This document discusses integrated care for people with dementia across different healthcare settings and proposes a gold standard for integrated dementia care. It finds that hospitals have many patients with dementia yet poor quality care, care homes have most residents with dementia but limited support from GPs, and home care has restricted access and understaffing. The gold standard proposed includes key workers, workforce training, community engagement, and information/advice. New models of integrated care are being tested in vanguard sites and cities like Greater Manchester are developing plans to better coordinate health and social care by 2020.

1. Delivering integrated care for
people with dementia
Jo Vavasour

3. Dementia-friendly health
and care settings? Hospitals
• 3.2 million hospital bed days.
• Over 40% of beds occupied by people
with dementia.
• Excessive hospital stays.
• High level of readmission.
Care homes
• 70% of residents have dementia.
• GP and acute care relationship.
• Dementia friendly environment.
• Community engagement.
Home care
• Limited access to home care.
• Services stretched or reduced.
• High turnover of staff.
Dementia can be the success
criteria for integrated health
and social care.

4. Iris’ story: a fatal fall (Kent)
Iris fell whilst in hospital causing significant harm. The fall directly contributed
to a quick deterioration of her dementia.
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David’s Story: when care is not personalised (Manchester)
David’s story is one of inadequate staff training at hospital and how staff
struggles with challenging behaviour, poor quality care.

5. ________________________________________________________________________
alzheimers.org.uk
Key findings
From the FOI

6. External Change
• The government will integrate health and social care services by 2020.
• Each part of the country will develop plans for this by 2017, to be
implemented by 2020.
• Local areas will integrate in different ways using a range of models which the
government supports.
• 44 Sustainable Transformation Plans
• NHSE Vanguards, Better Care Fund
• City devolution deals: Greater Manchester, Cornwall, North East.

7. Scale of the change
Vanguard sites City Devolution deals

8. What is the gold standard for integrated
dementia care?
Alzheimer’s
Society
service
offer to
vanguard
sites
Information and Advice
Includes information relating to risk, diagnosis, This is me, communicating and
supporting people with dementia, person-centred care, community links and end of life
Key-worker (DA/DSW)
can provide support across the whole pathway to care home provider, person with
dementia and family
Workforce training and development
Enabling the workforce to support improved dementia outcomes across the whole
pathway
Community Engagement
Improved well-being through Dementia Friendly Communities, Dementia Friends.
• Over 70% of people with dementia have co-morbidities
• What works for dementia, works for frail elderly

9. New models of care vanguards: Airedale and Partners

10. GM-Devo: Dementia United
www.dementiaunited.net

11. Let’s Keep Building…
5 Year Plan

12. Thank you