Making general hospitals fit for dementia care

27th International Conference of Alzheimer’s Disease International

London 2012Rachel ThompsonRCN Dementia Advisor

Dementia…..

Whose business is it?

Dementia in general hospitals:why do we need change?

Estimates suggest 25- 40% of people in hospital have a cognitive impairment

stay in hospital longer have poorer outcomes 1/3 discharged to care home use of antipsychotic medication poor identification and

understanding of needsCounting the Cost

(Alzheimer’s Society 2009)

National Audit of Dementia Care in General Hospitals 2011

210 hospitals across England and Wales Enhanced audit 145 wards across 55 hospitals 6% hospitals had dementia care pathway 32% of staff reported ‘sufficient’ training Very few wards demonstrated a culture which was

“person-centred” 15% of wards used colour schemes Assessments incomplete for mental health status,

nutrition, function, continence 40% of hospitals had clear procedure for information

sharing with families Lack of consistency in the determination of staffing

levels

RCN Dementia Project Sept 2010- Sept 2011

Supported by Department of Health Survey of practitioners : 712 responses Survey with people with dementia and carers :1484

responses Collaboration with external stakeholders Development of ‘Commitment to the care for

people with dementia in general hospitals’ Resources to support delivery

Improving care Strategies to improve care Identified by

practitioners as instrumental (n = 712)

Valued as ‘very important’ by carers and people with dementia (n = 1484)

Involving family carers 71% 98%

Education and training for staff 69% 98%

Individualised care planning 57% 97%

Assessment and identification 51% 93%

Improving mealtimes 48% 80%

End of life care 43% 90%

Environmental changes 40% 76%

Dementia pathway 40% 79%

Specialist support/clinical lead 40% 94%

Flexible visiting times 35% 73%

Providing activities and therapies 30% 72%

Dedicated wards/bays 26% 51%

Involving volunteers 25% 45%

Barriers to care Factors identified as barriers to care

Practitioners(n= 712)

Carers and people with dementia (n= 1484)

Not having enough ‘time to care’ 77% 97%

Insufficient staffing levels/mix 75% -

Frequent moves 49% 92%

Inappropriate environment 43% -

Lack of specialist support 39% 95%

Poor understanding /recognition 32% 98%

Lack of resources 40% -

Poor communication - 96%

Poor attitudes 92%

Commitment to the care of people with dementia in general hospitals

Join us in putting these principles into practice and make SPACE for good dementia care.

SPACE – top five ingredients to support good dementia care

1. Staff who are skilled and have time to care.

2. Partnership working with carers.

3. Assessment and early identification of dementia.

4. Care plans which are person centred and individualised.

5. Environments that are dementia-friendly.

Benefits

reduction in falls reduction in length of stay improved recognition of the needs of people with dementia and

their families reduced discharge to long stay care reduction in use of antipsychotic medications improved management of continence improved carer satisfaction rates and a more confident and competent staff workforce

Learning from what works

3. Assessment and early identification

2. Partnership working

4. Care planning

1. Staff

5. Environments

Dementia championsDementia champions

Please visit our on- line dementia resources and obtain further information on the ‘Commitment for the care of people with dementia in general hospitals’ at:www.rcn.org.uk/dementiarachel.thompson@rcn.org.uk