Changing Practice in Nursing and Care Homes    

National Dementia Learning Event29th September 2011

Jillian Torrens, Adult Services Manager, Glasgow CHP - South SectorJean Hannah FRCGP, Clinical Director, Nursing Homes Medical Practice

Sharing ideas: service delivery models

Variety of NHS models support people living in care homes:

• Standard GP registration• Local Enhanced Schemes• Dedicated services• Retained GPs

Successful joint working

• Care Home Services - Care Home Liaison Nurses, Dietician, SLT, Clinical Pharmacy Team, Admin. Team, PM, NHMP GPs, CD & Adult Services Manager

• 70(58) nursing homes & ~ 3500(2650) residents

• Central Practice – 1050 patients – 67% dementia– 10% ≤ 65 years – 36% dementia

Assessing the Prevalence of Dementia. Audit and Cognitive Screening in Glasgow Nursing Homes

Stephen Lithgow. Dementia Clinical Studies Officer. Specialist Occupational Therapist. NHSGGC Sept. 2010.

Objectives: 1. Audit care plans and establish existing levels of dementia

diagnosis in nursing homes. 2. Use cognitive assessment to establish levels of possible

undiagnosed dementia. 3. Update care plans and GP records with cognitive test results4. Inform GP’s of residents who may have undiagnosed dementia.

Methods & results

• Random selection 1 in 6 residents• 48(49) NH & 403/422 nursing home residents

Glasgow City• Standardised Mini Mental State Exam (SMMSE)• If difficulty participating, Functional Assessment

Staging Tool (FAST) used• 89.9% had scores in dementia ranges

124.8

47.2

76.6

186.6

104.1

116.9

636.5

151.3

64.8

355.6

99.2

8.8

79.6

187.6

13.1

56.8

13.6

43

29.2

22.8

5.7

39.4

7.9

125.9

29

4.6

9.3

20.2

AF

Asthma

Cancer

CHD

CKD

COPD

Dementia

Diabetes

Epilepsy

Hypertension

Hypothyroid

LD

Mental Health

Stroke

NHMPGGC

QoF Disease Prevalence /1000 Patients (Central Team n = 1018)

Provision of palliative care forpeople with dementia & their carers• New patient registration – hospital liaison• Supportive & Palliative Action Register (SPAR)• Early identification of those who may need palliative care• Advance/anticipatory care planning, including anticipatory

prescribing• Liverpool Care Pathway for the Dying• Accessibility to patient, carers and staff vital – encourage open

communication• Finding out about how we can do better

Preferred place of care

• Majority of nursing home patients and their carers hope that death will occur in nursing home

• Standard GP: 7-8 deaths per annum frailty or dementia, and total approx. 20 deaths per annum

Central Practice

Hospital % Nursing Home

% Total Deaths per GP

2008 57 20 227 80 284 372009 57 20 233 80 290 382010 62 20 246 80 308 40

Out of Hours Contacts

Annual Total (Oct-Sept) Calls/Patient/Yr• 2008-09 872 0.3• 2009-10 1118 0.4• 2010-11 1105 0.4

Contacts for deaths: 15% 2009 to 7% 2011

Hospital contactsNorth Glasgow Year A&E

2008-09 460

2009-10 332

20010-11 320

Total 1112 – 65% admitted

South Glasgow Month Admissions

June 2011 8

July 2011 8

SPARRA July 2011

936 patients post code for NHMP 385 dementia (41%) of which 70 Alzheimer’s

The future care and support of peoplewith dementia living in care homes

• Early diagnosis and support – how and who by?• Standardisation of GP support i.e. clear

specification with supporting IMT screens and reporting requirements

• Continue to strengthen evidence base for what works well and what does not

• Use this to support appropriately resourced services to individuals, families and carers

Workshop discussion point 1

Dementia diagnosis: views vary from “Anyone can diagnose dementia” to “Everyone with possible dementia should have a diagnosis made by a specialist (memory clinic or old age psychiatrist)”

For discussion: barriers & supports to diagnosing dementia and the impact of getting it wrong.

Workshop discussion point 2

Early dementia diagnosis:Many patients in care homes have undiagnosed

dementia and are cared for in a variety of care home settings.

What would the desired outcomes and benefits of early diagnosis be?

What changes to support, care and service provision would be needed to realise these?