In the UK currently it is estimated that there are 800,000 people living with dementia1.
Despite an improvement in the prevalence of advance care plans, people with dementia are still being admitted to and dying in hospital.
Reports looking at dementia2 and end of life care services3 have demonstrated a poor standard of care to those at the end of life, in wards that are failing to provide a person centred approach to care.
In response to this, I decided to implement the first ever hospital based Namaste Care programme.
Namaste Care is an end of life care programme designed to support the needs of people living with advanced dementia4.
The programme was designed by a social worker, Professor Joyce Simard, in the USA. It combines staff education, sensory stimulation/meaningful activity, carer support, advance care planning and after death care.
The programme has been hugely successful in care homes all over the world, demonstrating improvements in quality of life for patients, families and staff; increased nutrition and hydration intake and fewer inappropriate admissions to hospital5,6,7.
The name ‘Namaste’ originates from the Hindu greeting which means ‘honour the spirit within’.
Namaste Care incorporates best practice dementia care and best practice end of life care by using a person centred approach with the aim to provide quality of life, comfort, dignity and a ‘good death’4.
As a service, Namaste Care is traditionally provided for a minimum of four hours per day, seven days per week and is delivered in a designated space or at the person’s bedside.
The key elements of Namaste Care are: honouring the person as an individual, providing company through the presence of others, comfort care and multi-sensory stimulation.
Meaningful activity is integrated with nursing care and reminiscence work is used to connect and communicate with the person. The approach does not require extra staff or a new space.
The major aim of Namaste Care is to create meaningful and relaxing experiences for the person with advanced dementia.
Meaningful activity is integrated with nursing care and special emphasis is given to patient hydration and offering sweet treats and nourishments4,7.
Usual activities include: hand and foot massage, soaking of feet, gentle coming of hair and other personal grooming specific to the likes and wants of the patient – these are often incorporated into personal care and delivered with music to provide calm reassurance to the person.
The care session is open and patient-led. Family members and friends are encouraged to visit the Namaste care room and encouraged to get involved with delivery of the programme.
Other aims include increasing staff confidence in caring for people, and carers of people, with advanced dementia, assessment and support for carers, completion of advance care planning and after death care.
I conducted a pilot study which aimed to explore how accepted and effective Namaste Care is when serving patients with advanced dementia on an acute ward in a busy inner city teaching hospital.
Semi-structured face-to-face interviews with healthcare staff working in an area that Namaste Care was implemented in were conducted. A total of eight interviews with care staff were completed.
Staff at the hospital received training through a keynote presentation from Professor Simard; Namaste Care was delivered by activity coordinators and healthcare support workers with patients receiving one-to-one care for twenty minutes three times per week and tactile care incorporated into personal care when required. Staff worked in this way for two weeks prior to interview.
The results from this study mirror those found by Simard and Volicer5, Trueland6 and Stacpoole et al7 which evaluated the Namaste Care service in care homes.
To participants, Namaste Care symbolised quality, demonstrating true person centred care.
It was understood to be an activity that promoted well-being, while enriching quality of life.
The service was understood to be flexible, reacting to a person’s needs in the environment that was best suited to the person.
All participants felt that Namaste Care helped them in caring for people with advanced dementia, although some participants were more moved than others. Interviews varied in duration from one and a half to 15 minutes.
One participant delivered a powerful point commenting on the restrictions of rules and regulations within the National Health Service, which had left some staff members feeling scared to use a tactile approach while caring for people with dementia.
One participant noted that Namaste Care had given them the confidence to be able to touch a patient in a caring way, to which the participants’ response was emotional and moving.
Namaste Care had given this participant the confidence to connect with the patient through caring contact. Another staff member described Namaste Care as soothing, both for the staff delivering the care and the person receiving.
With current national focus on reintroducing compassion to the national health system, Namaste Care appeared to practically equip staff with the confidence and skill to care compassionately.
This pilot was led by healthcare support workers and activity coordinators, who were excellent in delivery of care but not trained to assess carers, complete advance care plans or in a position to lead after death care.
It is therefore recommended that future Namaste Care hospital programmes are led with support from a palliative care team.
 Alzheimer’s Society (2014) Statistics. London: Alzheimer’s Society.
 Department of Health (2013) Dementia: a State of the Nation report on Dementia and Support services in England. London: DH
 Department of Health (2012) End of life care strategy: Fourth Annual Report. London: DH
 Simard, J. (2013) The end of life Namaste Care Programme for people with dementia. 2nd edition, Baltimore, MD: Health professions press.
 Simard J and Volicer L (2010) Effects of Namaste Care on patients who do not benefit from usual activities. Americal journal of Alzheimer’s Disease and Other Dementias. 25, 46-50.
 Tueland J (2012) Soothing the senses. Nursing standard 26, 20-22.
 Stacpoole M, Hockley J, Thompsell A, Simard J, Volicer L (2013) Implementing the Namaste Care programme for People with Advanced Dementia at the End of their Lives: an Action Research Study in Six Care Homes with Nursing. London, St Christopher’s Hospice.