'You can't just put somebody in a situation with no armour'. An ethnographic exploration of the training and support needs of homecare workers caring for people living with dementia.

BACKGROUND: Homecare workers carry out complex work with people living with dementia, while under-supported, undervalued and undertrained. In this ethnographic study, we explore the skills, training and support needs of homecare workers supporting people living with dementia. RESEARCH DESIGN AND METHODS: We conducted 82 interviews with people living with dementia (n = 11), family caregivers (n = 22), homecare staff (n = 30) and health and social care professionals (n = 19) and conducted 100-hours of participant observations with homecare workers (n = 16). We triangulated interview and observational findings and analysed data thematically. RESULTS: We developed four themes: 1) 'Navigating the homecare identity and role': describing challenges of moving between different role identities and managing associated expectations, 2) 'Developing and utilising relational and emotional skills': boundaries between caring and getting emotionally involved felt blurred and difficult to manage, 3) 'Managing clients who resist care': homecare workers experienced clients' reactions as challenging and felt "thrown to the wolves" without sufficient training, and 4) 'Drawing on agency and team support': homecare work could be isolating, with no shared workplace, busy schedules and limited opportunity for peer support. DISCUSSION AND IMPLICATIONS: It is important that training and support for homecare workers addresses the relational, emotional and rights-based aspects of the role. Where a flexible, responsive, person-centred service is required, corresponding training and support is needed, alongside organisational practices, taking account of the broader context of the homecare sector.

Culturally tailored therapeutic interventions for people affected by dementia: a systematic review and new conceptual model.

Most people with dementia live in low and middle-income countries (LMICs) and there is an increased dementia prevalence in some minority ethnic groups in high-income countries. However, most interventions are devised for majority populations in high-income countries. We systematically searched 11 electronic databases for culturally tailored interventions for people with dementia and their family carers in LMICs and minority ethnic groups, without limit on language or date. 23 of 22 221 studies fulfilled inclusion criteria. Interventions adapted peripheral intervention components by, for example, translation and reducing the stigma of psychological therapy by emphasising physical illness and learning. Core therapeutic components were not changed. We found evidence-based, multicomponent interventions adapted for Latinx carers were acceptable, feasible, and effective in the USA and Columbia. Interventions developed for carers in India were effective there but not in other LMICs. Culturally adapted cognitive stimulation therapy was acceptable and effective for people with dementia in sub-Saharan Africa. We propose a new conceptual model from our findings to aid implementation of culturally appropriate treatments for people affected by dementia in LMICs and minority ethnic groups. Evidence-based interventions need cultural adaptation for different settings with therapeutic components retained. If they are acceptable, feasible, and remain effective then full effectiveness trials are unnecessary.