For me learning is a continual, lifelong process, and with this in mind I was delighted to sign up to the Dementia UK Summer School that ran earlier this month. This is an annual opportunity to learn from Admiral Nurses, helping everyone working in dementia care to keep our practice updated and refreshed.
I managed to join two sessions, and particularly enjoyed ‘Understanding and Supporting Changes in Dementia’. Much of what was discussed was already on my radar, but I was reminded of a fabulous tool that I haven’t signposted to in a long time – the VERA Framework by Amanda Blackhall, Dave Hawkes, David Hingley and Steven Wood.
The VERA (Validation – Emotion – Reassurance – Activity) framework isn’t new. It was first published in Nov 2011, so before my dad died, and frankly it’s a shame he didn’t experience staff practicing it more often in the last months of his life. As a communications framework it was originally intended to be used by healthcare professionals who support people with dementia, and focuses on simple but highly important concepts.
The abstract for the article showcasing the VERA framework says:
“The framework is based on four key concepts: validation, emotion, reassure and activity (VERA). It describes a stage-by-stage process of communication that guides staff towards providing compassionate and caring responses. The framework was developed in response to students who said they find it useful to have structured guidance on how to interact with people who have dementia. The VERA framework offers a means of interpreting communication and responding appropriately.”
Usefulness in social care
Listening to Admiral Nurse Caroline Ashton-Gough talking about VERA reminded me what a useful framework this is. Although Caroline was talking about it in relation to hospital settings, I believe it has real value in social care too.
With the recruitment and retention crisis in social care, many more inexperienced (and sometimes very young) staff and agency workers are covering care shifts. When these individuals are supporting people with dementia they can often feel particularly out of their depth, and whilst VERA is no replacement at all for comprehensive training in dementia (which in my opinion should be mandatory before anyone can work with a person with dementia) it has value as a component within such training, and generally as a guide for staff – something easy to remember and practice in every interaction.
Getting to know (and applying) VERA
I love that VERA begins with Validation. This is crucial for every interaction. I don’t know anyone who hasn’t been struck by the famous film of Gladys Wilson and Naomi Feil that epitomises the magic of validation. In reality, validation is often far more subtle, and you don’t always get that ‘breakthrough moment’ that Naomi refers to, but the concept of entering the person’s world and being with them in their reality is so, so important in dementia care.
When thinking about Validation, ask yourself:
What is the person’s understanding of the world in this moment? In their mind where are they? What do they need to be doing/finding/creating? Who do they think you are?
VERA then moves us on to Emotion. My experience of supporting my dad, and meeting many other people with dementia over the years, is that emotions play a big part in the experience of living with dementia. They may be obvious (my dad cried a lot), or unseen (hard to express), but trying to understand the person’s emotions is key to providing good support.
When thinking about Emotion, ask yourself:
How is the person feeling? Is the time and place they are in, or what they think they need to be doing, causing them distress or confusion? How would you feel in their situation? How can you empathise with the person?
The ‘R’ in VERA is Reassurance. For me this needs to be really meaningful, not a case of saying ‘It’ll all be ok’ as I explained in my November 2022 blog. You need to take your time to reassure the person and be prepared to do this multiple times if repetition is part of the person’s current symptoms.
When thinking about Reassurance, ask yourself:
How do I support the person to feel safe and secure? How do I use my knowledge of the person’s emotions to provide comfort? Do I need to slow down so I’m not rushing and/or dismissing the person’s experiences? Can I stay with the person until they feel they can trust me and are genuinely reassured? (If you can’t stay, can someone else stay with the person?)
Finally, the VERA framework asks us to support the person with Activity. This may partly provide distraction, but more importantly it will enable the person to find a sense of purpose. We all want to feel useful and like we are achieving something, and people with dementia are no different. Activity needs to be really person-centred though, not a one-size-fits-all.
When thinking about Activity, ask yourself:
What does the person enjoy doing? Could they try an activity that they haven’t tried before? How can I work with the person to find out what they might like to do? What does the person’s life story tell us about what they might enjoy if they aren’t able to articulate this now?
If you try the VERA approach in your workplace, or include it as part of your training for social care staff, I’d love to know how it works and if it’s useful as an easy-to-remember guide. I’ve already shared it with some of my clients and feedback has been positive.
Until next time…