Models of Care for Dementia Transforming experiences and outcomes for people with dementia & carers and families Edana Minghella Email: [email protected]

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


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.....


Consistent themes from people living with dementia

Relationships

Identity

Support early on


What is a model of care?



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.


Person-centred outcomes at each phase (1)


Person-centred outcomes at each phase (2)


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.


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)


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


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


Documents

Models of Care for Dementia Transforming experiences and outcomes for people with dementia & carers and families Edana Minghella Email: [email protected]