Purpose

To reduce the   risk of heat-related illness for Dementia Active members, particularly those   who are more vulnerable due to age, dementia, reduced mobility, reduced   ability to communicate discomfort, underlying health conditions, medication,   dehydration risk, or living arrangements.

1. Policy statement

Dementia Active recognises that people living with dementia may be at increased risk during hot weather. Some members may not recognise that they are becoming too hot, may forget to drink, may be unable to explain how they feel, or may find it harder to regulate their activity and clothing.

During periods of hot weather or a Heat-Health Alert, Dementia Active will take a cautious and person-centred approach. The safety and wellbeing of members, staff and volunteers will come before attendance at group sessions.

Where appropriate, Dementia Active will encourage more vulnerable members to stay with loved ones during heatwave periods. Members who live alone may be safer attending a Dementia Active group where they can be observed, supported, kept in company, and prompted to drink regularly, provided the group environment is suitable and the member can travel safely.

2. Heatwave trigger points

This policy will be considered active when any of the following apply:

· A UKHSA/Met Office Heat-Health Alert is issued for the relevant area.

· A Met Office extreme heat warning is issued.

· Local temperatures are forecast to be unusually high.

· A Dementia Active centre is assessed as too warm or unsuitable for safe group delivery.

· Staff judge that heat, travel, ventilation, hydration or member vulnerability creates a foreseeable risk.

Dementia Active does not need to wait for a formal red or amber warning before taking precautionary action.

3. Members most likely to be at risk

Extra consideration should be given to members who:

· live alone;

· live in a care home;

· have advanced dementia or significant cognitive impairment;

· are unable to communicate thirst, discomfort, dizziness or feeling unwell;

· have poor mobility, poor balance, reduced core strength or fatigue;

· are unable to manage stairs safely;

· have heart, lung, kidney, diabetes or other long-term health conditions;

· take medication that may increase heat or dehydration risk;

· rely on transport that may become hot or delayed;

· need close personal support with drinking, toileting, mobility or eating.

4. Attendance guidance during heatwaves

4.1 Members who can stay with loved ones

Where a member is particularly vulnerable and has family, friends or loved ones available, Dementia Active will encourage them to stay with those loved ones during heatwave periods, especially on the hottest days.

This is because they may be safer in a familiar home environment where they can rest, avoid travel, remain cool, and receive one-to-one support.

4.2 Members who live alone

Members who live alone should not automatically be encouraged to stay at home during a heatwave.

Where the home environment may be isolated, poorly monitored or at risk of overheating, the member may be safer attending a Dementia Active group, provided the centre environment is suitable. Group attendance allows staff and volunteers to:

· monitor the member’s wellbeing;

· prompt regular drinks;

· observe signs of heat-related illness;

· reduce isolation;

· ensure the member is not left unsupported during the hottest part of the day.

A judgement should be made case by case, considering the member’s health, transport, home circumstances and the temperature of the group venue.

4.3 Members living in care homes

During a heatwave, Dementia Active will strongly encourage members living in care homes not to attend group sessions.

Care homes are expected to have their own heatwave procedures, staffing and monitoring arrangements. Travelling to and from group, spending time in a warm venue, and disruption to care routines may increase risk.

Where a care home still wishes a resident to attend, Dementia Active should ask the care home to confirm that attendance is safe and appropriate, including transport arrangements, hydration, medication considerations and the member’s ability to cope in the group environment.

5. Venue-specific considerations

Dementia Active recognises that not all centres have the same level of cooling, ventilation or air conditioning.

The following venues require particular caution because they are not fully air conditioned:

· Banbury Centre

· Carterton Centre

During hot weather, these centres should be assessed before and during sessions. Staff should consider room temperature, ventilation, access to shade, availability of cool drinking water, member mobility, staffing levels and whether the session can be safely delivered.

As a practical benchmark, Dementia Active will strongly suggest that members who cannot manage a flight of stairs due to reduced core strength, stamina or mobility may not cope well in an area that is not air conditioned.

This benchmark is not intended to exclude members unfairly. It is a safety guide to help identify people who may be more vulnerable to heat stress, fatigue, dehydration or reduced physical resilience.

6. Actions before a heatwave

When hot weather is forecast, Dementia Active staff should:

· check UKHSA/Met Office heat-health information;

· identify members who may be more vulnerable;

· contact families, carers or care homes where appropriate;

· discuss whether attendance is advisable;

· remind members and carers to bring water, wear light clothing and avoid unnecessary exertion;

· check that venues have drinking water available;

· consider reducing session length, changing activities or cancelling sessions if needed;

· check transport arrangements, including whether vehicles may become too hot;

· ensure staff and volunteers know the signs of heat exhaustion and heatstroke.

7. Actions during group sessions

During hot weather, staff and volunteers should:

· encourage members to drink regularly, even if they do not ask for a drink;

· offer water frequently and record concerns where appropriate;

· avoid strenuous physical activity;

· use shaded or cooler areas where possible;

· keep curtains or blinds closed where this helps reduce heat;

· increase ventilation where safe and practical;

· avoid unnecessary outdoor time during the hottest part of the day;

· monitor members for changes in behaviour, confusion, agitation, tiredness, dizziness, headache, nausea, weakness, cramps, flushed skin, excessive sweating or lack of sweating;

· escalate concerns promptly to the duty lead, family, carer, care home, NHS 111 or 999 depending on severity.

8. Transport considerations

Transport should be reviewed during heatwave periods. Staff should consider:

· whether journeys are essential;

· whether the vehicle is cool enough before members board;

· whether water is available;

· whether delays are likely;

· whether a member may become distressed or overheated during travel;

· whether a shorter route or reduced passenger load is needed;

· whether attendance should be cancelled for individual members.

No member should be transported if staff believe the journey creates an unreasonable heat-related risk.

9. When sessions may be changed or cancelled

Dementia Active may adapt, shorten, relocate or cancel sessions during hot weather.

Reasons may include:

· unsafe room temperatures;

· lack of ventilation or cooling;

· high-risk members due to attend;

· insufficient staff or volunteers to monitor members safely;

· transport risk;

· care home advice;

· Met Office or UKHSA warnings;

· staff judgement that the session cannot be delivered safely.

Where sessions are cancelled or changed, staff should prioritise communication with members who live alone or who may be at greater risk of isolation.

10. Communication with families, carers and care homes

During heatwave periods, Dementia Active will communicate clearly and early with members, families, carers and care homes.

Communication should explain the reason for any attendance advice, changes to sessions or cancellations, and should make clear that safety and wellbeing are the priority.

Staff should record any significant attendance decisions, concerns raised by families or care homes, and any advice given.

11. Emergency response

If a member appears seriously unwell, staff should act immediately.

Call 999 if a member has symptoms such as collapse, loss of consciousness, severe confusion, seizure, very hot skin, rapid deterioration, or symptoms that suggest heatstroke.

For less severe but concerning symptoms, staff should contact the member’s family, carer, care home, GP, NHS 111 or emergency services as appropriate.

The incident should be recorded according to Dementia Active’s usual incident reporting procedure.

12. Staff and volunteer wellbeing

Staff and volunteers are also at risk during hot weather. Dementia Active will encourage regular drinks, rest breaks, suitable clothing, reduced exertion and early reporting of feeling unwell.

Staff should not be expected to work in unsafe heat conditions.

13. Review

This policy should be reviewed:

· before each summer season;

· after any heatwave-related incident;

· after any session cancellation due to heat;

· if UKHSA, Met Office, NHS or local authority guidance changes;

· if venue cooling, air conditioning or layout changes.

Guidance sources

This policy should be read alongside current UKHSA, Met Office, NHS and local authority heat-health guidance.

For members, families, carers, care homes, staff, volunteers and transport arrangements

Policy owner : Dementia Active

Applies to : All Dementia Active groups, staff, volunteers, members, families, carers, care homes and transport arrangements

Review period : Annually before   summer, and after any significant heatwave incident

1. Policy statement

Dementia Active recognises that people living with dementia may be at increased risk during extreme winter weather. Some members may not recognise or communicate that they are cold, tired, frightened, unsteady, unwell or unsafe. Cold weather, snow and ice can increase the risk of falls, injury, distress, chest infections, confusion, delayed journeys and transport incidents.

During periods of extreme winter weather, Dementia Active will take a cautious and person-centred approach. The safety and wellbeing of members, staff, volunteers and drivers will come before attendance at group sessions.

Where winter conditions create a foreseeable risk, Dementia Active may adapt, shorten, relocate or cancel sessions, and may decide that individual members should not be transported or should not attend.

2. Winter weather trigger points

This policy will be considered active when any of the following apply:

· A UKHSA Cold-Health Alert is issued for the relevant area.

· A Met Office weather warning is issued for snow, ice, rain, wind, fog or low temperatures.

· Local roads, pavements, car parks or access routes are affected by snow, ice, flooding or poor visibility.

· Local temperatures are forecast to be very low, especially where members may be waiting outside or travelling.

· Staff, volunteers or drivers judge that conditions are unsafe.

· Public transport, local schools, care homes or community services are disrupted due to weather.

· A venue cannot be safely accessed, heated or staffed.

Dementia Active does not need to wait for a red or amber warning before taking precautionary action. Local knowledge and staff judgement are important, especially where small roads, rural routes, hills, untreated surfaces or member mobility needs create additional risk.

3. Members most likely to be at risk

Extra consideration should be given to members who:

· live alone;

· live in a care home;

· have advanced dementia or significant cognitive impairment;

· are unable to communicate feeling cold, frightened, dizzy, tired or unwell;

· have poor mobility, poor balance or a history of falls;

· use a wheelchair, walking frame, stick or require physical assistance;

· are unable to safely manage steps, kerbs, slopes or uneven surfaces;

· have reduced core strength, stamina or confidence when walking;

· are at risk of chest infections or have heart, lung, circulation or other long-term health conditions;

· may become anxious or distressed during delayed journeys;

· may remove coats, gloves or warm clothing due to confusion;

· need support with toileting, eating, drinking, medication or personal care;

· rely on Dementia Active transport or family transport to attend.

4. Main winter weather hazards

4.1 Transport hazards

Transport is one of the highest-risk areas during extreme winter weather.

Hazards may include:

· icy or untreated roads;

· snow-covered roads or pavements;

· poor visibility from fog, rain, sleet or snow;

· increased stopping distances;

· delayed journeys;

· vehicle breakdowns;

· members becoming cold, distressed or confused while waiting;

· difficulty assisting members safely in and out of vehicles;

· wheelchair ramps or vehicle steps becoming slippery;

· unsafe parking or drop-off points;

· carers, staff or drivers needing to walk members across icy surfaces;

· rural roads becoming difficult or unsafe before main roads are affected.

No member should be transported if staff or drivers believe the journey creates an unreasonable risk.

4.2 Falls and injury risk

Snow, ice, slush and wet flooring can significantly increase the risk of slips, trips and falls.

Members living with dementia may not judge hazards accurately, may rush, may not use mobility aids correctly, or may need close physical support. A fall in cold weather may have serious consequences, particularly if a member is frail or has poor balance.

Particular care should be taken around:

· car parks;

· pavements;

· entrances and exits;

· ramps;

· steps;

· kerbs;

· toilet areas;

· wet floors;

· tiled or hard flooring;

· areas where snow or rain is walked into the building.

4.3 Cold exposure

Cold weather can affect members before, during and after group sessions. Risk may increase if members are waiting for transport, delayed in traffic, wearing unsuitable clothing, or unable to explain that they are cold.

Staff should be alert to:

· shivering;

· pale or cold skin;

· unusual tiredness;

· increased confusion;

· slower movement;

· distress or agitation;

· shortness of breath;

· chest discomfort;

· reduced alertness;

· refusing food or drink;

· seeming unusually quiet or withdrawn.

4.4 Venue hazards

A group venue may become unsuitable if:

· heating is not working properly;

· the building is cold on arrival;

· entrances, paths or car parks are icy;

· lighting is poor;

· toilets are difficult to access safely;

· emergency exits or routes are affected;

· staff or volunteers cannot arrive safely;

· the venue cannot be opened, heated or supervised in time.

5. Attendance guidance during extreme winter weather

5.1 Members who can stay safely with loved ones

Where a member is particularly vulnerable and has family, friends or loved ones available, Dementia Active may encourage them to stay at home with support during extreme winter weather, especially where travel would involve snow, ice, freezing conditions or difficult walking surfaces.

This may be safer than travelling to group, particularly if the member has poor mobility, poor balance, reduced stamina or high anxiety during journeys.

5.2 Members who live alone

Members who live alone should not automatically be left without contact during winter weather.

Where sessions are cancelled, transport is unsafe, or attendance is not advised, Dementia Active should consider whether welfare contact is needed. This may include a phone call to the member, family, carer or other support contact.

Where a member lives alone and the route, transport and venue are safe, attending group may provide warmth, supervision, food, drinks, social contact and reassurance. This decision should be made case by case.

5.3 Members living in care homes

During extreme winter weather, Dementia Active will strongly encourage care homes to consider whether residents should remain at the care home rather than travel to group.

Care homes are expected to have their own winter weather procedures, staffing and monitoring arrangements. Travelling to and from group may increase risk, especially where members are frail, have poor mobility, use wheelchairs, or may become cold or distressed during delays.

Where a care home still wishes a resident to attend, Dementia Active may ask the care home to confirm that attendance and transport are safe and appropriate.

6. Transport decision-making

Dementia Active will assess transport safety before agreeing that members should travel.

The following should be considered:

· current and forecast weather;

· Met Office warnings;

· local road conditions;

· condition of car parks, pavements and entrances;

· whether the route includes hills, rural roads or untreated areas;

· whether drivers can travel safely;

· whether members can be safely assisted in and out of vehicles;

· whether wheelchairs, ramps or mobility aids can be used safely;

· whether delays are likely;

· whether members may be exposed to cold while waiting;

· whether staff will be available at the venue when members arrive;

· whether return journeys may become more dangerous later in the day.

Transport may be cancelled even if the group session remains open. Equally, the group may be cancelled if transport risks make attendance unsafe for a significant number of members.

7. Vehicle safety and member support

Where transport is operating during cold or unsettled weather, staff and drivers should consider:

· allowing extra journey time;

· reducing passenger numbers if this improves safety;

· checking that members are wearing suitable coats and footwear;

· ensuring wheelchairs and mobility aids are secured;

· avoiding rushed boarding or disembarking;

· using the safest available drop-off point;

· avoiding icy slopes, kerbs or uneven ground where possible;

· keeping members warm if waiting is unavoidable;

· carrying contact details for family, carers and care homes;

· reporting any near miss, fall, distress or transport concern.

Drivers should not be pressured to continue a journey if they feel it is unsafe.

8. Venue preparation

Before a session goes ahead in winter weather, staff should check:

· heating is working and the room is warm enough;

· entrances and exits are safe;

· paths, ramps and car parks are clear enough for safe access;

· wet floors can be dried and monitored;

· lighting is adequate;

· toilets are safely accessible;

· drinks and warm refreshments are available where possible;

· staff and volunteers can attend safely;

· emergency contact details are available;

· the weather is unlikely to worsen before members return home.

If safe access cannot be provided, the session should be cancelled or moved where possible.

9. When sessions may be changed or cancelled

Dementia Active may adapt, shorten, relocate or cancel sessions during extreme winter weather.

Reasons may include:

· snow or ice affecting roads, pavements, car parks or entrances;

· Met Office warnings for snow, ice, wind, rain or fog;

· UKHSA Cold-Health Alerts;

· unsafe transport routes;

· drivers, staff or volunteers unable to travel safely;

· heating failure or cold indoor temperatures;

· high risk of falls;

· unsafe access for wheelchairs or mobility aids;

· likely delays to return journeys;

· care home advice;

· staff judgement that the session cannot be delivered safely.

A decision to cancel should be made as early as reasonably possible. However, Dementia Active may cancel at short notice if conditions deteriorate.

10. Communication with members, families, carers and care homes

During winter weather, Dementia Active will aim to communicate clearly and early.

Communication should explain:

· whether the session is going ahead, changed or cancelled;

· whether transport is operating;

· whether individual members are advised not to attend;

· what time a decision will be reviewed if conditions are uncertain;

· who to contact with concerns;

· whether welfare contact will be made for members living alone.

Where sessions are cancelled, priority should be given to contacting members who live alone, members who may not understand the change, and those who rely on Dementia Active transport.

11. Staff and volunteer safety

Staff, volunteers and drivers must not put themselves at unreasonable risk to deliver or attend a session.

Staff and volunteers should not be expected to travel where local conditions are unsafe. Dementia Active recognises that conditions can vary significantly between locations, and one person's route may be unsafe even if another person can travel.

Managers should support cautious decision-making.

12. Emergency response

If a member falls, becomes unwell, is exposed to cold, or becomes distressed during winter weather, staff should act immediately.

Call 999 if a member has symptoms such as:

· serious injury after a fall;

· suspected fracture;

· loss of consciousness;

· chest pain;

· severe shortness of breath;

· severe confusion or sudden deterioration;

· signs of hypothermia;

· inability to warm up;

· any situation where staff believe urgent medical help is needed.

For less severe but concerning symptoms, staff should contact the member's family, carer, care home, GP, NHS 111 or emergency services as appropriate.

All incidents, near misses and transport concerns should be recorded according to Dementia Active's usual incident reporting procedure.

13. Post-incident and post-weather review

After a period of extreme winter weather, Dementia Active should review:

· whether decisions were made early enough;

· whether communication was effective;

· whether any members were left isolated;

· whether transport routes were appropriate;

· whether any falls, near misses or delays occurred;

· whether venue access was safe;

· whether the policy needs updating.

14. Review

This policy should be reviewed:

· before each winter season;

· after any winter weather-related incident;

· after any session cancellation due to snow, ice or cold weather;

· if UKHSA, Met Office, NHS or local authority guidance changes;

· if transport arrangements, venue access or staffing arrangements change.

Key operating principle: Winter weather decisions should be based on the safest member, driver and route combination, not just whether the centre itself is open. Snow and ice often make the transport and handover risk greater than the group session risk.

For members, families, carers, care homes, staff, volunteers and transport arrangements

Policy owner: Dementia Active

Applies to: All Dementia Active groups, staff, volunteers, members, families, carers, care homes and transport arrangements

Review period: Annually before winter, and after any significant winter weather incident

Purpose: To reduce the risk of harm to Dementia Active members, staff and volunteers during extreme   winter weather, including snow, ice, freezing temperatures, heavy rain,   strong winds, fog and unsafe travel conditions.