Living Well with Dementia

Developing the Home Care Response

Oct 2011

Catherine Pascoe

South West Dementia Partnership

South West Dementia Partnership

http://www.southwestdementiapartnership.org.uk/system-redesign/domiciliary-care/

Where are we now?

Where do we want to be?

How are we going to get

There?

?

Domiciliary care for people with dementia

Where do we want to be?National Dementia Strategy

Objective 6: Improved community personal support services.

Improving outcomes

Support.Stay.Save

• Live in own home

• Maintain independence

• Stay active and engaged

Support. Stay.Save._____________ Care and support ofpeople with dementiain their own homes

January 2011

• I have personal choice and control or influence over decisions about me.• I know that services are designed around me and my needs.• I have support that helps me live my life.• I have the knowledge and know-how to get what I need.• I live in an enabling and supportive environment where I feel valued and understood.• I have a sense of belonging and of being a valued part of family, community and civic life.• I know there is research going on which delivers a better life for me now and hope for the future.

Improving outcomes

Where are we know? Headlines

• 58.4% extremely or very satisfied with the care you receive

• Over half of all home care visits are 30mins– 19% are 15mins

• 21% people said their carers were always or often in a rush

• 91.9% always or nearly always see the same care worker

Where are we know? Headlines

• Task- and time-focussed purchasing• Majority of LA purchased provision for personal

care tasks• Difficulties in translating outcomes required into

practical support to be delivered and in measuring progress towards outcomes

• 1 in 10 said poor care resulted in– avoidable admission to hospital– going into residential care earlier than expected

• 52% said carers not receiving sufficient support

SPECIALIST GENERIC

• Amount and frequency of visits • Easy access to mental health advice and support

Providing domiciliary care for people with dementia should be seen as a mainstream

activity.

1/2 to 2/3 people

with dementia are undiagnosed

98% Home Care Workers currently

support someone with dementia

You’re already doing it!

How can we move things forward?

• Implementing Putting People First/ Think Local Act Personal for everyone

• Ensuring people with dementia benefit fully • Making the case (economic and quality of life) for more effective service delivery for people with dementia focussed on prevention and early intervention

Start with the person

Be clear about what good dementia domiciliary care looks like

Promote resilience and support to live well

• Plan well• Identify what is important• Build life story information• Focus on delivering outcomes• Outcomes to do with engagement and relationships carry equal wait to those about personal care• Balance rights and risks, use MCA

Start with the person

• Be flexible• Provide consistency and continuity• Build on strengths• Understand cognitive ability• Plan for contingencies• Ensure access to reablement

Support Carers

– Personal qualities– Dementia “nous”– Problem solving and coping strategies– Communication skills– Behaviour management strategies – Cultural change

Develop the workforce

• Clear linkages with other services

• Crisis support

• Early intervention and Prevention

DON’T BE CRISIS LED!

CRISIS 1Increased agitationIncreased demands on carerMore resistive to support

Home care increased8- 13hrs£120-£195

CRISIS 2Missed UTIVery poorly

Hospital admission17 days in hospital£2572

CRISIS 3Returned home from hospitalProblems now with continence and mobilityCarer in despair

Emergency admission for care home respite2 weeks stay£400 a week

CRISIS 4Increased agitationGeneral health deterioratingFall, fractured hipCarer no longer ableto accept back at home

Readmission toHospital8 weeks in hospital£7954

YEARDIED IN HOSPITAL

PROVIDE CHOICE AND PLAN TO STAY IN CONTROL

Allocation of £200 per week for person with dementiaAllocation of £1, 600 per year for carer for breaks

Additional contingency support usedas required

Carer accessesflexible breaks

Support staff spot any changes

in person and seek help toinvestigate

possiblecauses

Primary care andother communitystaff promptly treat/supportas required

Support plans focuson well-being and

resilience of personwith dementia and

carer

YEAR

Improve contracting and procurement

• Personal budgets– Direct payment– Managed account (Individual Service Fund)

• Be clear how the provider’s ability to support people with dementia will be assessed– Dementia Quality Mark for Domiciliary Care

• Outcome focussed specifications• Purchasing of blocks of support to meet set

outcomes, to be delivered over a set time period• Financial and monitoring processes must

support flexible responses

• Provider perspective