Models of Care for Dementia Transforming experiences and outcomes for people with dementia & carers...
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Transcript of Models of Care for Dementia Transforming experiences and outcomes for people with dementia & carers...
Models of Care for Dementia
Transforming experiences and outcomes for people with dementia & carers and families
Edana Minghella
Email: [email protected]
(C) Edana Minghella 2012
How we got here
• Talking to commissioners, providers, staff and other experts
• Listening to people with dementia & carers• Visiting services• Non-participant observation/shadowing
practitioners• Reviewing good practice, policy and relevant
literature
(C) Edana Minghella 2012
Why have a revised model?
• Changing expectations• Clarity of purpose• Improving and measuring outcomes• Policy changes • Resource pressures• Ongoing dissatisfaction• Revolutions only happen when things are
already changing.....
(C) Edana Minghella 2012
Consistent themes from people living with dementia
Relationships
Identity
Support early on
(C) Edana Minghella 2012
What is a model of care?
(C) Edana Minghella 2012
(C) Edana Minghella 2012
Understanding the person’s journey
Phase 1: When memory problems have prompted me, and/or my carer/family to approach my GP (or other) with concerns
Phase 2: Learning that the condition is dementia.Phase 3: Learning more about the disease, self-management,
options for treatment and care, and support for me and my carers/families
Phase 4: Getting the right help at the right time to live well with dementia, prevent crises, and manage together
Phase 5: Getting help if it is not possible to stay at home, or if hospital care is needed
Phase 6: Receiving care, compassion and support at the end of life.
(C) Edana Minghella 2012
Person-centred outcomes at each phase (1)
(C) Edana Minghella 2012
Person-centred outcomes at each phase (2)
(C) Edana Minghella 2012
Good practice examples show...
• Collaboration and partnership (for example, between commissioners, health & social care providers and non-statutory sector)
• Practitioners who demonstrate not only knowledge and skills, but also empathy, flexibility and compassion and carry those values into their everyday work
• Clarity of roles• Involvement of people living with dementia• Foresight and an emphasis on planning and early
intervention in order to manage the person’s journey proactively.
(C) Edana Minghella 2012
Service design & commissioning implications
• Range of services working together, including voluntary sector, designed to keep people at home as long as possible
• Concept of person’s journey indicates what, how and when services should be provided, linked to QIPP
• Primary care in lead. Mental health & specialist services only when needed with specific role.
• Support, education and training in primary care based services • Commission education, training and co-production with carers• Involvement of non-service sector, community resources, etc• Capacity building in non-specialist services (eg. residential care)
(C) Edana Minghella 2012
Some implications for service delivery
• Individualised person-centred care along the whole pathway• Involvement• Work proactively• Accessible services, inclusive approaches• Training others• Clear roles, including navigator• Imaginative use of existing resources & opportunities• Build relationships to work proactively and preventatively• Limited or no use of antipsychotic medication• Information• Manage risk collaboratively and imaginatively• Advance planning and good end of life care
(C) Edana Minghella 2012
Key messages• Recognise the dementia journey, and work sensitively, proactively
and preventatively to help pre-empt and manage crises• Deliver personalised, co-ordinated care that focuses on the unique
person, and design services around person-centred outcomes• Work together with people living with dementia, including carers,
recognising their needs and assets• Manage the range of issues associated with dementia – not just
‘mental health’; social engagement is critical. Make sure services and opportunities are joined up
• Provide services predominantly in the community, led by primary care.
• Specify the role of specialist services and treatment, promoting therapies, rethinking the role of inpatient care and reducing reliance on medication
(C) Edana Minghella 2012