Residential, Nursing & Care Newsletter Summer 2019 THE IMPORTANCE OF DOING FOR PEOPLE WITH ALZHEIMER'S MOVING & HANDLING TRAIN THE TRAINER 4 day course
REASSURANCE AS A FORM OF SUPPORT THE HYDRANT A free product
DO YOU SUPPORT CHILDREN? Latest edition of the Kidz to Adultz magazine
Charity number: 224742
Do You Get Frustrated Waiting for Occupational Therapy Assessments for Your Residents?
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The importance of doing for people with Alzheimer's...............…………………............................................4 Putting the care back into telecare……............…...…......…......…...…...……......…......…………...….....………..7 Moving and Handling - Update for Trainers course......……...………………...............………...…...……....……..9 In the Dock with an Expert Witness...…………………………………………………………………………………...…......11 Reassurance as a form of support...……………...…………………………………………………………………………….12 Kidz to Adultz magazine - 4th edition...……………………………………………………………...…………………………15 Supporting staff and residents with IBS...…………………………………………………………...…………………….....16 Reasons why carers are so important...…………………………………………………………………………………...…..19 Disabled Living's online shop......……………………………………………………………………………………………......21 New suppliers in Disabled Living's directory...………………………………………………………..………………….....22
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The Importance of ‘Doing’ for People with Alzheimer's
Jayne Watson, Occupational Therapist at Disabled Living talks about how activities can have a positive benefit for people with Alzheimer's. The article focuses on her mum's diagnosis and the different activities that help her. In 2016 my mum was diagnosed with Alzheimer's after a long battle to get a diagnosis. When she lost her partner, as a family we started to notice that she wasn't eating. She was losing weight and constantly fidgeting in her bag. My mum would often go out on her own carrying out her regular chores e.g. getting her pension, paying bills, and attending the local supermarket. Once we established her diagnosis carers were provided to offer support in order for my mum to make her meals 3 times a day. However on arrival, my mum would tell the carers that she had already eaten even though there were no signs of any meals being made. As my mum had capacity to make her own 4
decisions at that time, the carers would document what she said before leaving for their next visit. Every Monday mum would regularly do her weekly shopping then would visit the cafe for a pot of tea. However, when visiting the cafe and seeing pictures of food, this triggered an automatic response to eat.
She would often like to have fish and chips in the restaurant. One of the things I identified was that seeing pictures of her favourite foods, triggered hunger, which led to her independently ordering her own food. Having prompts at hand has enhanced her appetite and she is now gaining weight which improves her health and well-being. Being a professional crown green bowler and winning lots of trophies she loves being around people and socialising. My mum always went out on trips to the seaside as part of the bowling season and competed with other bowlers all over the the country.
However, having all her photographs around the home helps to keep her fond memories alive. Bingo is a very engaging activity which my mum has enjoyed for many years, so keeping up her tradition of going three times a week helps her to socialise with other people. In the past she always met her best friend of 50 years until passing away with dementia. My auntie was 6 years older and together had a very devoted friendship. When taking mum to bingo she would always sit in the same seat where she and her friends always sat together. My mum has fond memories and can still revert back to the times when they won big money which they would save in a pot for when they went on holidays together with their partners. Going to bingo is extreme fun and a great way of socialising with other people.
It seems such a shame that when her partner died all their friends seem to have disappeared being that she is no longer a couple. I have tried to get her back there as she talks a lot about her bowling experiences and mentions that she would like to return. Taking on board what mum said I attempted to take mum to join a new club local to where she lives. On joining, my mum become agitated and suddenly wanted to go back home. Although this was a big part of her life with her partner, the memories are too hurtful to start a fresh and meet new people. Sometimes you cant always get back what was once a very significant period of time.
Throughout her life she has always been great at socialising. This was mainly down to being an occupational therapy assistant within a hospital, helping people to get well and be active. Music has always been a passion whether listening to the radio or going to watch a musical.
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Having a keen interest in music my daughter took it upon herself to download old songs on her mobile phone so she can play the songs in the car while travelling to the shops. More often than not, my mum will sing her heart out speaking of all the clubs she used to go to with her partner and reminiscing over their favourite song that was meaningful to them both.
Some people with dementia may decide they want to continue to live successfully on their own, and can still engage in meaningful and fulfilling activities. By developing and using strategies, activities can be adapted to best suit the individual’s needs. To a certain extent, some people may give up on activities and interests due to memory loss. However, by breaking down the task it may be possible to modify the activity to suit the individual’s character and personality. Keeping my mum active seems to have slowed the process of the affects of her Alzheimer’s down. Although mum is not aware that she even has the disease, we have been able to adapt many activities that benefits her long-term needs.
Music can be a very powerful and meaningful activity that engages lots of people who find it difficult to communicate. It is very important to keep enjoying something that gives meaning to someone's life or provides a sense of pleasure or relaxation. Many people enjoy creative hobbies such as playing a musical instrument, knitting, gardening, photography, or even painting. Others enjoy social contact. Whatever the hobby, it is important to maintain activity into a person's life as much as possible. A person with dementia may enjoy an outing even if they don't remember where they have been. Yet the outing provides a purpose to their existence.
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Meaningful activities address underlying boredom, loneliness, frustration and lack of purpose or enjoyment. Responsive behaviours may be reduced when the person experiences pleasure, happiness, relationships, and a sense of purpose enhances well-being. Never underestimate the power of little things that are meaningful and fulfilling in someone's life. ‘Doing’ for any individual helps all of us to maintain a purpose in life and to feel connected with people to maintain positive outlooks and stimulate health and well-being.
Jayne Watson Occupational Therapist
Putting the Care Back into Telecare Supporting People Living with Dementia
Cost: ÂŁ750 plus VAT for up to 12 delegates.
Delegates will learn how to: Explain how one person’s dementia journey is very much an individual journey and describe how using relevant technology appropriately and at the right time, can support the management of risks and reduce the potential for harm for service users, carers and families. Learn how it can improve quality of life and support them to live independently for longer. It will also give a chance to network and learn from peers working on case study based learning. Leaving with real examples and a tool box of information to use in every day assessments.
For more information please visit: www.disabledliving.co.uk/training/bespoketraining/putting-the-care-back-in-to-telecare-day-two/ or contact the training team on 0161 607 8200 or email: training@disabledliving.co.uk
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Moving and Handling People - Train the Trainer Are you responsible for training others safe Moving and Handling in your role? Are you responsible for carrying out Risk Assessments and Handling plans?
Now a 4-day training course
Do you need to plan training courses and deliver your training to a variety of different people?
Content Relevant legislation and guidance Factors to be considered when carrying out a Manual Handling Risk Assessment How to carry out a Risk Assessment Techniques and equipment that can be used to reduce risk when Moving and Handling Correct techniques used to assist those with mobility needs and how to teach this to others Controversial techniques in order to teach people the safest way to move someone How to identify individual learning needs plus aims and objectives of a training session How to prepare a lesson plan How to deliver a session and evaluate a training session How to feedback and support when learning safe techniques
Dates 13th, 17th, 18th & 26th September 2019 4th, 8th, 11th & 15th November 2019 Presenter: Elizabeth Hallows Chartered Physiotherapist MCSP LPC (Back Care Management). Target Group: Nurses, Physiotherapists, Occupational Therapists and others who have responsibility for carrying out Manual Handling Risk Assessments and training. Cost: ÂŁ650 plus VAT - includes light lunch and refreshments, Open Awards registration, verification and certification. Venue: Disabled Living, Burrows House, Priestley Road, Worsley, M28 2LY How to book Booking forms can be completed on the Training Section of our website at: www.disabledliving.co.uk/training
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Individual bookings and bespoke group bookings for your organisation taken for this course.
Moving and Handling - Update for Trainers Have you updated your training delivery? Do you know the latest information and professional guidance available for your Moving and Handling training? Are you aware of recent legal cases which you can use to refresh and update the training you deliver?
This interactive training day will help you reflect how you train and assess learners. Offering a participative theoretical and practical session each delegate will achieve satisfaction that they have updated and consolidated their knowledge and skills related to their work. A wide range of topics can be included in the course which uses relevant legislation and current guidance, equipment and techniques.
Content Review of Law, Guidance and Legal Cases Law, guidance and legal case up-date: what’s new Assess implications of changes Review of Safe Manual Handling Principles and Techniques Practical Demonstration and Practical Workshops
Dates 19th September 2019 9th October 2019 Presenter: Elizabeth Hallows Chartered Physiotherapist MCSP LPC (Back Care Management) Target Group: Moving and Handling trainers and advisors. Cost: ÂŁ95 plus VAT - includes light lunch and refreshments Venue: Disabled Living, Burrows House, Worsley, M28 2LY How to book Booking forms can be completed on the Training Section of our website at: www.disabledliving.co.uk/training
Individual bookings and bespoke group bookings for your organisation taken for this course
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Bladder & Bowel UK's Adult Bowel Education Day - 26th September 2019
Price ÂŁ25 per delegate Venue Manchester
Thursday 26th September 2019 Are you a Healthcare Professional who works with adults in bowel care? Would it be beneficial to network with other professionals? Would you like to join a group and attend an education event where you can share ideas and benchmark evidence based practice? This interactive day offers Healthcare Professionals an opportunity to attend a variety of educational presentations and workshop sessions. It provides a platform to network with others who work with patient with bowel problems and attend the company exhibition and update on, current treatment, products and management options. In addition, you can join the group for ongoing virtual networking and support. This event provides an excellent opportunity to obtain CPD evidence providing 4 hours of participatory learning and is relevant to all nurses working within the continence arena
and will contribute towards the 20 hours of participatory learning required for re-validation. Topics to include: Cauda Equina Syndrome continence management Constipation, IBS Diarrhoea treatment and management , overview and case studies Pelvic pain management Update on bowel award winners project, MFT and SIA joint project – bowel management & HCP education in spinal cord injury Advanced management of faecal incontinence, constipation and obstructed defecation
It was a brilliant day. All training, networking and company reps stalls was very beneficial for my role. I learnt so much on the day, a valuable update for my knowledge. I look forward to the next event.
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Visit the Training BBUK section of our website under Professionals for more information: www.bbuk.org.uk
'In the Dock' with an Expert Witness
Click here to watch the video via our website
A Workshop for Healthcare Professionals Including Those Who Work in Residential, Nursing & Community Care There are different scenarios which could end up with someone being summonsed as a witness. Whether it is a coroner's court or a civil negligence case this workshop will help you to understand what will be required and how to improve your practice so that a court appearance will be less intimidating. Using real life scenarios, expert witnesses and solicitors will lead you through the process and highlight areas you can improve and share good practice in. On this interactive day you will work on a project which culminates in you appearing in the dock in front of a Judge and Jury. Find out how to protect yourself in your reporting and recording at work, what your responsibilities are and how to be confident in your work and not be afraid of being taken to court. Our next workshop Date: Thursday 10th October 2019 Venue: Manchester Cost: ÂŁ65 + VAT (includes light lunch and refreshments) Please visit our website to book your place and for more information: www.disabledliving.co.uk/training/our-workshops/in-the-dock-with-an-expert-witness/
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Reassurance as a Form of Support
Sam Smith, our regular contributor to the Disabled Living newsletters has been working with vulnerable adults with complex physical needs for 4 years, supporting them in their own homes to lead fulfilling lives. He helps promote independence, choice and inclusivity by putting the service user first and ensuring their voice is always heard. Supporting people to achieve long-term goals is one of Sam's main priorities. He does this through regular key-working sessions and evaluations. Sam will provide an insight into his day to day work, share his opinions and pass on invaluable tips. Every single person that I support is completely different with regards to their level of ability. Some of them are completely dependent on staff support for every aspect of their lives. However, there are also those for whom staff support is an occasional interference in their otherwise untethered lives. Now, you may think that the latter of the two is the more straightforward as they require only minimal support, but this isn't necessarily the case. Emotional support brings with it its very own set of nuanced challenges that simply aren't present with the more physical side of things. It can also be extremely difficult if, like me, you find difficulty in expressing your own feelings, let alone talking with another person about theirs.
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These clients can often accomplish a lot by themselves but will opt to have you do it for them because they believe it to be 'easier'. But really, it's no easier because it means in the future they'll ask more and more of you and do less and less for themselves. I think the key is to take it slowly and in stages to ensure they're able to advance comfortably at their own pace. An example of putting this into practice (and this is obviously dependent on the individual's ability level) could be that when you're getting your client ready of a morning, you ask them to put an item of clothing on whilst you make their breakfast. This then allows them time to do the required task at their own speed, without someone stood over them watching.
It does take time to synchronise to someone else's routine to that extent, and it's one of those things that will come naturally given time, rather than being forced early on. However, people are a strange breed, and will often take the easiest route when given a choice. A number of individuals I work with are capable of doing so much more than they let on, but are quite content to let other people do everything for them. This is because they're used to having everything done for them, hence they've grown accustomed to it. This means that having to then break this way of thinking becomes something of an uphill struggle, to say the least. What you're doing, in essence, is making things hard in the short-term to make them easier in the long-term. Quite often, however, the person you're supporting doesn't see things this way at all. Instead, what they choose to see is a staff member 'not doing their job' or 'telling them what to do'. They can't or won't look ahead to the future and what they could be achieving 3 months, 6 months, 1 year down the line; they tend to focus more on the here and now. So it pays dividends to be infinitely patient and don't be afraid to try different methods if the first one doesn't succeed. Go at their pace, go at your pace, talk to them on their level, try using clinical language, be hands-on, take a step back, and so on. Finding the right approach is key, and once you've come across one that works for you both, that's half the battle done.
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Consistency is also very important, and doubly so when you're working alongside a team. You need to ensure that every individual is on-board with whatever you decide and follows it to the letter. If you don't, you risk slipping back into old habits and you'll be wasting everybody's time. Going back to what I mentioned earlier regarding talking things through with clients, a good technique is to talk to people in pairs. This takes a lot of the pressure off you if the client isn't a big talker, as you can bounce things off of each other and build up more of a dynamic interaction. It also means, from a slightly more practical perspective, that one of you can do the talking, while one of you can document everything you discuss. Attempting all of this on your own means you may either miss out on something being said as you're writing it down, or you'll forget to write something down as you're too busy listening to what's being said. What a lot of this boils down to is trial and error, seeing what works for you and/or your clients, and sticking at it until such time as a change arises. Nothing I've put forward is likely to illicit an immediate outcome, rather it's to be persevered with, but you'll hopefully start reaping the benefits before too long, both for you and the people who you support!
Sam Smith Support Worker & Freelance Writer
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Do you care for children?
IT'S FREE!
Kidz to Adultz North Thursday 14th November 2019 9.30am – 4.30pm EventCity, Barton Dock Road, Manchester, M17 8AS
180+ EXHIBITORS FREE CPD SEMINARS CHILDREN WELCOME
One of the largest events supporting children & young adults up to 25 years with disabilities and additional needs, their families, carers and the professionals who support them.
Register at: www.kidzexhibitions.co.uk Tel: 0161 607 8200 Email: info@disabledliving.co.uk
#kidztoadultz Kidz to Adultz is a trademark registered to Disabled Living, Manchester. Established in 1897, Disabled Living, Charity registered with the Charity Commission for England and Wales. Registered Charity Number 224742.
4th Edition of Kidz to Adultz Magazine
The 4th edition of our Kidz to Adultz Magazine is now live online! The 44 pages are packed with interesting articles including: Olly Murs and Brainwave Charles Dickens Charity Link 24 Hour Postural Care ÂŁ18M Centre Opens Employing Personal Assistants Bedtime Worry-Free for Summer From School to Award Winner 70 Years of Life-Changing Work
Take a look at the new magazine via: https://issuu.com/disabledliving/docs/kidz_to_adultz_magazine _4th_issue?fr=xKAE9_zU1NQ You can also access the magazine via our Kidz Exhibitions website: www.kidzexhibitions.co.uk
Kidz to Adultz North Our next event is...
Thursday 14th November 2019 9.30am – 4.30pm EventCity, Barton Dock Road Manchester M17 8AS
Visit our website for more information: www.kidzexhibitions.co.uk/kidz-north
IBS - Supporting
Up to one in five individuals in the UK are affected by Irritable Bowel Syndrome (IBS), a longterm condition that affects the functioning of the digestive system. Often with debilitating symptoms including painful bloating, abdominal discomfort and extreme bowel changes, the condition may be persistent or flare up at times of heightened stress, emotional trauma or anxiety. If members of your staff have IBS, it’s sadly likely that they will feel embarrassed and frustrated by the symptoms that impact daily life. Debra Thomas BSc Registered Dietitian, says, “IBS can be debilitating and can have a significant impact on the lives of sufferers and even their families. People report avoidance behaviour such as refusing invitations for nights out, shopping and even holidays. It can also affect work negatively, with sufferers needing time off to manage their symptoms or visit their GP, but it can even affect the way people work in avoiding meetings.” Last year, a study by PrecisionBiotics found a staggering 48% of people thought to be suffering with IBS, put off going to see their doctor because of embarrassing bowel symptoms and miss out on the essential help they need. As a result of the impact IBS symptoms can have on daily life, the condition can also have a psychological impact on a person, resulting in mental illnesses such as depression.
Maintaining a healthy mindset along with managing IBS symptoms with self-care is important, as our mind and body are in tune with one another, and vice versa. Try these four steps to manage self-care with IBS. Exercise If constipation is a symptom you struggle with from IBS, exercise can be effective in calming these symptoms. Regular activity helps to keep the digestive system moving and regular exercise is not only essential for maintaining a healthy body, but also a healthy mind. Yoga is a great practice if you don’t enjoy high intensity workouts. Focusing on structured breathing exercises and complete mind-body synchronisation will not only help you relax, but ensure your body is moving and flowing to encourage healthy digestion.
Staff and Residents But taking care of yourself with simple adjustments can be an essential part of your daily routine, ensuring you make the most of your leisure time, not only for your mind, but the body too.
Sushma Manish PGDip, Ayurvedic yoga therapist details the benefits of yoga and digestion: “Yoga is all about attuning to the core of who we really are. We are complete, and to realise it we need to look within ourselves and be more vigilant about energy within, and our breathing. When we practise breathing techniques like pranayama (breath control), our mind calms down and everything becomes aligned. “The tridoshas (biological energies with the body that govern both physical and mental processes in the body) which keep fluctuating, come to a balance. This helps in proper secretion of digestive juices and leads to the correction of digestion. There is a close relation between the gut and mind as the practice of Ayurveda (a historical medicinal practice with Indian roots) has been highlighting for ages. Simple postures like the vajrasana (thunderbolt pose), padmasana (lotus pose), tadadana (mountain pose) and pranayama (breath control) will help a great deal.” If, however, you haven’t exercised regularly or the thought of exercise makes you uneasy, try a non-conventional form of exercise: dancing to your favourite playlist in your bedroom, jigging to the radio when doing the washing or simply going for a walk with a friend. Relaxation As we lead busy lives, it’s easy to forgo self-care when the washing needs doing, a report needs submitting or daily life in general gets in your way.
Instead of sitting on the sofa in the evening, try lying flat, with your arms outstretched. Lying flat helps to release tension in muscles and joints and encourages easy blood flow around the body. This leads on to ensure you get enough sleep. If you’re struggling to sleep due to pain and discomfort, soothe those physical pains with a hot water bottle or non-caffeinated drink. Heat can help relax cramping muscles which may be stopping you drift off to sleep. Good quality sleep is essential for the body to recover from exertion, both physical and mental. Mental Health Our mind is incredibly receptive to our physical body, and vice versa. If one is out of whack, the other is sensitive to this unbalance. Our bodies are in tune with our minds, and if you suffer with anxiety, it’s possible your IBS symptoms may flare up at times of heightened anxiety. Maintaining a healthy mind can be highly effective in your treatment for IBS, with a variety of treatments available including talk therapies, CBT and other forms of medication that your GP can advise. This is particularly important in managing everyday stressors and your IBS.
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Stress The research published by PrecisionBiotics found stress to be the biggest trigger for IBS, so it’s helpful to learn effective coping mechanisms for everyday stressors. Relaxation therapies including mindfulness and daily meditation practice can help to focus the mind in the present, and give yourself a little headspace. Complementary therapies such as Hypnotherapy, recognised by the National Institute for Health and Care Excellence as a treatment option for IBS, can be highly effective in relieving stress and anxiety, using the power of suggestion and the deep unconscious.
Irritable Bowel Syndrome can often be a lonely condition, with complicated or misunderstood symptoms making leaving you isolated and embarrassed. If symptoms become so debilitating that they affect your everyday life, and essentially the quality of your life, it may be time to speak with a professional, whether that’s your doctor, counsellor or nutritional therapist. You might also discover that you aren’t alone with those closest to you when it comes to IBS. It’s important to consult your GP or qualified nutritional therapist before trying new dietary approaches or supplements. www.nutritionist-resource.org.uk Written by Katie Hoare Nutritionist Resource
The Hydration Foundation The Hydration Foundation was established to raise funds to be able to deliver the multiple award winning Hydrant hands free drinking systems free of charge to vulnerable people in community. See www.hydrateforhealth.co.uk for more information. As such we would like to offer Hydrants free of charge to those who need them, and to the professionals who support them. All we need to know is where to send them to so if people are interested they should simply send us an email with a delivery address to request@thehydrationfoundation.org Vist www.thehydrationfoundation.org for more information.
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Top 10 Reasons Why Carers Are So Important
At Disabled Living we interact with so many people who rely on carers – those who come to the They see things Disabled Living Centre for assessments, clients coming to our Redbank House sensory rooms and the thousands (yes thousands!) who support the young people and their parents visit the Kidz fromwho a greater to Adultz exhibitions. The contribution many carers make to improve the quality of life for the people perspective they support and their families should not be underestimated, that is why we thought we would ask the question ‘Why are carers so important to you? Take a read of our top 10 answers and thank you for caring! 1. The number of older people is rising which means more carers are needed 2. Carers do their best around challenging circumstances 3. Carers dedicate a lot of time in their role 4. They are compassionate and want to make a difference 5. Their experience and professionalism creates a lot of great empathy 6. They create a resilient working environment 7. They see things from a greater perspective 8. They provide company just by being there for somebody 9. They deal with personal situations –personal physical care or listening 10. They do their utmost to make sure a person is happy and comfortable
www.disabledliving.co.uk/blog/why-carers-are-important
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NHS Health Information Available Through Amazon's Alexa
Photo by seewhatmitchsee on Shutterstock.com
The NHS is collaborating with Amazon to provide reliable health information from the NHS website through voice-assisted technology. The technology will help patients, especially the elderly, blind and those who cannot access the internet through traditional means, to get professional, NHS-verified health information in seconds, through simple voice commands. Amazon’s algorithm uses information from the NHS website to provide answers to voice questions such as: "Alexa, how do I treat a migraine?” "Alexa, what are the symptoms of flu?” "Alexa, what are the symptoms of chickenpox” The technology has the potential to reduce the pressure on the NHS and GPs by providing information for common illnesses. Voice search has been increasing rapidly. By 2020, half of all searches are expected to be made through voice-assisted technology.
For more information visit: www.gov.uk/government/news/nhs-health-informationavailable-through-amazon-s-alexa
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New NICE/SCIE Quick Guide - Giving Medicines Covertly Adults should not be given medicines covertly unless they have been assessed as lacking the mental capacity to make decisions about their health or medicines. This quick guide will help care home and home care managers to ensure that decisions about giving medicines covertly are made in the person’s best interests. The guide, available online and as a PDF, will also be very useful for staff training. For more information please visit: www.scie.org.uk/home-care/medicine/giving-medicines-covertly
Visit Disabled Living's Online Shop
Visit Disabled Living's Online Shop
Visit: www.disabledliving.co.uk/online-shop or call: 0330 053 5930.
We are delighted to be working in partnership with Complete Care Shop to provide you with a comprehensive online shopping facility for equipment and products to make life easier. Complete Care Shop has over 250,000 in stock items at competitive prices offering you choice from a wide range of manufacturers including mobility aids, daily living products, continence supplies together with telecare and telehealth equipment. In addition, Complete Care Shop has a reputation for excellent customer service which made the decision to enter into this partnership an easy decision to make! The main advantage of purchasing via the Disabled Living website, is the opportunity for you or your clients to speak to Occupational Therapists or Continence Specialists for free impartial help and advice, ensuring unnecessary purchases are not made.
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Welcome to Our Supplier Directory The following suppliers have recently joined our directory...
HERE'S THE EASY WAY TO FIND WHAT YOU ARE LOOKING FOR... The Disabled Living Supplier Directory provides information about companies and organisations that provide equipment, products and services to support disabled children, adults and older people. You'll find the Supplier Directory on our website. www.disabledliving.co.uk
Get in touch with us
For more information please visit: www.disabledliving.co.uk
Disabled Living Head Office - Disabled Living, Burrows House, 10 Priestley Road, Wardley Industrial Estate, Worsley, Manchester M28 2LY Tel: 0161 607 8200 Email: info@disabledliving.co.uk Website: www.disabledliving.co.uk