NHS South of England (East) Prompt Cards - PMLD - KSS Deanery

South of EnglandSupporting & meeting the needsof people with Profound & MultipleLearning Disabilities- Top TipsIntroductionBasic Health NeedsCommunicationEating & DrinkingPosture & Mobility

Useful resourcesHealth:• UK health and learningdisability networkwww.jan-net.co.uk• Department of Healthwww.dh.gov.uk/health/search/?searchTerms=learning+disability+publications• RCGPswww.rcgp.org.uk/clinical_and_research/circ/innovation__evaluation/learning_disabilities_resource.aspx• Learning Disabilities Observatorywww.improvinghealthandlives.org.uk/Easy read:• Easy Healthwww.easyhealth.org.uk• CHANGEwww.changepeople.co.ukMulti media:• www.multi-me.comSouth of EnglandPMLD specific:• Raising our Sightswww.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_114346• PAMISwww.pamis.org.uk/• PMLD networkwww.pmldnetwork.org/• PMLD linkwww.pmldlink.org.uk/• PMLD fact sheetwww.pmldnetwork.org/pmld%20definition%20factsheet%20-%20standard.pdf• Mencap’s PMLDCommunications Guidewww.mencap.org.uk/page.asp?id=1539Research:• Centre for disability researchwww.lancs.ac.uk/cedr/• Norah Fry research centrewww.bristol.ac.uk/norahfry/

IntroductionTop Tips for supporting and meetingthe needs of people with Profound andMultiple Learning Disabilities (PMLD)People with Profound and MultipleLearning Disabilities (PMLD)are amongst the most disabledindividuals in our community.They have a profound learningdisability which means that theirintelligence quotient is estimatedto be under 20 and therefore haveseverely limited understanding.In addition they have multiple disabilities,which may include impairments of vision,hearing and movement as well as otherproblems like epilepsy or autism.Most people in this group are unable towalk unaided and many have complexhealth needs requiring extensivehelp. People with PMLD have greaterdifficulty with communicating: theytypically have very limited understandingand express themselves through non– verbal means or at most throughusing a few words and symbols.This means that people with PMLDneed high levels of support from otherswith most aspects of daily living: helpto eat, to wash, to dress, to use thetoilet, to move about and to participatein any aspect of everyday life.All children and adults who have profoundand multiple learning disabilities willhave greater difficulty communicating.Many people will have additional sensoryor physical disabilities, complex healthneeds or mental health difficulties.People with profound andmultiple learning disabilities havemore than one disability.Their main disability is a profoundlearning disability. This meansthey need lots of support.They might have these otherdisabilities as well.• Physical disabilities. This is adisability to do with the body• People who use a wheelchairhave a physical disability• Sensory disabilities. This is whenpeople find it difficult to see or hear• Lots of health problems• Mental health problems• Autism• People with profound and multiplelearning disabilities need a lotof support: They also find it verydifficult to communicate

IntroductionDespite such serious impairments, peoplewith PMLD can form relationships,make choices and enjoy activities. Thepeople who love and care for themcan often understand their personality,their mood and their preferences.These Top Ten Tips have been developedto support everyone, professionals andcarers alike to help the person with PMLDlive a fullfilling, happy and healthy life.It is important that everyone understandsthat people with profound and multiplelearning disabilities have the same rightsas every other citizen. We must enableeach individual to engage with theirworld and achieve their potential so thattheir lives go beyond being `cared for’ tobe valued for who they are as people.It is acknowledged that there are a numberof definitions used world wide. Forexample -• Profound Intellectual andMultiple Disabilities (PIMD)(Raising our Sights: Services forAdults with Profound Intellectualand Multiple Disabilities,Professor Jim Mansell 2010).• PMLD Network (2002) `ValuingPeople with Profound and MultipleLearning Disabilities (PMLD)`www.pmldnetwork.org/• Department of Health (2001)‘Valuing people: a NewStrategy for Learning Disabilityfor the 21st Century’Further readingBellamy, G Croot L, Bush, A, Berry H. SmithA (2010) A study to define profoundand multiple learning disabiliites (PMLD)Journal of intellectual disabilities,September 2010, Vol. 14, 3:pp.221-235In the words of a family carer:“People with PMLD are just that: PEOPLE andsupporting them to live a fulfilling, happy andhealthy life is everybodys responsibility.”

Basic Health Needs110 Top Tips for supporting the basic health needsof people with PMLDPeople with Profound and Multiple Learning Disabilities have greaterhealth needs than the general population. They are more likely to havethe following conditions;Respiratory Disease, Epilepsy, Coronary heart disease, Gastrointestinal reflux,Diabetes, Helicobacter pylori, Osteoporosis.http://www.advocacyresource.org.uk/LD (Raising Our Sights report)2It is important to recognise when someone with PMLD is in pain and tomanage this effectivelyListen to those who know the person well, ask about any changes in behaviourand interactions, facial expressions and gestures, reduction in appetite.3There should be an annual health check and assessmentThe GP and/or community nurse will arrange this. Always involve the carers.www.rcgp.org.uk/pdf/CIRC_A%20Step%20by%20Step%20Guide%20for%20Practices%20(October%2010).pdf - When page open use search tool, entering‘Annual health checks for people with learning disabilities’ to find step by stepguide.4Involve professionals who can offer support and advice in the communityand hospitalCommunity learning disability nurse, health liaison/facilitator, acute liaison/facilitator, dietitian, physiotherapist, speech and language therapist.5Don’t make assumptions about the person’s symptoms or quality of lifeListen to those who know the person well and read their Health Action Plan(HAP)/Person Centred Plan (PCP).

Basic Health Needs6Adjustments should be made to ensure that people with PMLDcan access servicese.g. longer appointment times, ensure equipment such as hoists are availableOrganisations have to make sure that there is equal access to services.Visit: www.equalityhumanrights.comhttp://www.improvinghealthandlives.org.uk/publicationsClick on the ‘Reasonable Adjustments’ link7Use resources to help people with PMLD have a positive experience inhospital settingsCommunication tool/passport, traffic light assessment, health action plan.An example can be found on: www.easyhealth.org.uk8Be aware of good dental and oral hygiene, weight changes, appetite,and skin integritywww.dentalhealth.org.uk9Be aware of the importance of eye care and visionVisit your local opticianor visit www.lookupinfo.org10It is essential to know and follow the principles of the Mental Capacity ActThe law says that people must be supported as much as possible to make theirown decision before anyone concludes they lack capacity to make that decision.Best interests should be followed when a person lacks capacity.

Communication10 Top Tips for supporting the communicationneeds of people with PMLD1Gain information about communication from a parent, key worker orpaid carer with a long relationship with the personMencap’s PMLD communication guide has useful hints and tipswww.mencap.org.uk/page.asp?id=15392Key Information about the individual’s communication needs should befound in: communication tool/passport, traffic light assessment or healthaction planwww.totalcommunication.org.uk or www.scope.org.uk orlocal speech and language therapist (SALT) www.rcslt.org3Hearing and or vision can impact upon communicationVisit www.lookupinfo.org to find a local optician who makes adaptationsto their eye tests for people with learning disabilities. A hearing test can bearranged through the individual’s GP.4Objects or photographs can help the person to understand whatis happeningFor more information on objects of reference visitwww.totalcommunication.org.uk or contact your local SALT.5Allow more time for the person to process what is being said andwhat is happeningAllow plenty of time for conversations and reduce distractions.

Communication6A person may be trying to tell you something throughtheir facial expression and body languageTalk to someone who knows the person well or refer to information on/inthe individual’s communication tool to ensure you interpret their non-verbalcommunication accurately.7The person may have a communication aidCan the person use a BIGmack switch or another electronic device tomake requests? Visit www.ace-centre.org.uk for more information orcontact local SALT.8Make sure that you help the person have a chat/tell their storyIntensive interaction www.intensiveinteraction.co.uk and interactive storytelling www.bagbooks.org offer ideas on how to approach interaction.9Make sure the environment encourages communication and interactionExploring different sensory experiences together promotes sharedcommunication e.g. objects to touch, sounds, things to look at or watch,opportunities for movement, things to taste and or smell.10Follow the principles of the Mental Capacity Act to support someoneto make a decision or if they lack capacity, act in their best interestsIt may be beneficial for the person to have an advocate who can make sure thateveryone who knows the person well is involved, communication tools, HAP’sand person centred plans are followed.

Eating & Drinking110 Top Tips for supporting the eating and drinkingneeds of people with PMLDSupporting eating & drinking needs falls within the expertise of a rangeof different professionals and agenciesVisit: www.rcplondon.ac.uk www.npsa.nhs.ukwww.cwt.org.uk/publications.html?ewld2Good nutrition is vital for good healthLook out for:• Visible weight loss• Changes in appetite• Changes in behaviour at mealtimesDietitians provide support for both oral and non-oral feeding regimes.www.bda.uk.comThe MUST is a useful screening tool for malnutrition. www.bapen.org.uk3Adequate hydration is vitalFluid can be given in a range of forms such as puddings, jellies, soups andsmoothies.4Chewing and swallowing can be problematic and coughing/choking at drink/mealtimes can lead to chest infectionsContact Speech and Language Therapy service so that a Dysphagia assessmentcan be carried out. Advice will be given re. best techniques and safest food/drink textures.To find a speech and language therapist visit: www.rcslt.org.uk5A good posture must be achieved during mealtimesContact local Physiotherapy service for advice.To find a Physio visit: www.csp.org.uk

Eating & Drinking6Adaptive crockery or cutlery or other mealtime aids can be beneficialContact local Occupational Therapy service for advice.To find an OT visit: www.cot.co.uk7Good oral hygiene can help prevent chest infectionsA Specialist Dentist or Oral Health Advisor can help. Contact local communitydental service or visit: www.dentalhealth.org.uk8Medication may be given in tablet/syrup/jelly or suspension form toassist swallowingContact local GP or local Pharmacist for advice.9Communicate informationEnsure ALL available advice is readily accessible to everyone involved inmealtimes and that a copy of guidelines is in the Health Action Plan.10When giving food/drink to someone:• Give choices wherever possible• Use the right utensils• Check the textures are correct• Consider the best environment for the person• Adjust your rhythm and pacing to suit the individualNB Find out what it feels like to be assisted by another person wheneating/drinking!

Posture & Mobility10 Top Tips for supporting the postural andmobility needs of people with PMLD1A 24-hour approach to postural-careIt is vital to consistently support posture throughout the day and night inorder to reduce the risk of complications associated with severe physicaldisability e.g. pain, pressure sores, spinal deformity, joint contractures andrespiratory infection.www.posturalcareskills.com2Details of local specialist postural-care therapists and otherprofessionals involved in care should be identified in the person’sHealth Action Plan (HAP)This will include:Physiotherapist/OTWheelchair therapist/servicesDistrict nurse3Postural-care guidelines and equipment should be agreed before theyare issuedClient and carers should be involved with assessment, selection and issue ofequipment and review to ensure equipment and guidelines are acceptable and‘fit’ with family life.4Clear photographic postural-care guidelines should be issued along withtraining and supportAsk the specialist therapist about this.5Contact a specialist therapist to support training in 24-hour postural-care

Posture & Mobility6Make sure that postural-care guidelines and equipment are reviewed aspart of an annual review of health needsIn order to reduce risk of complications, annual reviews should be arrangedwith your specialist therapist to establish whether equipment and guidelinesremain appropriate.7Be aware of any gain or loss of weight or a change in body shape“Made to measure” supportive equipment may no longer be appropriate andcould increase the risk of complications (see 1.)Arrange a review with a specialist therapist.8Be aware of skin integrity, don’t ignore areas of reddened, blistered orbroken skin. If you have concerns:• Contact a district nurse immediately for assessment, treatment and advice• Contact a specialist physiotherapist or occupational therapist as an urgentreview of postural-care and seating / lying equipment may be indicated.9The prescribed equipment should improve quality of lifeEquipment should be comfortable, enable purposeful activity and should notcause harm. Contact a specialist if concerned.10Hospital staff need to be aware of postural-care guidelines for anyadmission, this includes bathing and toileting needs

Key ContactsDoLS/MCA - LeadIndependent IMCABest Interest AssessorLearning Disability Liaison/LeadPREVENT Co-ordinator/LeadLocal Authority Adult Safeguarding LeadLocal Authority Contact/Referral CentreNamed Nurse, Child ProtectionNamed Doctor, Child ProtectionName: Email: Tel:

South of EnglandThis set of cards was produced in a partnership between NHS StrategicHealth Authority Adult Safeguarding Leads with thanks to the EastMidlands Safeguarding Adults Health Network, for the original idea.Sponsored by NHS South of England (East)Copyright © 2012Published June 2012Design & print:www.shoutpr.co.ukwww.trentpublications.com