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Improving Hospital Care for Dementia Patients
- 1. Getting it right for dementia: Real solutions for improving hospital care ________________________________________________________________________________________ alzheimers.org.uk Veronica King, Stakeholder Relations Manager – North Alzheimer’s Society
- 2. The need for better dementia care in hospitals and why it matters • Counting the Cost • Enhancing the Healing Environment • Cracks in the Pathway
- 3. The need for better dementia care in hospitals and why it matters • >40% of people in hospital over 65 • 3.2 million bed days • £265m cost of additional time in hospital
- 4. What do we need? • Achievable solutions and practical guidance • Education, training and awareness among acute sector staff • Hospital dementia strategies • Commitment to developing dementia friendly hospital environments • Better discharge and post discharge support
- 5. An Innovative Approach • The role of the third sector, and voluntary services • A new approach to integrating care • Support for people and carers in hospital • Support for people and carers at discharge and beyond • Awareness, information and training
- 6. Thank you Veronica King Alzheimer’s Society Veronica.King@alzheimers.org.uk ________________________________________________________________________________________ alzheimers.org.uk
- 7. Thank you Veronica King Alzheimer’s Society Veronica.King@alzheimers.org.uk ________________________________________________________________________________________ alzheimers.org.uk
Editor's Notes
- Thank you Today I am going to be talking about hospitals, the care they provide for people with dementia, and our thoughts, from both an overarching and more detailed perspective on how improvements in caring for people with dementia in hospital should happen and are being developed.
- Need The issues for people with dementia in hospital are well known Hospitals are still frequently challenging and disorientating environment for people with dementia, and more needs to be done to make them more dementia friendly. There is still unacceptable variation in the quality of care that people with dementia receive when they go in to hospital, despite a number of key national objectives and strategies aimed at reducing that variability and improving care, including the NDSE and the recommendations of the National Audit of Dementia Care in general hospitals People with dementia stay in hospital far longer than those without dementia, and this additional length of stay significantly increases the risk of deterioration in their mental and physical health, the use of antipsychotic drugs, and being discharged to a care home. Over the last few years, we have looked at the costs associated with dementia care in hospital, the King’s Fund published their Enhancing the Healing Environment guidance on dementia, and the Care Quality Commission’s Thematic review of dementia looked at care in hospital.
- There is a statistic that has been used for a few years now that estimates a quarter of hospital beds are occupied by people with dementia at any one time (though this likely to be an understimate) It’s estimated that over 40% of people over the age of 65 in hospital beds will be living with dementia (Cracks in the Pathway) Research show that this amounted to a total of 3.2 million bed days in 2013/14, and the estimated cost burden on the NHS of Dementia in 2013 was £265million, calculated by looking at the additional time spent in hospital by people with dementia, for things such as delayed transfer of care and extended length of stay. Other factors include people with dementia being over twice as likely to have a readmission following an emergency admission, and being three times as likely to have a fall whilst in hospital compared to those without dementia. Analysis shows that when a patient experiences a fall, that in itself more than doubled the average length of stay. Our key recommendations in Counting the cost in 2009 were for: better integrated care for people outside of hospital, with better intermediate care that reduces the need for admission Hospitals to identify a senior clinician to take the lead for quality improvement in dementia ensuring that the acute care workforce is informed and educated on the needs of people with dementia people with dementia, their carers and family to be involved in the development of personalised care Five years later, the CQC reported that while there are some excellent examples of good hospital care for people with dementia, little of this has been achieved, and their assertion is that ‘It is likely that someone living with dementia will experience poor care at some point while being treated in hospital’. This air of ‘inevitability’ is obviously unacceptable. They found that peoples physical needs were being assessed, but not their dementia related needs and in 42% of the hospitals they assessed, they found aspects of variable or poor care.
- There are some excellent examples of dementia friendly hospitals and projects that consistently meet the needs of their patients and carers, provide high quality responsive care with improved discharge and patient centred care, and who have involved all staff in this. We need to help other hospitals to achieve this, but it has to be done in a way that is practical and accessible, that enables them to progressively work towards becoming dementia friendly, rather than being overwhelmed by the scale of what needs to be done, which results in just certain areas of hospitals being dementia friendly. We have considered some overarching actions that provide a foundation or starting point for becoming dementia friendly, that provide some information about the must dos : Education, training and awareness of dementia - Where acute trusts have committed to widespread education and awareness of dementia among staff, they have been shown to become more uniformly dementia friendly and committed to meeting the needs of people with dementia The development of the dementia friendly environment – across the board, reducing variability in the hospital that people tend to move through The Enhancing the healing environment work has demonstrated that relatively inexpensive changes for example to flooring, lighting and improved wayfaring have a significant effect, making it possible to improve the experience of people with dementia, and can be easily replicated throughout other areas. Hospital wide dementia strategy - the best examples of dementia friendly hospitals are known to have high level leadership from dementia champions, where the commitment is cascaded throughout the organisation and all staff are engaged in the process The CQC’s State of Care report published in October showed that the best performing hospitals demonstrated excellent leadership and governance from the top down, across a range of issues The incorporation and integration of carers of people with dementia in hospital, recognising them as key contributors to enabling better care and support - this has been shown to work in other groups of patients such as for children, where there are established guidelines for the involvement and partnership of carers This is reflected in Johns’ Campaign, which AS supports, and calls for carers of pwd to be allowed full access to their loved one and to be treated as an expert in their care. In just over a year, 170 acute trusts have signed up to the campaign to allow full access to carers
- There is also the opportunity for an innovative approach to the provision of support and services, and that hospitals don’t necessarily need to be doing it all them selves AS pilots/service examples DSW in hospitals – taking referrals and assisitng staff with care, support and discharge, sometimes as part of a MDT, some standaalone Support sand information for carers in hospital, and navigating the system, advice etc Support at discharge, back to home, adaptations, extra support etc Information points not just benefiting pwd and carers but also a resource for staff
- These are just some of the real solutions that are being identified, developed or put into practice. These have to continue to be developed and acute trusts have to commit to an approach of becoming truly dementia friendly, learning from the best, but also developing what works best for them and ultimately what is best for their patients with dementia