Making adjustments for clients living with dementia

Making adjustments for clients living with dementia

Most people can only process or think about 4-5 things at any one time, more than this causes “cognitive overload” and stress. This means we cannot think straight, concentrate, focus, retain information or make decisions. Without these abilities we cannot give valid instructions.

Clients who are living with dementia, or showing early signs of cognitive impairment, can make decisions and give instructions but professionals interacting with them should take steps to reduce distractions or cognitive overload. In this way we can comply with the requirements of Mental Capacity Act 2005 to make reasonable adjustments and support them in making decisions.

We can reduce environmental stress by making our offices more dementia friendly (or making home visits!). Avoid shiny floors, which look wet and slippery; remove large black door mats, which look like a deep hole and do not have striped carpets or lots of mirrors, which are visually confusing and even hallucinatory. Try and have clear signage, to avoid wandering and paint doors a different colour to walls to make them stand out.

We can improve our interaction with clients by clearly giving our name (wearing a badge helps) and stating our connection to them (my name is Iain, I am a solicitor and I believe you would like to talk about …). We should allow clients time to think; to find the right word, answer questions or even write down their thoughts. We may prompt and give reminders, but should not finish sentences or rush clients. Always ask clients how they would like to be helped.

Written communications can be vital to confirm our understanding of a client’s needs, but they need to be done carefully. We should deal with one issue at a time and only have one subject per sentence. We should be concise and use simple but adult language, and no jargon. Documents printed in black on white are difficult to read for someone with cognitive impairment, black on a yellow background has been found to be far easier to read and enclosing the most important information in a box helps tremendously.

Superfluous images and logos (no matter how expensive they were) are confusing and although we may have to include statutory information in our letters, it would be better to confine that to a covering letter on corporate letterhead and print advice in a simple enclosure or attachment.

Clients with any degree of cognitive impairment are vulnerable to financial abuse and advisers need to be alert to indicators of this. The warning signs include; notable differences between known finances and living conditions or personal appearance, efforts to isolate the client from their normal support network, the sudden appearance of a previously unknown individual in their life and new interest from a “carer” in proving capacity to change a will or lasting power of attorney, or to prove incapacity and have benefits paid to an appointee.

Full attendance notes are vital in this area of work, to defend the client’s instructions against future challenges and it may be necessary to involve the client’s medical practitioner in the process (the infamous “Golden Rule”).

Working with clients living with dementia is challenging, but very rewarding.

Iain Cameron

Iain Cameron

Principal of Acer Legal Solutions and a director of Acer Prime Law Limited

Iain Cameron is an accredited member of Solicitors for the Elderly with over 30 years’ experience in advising elderly clients. He is a Dementia Friends Champion for the Alzheimer’s Society. Having worked in private practice and as Legal Director of a major trust corporation he is now Principal of Acer Legal Solutions and a director of Acer Prime Law Limited.