The island now has 139 newly certified dementia patient caregivers, after the latest round of a heavily subscribed training course.

But more will be required to meet demand, as the numbers of residents with dementia — which are still not known — continue to rise.

Marc Wortmann, the executive director of Alzheimer’s Disease International, gave Bermuda points for awareness and openness about the rising population of elderly people needing care, but said there was “still work to be done to have a comprehensive approach to the services needed”.

Mr Wortmann came to the island to deliver this week’s course hosted by Argus insurance, and funded by the Bermuda Legion, which took on “more than we expected”.

“There is clearly a need — we have already been asked if we can do more,” Mr Wortmann told The Royal Gazette.

It was the second round of a course designed to meet the island’s needs, introduced here in 2015 and successfully applied in other countries.

Supporting family caregivers is “at the heart of our work”, the ADI head said, along with training up professional caregivers.

“We share strategies to communicate and deal with behaviour that you may find challenging,” Mr Wortmann said. “But also we find meaningful activities to do together.

“The nice thing about this course is that people are talking to each other, engaging and giving tips and examples.

“Everyone with dementia is still an individual and they have their own routines, their own likes and dislikes, but they are not always able to express what they want. Sometimes they become frustrated, and that comes out in their behaviour. If you try to figure out what is behind it, the answer can lie in the personal story of the person with dementia.”

About half the people taking the course were family members, he said. Among yesterday’s students was Sandra DeSilva, who takes care of an ageing patient with Down’s syndrome.

“I thought this class would be helpful to give me some input and different techniques,” Ms DeSilva said.

Her patient’s dementia has grown “severe”, she added: his ability to use the bathroom has declined — but tapping into his love of music, such as his fondness for the country singer Charley Pride, helps him to regain his sense of self.

“He is always talking about his father, who is dead,” Ms DeSilva said. “I always tell him ‘you will see him’. What can you say when a person has lost a loved one and they don’t understand?”

Her account illustrated the time-consuming nature of the job: the need for reassurance and affection to keep her charge from becoming distressed, even as his condition continues to deteriorate.

“I like doing this,” Ms DeSilva said. “It’s challenging, but I have a lot of patience. It takes more every day, and I ask God to give me more.”

Carol Everson, a case worker with the Bermuda Legion, said the group was especially keen to secure a high-care unit for the island, which she said would “quickly save money, substantially, from what is now spent on hospital beds”.

“Building a dementia care unit would free up more than 40 acute care beds,” Ms Everson added. “Plus, the cost of care could go down approximately one-third of what the hospital is spending right now.

“When people have severe dementia, they still need institutional care. But what we envisage is a facility where you have assisted living and a dementia unit on the same side. Let’s say there is a husband and wife and one needs higher care. They could both move to the dementia unit but still have interaction.”

Separating couples by putting one into care “means that the remaining spouse deteriorates”, she said.

“Our aim is to keep people at home as long as possible, and give their carers the best training possible. Secondly, we want to avoid putting them in nursing homes where they are mixing with the general population, because their needs are entirely different.”