It is important to check that the person with dementia (and their carer, if appropriate) claims all the benefits to which they are entitled. In particular, you will need to check: • whether the person with dementia is eligible for disability living allowance or attendance allowance • whether the carer, if there is one, is eligible for carer's allowance.
Other benefits (depending on circumstances) include income support or minimum income guarantee, incapacity benefit, housing benefit and council tax relief. To find out more about eligibility, Age UK has a welfare and pension helpline (T: 00 8878 56), where you can get advice on state pension age on welfare benefits. They can also provide information about other services for people with dementia and their carers that may improve their quality of life. For people under the state pension age, Richmond Aid (T: 00 88 6070) can provide advice on benefits (including eligibility) ranging from disability benefit to housing and welfare.
Making financial and legal arrangements
The person with dementia should consider arranging their financial and legal affairs while they are still able to do so. This ensures that in the future, their affairs will be set up in a way that they have chosen. The person may want a friend or family member to help them with this.
Make sure that all important papers can be easily found. These might include bank and building society statements, mortgage or rent documents, insurance policies, a will, tax and pension details, bills and guarantees. Consider setting up direct debits or standing orders for regular bills. This will mean that the bills are paid automatically from your bank account each month. For advice on making financial and legal arrangements, Age UK have a national advice line (T: 0800 69 6565) who can direct you to the help required on issues such as claiming benefits, income and tax, money management, pensions, legal issues (such as making a will), attendance allowance and consumer advice.
Lasting powers of attorney and enduring powers of attorney
A Lasting Power of Attorney (LPA) allows an individual to give another person authority to make a decision on their behalf. There are two types of LPA and they are applied for separately. Health and welfare LPAs allow an attorney to make decisions about healthcare and welfare, including decisions about medical treatment. Property and affairs LPAs cover property and financial matters. It is important to note that decisions about care often relate both to financial matters and personal welfare - for example, when a person moves to a care home. LPAs must be registered with the Office of the Public Guardian before they can be used.
LPA has replaced Enduring Power of Attorney (EPA), which only covered property and affairs, not personal welfare. Now that the Mental Capacity Act 005 has come into force it is not possible to make an EPA, but the act does allow existing EPAs to continue to be valid. Making a will
A will ensures that when a person dies, their money and possessions go to people of their choosing. A person with dementia can still make or change a will if they can show that they understand what they are doing and what the effects of it will be. Their solicitor will make a decision about this, sometimes after taking medical advice.
People with dementia may wish to make an advance decision, so that they can have a say in their future care. An advance decision enables adults to refuse, in advance, a specific medical treatment or procedure should they become unable to decide for themselves in the future. An advance decision is legally binding if it is valid and applicable, as set out in the Mental Capacity Act 005 (for England and Wales), which came into force in October 007. If someone wants to refuse life sustaining treatment they will have to make an advance decision in a certain way.
Independent Mental Capacity Advocates (IMCAs)
The Mental Capacity Act gives people a legal right to support from an Independent Mental Capacity Advocate (IMCA) if they: • lack capacity to make a decision and • require serious medical treatment or a significant change of accommodation • have no family or friends to act in their best interests.
Staff in the NHS or local authority should instruct an Independent Mental Capacity Advocate (IMCA) when the above criteria are met. The IMCA will meet with the referred person and find out their views, wishes, feelings, beliefs and values. The IMCA also consults with professionals and others who are involved with the person's care, treatment or support. The IMCA's report is then given to the decision-maker (either the NHS or local authority). The IMCA's report should help the decision-maker to decide what is in the referred person's best interests.
The IMCA safeguards the interests of vulnerable people who lack capacity to make a decision themselves and who do not have friends or family to support them. It is strongly advised that any changes regarding a person's financial or legal affairs are made with the assistance of a financial or legal Getting independent financial advice
You may find it useful to get some independent financial advice before deciding how to manage your money. Always make sure the firm you use is on the Financial Services Authority (FSA) register. You may also want to talk to a solicitor, for example, if you want to set up a Lasting Power of Attorney to let a relative or friend act on your behalf. Either a relative or friend can be appointed as a suitable person to look after your state benefits and use the money to pay for daily living bills should you become unable to manage them yourself. Also in Sections  and : Local and National Directories, there is a list of professional or voluntary organisations who can assist in this process.
Advocacy means having someone to speak on your behalf who will express your views and wishes, safeguard your rights and represent your interests. This is particularly helpful for people who are vulnerable, such as those living with dementia. Advocacy is completely independent from organisations that provide social care and act only according to the wishes of the person they are speaking for.
For further information, see Alzheimer's Society's factsheets Benefits, Legal and financial
affairs, Enduring Power of Attorney and Lasting Powers of Attorney, Advance decisions
and Mental Capacity Act 2005 which can be downloaded from alzheimers.org.uk/
factsheets or contact Alzheimer's Society's South West London office on 00 8877 00. The Employment and Driving and dementia booklets from the Living with dementia series may also be helpful. 5 Living day to day
Memory loss is a distressing part of dementia, both for the person with dementia and for those around them. However, there is plenty that can be done to help manage memory problems to enable people to retain their confidence and independence for as long as possible.
Tips to help with memory loss
Taking in new information
People with memory problems often find it very hard to absorb and remember new information. Keep information simple and repeat it frequently. Break new activities down into small steps and try to begin new routines or regimes early on in the dementia, while the person's memory is still relatively intact.
Avoid unnecessary stress
If someone is tired, unwell, anxious or depressed, they will find it even more difficult to remember things. Help keep the person's life relatively stress-free – make sure they have plenty of support, help them to concentrate on one thing at a time and try to make sure that there are no distractions, such as background noise or lots of people.
Put a regular routine in place
Although variety and stimulation are important, too many changes can be confusing for a person with dementia. Setting up a regular routine will help someone feel more secure and will make it easier to remember what usually happens during the day. Make the most of memory aids
In the early stages of dementia, memory aids such as lists, diaries and clear, written instructions can help jog the person's memory if they are willing and able to make use of them. Place helpful telephone numbers by the phone and put labels on cupboards and drawers.


Devices to help with everyday living
Technological developments can help make life easier for people with dementia and their carers in certain situations. This is sometimes called assistive technology. Assistive technology refers to any device or system that allows an individual to perform a task that they would otherwise be unable to do, or increases the ease and safety with which the task can be performed. It can include things like automatic calendar clocks for people who forget what day it is, Telecare devices that monitor people in the home and satellite tracking devices to allow safer walking and trace people who have gone missing. Maintaining everyday skills
It is easy to assume that adults with dementia will inevitably lose everyday skills and become dependent on others. With time, dementia can affect a person's skills, however the degree of impairment will vary from person to person. People with dementia need to continue carrying out as many of their previous activities as independently as possible, in order to retain their skills. Doing things for themselves will enhance their physical, social and emotional well-being, and their confidence and self-esteem. If you spend time with someone with dementia, support and encourage them to do whatever they can for themselves, and offer only as much help as they need. The following tips may help: • Always try to focus on what the person can do rather than what • Remember that they may have a short attention span and may find it hard to remember or concentrate on things. • Try to be patient and allow plenty of time and rest breaks in • If you do need to offer help, try to do things with, rather than for, the person. This will help them feel more involved.
• Give plenty of praise and encouragement.
• Make sure the person has things to do. Aim for a balance between active and passive activities, depending on what is important to the individual and their energy levels – remember that it's more important that the person feels useful than that they complete the task perfectly.
Keeping active and staying involved
It is important to help the person with dementia find activities that they enjoy doing and continually adapt them to meet the person's changing interests and needs. The word ‘activities' is often associated with structured group activities, such as bingo or exercise classes, but not everyone enjoys this type of pursuit. In fact, many beneficial activities are the simple, everyday tasks that many of us take for granted. Ideas for activities could include the following.
• Exercise – for example walking, swimming or classes.
• Reminiscing about the past – talking, making a memory box or book, or a visit to a favourite place.
• Music and dance – many people still enjoy singing, dancing and listening to music.
• TV and radio − many people with dementia enjoy listening to the radio. Television, however, can cause problems, as people can become confused by too much noise or have difficulty following complicated plots.
• Doing things together − the person may like to play cards or board games, or do some gardening or baking together.
Remaining physically and mentally active can have a significant impact on a person's well-being. What is good for someone with dementia is often good for those who spend time with them too. Through helping maintain the interests of the person with dementia, family members and carers may be able to follow their own interests. Keeping occupied and stimulated can improve quality of life for the person with dementia as well as those Practical tips to help with daily life
As dementia develops a carer may face greater problems and challenges caring for someone with dementia. Alzheimer's Society provides information on a wide range of topics, including eating, dressing, maintaining skills and safety in the home. There are some simple practical tips, which may make things a little easier and safer for all.
• With clothes, replace buttons with Velcro, buckles and belts with elastic and laced shoes with slip-ons.
• At regular intervals, before you go out and after meals, remind the person with dementia to use the toilet.
• Consider having an isolation valve fitted to a gas cooker.
• Spoons are easier to use than knives and forks if food is cut up first.
• Sew a nametag into the person's coat, arrange for them to wear an identity bracelet or carry an Alzheimer's Society helpcard where they can record their details.
• Advise that alcohol consumption should be in moderation.
• If you cannot dissuade the person from smoking, ensure they can only do so under supervision by keeping hold of matches or lighters.
• A bedside lamp with a low wattage bulb may help if the person wakes up at night frightened. If they need the toilet, try leaving a light on at night so they can find it easily.
• Keep essential or frequently used items, such as glasses, in a large bowl.
For more information, see Alzheimer's Society's factsheets Assistive technology – devices
to help with everyday living, Keeping active and staying involved, Maintaining everyday
skills, Helpcards and Exercise and physical activity for people with dementia which can be
downloaded from alzheimers.org.uk/factsheets or contact Alzheimer's Society's South West London office on 00 8877 00. Alzheimer's Society's Memory handbook provides more practical tips for coping with memory loss and can also be ordered through the local office.
6 Community support services
for people with dementia in
Richmond
Support services for people with dementia in the London Borough of Richmond are available through local Richmond NHS services (the GP, Memory Service and Community Mental Health Team), Richmond Borough Council Social Services and through independent voluntary or charitable organisations such as Alzheimer's Society.
NHS South West London, Richmond Borough Team
NHS General Practitioner (GP)
If you are at all concerned about your own memory, showing signs of dementia, or are concerned about a friend or family member, the first point of contact should always be your GP. The GP has overall responsibility for an individual's healthcare in the community. As well as diagnosing and managing individual illnesses, a GP is able to keep an overall view of your condition as your needs change. GPs are able to organise services from other professionals in the community, as well as from hospitals. Following the first visit to the GP you may be referred to the Memory Service (see below) for further assessment, diagnosis and treatment. If the person presenting with dementia-like symptoms is under 65, the GP may sometimes refer to a neurologist Someone who has dementia should see their GP as soon as they feel unwell or have concerns about their health, if they suddenly become more confused or agitated, or if there are any worrying changes in their behaviour, as these could be signs of a physical illness. Many physical conditions, ranging from chest and urinary tract infections to infected leg ulcers and constipation, can cause additional confusion and distress to people with dementia. These conditions usually respond to treatment.
The memory service provides a comprehensive assessment of memory symptoms. Referrals are through the GP. In the first instance people will be seen either by the consultant in old age psychiatry or the specialist memory nurse who will arrange necessary investigations, usually including blood tests and a CT brain scan (computerised tomography scan). The memory service works closely with the Community Mental Health Team (CMHT) and Alzheimer's Society Dementia Advisers to ensure that people diagnosed with dementia receive the most appropriate and helpful There are two memory assessment clinics – Barnes Hospital and Teddington Health and Social Care Centre, each serving different parts of the Borough.
Community Mental Health Team (CMHT) and Richmond Integrated
Health and Social Care Teams
The NHS Community Mental Health Team (CMHT) is made up of a team that includes a consultant in old age psychiatry, community psychiatric nurses and community support workers, occupational therapists, psychologists, speech and language therapists and dietician. The CMHT provides a community mental health service to adults with mental health needs that cannot be effectively treated within primary care (that is, by the GP). Following referral to the CMHT, they will assess which of the services they offer, are the most suitable for individual cases. The services they offer include outreach, day centre assessment, intensive home treatment and in-patient admission if necessary Older people's in-patient beds are usually provided at Barnes Hospital. However, all older people's in-patient mental health admissions are currently at Tolworth Hospital in Kingston. In addition, there are two Intensive Home Treatment Teams (IHTT's) in the Borough aligned to the two CHMT's. The aim of the IHTT's are to deliver an alternative to an acute admission with appropriate treatment and interventions for older people (over 65 years) with a functional or organic illness. It will provide all patients who fulfil the referral criteria with a person-centred service, which empowers people and their carers to make informed decisions about care and which helps maximise quality of life and retain independence in their home environment. The key service objectives are:• to prevent in-patient admission for patients who would previously have been admitted to hospital thus preventing institutionalisation and a change of environment. • to promote and facilitate early discharge of people who are in-patients and related settings and thereby reduce length of stay. • to initiate rapid treatment which is likely to prevent further • to promote the Recovery model and assist in maintaining and improving a person's networks as part of their treatment and recovery. Referral to the Community Mental Health team is through the GP
For people living in Twickenham, Whitton, Teddington and the Hamptons, the CMHT is based at:
Teddington Health and Social Care Centre
(behind Teddington Hospital) Teddington TW OLR T: 00 86 500For people living in Barnes, Kew, Mortlake, East Sheen, and Richmond the CMHT is based at:
Barnes Hospital
The Richmond Integrated Health and Social Care Team Service work in partnership with the CMHT's. In these teams, NHS South West London, Richmond Borough Team works with Richmond Social Services to provide integrated health and social care support, involving staff from Hounslow and Richmond Community Healthcare (HRCH) and Richmond Social Services. The Integrated Health and Social Care Teams provide care to people who are housebound, live in a residential setting, or have care requirements that are best met in their own home environment. They exist to make sure people in the borough get the mental health and social care support that they need within their own home. The teams comprise Community Matrons, District Nurses, Social Workers, Social Care Assessors and Occupational Therapists (OT's) who provide an holistic community care service. These integrated teams provide care to all people who are resident in the Borough of Richmond, are registered with a Richmond GP and who need support either in their own homes, or in residential or nursing care homes. The Teams are aligned to GP practices, but also work with hospice services, community services, local hospitals and the voluntary sector including Alzheimer's Society Dementia Advisers and Dementia Support Workers.
Referral to the Integrated Health and Social Care Teams are through
a GP via the Richmond Adult Social Care Access team (see page 55)
There are  Integrated Health and Social Care Teams each serving different parts of the Borough:
Teddington and the Hamptons
Teddington, Health and Social Care Centre Teddington TW 0LR T: 00 86 500
Twickenham and Whitton
Adult Community Services th Floor Regal House, London Road Twickenham TW QB (NB Moving to Whitton June 0) Richmond, Ham and Kew Team
East Sheen and Barnes Team
68 Sheen Lane, SW 8LP On receipt of a diagnosis of dementia there are a number of people and services available within the CMHT and Integrated Health and Social Care Teams. The different job titles may appear confusing and you may find that you are working with one or all of them. There is a guide to clarify the different roles in Section : Guide to Health and Social Care Professionals and Directory (see page 6). Alzheimer's Society Dementia Support Services
Alzheimer's Society in Richmond provides information, guidance and support for people with dementia and those who care for them living in the Borough of Richmond-upon-Thames.
Trained Dementia Advisers provide personalised information, advice and signposting services to people in the process of getting a diagnosis or from diagnosis of dementia onwards. They will provide accurate, accessible information to help people with dementia make informed decisions for as long as possible. The service offers a point of contact for all information and advice as required to ensure that people with dementia and their carers have access to the right help for them at the right time and are able to make the most of their abilities. In Richmond the Dementia Advisers work in partnership with the Memory Service.
Trained Dementia Support Workers provide support for the person with dementia and their carer when more intensive, group or specialised support is required. They offer individual ongoing information programmes and emotional support to people with dementia and carers through home visits, telephone contact, email and post (dependent on the person's preference and needs). Dementia Support Workers have an excellent working knowledge of dementia services available in the


Dementia support groups take place weekly for people in both the early and later stages of dementia. Dementia support groups offer a place where people with dementia can share how they feel about their diagnosis and look at practical ways of coping. The emotional support and bonds that form within this group are extremely beneficial to the person's feeling The Caring Café is a regular gathering where people with dementia and those who care for them can spend time together in a supportive non- judgemental environment and gain practical information, peer support, respite and activity.
On receipt of a diagnosis, people are able to self-refer to Alzheimer's
Society
If you are interested in any of the services described above, please contact:
Alzheimer's Society South West London office
Wandsworth SW8 DU London Borough of Richmond-upon-Thames Adult
Adult Social Care services aim to support residents with an eligible social care need to remain as independent as possible either in their own home or in a residential or nursing home The Adult Social Care Access team
The Adult Social Care Access team is the first point of contact for all
referrals and general enquiries about Adult Social Care in the Borough
of Richmond.
The Adult Social Care Access team (sometimes just called the Access Team) can provide people with a wide range of information on local community and voluntary services and of local care providers such as day care, service home care and care homes. They are also able to offer emergency services to help people in a crisis and to offer equipment and sensory needs assessments at the point of contact e.g. Telecare and Careline services, the Welfare Benefits team, Housing, Falls clinic and the Handy Person Scheme. If your needs are more complex then they will direct you to the Integrated Health and Social Care Team covering your area (see page ).
Getting help from the Adult Social Care Access Team
If your needs are more significant and you need ongoing support, the Access Team will refer you to the Integrated Health and Social Care Teams staff who will undertake a detailed assessment of your needs: The Care This assessment is simply a discussion with you that will help us understand what help and support you might need coping with life on a day to day basis to live independently in your own home and access your community. It usually involves a chat in your own home, and you can involve a friend, relative or carer in the discussion. The assessment is a two-way conversation. They may ask you to tell them something about yourself and you can tell them how you think they can help and support you. They may also ask the opinion of other professionals who know and work with you, like your GP, but will only do this with your permission. They also take account of the needs of your family or carer and assess them separately if they ask them to.
The aim of the assessment is to understand how you are coping day to day and to see how Adult Social Care may help to improve your quality At the assessment they identify and agree your needs with you and discuss the help and support available to meet them according to the seriousness of your situation.
After the assessment
If you are eligible for help from Adult Social Care, they will arrange services within seven days of the assessment being carried out. If you aren't eligible for help, they will still give you information and advice on other services that are available to help you to continue to live independently and to maintain your quality of life. In Richmond, the Adult Social Care teams are committed to people being able to exercise maximum levels of choice and control. Once your needs have been assessed and agreed with you, they will let you know how much they think your care should cost. They will then work with you to agree how you can meet your needs in a way that best suits you. This is called Support Planning. They will offer you the option to take the support in the form of a Direct Payment. They work with a local user-led organisation, Richmond Users Independent Living Scheme (RUILS) (see below) who can help you to manage your Direct Payment. With a Direct Payment you can choose how you would like to get your support needs met. This might mean using an agency of your choice or employing your own staff. This way you will have more choice and control over the support that you require. If you prefer, Adult Social Care can arrange the support for you. You cannot have a Direct Payment if you need to be cared for in a residential or nursing home. More information is available on the Richmond website, or by following the following link: http://www.richmond.gov.uk/home/health_and_social_ assessment.htm, or by contacting the Access Team on 00 889 797.
Should your needs change then a Social Worker or Social Care Assessor will be allocated to review your plan and help you to make the changes that you need to make. If you need help to manage day to day living, contact the Adult Social Care Access Team to discuss your situation.
Adult Social Care Access Team th floor Regal House Twickenham TW QB Richmond Users Independent Living Scheme (RUILS) is an independent grassroots organisation that is user run and led by its peers – the people who use its services. They support individuals who need extra support to live at home to live independently in their community and provide information on accessing social care, finding the right support and finding and managing Personal (care) Assistants. They support individuals to write their own support plan that outlines how they are going to get the support that they need, and then help them put that plan in to action. They provide on-going support to individuals who are using a Direct Payment to get their support needs met. If you do not qualify for financial support from Social Services, RUILS can help you to get the support that you need. Richmond Users Independent Living Scheme (RUILS) The Disability Action & Advice Centre  Waldegrave Road Teddington TW 8HT Paying for care
Most people will have to pay something for their social care but it very much depends on your own particular financial circumstances. You will be asked to fill in a finance form telling us about your level of savings and your regular costs. Based on this the finance team will work out how much, if anything, you have to pay.
Most services do have a cost and many will charge for their services, even if only to cover the cost of providing those services. Paying for care is covered in Section 8: Getting the help you need: Paying for care (p 5) for information on how to qualify for help towards paying for the cost of any of the services outlined. Any contribution you have to make will depend on your income, savings and expenses and the cost of your support needs. People who are not eligible for social services support at this time should be signposted to alternative sources of support, e.g. in the private and voluntary sector. Care in the community
Care and support in your own home
Help with day-to-day living is available for people with dementia who need extra support to live independently at home. Help is available with personal care, such as washing, bathing or dressing, or support getting in and out of bed. You can also access assistance with setting up and maintaining a home, managing money and paying bills, dealing with paperwork, claiming benefits and helping to maintain domestic and life skills, such as cooking, eating healthily and shopping.
Many people have someone they know who can offer support, be it family, a friend, neighbour or local charity. However, for people who do not, or people who need extra help, the Adult Social Care Access team can offer advice and support to people in the borough. This may include signposting to private care agencies (PCAs) or services to help find a personal assistant. Careline and Telecare The Council's Careline and Telecare services offer any vulnerable person help and security at the touch of a button. Using a Careline connected to your phone line, you simply press the button and the call centre knows who and where you are. Careline provide a  hour, 65 days a year emergency service, enabling you to live as independently as possible within your own Telecare is a system of alarms, sensors and other equipment fitted in the home to help people live independently. Telecare monitors activity in the home over time and will raise a call for help in emergency situations such as falls, fire, flood and/or lack of movement in the home. Telecare monitors are linked to Careline who then contact the necessary help. (See Section : Richmond local services directory on p 7 for contact information).
Day services in the community
There are various day centres available in Richmond. Good day care and support can help a person with dementia continue to enjoy living in their own home, providing stimulating activities as well as giving family and friends a break from caring. There are a number of social day centres in the Richmond borough offering a range of stimulating activities for people over 55. There is currently no direct dementia care provision available at the social day centres in the borough therefore if a person with dementia needs support it is suggested that a carer or companion attends with them. Social day centres can offer good opportunities for people with dementia and their carer to stay socially active together and can be particularly useful in the early stages of dementia. A list of day centres in the borough can be found in Section : Richmond local services directory (page 7). Social day centres typically offer a range of social and leisure activities including talks, discussion groups, outings, bingo, quizzes, film shows, painting, drawing, pottery and photography courses, gentle keep fit exercise groups, personal care, emotional support and encouragement. Most centres will continue to support people who begin to develop dementia and will fully include them in the life of the centre for as long as
Voluntary neighbourhood care groups
There are a number of voluntary neighbourhood care groups in the borough that offer practical advice to older people in need. They also offer befriending services, which involve specially trained volunteers visiting people in their own homes to provide company or help with problems or issues. Each part of the borough has its own local group (see Section


: Richmond local services directory (page 7) for contact details about groups in your area).
Specialist day centres for people with dementia
A specialist day centre for people with dementia has been established at The Woodville Centre at Ham and provides a therapeutic, stimulating and safe environment along with a range of activities, specifically designed for people with dementia. The Woodville Centre provides mainstream activities found in other day centres, such as art and craft groups, bingo and music, but also provides activities particularly suited to people experiencing dementia including Singing for the Brain groups and reminiscence. Transport can be arranged from any part of the borough and a hot lunch is provided as well as visiting hairdresser and chiropody The Woodville Centre at Ham is run by Richmond Social Services and requires referral through the Adult Social Care Access team. There is a daily attendance charge that may be included in a personal budget allocated to a person by social services dependent on the outcome of a financial assessment (see Section 8: Getting the help you need: Paying for Care on page 5).
The Woodville Centre welcomes people with dementia and carers to visit informally to have a look around. Please contact the manager to arrange this. Woodville Centre at Ham Woodville Rd, Ham TW0 7QW T 00 898 09Homelink day respite care is a local charity based in Whitton who also offer support and day care for people with dementia two days each week. They are a nurse-led day respite centre, supporting carers of any age who give help and care to a partner, relative, friend or neighbour who can not manage without their help, in the Whitton, Hounslow borders, Twickenham, Hampton and Teddington areas. Homelink provides a happy and vibrant environment where people can enjoy the company of others supported by trained staff and volunteers. The centre enables carers to take a well earned day's respite while the person they care for attends the centre. Referral can be made through any of the professionals that you are involved with or you can contact the centre directly.
Referral to Homelink can be made by contacting them directly. There is a daily attendance charge that may be included in a personal budget allocated to a person by social services, dependent on the outcome of a financial assessment (See Section 8: Getting the help you need on page 5 for more information).
Homelink Specialist Day Centre St Augustine's Vicarage Hospital Bridge Rd Twickenham TW 6DE 7 Carer support in the
community
When you are caring for someone with dementia, it can be all too easy to ignore your own needs and forget that you matter too. Looking after yourself
As a carer, it is important to look after your own health and well-being.
• Try to eat a well-balanced diet, take regular exercise and make sure you get enough sleep. If you have to help the person move around, make sure you don't damage your back. Ask your GP to refer you to a community physiotherapist for advice.
• See your GP on a regular basis to check up on your own health. Make sure they are aware of any stress or problems you are experiencing.
• Your legal and financial situation may be affected. There are a number of areas to think about before you make changes to your circumstances including making sure you are claiming all of the benefits to which you are entitled and what may happen if you choose to give up your job to continue caring. It's also important to check your own position in terms of home and finances for the future.
• Make sure you have some regular time to relax or do something just for you - if the person you are caring for can't be left alone, ask friends or family whether they could pop in for a short time.
In Richmond there are a number of carer support activities including The Caring Café, carer support groups, carers training and Richmond Carers Centre (see Section : Richmond local services directory (page 7) for contact details). Your Richmond Alzheimer's Society Dementia Support Worker (T: 00 8877 00) will be able to provide more information about the services available for carers in the borough.
Legal recognition and Carers Assessments
The work undertaken by carers has been officially recognised in the Carers (Recognition and Services) Act 995, the Carers and Disabled Children's Act 000 and Carers (Equal Opportunities) Act 00. These acts place a duty on local authorities to assess, on request, carers who provide a substantial amount of care on a regular basis, even if the person being cared for does not wish to be assessed. This assessment is called a Carers Assessment.
Whether you are a carer providing a substantial amount of care on a regular basis depends upon the impact that caring has on you. It does not depend on whether you live with the person or if you are providing a set number of hours of care per week. The acts allow local authorities to provide services to carers in their own right.
Carer's Assessment
The Carer's assessment is a conversation that will help the Adult Social Care Access Team to understand the physical, emotional and practical impact on the life of a carer, and ensures that their needs are taken into account. A carer also has the right to have their needs considered when decisions are being made about any support being provided for the person with dementia. This could include any education, training, work or leisure activity that they would like to take part in. The Carers Assessment could also include help with financial worries, your own health, practical help around the home, introduction to support groups, respite care for time off, signposting to other services and concerns about future needs.
Support from family and friends
Even though you may be coping well now, caring for a person with dementia may gradually become more demanding, both physically and emotionally. These are some ways you could relieve some of the responsibility from yourself.
• Try to involve other family members right from the start so that the responsibility doesn't all rest with you. • Always try to accept help from friends or neighbours when they offer it and suggest ways that people can help when they offer. • Tell people that you value their support. Remind them what a difference it makes when they pop in for a chat or phone regularly to see how • Explain to your family and close friends how dementia can affect a person's behaviour. Tell them what life is like for you and for the person Every carer needs support and people with whom they can discuss their feelings. You can get different types of support from: • friends and family • professionals, such as GPs, counsellors, Alzheimer's Society Dementia Advisers and Support Workers, Richmond Carer's Centre carer • carers support groups • online discussion forums, for example Alzheimer's Society's Talking Point (see alzheimers.org.uk/talkingpoint for details). Your relationship with the person with dementia may change and this can have an effect on how you feel towards them. It is important to be able to talk about these feelings with someone you trust. You should not be afraid to say how you feel - it is natural to be confused, upset or even angry Coping with conflicting demands
Try to pace yourself - you can only do so much. Many carers feel torn between responsibilities, especially if they are trying to care for children, look after someone who is unwell, or go to work as well as caring for the person with dementia.
Congratulate yourself
At times, caring can feel like a thankless task. The person with dementia may no longer seem to appreciate your efforts, and others may be unaware of how much you do. Pat yourself on the back from time to • managing to cope, day in, day out, with a very difficult situation • becoming ever more flexible and tolerant, and finding new strengths and skills that you did not know you possessed • being there for someone who needs you.
Taking a break
Being a carer can be physically and emotionally exhausting. Feelings of overwhelming tiredness are a common experience. It is therefore important that a carer considers their own personal needs by taking a break from caring. An opportunity for a break or respite from caring is not only essential for the health and well-being of the carer but can have a positive effect on the person they care for. A rested carer may be in a better position to be more patient and understanding of the person with dementia. A carer should talk to someone about any feelings of guilt.
A break could be for a few hours, days or weeks and may be occasional or regular. It may involve someone coming into your home or the person you care for going to a residential care home or a day centre or other social activity while you have some time for yourself.
A social worker can help you find the type of respite service that best suits you and the person you care for. This may involve you exploring and trying out a few different options before you find the right one.
The emerging personalisation of social care means there is greater choice and control being offered to people needing support and to their carers. This means that there should now be a greater choice in how a carer can Your local Dementia Adviser will be able to point you in the right direction for the available support services or you can contact the Richmond Adult Social Care Access team (see page 8) to discuss respite care.
Further information about carers rights and looking after yourself can be found in Alzheimer's Society's factsheets Carers: looking after yourself and Community care assessment
which can be downloaded from alzheimers.org.uk/factsheets, or ordered through your local Dementia Adviser or Alzheimer's Society's South West London office on 00 8877 00. Support from Richmond Adult Social Services
The Adult Social Care Access team is responsible for the provision of, and access to, services specifically for the carer. If you are being assessed as a carer, prepare for the Carers Assessment carefully. Think about your role as a carer, how you are managing and what support you may need to continue. Think about the difficulties you have now and those you may experience in the long term if you continue caring at the same level. Think about what would help you to cope. Solutions may include respite care, training, and adaptations to the home or counselling. Think about what help you might need and where you can get it before you actually need it. That way when the time comes you'll know where to turn.
The Access team can direct you to services such as: • carer's payments and carer's allowance via Richmond Aid (see below) • community support via the Carer's Centre in Twickenham • application to the carer's emergency card and respite schemes • adjustments to existing care packages to manage a crisis The carers assessment can be undertaken at the same time as, or separately to, the community care or financial assessment of the person Financial support for the carer
The rules on eligibility for various benefits are very complicated and independent advice should be sought to understand the ramifications for each individual, but assistance is available for the following: • carer's allowance • carer's allowance and national insurance contributions • carer's credit • carer's allowance and state pension • income support • carer premium • community care grants • direct payments for carers • paying for a carer using a personal budget.
For impartial advice, contact the carer's benefits adviser at Richmond Aid. The Richmond Aid Benefits Service is a free service for people receiving or applying for disability benefits in the London Borough of Richmond-upon- Thames. This project is funded by Richmond-upon-Thames Council and helps people with form filling, and benefit reviews so that people receive all the benefits to which they are entitled. The carer's benefits adviser can meet people face to face or arrange telephone consultations.
Disability Action and Advice Centre Teddington TW 8HT Help in an emergency
Carers Emergency Alert Card Scheme Richmond Council offers a Carers Emergency Alert Card Scheme following a carers assessment. The scheme helps carers to develop a care plan that can be put into place in case of an emergency. This covers any emergency situation that arises where the carer is unable to carry out their normal caring responsibilities. The carer is given a card to carry which has the Careline phone number and a personal identification number to identify the personal emergency care plan. Contact the Access team (see page 8 for more information).
This is a 7-day a week NHS confidential advice and information service to help the individual as a carer, including advice on how to cope in a crisis, a guide to caring, financial and legal advice, help for young carers, local support groups and advice on keeping healthy.
For more information, see Alzheimer;'s Society's factsheet Benefits, which has a section
specifically for carers that can be downloaded from alzheimers.org.uk/factsheets or contact Alzheimer's Society South West London office on 00 8877 00 Alzheimer's Society services for carers
Alzheimer's Society is a national charity that supports the well-being and rights of anyone caring for a person with dementia as well as people experiencing dementia. Alzheimer's Society Richmond covers all areas of the London Borough of Richmond-upon-Thames and has a team of Dementia Support Workers within the Borough to help people facing the challenges associated with caring for a person with dementia. Dementia Support Workers can visit carers at home or discuss their situation on the phone and can provide information, guidance and support in understanding and caring for a person with dementia.
Carer support groups Carers support groups offer the space to talk in a safe environment about the experiences of caring for someone with dementia and the impact on carers' lives. Carers support groups allow carers to meet others in a similar situation and gain practical information as well as emotional support to promote self-esteem, coping and well-being in dementia. Carers support groups specifically for carers of people with dementia are held at the Caring Café and in the Community.
The Caring Café is run in partnership with Richmond and Kingston Crossroads Care. It offers a place where people with dementia, their families, friends and carers can meet in a welcoming and supportive environment. They can also meet others in a similar situation and gain support, guidance and information from other carers and staff from both Alzheimer's Society and Richmond and Kingston Crossroads.
Sheen Lane Day Centre East Sheen SW 8LP Open on the first and third Saturday of each month am - .0pm If you are interested in any of the services described above, please
contact Alzheimer's Society South West London office:
Alzheimer's Society South West London office Wandsworth SW8 DU Voluntary sector and community support for carers
There are a number of voluntary and council funded programmes within Richmond that also provide services for carers. Richmond Carers Centre offers a gateway to the provision of direct support, information and access to services for unpaid carer's in the London Borough of Richmond-upon-Thames. The Carer's Centre also offers a service called Carer's First Alert Scheme to provide support for carers having to cope alone. See Section: Richmond local services directory (page 7) for contact details.
Crossroads Care (Richmond and Kingston) is part of a national charity that has been providing respite care for the Borough of Richmond for more than  years. Crossroads care for people of all ages in the comfort of their own homes, giving their carers time to relax and spend a couple of hours doing things that they would not normally have the time to do. Crossroads have some limited funds to offer some people up to two hours free respite care each week as well as people having the opportunity to purchase home care. See Section: Richmond local services directory (page 7) for contact details. Homelink is a charity with a nurse-led day respite centre. It also supports carer's and enables them to take a well-earned break. See Section: Richmond local services directory (page 7) for contact details.
The Richmond Online Study Environment (ROSE) has produced a training programme specifically aimed at carers and those working with people with dementia in the Richmond community. The ROSE programme is accessible to all residents in Richmond with access to a computer and email address. Once registered for the e-learning programme, there is access to two relevant dementia modules – ‘Safeguarding adults' and ‘Basic dementia'. For more information call ROSE on 085 5 60.
8 Getting the help you need:
Paying for care
NHS healthcare is free at the point of delivery whereas social care is not free to everyone and is subject to means testing (i.e. an assessment of your ability to pay). The London Borough of Richmond charges for some of its services but others are currently free. There is no charge for any
information or advice you are offered or for your needs assessment.
The way that Richmond Social Services provides and pays for community social care is through a system called Self Directed Support.
Most people with dementia want to stay in their own homes for as long as possible. If this is your choice and a realistic possibility for you, the Self Directed Support budget can be used to support you to live at home.
Self Directed Support
Any person who lives in the London Borough of Richmond and requires practical support will be eligible for help from the Richmond Adult Social Care Access team. Self directed support aims to give people who require ongoing personal care and support more choice over how they wish to live their lives through the allocation of a personal budget. The cost of providing the care that has been agreed in the Support Plan will be worked out and a financial assessment (the Self Directed Support assessment) carried out. The capital value of a person's home will not normally be taken into account in the financial assessment where the person with dementia continues to occupy this as their home/dwelling. The capital value of any other property owned or part-owned however will be regarded as capital. Depending on your income, savings, or assets, the outcome of the financial assessment might be that you may have to pay for some or all of your care, or you may receive a financial contribution called a personal budget. More information is available from the Access Team on 00 889 797 or on the Richmond Council website, by following the link: care_charges.htm. If you are unable to access the internet yourself, please ask your Dementia Adviser or contact the Access Team directly.
A personal budget can only be used for the social care needs identified in the assessment. If you do not qualify for a personal budget, then you may still access the services identified in the assessment but will have to use your own money to pay for them. The amount of personal budget received depends on the amount of support any individual needs as well as the outcome of the financial assessment. There are various ways people can use their personal budget. They can • Have it all as cash (a direct payment) to employ someone to help cook and eat, wash and dress, keep healthy and get out and about, for example.
• Use it to pay for a day service and to get help from a care agency.
• Have some of it as cash and some of it in the form of services. For example, you may choose to use some of your budget to employ someone to help you get out and about and some of it to get help with washing and dressing from a care agency in addition to accepting a place at The Woodville Centre that will be paid for directly by the council.
The London Borough of Richmond-upon-Thames uses a process called Fair Access to Care Services (FACS), which ensures that access to social care is offered in a fair and transparent way. If you want more information about the assessment process, you can check the Council website on www.richmond.gov.uk. To arrange an assessment, contact: Adult Social Care Access Team
th floor Regal House Twickenham TW QB
Organisations providing help and support
There are a number of local organisations which can assist in this process of organising and paying for care and support: Richmond Users Independent Living Scheme (RUILS) act as a champion, representative and peer supporter to anyone wanting to live independently in the community. Their aim is to ensure that people get the outcomes they want from their personal budget or direct payment and that it gives them maximum choice, control and independence. For people living with dementia having the same person assisting them every day can help to reduce confusion. By using a Direct Payment to employ your own member of staff you can have control over who comes in to your home and can build a relationship with one individual rather than have a number of agency workers visiting the home. RUILS provide the following services: • Helpline to provide information and advice accessing social services, personal budgets, Direct Payments and living independently in • Support Brokers to assist you to write a Support Plan outlining how you are going to get your needs met and will help you to put that plan • paFinder Service: helps you to find someone to employ as a Personal (care) Assistant. You can do it yourself online at www.find-a-pa.co.uk or RUILS staff can help you to do this. • Independent living advisers provide support, advice and information to individuals and families interested in taking their personal budget as a Direct Payment. They will help you to set up and manage a Direct Payment. • Buddy Scheme: Buddies are people who are using a Direct Payment to get their needs met. They may be employing their own staff or purchasing activities. They have a wealth of experience of negotiating the system and are able to support you if you are new to the process or if you have a specific issue with which you are dealing. • Information and advice to people who do not qualify for social services support, but who are looking to employ their own care workers. To contact RUILS: Disability Action and Advice Centre  Waldegrave Rd, Teddington TW 8HT www.ruils.co.uk • www.employ-a-pa.co.uk • www.find-a-pa.co.uk
Other help to pay for care
Third party top-up payments

You may be able to get a top-up from a third party to make up the difference between the amount Richmond Council is prepared to pay for a place in a care home and the care home's fees. The third party could be a friend, relative, union, charity or similar organisation.
Free care under the Mental Health Act
If you have been kept in hospital under certain sections of the Mental Health Act, you may be entitled to free care when you go home.
Benefits
You should make sure you claim all the benefits to which you are entitled. More than £ billion is left unclaimed by older people each year. Richmond Council's Welfare benefits team, AgeUK and Richmond Aid can help you to claim any welfare benefits to which you may be entitled, in particular attendance allowance, council tax reduction, and carer's allowance.
Problems paying for care
If you have problems paying for your care you should talk to your care manager or social worker if you have one, or contact social services thorough the Access Team on 00 889 797. 9 Residential and nursing care
Many people with dementia will need the services offered by sheltered housing schemes or care homes at some stage. These services are generally run by the voluntary sector or private organisations. Living in a sheltered housing scheme
Sheltered housing schemes are made up of a number of unfurnished properties specially designed for the needs of people who need some support to help them live independently but who do not need to live in a care home. Some schemes offer extra help for people who need a lot of help to keep independent, safe and well. There are two Extra Care Housing schemes available in Richmond. These schemes allow the resident to live independently, but have extra care facilities on site, with fully trained care staff either on site or on call to provide extra support. Sandown Court in Twickenham and Dean Rd in Hampton are self-contained apartment blocks offering this service. Both of these schemes are owned and managed by Richmond Housing Partnership who works closely with Richmond Council and NHS Richmond. (See Section : Richmond local services directory (page 7) for more contact Moving to a care home
There may come a time when you may be finding it too difficult to live at home even with support. It is best to think about this in advance and understand the alternatives available. An Alzheimer's Society Dementia Adviser can work with you and your carer to complete an Anticipatory care plan that allows you to document your wishes and ideas for future care. Care homes provide accommodation, meals, help with personal care and some provide nursing care. The two main types of care homes are 57 residential care homes without nursing care and residential (nursing) care homes with nursing care. Some residential nursing care homes have Registered Mental Health Nurses and other staff who are specially trained so they know how best to help and care for residents with dementia. These are sometimes referred to as EMI homes.
The Social Care team can make an assessment of your needs, including residential/ nursing care needs and advise on the choices available in order for each individual's needs to be best met. Care homes without nursing care can provide short or long term accommodation, meals and personal care such as help with washing and eating. These homes are a ‘home from home' and offer people a safe and secure place to live, but with as much independence as possible. They may also offer social activities and outings.
Care homes with nursing care are the same as those without nursing care but they have qualified nurses who can provide specialist care for people with more complex needs. Some care homes provide specialist care for people with dementia and have specialist registration for this care. Some homes have dual registration, which means they are both a residential and a nursing home, so that people do not have to move as their needs A list of residential and nursing care homes is kept by Richmond Council or is available through the following link: http://www.richmond.gov.uk/ nursing_homes. Alternatively the Care Quality Commission also provide a list, visit www.cqc.org.uk for more information. For people who do not qualify for local authority supported housing, they may want to purchase a property within a private supported living facility.
All health and adult social care services in England are regulated by the Care Quality Commission (CQC) whether they are provided by the NHS, local authorities, private companies or voluntary organisations. The CQC also protects the rights of people detained under the Mental Health Act. When choosing any health or social care service it is a good idea to check with the CQC to see how the service has been rated. For CQC contact details see Section : National Resources Directory (page 87). Also Age UK Richmond has a telephone Advice line for queries and provides information and advice. See local and national directories (sections  and ) for contact information.
Paying for residential care or a nursing home
To move into a care home (either with or without nursing care) a financial assessment by the Adult Social Care Access team will be required to find out how much you will be required to contribute towards the cost of living in a care home. The first step is to contact the Adult Social Care Access team to request both a needs assessment and a financial assessment to help you to plan the most appropriate type of care and find out how much People living with dementia in a nursing home should receive their nursing care provided by a registered nurse free of charge by the NHS through funding known as the registered nursing care contribution (RNCC). The NHS will automatically arrange an assessment. The money will be paid straight to the care home and depending on the funding arrangements, the person with dementia may not actually see a reduction in their fee. Nursing care is defined as ‘care provided, delegated, monitored or supervised by a registered nurse'. This does not include the care provided by a nursing or care assistant, even if that care is delegated or supervised by the registered nurse. This funding is only for the actual nursing care. Accommodation, board and personal care costs in a care home are subject to means testing as described earlier, although people with limited income and capital may be entitled to significant financial support from Social It is also possible to be assessed for NHS continuing care (ongoing fully funded healthcare funding provided in any setting), which is a package of care arranged and funded solely by the NHS. It is awarded depending on whether a person's primary need is a health need. To qualify for NHS continuing care a person must have a high level of health care need that requires regular nursing care and support. It is not easy to get NHS continuing care funding and can take a long time. If you think that the person you care for may be eligible you can request an assessment from the NHS Continuing Care co-ordinator at 00 88 77. For residential services, such as care homes, Richmond Council may ignore the value of your home if your husband, wife or partner is still living there. They may also be able to ignore the value of your home for up to  weeks and offer you a loan to give you time to decide what to do with your property. Contact Richmond Council for more information about their charging policies.
For more information, see Alzheimer's Society's factsheet Community care assessment,
Assessments for NHS-funded nursing care, Choices in care which can be downloaded
from alzheimers.org.uk/factsheets or contact Alzheimer's Society south West London office on 00 8877 00.
10 End of life care
The earlier a person can think about the sort of care they want at the end of their life the better. The life expectancy of a person with dementia is unpredictable and the disease can progress for up to around 0 years. End of life care (which is often called 'palliative care') focuses on reducing physical and psychological distress, and providing the person's family with support. End of life care aims to maximise quality of life and comfort.
Places in which a person may be cared for
Care of a person with dementia at the end of their life will involve a range of professionals across social services and the NHS. Many people with dementia reaching the end of life live in a care home, although some may be in hospital or a hospice, and some may still live at home.
Care and treatment that the person might receive
If someone in the later stages of dementia becomes seriously ill, there may be a discussion about whether to try to prolong their life or allow nature to take its course. Only the doctor can make the final decision about whether to give or withhold treatment in the final stages of dementia, although consideration should be made regarding any Advance Decision that has been prepared. However, the views of relatives and of the person with dementia should always be taken into account where End of life interventions may include: • resuscitation after a heart attack • antibiotic treatment for pneumonia or severe infection • oxygen therapy for shortness of breath • giving the person foods or liquids through a tube, if they are unable to eat or drink normally.
Pneumonia (an infection of the lung) is listed as the main cause of death in up to two-thirds of people with dementia. In some people, death is caused by a completely unrelated illness. Sometimes no specific cause of death, other than dementia, is found.
Advance decisions
Under the Mental Capacity Act 005, people in England and Wales are strongly encouraged to write an advance decision, setting out the types of interventions they would not want doctors to provide at the end of their life. An advance decision (or ‘advance directive' in Northern Ireland) needs to be made when the person is still able to make decisions for themself, so it is important to start thinking about it early on.
Advance care planning
There are systems in place through the Mental Capacity Act where a person can nominate someone to hold Power of Attorney in order to make decisions about their welfare if they lack mental capacity to make these decisions for themselves. There is also the possibility of making a decision in advance about any treatment that the person would not like to receive, such as cardiac pulmonary resuscitation (CPR). This is called an advance decision to refuse treatment. Both advance decisions and Powers of Attorney have to be treated by medical staff as if the person still had capacity and were saying these things for themselves. However, even if the formal measures are not gone in to, it is helpful to know as much as possible about what the person would want so medical staff can take this into account.
Co-ordination of care
People with dementia may reach the end of their lives in a variety of settings. Many may be living in a care home or have extensive social care support at home. With the right co-ordination of care and input from specialist palliative care teams it is possible for them to be cared for where they are, right to the end of their life. However, many people with dementia are often admitted to hospital in the last few months of their lives and many people with dementia die in hospital. While much of this may depend on the individual circumstances, problems most often occur where care is not co-ordinated, and where there is poor communication, for example between the GP, the hospital and the specialist team. This can be frustrating and distressing for those involved. However, Richmond operate a "Co-ordinate My Care" programme aimed at ensuring good communication between the different agencies involved at this time of life are linked up so they are all aware of what the person approaching end of life wants. This ensures that care is well co-ordinated and the person with dementia is able to have a ‘good death'. Ending life at home
If a person's family or friends feel able to provide care for the person at home, they need to make sure that adequate community nursing and other forms of support are available. This information is available from the GP and social services. Your Dementia Adviser will help you to access the right type of support.
Palliative care, artificial hydration and nutrition
Palliative care is designed to relieve pain. Treatment should be given to maximise the quality of life and comfort of a person with dementia in line with the General Medical Council's guidelines on treatment and care towards the end of life (00). When people in the late stages of dementia experience great difficulty with swallowing, most people accept that this is part of the dying process and that the most appropriate response is palliative care. In line with this guidance the Society believes that it is inappropriate for a person with advanced dementia to be given artificial hydration and nutrition for the sole purpose of prolonging life. 11 Guide to Health and Social
Care professionals and directory
NHS South West London, Richmond Borough Team
Currently, government NHS funding is managed through Primary Care Trusts (PCT's). The local PCT, formerly known as NHS Richmond, is now working within a cluster of PCT's in South West London. Richmond Borough Teams role is to commission primary, community and secondary care from health providers, and they are responsible for their own budget and priorities within the healthcare framework set out by the Department of Health. This role will be taken over by groups of GP's in the form of Clinical Commissioning Groups from 0. The service works closely with Richmond Council's Social Services department.
NHS South West London Richmond Borough Team Teddington, TW 8HU GPs (general practitioners) The GP is responsible for a person's general health and is the first point of contact for any health issues. The GP can also provide information on helpful services or refer you to other professionals. Consultants are qualified doctors who have had further extensive training and experience in a particular specialty. The specialty of the consultant will depend on the age and symptoms of the person being diagnosed, and on how services are organised in your area. For example, the consultant may be a specialist in neurology, geriatrics or psychiatry.
• Neurologists specialise in disorders of the brain and nervous system.
• Geriatricians specialise in the physical illnesses and disabilities of old age and the care of older people.
• Psychiatrists diagnose and treat a wide range of mental health problems.
• Old age psychiatrists are psychiatrists who have had further training in the mental health problems of older people.
Consultants work with a number of qualified doctors who are at various stages in their medical training. You may be seen by one of these doctors rather than the consultant.
Nurses work with people with dementia, and those who care for them, through a range of roles. They often work alongside or within the Integrated Health and Social Care teams. These are described below: Community (District) Nursing Service provides patients with ongoing nursing support at home, offering efficient and quicker access to clinical treatment to prevent hospital admission as well as to ensure support to assist earlier discharge from hospital. They work closely with GPs, Social Services, Hospitals, Community Matrons, Continuing Care Nurses and Voluntary Agencies. The Community District Nursing Service helps people to handle their own medicines safely at home and manage the nursing care for people who receive continuing NHS healthcare funding. They are community based and can also help with advice on issues such as bathing and incontinence. Community Matrons (also known as Advance Primary Care Practitioners) also provide ongoing nursing support at home, but also are more involved in case management, looking after more difficult cases at home and are more highly trained so are able to undertake more complicated services (e.g. independent prescribing). The intent is to prevent avoidable admissions and promote more self-management plans.
The contact details for the Community Nursing Service (incorporating the above) for people aged 65 or older and whose family doctor is based in the following areas are included below.
Sheen and Barnes: T 00 887 600 Richmond, Ham and Kew: T 00 887 600 Teddington and the Hamptons: T 00 86 500 Twickenham and Whitton: T 00 889 796 Night Service: T 00 87 9 Community Mental Health Nurses also known as Community Psychiatric Nurses (CPNs), are part of CMHT. They are mental health nurses who have had further training to work in the community. They provide treatment, care and support for people with mental health problems and dementia. They carry out assessments of people at home and can advise people with dementia and their carers about ways of coping and improving their health and quality of life. They do not normally carry out physical nursing For Twickenham, Teddington, Whitton and the Hamptons:
Teddington Health and Social Care Centre Teddington TW 0LR For Barnes Kew Mortlake, East Sheen, Richmond:
Intermediate Care Team (ICT) provides a nursing and rehabilitation service, primarily for older people within the NHS South West London, Richmond Borough Team area. The team provides a rapid response to manage crises, support and enable people to stay at home, preventing unnecessary admission to an acute hospital or a residential/nursing home, and provide rehabilitation to help them gain maximum independence for a stronger future. The team is multi-disciplinary and includes nurses, occupational therapists, social workers, physiotherapists, dieticians, and rehabilitation assistants. This service is based at Teddington Memorial Hospital. T: 00 87 060.
Health visitors are nurses (who generally work with children and families) and who have had further training to advise people in the community about preventing illness. They can provide information on local services and suggest ways of keeping well. They can also help you press for appropriate services, and may sometimes initiate services such as carers groups, when they identify a need.
Practice nurses work with GPs and other community nurses and carry out a range of nursing activities within the GP practice. You can contact the practice nurse at the GP surgery.
Audiologists check for hearing problems and can fit a hearing aid, if appropriate. Once fitted, hearing aids should be checked regularly. Hearing tests, equipment and equipment checks are free on the NHS. Ask the GP for a referral to the nearest NHS hearing centre, preferably while the dementia is at an early stage.
Chiropodists. Healthy, pain-free feet are important in maintaining mobility. NHS chiropody (also known as podiatry) services can be accessed Clinical psychologists assess memory, learning abilities and other skills and offer support. They often work with consultants in memory clinics as part of a team. Referral is through the CMHT.
Continence advisers. The Continence team based at Teddington Memorial Hospital provides an outpatient service run by specialist nurses who assess, investigate, treat and review patients in Richmond. They can also give information on useful equipment ranging from commodes to incontinence pads. Your GP may refer you, or you can get in touch directly. Your district nurse or health visitor will advise you on managing the use and disposal of pads. T 00 87 086. Dieticians can provide advice and guidance about food, nutrition and issues such as a poor appetite, weight loss, weight gain, vitamins and food supplements. Your GP or consultant can arrange for a referral to a Dementia Advisers (who work for Alzheimer's Society) are for people with dementia and their family and carers, and provide a named contact throughout the person's journey with dementia to provide advice and help to access services. You can be referred to a Dementia Adviser through your GP, Memory service or Community Mental Health team.
Ears, teeth, eyes and speech professionals Problems with hearing, teeth or sight can undermine the overall well-being of someone with dementia, and may increase their levels of confusion. They may also be unable to tell others that they are in discomfort, so it is important to make sure these areas are checked regularly. Professionals within these areas include: • Dentists: Professional dental advice should be obtained as soon as dementia is diagnosed because dental treatment may become more difficult as symptoms progress. Dentists can also advise anyone caring for someone in the later stages of dementia about how to clean their teeth.
• Optometrists: Problems with sight can add to the confusion of someone with dementia. The person's eyesight should be checked regularly by an optometrist, who will also examine the eyes for signs of glaucoma, cataract and other eye and medical conditions. You will need to find an optometrist who understands what examining someone with dementia may involve. Some will carry out a home visit. People aged over 60, and some under-60s who have dementia, are entitled to a free NHS eye examination. Ask at your local GP surgery for advice.
• Speech and language therapists: Speech and language therapists can advise someone with dementia and their carer on ways of communicating more effectively, and on relieving any swallowing difficulties. Your GP may be able to refer you or you can contact your local speech and language department directly.
Falls Prevention. The Falls Prevention Clinic, based at Teddington Memorial Hospital, is a service that aims to improve the health and mobility of older people and sustain their independence. You can be referred through your GP. T 00 87 006.
Occupational Therapists (OT's) can advise on adaptations and equipment, and on ways of maintaining independence for as long as possible. Some OT's work for the health service and some for social services. If you think an OT might be helpful, ask your GP, consultant or social services. Some OT's also work privately. Physiotherapists can advise on exercise for people at all stages of dementia. They can also advise carers on safe ways of helping someone to move. The GP or consultant can refer you to the community physiotherapy service or the hospital physiotherapy department. Some physiotherapists are in private practice. Wheelchair service: This service provides a comprehensive service to people with permanent mobility problems and assesses needs for provision of manual and powered wheelchairs.
Queen Mary's Hospital T 00 887 608.
Other NHS services
Teddington Memorial Hospital
Teddington Memorial Hospital is a facility providing a range of inpatient and outpatient services and which allows residents from across the borough to access care close to home. Services provided include: • walk-in centre • outpatients department • inpatients department • rehabilitiation unit • physiotherapy • diagnostics.
Teddington Memorial Hospital
Middlesex TW 0JL Accident and Emergency departments
The following hospitals close to the Richmond borough have a -hour accident and emergency department.
West Middlesex Hospital
West Middlesex University Hospital NHS Trust Isleworth TW7 6AF The following hospitals treat people with minor injuries. Patients are advised to telephone the minor injuries unit prior to visiting to check opening times and that the service required is available.
Minor Injuries Unit
Queen Mary's Hospital Roehampton, SW5 5PN T 00 887 6000
Teddington Memorial Hospital
Teddington TW 0JL Patient support service (PALS)
Provides information and advice to patients, carers and their families on local NHS services and can help with concerns, complaints, compliments, suggestions and queries.
The service is confidential and can be contacted at: NHS Richmond, Thames House, 80 High Street Teddington TW 8HU Social Care Staff
Many helpful care services can be arranged through your local social services department. The Civic Centre provides face-to-face access for residents of the London Borough of Richmond-upon-Thames, offering advice and information on all council services Twickenham TW BZ Social workers have specific professional training and qualifications. They may be involved in assessing needs for services and in planning, co-ordinating and advising on services. They can also offer support if you need to talk things through. Social workers are also referred to as care managers and may be based in social services departments, hospitals and care homes. To talk to a social worker, contact your social services, ask a nurse at your GP practice or hospital.
Social care workers
Social care workers work in a wide variety of settings and are known by a variety of names. For example, some work as home care workers or care attendants in the person's home or in care homes as residential care workers. They may help with personal care, such as getting the person up, washed and dressed, changing bedding and emptying commodes, doing laundry, supervising meals to make sure the person eats properly and putting them to bed at night.
For more information, see Alzheimer's Society's factsheet on Health and social care
professionals which can be downloaded from alzheimers.org.uk/factsheets or contact
Alzheimer's Society South West London office on 00 8877 00.
12 Directory: Richmond local
services
Voluntary sector charities
Alzheimer's Society Alzheimer's Society South West London office Wandsworth SW8 DU Alzheimer's Society's National Dementia Helpline England and Wales Alzheimer's Society Talking Point is an online support and discussion forum, for anyone affected by dementia. It's a place to ask for advice, share information, join in discussions and feel supported: www.
alzheimer's.org.uk/talkingpointAge UK Richmond Providing advice, information and advocacy services, aimed at supporting and empowering older people by providing timely, accurate and independent advice, information and support.
Suite 0, rd Floor Parkway House, Sheen Lane East Sheen SW 8LS E info@ageukrichmond.org.ukINS INS is a Twickenham-based charity providing long-term rehabilitation and support for people with neurological conditions particularly multiple sclerosis, Parkinson's disease or who have had a stroke. Their experienced neuro-specialist team of physiotherapists, occupational therapists and social workers support their clients and their carers in groups and individually, at their centre, in their home or in the community, for as long Twickenham TW 5QS E admin@ins.org.uk Parkinson's UK offer information, friendship and support to local people with Parkinson's, their families and carers. They also organise regular events and social activities. As well as the main monthly meeting (see below), they run a Parkinson's People group which meets on the third Tuesday of the month at .0am at The Cambrian Community Centre, Caplan Court, Grove Road, Richmond TW0 6SN.
Whitton Community Centre Whitton, Twickenham TW 6JL Richmond Borough Mind (RB Mind) is rooted in the local community and exists to meet local mental health needs for adults who experience mental distress and their carers. They provide high quality, individually tailored services so people can live full lives and be connected to other people in their communities.
Richmond Borough Mind Richmond Healthcare Hamlet Legal and financial services
London Borough of Richmond-upon-Thames: Finance, adult and community services For information and advice on revenue, benefits and council tax W: www.direct.gov.uk Age UK First Contact First Contact provides information and advice for older people in Richmond-upon-Thames, Sutton, Wandsworth and Croydon Boroughs.
A telephone advice line is open Monday to Friday, 0.00am to .00pm. The line is staffed by an adviser, who can answer queries, provide information and advice, and signpost to other agencies. T 085 600 090 (line is open from 0.00am to .00pm Monday to Friday) Age UK Welfare benefits advice Age UK works with the Adult and Community Services department of the London Borough of Richmond-upon-Thames. This service provides advice on welfare benefits and on other services concerning people over state pension age that may improve their quality of life. They have a team of benefits advisers who can provide the following: • face-to-face benefits advice to people over state pension age in their • face-to-face benefits advice by appointment at offices based in Parkway House, Sheen Lane, East Sheen, London SW 8LS • follow-up discussions to determine if additional help is needed. Welfare benefits advice team Richmond Citizens Advice Bureaux (RCABS) RCABS offer advice and information on a wide range of subjects. These include welfare benefits, debts, housing, employment, relationships and legal issues. There is an information centre, which distributes self-help leaflets and factsheets. Open Monday to Friday 0.00am - .0pm.
Telephone line for all Borough of Richmond offices: 08 86 9700.
White House Community Twickenham TW AW , Lower Mortlake Road Sheen Lane Centre The Health Centre FirstStop Advice is an independent, free service offering advice and information for older people, their families and carers about housing and care options in later life. It is led by the charity Elderly Accommodation Counsel (EAC) working in partnership with other national and local organisations. The service spans housing, care, finance and rights and is delivered through their website, telephone Advice Line and network of local and specialist partner organisations. The advice line is open from 9am to 5pm, Monday to Friday: 0800 77 7070KAG Advocacy Richmond The Kingston Advocacy Group (KAG) helps vulnerable people to have a say in decisions that affect them and how they live their lives. Richmond Aid is a charity run by and for disabled people in the London Borough of Richmond-upon-Thames. They support disabled people (including those with physical and sensory impairments, mental health issues and learning difficulties), and their families, carers and professionals by providing services. These include the Advice service, Richmond SPADE (gardening service) and the Benefits service, as well as support with employment and training. Their aim is to support disabled people to live independent lives and to have the same opportunities as non-disabled people. Richmond Aid Disability Action and Advice Centre (DAAC)  Waldegrave Road Teddington TW 8HTAdvice Line: 00 88 6070 DAAC Reception: 00 88 6080 For general enquiries: info@richmondaid.org.uk Richmond Housing Partnership The Richmond Housing Partnership (RHP) Group is a dynamic, innovative and customer focused organisation made up of two Registered social landlords, which now own and manage over 0,000 properties in South 8 Waldegrave Road Middlesex TW 8GT T 0800 0 Richmond Users Independent Living Scheme (RUILS) RUILS support individuals to live independently in their community by acting as the champion, representative and peer supporter for anyone who has a personal budget and in particular a Direct Payment. Their aim is to ensure that people get the outcomes they want from their personal budget and Direct Payment and that it gives them maximum choice, control and independence.
Richmond Users Independent Living Scheme (RUILS) Disability Action & Advice Centre (DAAC)  Waldegrave Road Teddington TW 8HT E info@ruils.co.uk W: www.ruils.co.uk W: www.find-a-pa.co.uk W: www.employ-a-pa.co.uk Support for carers
This is a free, confidential advice and information service to help carers with advice on how to cope, a guide to caring, and financial and legal advice. Open seven days a week.
www.nhs.uk/carersdirectRichmond Carers Centre Richmond Carers Centre is part of the Princess Royal Trust for Carers network and provides support and information for carers. Richmond Carers Centre Twickenham TW 6RB T 00 8867 80 (Carers support line) E info@richmondcarers.orgRichmond and Kingston Crossroads Care This a charity that offers respite breaks to carers by providing care in their own home or by taking them out in the community. The service is free, (resources permitting) but respite hours can be purchased from them (Direct charge service) or through personal budgets. Richmond Crossroads Care  Beverley Court, 6 Elmtree Road, Teddington TW8ST Day centres
Woodville Centre at Ham
Social Services in Richmond also run a Specialist day centre for people with dementia in the Borough. Open 7 days a week for anyone living in the Borough of Richmond. There is a daily charge for attendance and referral though a care manager is required.
Woodville Centre at Ham For more information and advice and to speak to someone in confidence, contact: Richmond Adult Social Care Access Team
T 00 87  (emergencies only) Homelink (a registered local charity) is a nurse-led day respite centre in Whitton, supporting carers of any age who give help and care to a partner, relative, friend or neighbour who cannot manage without their help, in the Whitton, Hounslow borders, Twickenham, Hampton and Teddington areas. Homelink provides a happy and vibrant environment where people can enjoy each other's company supported by trained staff and volunteers. The centre enables carers to take a well earned day's respite while the person they care for attends the centre. Referral can be made through any of the professionals that you are involved with or you can contact the centre directly.
Homelink Day Respite Care Centre St Augustines Church Hall Hospital Bridge Rd Voluntary social day centres Provide social opportunities and can be contacted directly by you for more information. These social centres offer a wide range of activities for people over 50, including computer classes, exercise classes and discussion Barnes Green Centre
Elleray Hall Day Centre
Teddington TW 0HG Hampton and Hampton Hill Voluntary Care Group Hampton Hill TW QL Linden Hall Day Centre
Hampton TW JG The Avenue Club
Kew Community Trust Twickenham Wellbeing Centre
Twickenham, TW NH Whitton Social Centre
a Kneller Road Age UK runs three of these social centres: Whitton Social Centre,
Twickenham Wellbeing Centre and Barnes Green Centre. rd Floor, Parkway House Sheen Lane, London, SW 8LS E info@acrut.org.uk EMAG, the Ethnic Minorities Advocacy Group, is an independent voluntary organisation working for equality and fairness in the Black and Ethnic Minority communities living and working in the London Borough of Richmond-upon-Thames. E emag@emaguk.net
Voluntary care groups
The Borough's voluntary neighbourhood groups provide practical help to elderly people who are unable to get help from family, friends or neighbours. This help includes door to door transport to GP surgeries, clinics and hospitals, prescription collection, transport to local shops or even doing the shopping. Many groups can also help with everyday household tasks such as putting up shelves or handrails, light gardening or changing fuses in electric plugs. The groups do not undertake housework or cleaning.
The groups all operate in specific parts of the borough (Barnes).
FiSH Neighbourhood Voluntary Care scheme
T 00 8876 5 (9am –  noon weekdays) FiSH busline: 00 8876 765 Ham and Petersham SOS Scheme
T 00 898 090 (Mon–Fri 0.00 am –  noon, answerphone at Hampton and Hampton Hill Voluntary Care Group
T 00 8979 966 (Mon–Fri 9.0am–.0pm) T 00 8979 966 (Mon–Fri 9.0am – .0pm). Kew Neighbourhood Association
T 00 898 805 (Mon – Fri 0am – noon) Mortlake Community Association
T 008 87 5500 (Mon – Fri 9.0am – .00pm) Richmond Good Neighbours
T 00 8 97 (Mon – Fri 9.00am – noon) Teddington and Hampton Wick Voluntary Care group
T 00 89  (9.0am –.0pm weekdays) Twickenham Help a Neighbour in Distress Scheme (HANDS)
T 00 889 6 (Mon – Fri 9.0am – .0pm) Whitton Network
T 00 8755 6 (Mon – Fri 9.0am –  noon) Travel
The Accessible Transport Unit
The Disability Action and Advice Centre run the Council services for transport around the Borough.
Blue Badge scheme
The Blue Badge scheme is for people with severe mobility problems. It allows Blue Badge holders to park close to where they need to go. The scheme operates throughout the UK and is managed by local authorities, who deal with applications and issue Blue Badges. Freedom Pass
The Freedom Pass is available to anyone over 60 years of age and can be used to travel free on Transport for London buses, tubes, trams, DLR at any time, and on national rail within Greater London after 9.0am. There are three types: a disabled person's pass, a discretionary pass and an older The London Taxicard scheme provides subsidised door-to-door transport for people who have serious mobility impairment and difficulty in using public transport. Taxicard holders make journeys in licensed London taxis and private hire vehicles, and the subsidy applies directly to each trip.
To obtain a Taxicard/Freedom Pass/Shopping Bus scheme contact The Accessible Transport Unit
Disability Action and Advice Centre (DAAC)  Waldegrave Road Teddington TW 8HT T 00 88 6 / 6097 (general enquiries) E accessibletransport@richmond.gov.ukOffice hours are 9am to 5.5pm Monday to Thursday, 9am to 5pm Friday.
Dial-a-ride Dial-a-ride is a free door-to-door service for people who can't use buses, trains or the tube. Dial-a-ride can be used for all sorts of journeys and is generally best at providing local trips, although longer journeys can often be arranged on request. Bookings are usually made a day before travel.
Dial-a-ride T 085 999 999 or 00 709 8900 Richmond and Kingston Accessible Transport (RaKAT) RaKAT aims to provide high quality, low cost accessible transport services for charities, voluntary organisations, community groups, faith groups and schools and sports based in the boroughs of Richmond and Kingston.
RaKAT North Kingston Centre Kingston upon Thames E info@rakat.org.uk Community support resources
Local Involvement Network, Richmond (LINks) Local Involvement Networks (LINks) give local residents and groups a stronger voice in how local health and social care services are delivered. The role of LINks is to find out how the local community would like health and social care services to improve, investigate issues and use its powers to hold services to account.
Richmond upon Thames LINk E info@richmondlink.org.ukOffice hours are Monday to Friday 9.00am–5.00pm Third Age Foundation Third Age Foundation is helping disadvantaged people forty years and over to find a new direction and up-skill them in up-to-date computer technology, including undertaking a personal development programme and developing an action plan in an innovative holistic way.
E info@thirdage.org.uk Living at home / mobility aids
Meals on wheels ensure that people receive proper nutrition on a daily basis, no matter their circumstances. There is a cost of service, which is subsidised by Richmond Council.
Contact: Adult Social Care Access team (London Borough of T: 00 889 797 (prefix 800 for Textphone Users) Richmond Homeline Richmond Homeline is a new pilot telephone befriending project set up by Bishop Creighton House in July 0 in partnership with the NHS in Richmond. It provides a telephone befriending service that supports older people in the Richmond borough who are experiencing isolation and loneliness. The service supports people in their own homes by providing social phone calls from our volunteers to check people are safe and well.
Bishop Creighton House Telecare and Careline equipment A -hour emergency monitoring system to help elderly and vulnerable people live independently and safely in their own homes. Careline provides a -hour, 65-days-a-year emergency service, enabling you to live as independently as possible.
Telecare and Careline
T 085 600 775 (Textphone) Or contact: Adult Social Care Access team (London Borough of Phone: 00 889 797 (prefix 800 for Textphone Users) MedicAlert is a registered charity that provides a MedicAlert emblem in the form of a necklace, bracelet or watchstrap, which has engraved on it any vital information about you, a personal membership number, and a -hour emergency call centre number. It is particularly useful for people who are unable to remember personal details and who may get lost away from their home. The central call centre holds contact details for carers and other information that may be useful in an emergency. Home maintenance and gardening
Age UK Richmond Handyperson service The Age UK Richmond Handyperson service is available to older and/or disabled people who live in the London Borough of Richmond-upon- Thames. This low cost service offers assistance with practical non- emergency jobs around the house that help an older or disabled person to live within their own home for longer or improves their safety and security.
The Handyperson Service team is made up of staff and volunteers who work together to make a difference. All staff and volunteers are trustworthy and reliable and are required to undergo enhanced Criminal Records Bureau checks. They also carry Age UK ID. They will provide all the necessary tools to complete the job. Housing improvement repairs and grants Richmond Council offers many types of financial assistance to people in various housing circumstances, including those who would like to continue to live in their own home to ensure that the house is in good repair, warm Residential Housing Team
Richmond Aid provides a gardening service for disabled people, which includes cutting grass, pruning, weeding and raking leaves.
13 Directory: National
resources
Action on Elder Abuse If you are worried that someone you know is being treated in a way that is causing them significant harm and suffering.
Streatham SW6 9BY T 00 885 980 / 0808 808 8 W elderabuse.org.uk Age UK National Helpline Age UK aims to improve later life for everyone by providing life-enhancing services and vital support through their information and advice, campaigns, products, training and research.
E contact@ageuk.org.uk Lines are open between 8.00am and 7.00pm, 65 days a year. Age Exchange Reminiscence Centre Works with older people to improve their quality of life through reminiscence activities  Blackheath Village W age-exchange.org.uk A web-based information resource on assistive technologies (including telecare) for people with dementia.
Trent Dementia Services Development Centre Leicester LE 5SN E info@trentdsdc.org.uk W atdementia.org.ukBenefits Enquiry Line Confidential advice and information for people with disabilities, and their carers and representatives, about social security benefits and how to claim.
Red Rose House,Lancaster Road W direct.gov.ukBritish Red Cross The British Red Cross provides valuable short-term support to vulnerable people in the UK, whether they're recovering from an operation, need a wheelchair or just need help coping around the house.
UK office address British Red Cross T: 08 87   Care Quality Commission (CQC) The Care Quality Commission is the independent regulator of all health and adult social care in England. Their website includes ratings and reports on residential homes.
Care Quality Commission National Correspondence Citygate, Gallowgate Newcastle upon Tyne NE PA Carers Direct helpline The helpline advisers can give information to help carers make decisions about personal support needs and the needs of the person being cared for. Telephone translation and interpreting services are available.
8am – 9pm Monday to Friday, am – pm at weekends Carers UK speaks up for people who provide unpaid care by looking after an ill, frail or disabled family member, friend or partner.
0 Great Dover Street CarersLine 0808 808 7777 E info@carersuk.org.uk W carersuk.org.uk Counsel and Care Counsel and Care is a national advice service working with older people, their families and carers to get the best care and support.
Kensington Olympia T: 00 7605 00 Helpline 085 00 7585 W counselandcare.org.uk Court of Protection The Court of Protection makes decisions for people who are unable to do so for themselves. It can also appoint someone (called a deputy) to act for people who are unable to make their own decisions. These decisions are for issues involving the person's property, financial affairs, health and personal welfare. Royal Courts of Justice Thomas More Building, Strand W publicguardian.gov.uk Driver and Vehicle Licensing Agency (DVLA) The Driver and Vehicle Licensing Agency aims to facilitate road safety and general law enforcement by maintaining registers of drivers and vehicles and collecting vehicle excise duty (car tax).
Drivers Customer Services (DCS) Correspondence Team Elderly Accommodation Counsel Helps older people make informed choices about meeting their housing and care needs. They are the leading organisation offering support and advice on individual budgets. 89 Albert Embankment E enquiries@eac.org.uk Office of the Public Guardian The Office of the Public Guardian (OPG) supports the Public Guardian in registering Lasting Powers of Attorney and supervising Court of Protection appointed deputies. Lasting Power of Attorney forms can be downloaded from their website.
Birmingham B6 6GX W publicguardian.gov.uk Relatives and Residents Association Support and advice for the relatives and friends of older people in residential and nursing homes and long stay hospitals 6 –8 Northampton Street Helpline 00 759 86 E info@relres.org Provides short respite breaks for disabled people, people with dementia and their carers throughout their UK holiday centres. During certain periods of the year the breaks are subsidised by Alzheimer's Society for people with dementia to enjoy a break.
 Business Design Centre T: 00 0 07 W vitalise.org.uk 14 Safeguarding adults
If you are worried about the safety or welfare of a family member, neighbour of friend, there is help available.
The London Borough of Richmond-upon-Thames works in partnership with the NHS, police and other groups to respond to concerns that a vulnerable adult is being abused and work to ensure their safety. Signs of abuse can be: • injuries (eg cuts, lacerations, bruises, unexplained finger marks (or others), burns scalds, fractures) • clothing in poor condition/worn daily/soiled • withdrawal from communication/normal activities • difficulty in gaining access to the person with dementia • lack of money/inability to pay bills or buy essentials/services disconnected.
If you are worried about someone, you can contact the Adult Social
Care Access team who will put you through to the appropriate team or
complete an alert form which can be found at www.richmond.gov.uk and send it to the adult safeguarding coordinator. (or in an emergency outside office hours 00 87 ) For more information refer to Alzheimer's Society's publication Safeguarding people with
dementia: recognising adult abuse or contact your local Alzheimer's Society South West
London office on 00 8877 00.
Thanks and acknowledgements
Alzheimer's Society Richmond would like to thank everyone who has helped publish this guide. Special thanks to: • NHS South West London, Richmond Borough Team for funding the production of this guide • All featured organisations for information about their services.
• Hilary Dodd and Lynn James, Alzheimer's Society South West London Office, for their local knowledge • Alzheimer's Society Central Office who provided publication and dementia guidance • Dr Robert Lawrence and Dr Malar Barheerathan at South West London and St. George's Mental Health Trust, and Dr Lees, GP, for providing the foreword.
While every effort has been made to ensure details in this publication are correct and up to date, some information may be subject to change. The publication is valid at publication date April 0.
Alzheimer's Society is the UK's leading support and research charity for people with dementia, their families and carers. We provide information and support to people with any form of dementia and their carers through our publications, National Dementia Helpline, website, and more than ,000 local services. We campaign for better quality of life for people with dementia and greater understanding of dementia. We also fund an innovative programme of medical and social research into the cause, cure and prevention of dementia and the care people receive.
Alzheimer's Society Richmond
South West London office Wandsworth SW8 DUT 00 8877 00 Alzheimer's Society (Central Office)
58 St Katharine's Way London EW LBT 00 7 500 E info@alzheimers.org.uk Alzheimer's Society April 0 Registered charity no. 9665. A company limited by guarantee and registered in England no. 599.
Alzheimer's Society operates in England, Wales and Northern Ireland

Source: http://www.datarich.info/resource/view?resourceId=36

biobel.com.mx

Estimada Esteticista: Laboratorios Biobel, S.A. de C.V. consciente de la necesidad de toda profesional de conocer a fondo los productos que utiliza, ha elaborado este manual de trabajo que describe cada producto de las líneas Biobel y DU con sus componentes, indicaciones y modo de empleo. Estamos seguros de que este manual de consulta facilitará tu trabajo y podrás

revistas.javeriana.edu.co

Univ. Sci. 2014, Vol. 19 (1): 11-29 Freely available on line Técnicas analíticas contemporáneas para la identificación de residuos de sulfonamidas, quinolonas y cloranfenicol Y. Verónica Talero-Pérez scar Julio Medina 1, Wilson Rozo-Núñez2 Contemporary analytical techniques to identify residues of sulfonamides,