Models of Care for Dementia

Models of Care for Dementia

Improving experiences and outcomes for people with dementia & carers and

familiesEdana Minghella

(C) Edana Minghella 2011

This presentation...

Shares some of our thinking in order to hear your views and ideas on

• Rethinking models of care for dementia• Implications for commissioning and service

delivery

• Health warnings: – Not a prescription and not yet completed


Where we are

• A provisional model developed, updating existing models and approaches

• Model links person’s experience & journey with expectations, needs, outcomes and service response

• The model has informed the DH Commissioning Pack (Commissioning Framework)


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


What is a model of care?


Why have a revised model?

• Changing expectations of the people with dementia, carers, the public

• Clarity of purpose for providers and commissioners• Improving and measuring outcomes• Policy changes • Resource pressures• Ongoing dissatisfaction in many instances despite

important, valuable developments• Revolutions only happen when things are already

changing. Things ARE changing – the time is right!


Just for today, I will have a plan. I may not follow it exactly, but I will have it, thereby saving myself from three pests: hurry, indecision - and overdoing things


Living with dementia: consistent themes from people living with dementia


Some implications for services (1)

• Giving a diagnosis with sensitivity• A range of physical, mental health, behavioural and

social needs requires range of services working together

• This range of services needs to be easily accessible and navigable – might need support with navigation

• Person’s journey helps planning by providing indications for what, how and when to offer help proactively

• Mental health and life-limiting factors are only part of the picture


Some implications for services (2)• Individualised person-centred care along the

whole pathway• Involvement in assessment, decisions, forward

planning• Work to support living well with dementia• Recognising loss but working with hope and

optimism• A proactive service• Family/carers expertise, involvement and needs• Community involvement


Some implications for services (3)• Accessible support for people with dementia and their carers,

that actively promotes inclusion regardless of age• Support, education and training in primary care based

services • Plurality of provision including voluntary sector and non-

service sector• Co-production of care and support• Training others to work preventively, anticipate needs and

enable access to more specialist help when needed• Clear roles tailored to anticipate and address range of needs,

including a navigator role similar to cancer care navigators• Imaginative use of existing resources & resource streams eg.

personal budgets, community development fund


Some implications for services (4)• THINKING ABOUT THE WHOLE SYSTEM including

– Primary care– Social care– Voluntary sector– Independent sector– Non-service organisations

• A range of joined up local, community-based services and options to enable people living with dementia to stay at home as long as possible, in the care of primary care

• Education, training and co-production with carers• Early intervention• Limited or no use of antipsychotic medication• Information• Psychological therapies• Wellbeing services• Using creative approaches to therapy• Managing risk collaboratively and imaginatively• Advance planning and good end of life care


Underpinning the model....


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.


A commissioning framework

• Recognising the dementia journey and:– outcomes for the person with dementia, and

carers/families– needs underpinning these outcomes– what people can expect to be able to access and

receive – workforce and skills implications– cost implications– options for commissioners to consider, in order to

deliver these outcomes.


Using the model in Commissioning Framework

At each phase of the ‘dementia journey’, the framework sets out:

• outcomes for the person with dementia, and carers/families;

• needs underpinning these outcomes;

• what people can expect to be able to access and receive (information, resources, services, care and support);

• options for commissioners to consider, in order to deliver these outcomes.


Example of applying model in DH Commissioning Framework: OutcomesPhase 1 When memory problems have prompted me, and/or my carer/family to approach

my GP or other primary care practitioner with concerns. Outcomes• I am confident that my primary health care worker/GP has taken my concerns

seriously. S/he understands the nature and cause of memory problems, and will refer me quickly for an appropriate assessment if needed.

• I can access a range of information and guidance in the community about memory problems, and resources to support me and my family.

• My GP/primary health care worker works with me to help me to stay well and

live well.


Example of applying model in DH Commissioning Framework: Needs

Phase 1 When memory problems have prompted me, and/or my carer/family to

approach my GP or other primary care practitioner with concerns.

Needs• recognition• concerns taken seriously• physical causes investigated• prompt referral for memory assessment• community awareness• help with understanding with what might be going on now, what to

expect next, & to plan for this


Example of applying model in DH Commissioning Framework: Expectations

Phase 1 When memory problems have prompted me, and/or my carer/family to approach my GP or other

primary care practitioner with concerns.

What people should expect• GPs and primary health care teams

– have a comprehensive understanding about memory problems and dementia, and appreciate the value of early diagnosis;

– are aware of the assessment & treatment options, and of the potential for living well with dementia;

– know how to promote living well with dementia;– understand and recognise the role and support needs of carers

• Prompt referral and easy access to a memory service • there is access to an up to date directory of community services and support, provided in a

range of media • dementia awareness is actively promoted in the local community•


Example of applying model in DH Commissioning Framework: Commissioning Options

Phase 1 When memory problems have prompted me, and/or my carer/family to approach my GP

or other primary care practitioner with concerns.

Commissioning options• education and training for GPs and primary health care teams• general practice ‘lead’ for memory problems• Local Enhanced Service agreements• regular patient reviews• memory checks incorporated within routine health checks• memory liaison workers/dementia liaison workers • carers support workers• carers’ assessments• local directory of services• ensure easy access to memory service and specialist dementia service, as and when

other needs present, which is not defined by age.• in line with Disability Discrimination Act (2005)


Models of Care for Dementia

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