Care homes are an increasingly important part of the UK’s healthcare system. Despite their importance, particularly in providing care for older people with complex needs, the sector is often disadvantaged and overlooked by commissioners, policymakers and researchers. The authors provide an overview of some important challenges for the sector. These challenges relate to funding, education and research, overseas staff, career pathways and staff recruitment and retention.

They conclude that recruitment and retention of registered nurses is arguably the greatest challenge, as high staff turnover is the catalyst for other challenges identified.

The care home sector should be considered as equal to hospitals, community settings and hospices. Care homes offer registered nurses many opportunities for development of clinical and organisational skills.

This article, the second of two, provides healthcare practitioners with an overview of best practice in palliative and end-of-life care, including nutrition, hydration, oral hygiene and pain management. Communication and spiritual care are discussed, as well as care after death. Providing support and education for families is an important aspect of palliative and end-of-life care. Care home nurses should ensure that the person living with dementia is at the centre of decision making, and provide care that is inclusive of their needs and wishes. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes

The terms palliative and end of life care are often used interchangeably and healthcare practitioners may perceive that palliative care is only appropriate during the terminal stages of an illness. This article, the first of two parts, provides healthcare practitioners with an overview of the concept of palliative care. It explains how this can be differentiated from end of life care and how it should be commenced in a timely manner, so that people who are living with dementia can contribute to the planning of their future care and death. The policies and tools used in the provision of palliative and end of life care are discussed, including advance care planning and The Gold Standards Framework. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. The second part of this article will discuss end of life care and the best practices for providing end of life care, including nutrition and hydration, oral hygiene, pain management and spiritual care.

Aim To present a narrative review of the empirical literature on the use of horticultural therapy in dementia care.

Method A comprehensive literature search, conducted in December 2014, resulted in the selection of 15 primary research articles for review. Of these, three used qualitative methods, five used quantitative methods and seven used mixed methodology. The articles were critically appraised, and the narrative synthesis used a thematic approach whereby prominent themes from the articles were grouped to form representative themes.

Findings Three main themes emerged from the narrative synthesis: the emotional health of people living with dementia, their perceived self-identity and their levels of engagement.

Conclusion Horticultural therapy can be beneficial. At a macro-level, it is an inexpensive therapy that does not require specialist training to deliver. At a micro-level, it enhances the wellbeing of people living with dementia. Recommendations are made to promote access to appropriate horticultural therapy for people living with dementia, and for further research in this area.

Person-centred dementia care has been emphasised in health services for a number of years. However, one fundamental but rarely considered aspect of such care is the importance of a person’s culture or ethnicity.

This book takes 40 myths and stereotypes related to ageing and older people and explores them for accuracy.

Distress is one of the most common clinical manifestations associated with dementia. Pharmacological intervention may be appropriate in managing distress in some people. However, best practice guidelines advocate non-pharmacological interventions as the preferred first-line treatment. The use of non-pharmacological interventions encourages healthcare professionals to be more person-centred in their approach, while considering the causes of distress. This article provides healthcare professionals with an overview of some of the non-pharmacological approaches that can assist in alleviating distress for people living with dementia including: reminiscence therapy, reality orientation, validation therapy, music therapy, horticultural therapy, doll therapy and pet therapy. It provides a summary of their use in clinical practice and links to the relevant literature.

There is a plethora of literature on person-centred care and its importance in health care. The principles of person-centred care are especially important for people living with dementia because of the clinical manifestations of the disease. This article intends to provide nurses with an overview of the work of Tom Kitwood and how it pertains to providing best practice in dementia care. Various person-centred theories have been developed. However, Kitwood’s work is by far the most widely referred to in dementia care. An understanding of Kitwood’s ideas, in particular those of malignant social psychology and positive person work, enables nurses to develop competence in delivering optimum person-centred care to people with dementia in clinical practice.

Many people living with a dementia are either not recognised as having pain or do not receive effective treatment. Currently 50% of older adults living with dementia in nursing home settings have been identified as having pain, but about half of these may be unable to communicate their experience and so do not receive pain relief or treatment. The person’s resulting distress may manifest as ‘challenging behaviour’ that is often attributed to the dementia and is not appreciated as a reaction to an unmet need such as pain. Evidence suggests that if ‘challenging behaviour’ occurs in a person living with a dementia, prompt use of validated pain assessment and improved, person-centred pain management can reduce the distress and improve the quality of life for the service user, staff and other care-givers. This will involve appropriate training of practitioners and also multi-agency collaboration.