Challenges in dementia provision – a service that can support you

Sandra BaileyRMN, BSc, Ma, Independent Non-Medical Prescriber

Team Leader DIST

Dementia Intensive Support Team (DIST)

• Secondary Mental Health Service (NSFT)

• St Clements Hospital

• Project

• Funding - Suffolk CCG/previous Day Treatment Unit

Background

• Dementia affects an estimated 670,000 people in England, and the costs across health and social care and wider society are estimated to be £19 billion – both figures are set to rise with the ageing of the population.

• Dementia is a significant challenge for the NHS with an estimated 25% of acute beds occupied by people with dementia, their length of stay is longer than people without dementia and they are often subject to delays on leaving hospital.

Background• It is estimated that 25% of general hospital beds in the NHS are

occupied by people with dementia, rising to 40% or even higher in certain groups such as elderly care wards or in people with hip fractures.

• The presence of dementia is associated with longer lengths of stay, delayed discharges, readmissions and inter-ward transfers. Many admissions are because of ambulatory conditions (about 40%) such as urinary tract or respiratory infections, which can be managed in the community.

(Department of Health (2012) Using the Commissioning for Quality and

Innovation (CQUIN) payment framework: Guidance on new national goals for 2012-13)

Function of DIST

• Reduce/Prevent inappropriate admissions of people with dementia/delirium to acute hospital

• Reduce the length of stay in acute hospital of people with delirium/dementia

• Reduce/prevent inappropriate admissions of people with delirium/dementia into 24 hour care settings.

Who we are

• Registered Mental Health Nurses (x5)

• Occupational Therapists (x1.5)

• Social Worker (x1)

• Assistant Practitioners (x2)

• Community Support Workers (x2)

• Technical Instructor (x0.6)

• Admin Team (x2)

What we do

• Hospital referrals –

See on ward, attend ward discharge planning meetings, negotiate with client and family, arrange monitoring and support upon discharge, facilitate timely discharge.

• Community referrals

Assess at current location, support, monitor symptoms, at home, liaise with other agencies/professionals, refer on.

What we actually do..

• Take history. Check for symptoms (MSU, BM levels, arrange blood testing)

• Monitor symptoms (improvement/worsening)

• Liaise with GPs

• Recommend to GPs medication(s) to settle symptoms and monitor efficacy once prescribed

What we actually do

• Educate carers on dementia/delirium and how to meet the needs of the client

• Work closely with GPs/ACS (including requesting GP visits and/or new/increased care packages to support clients at current time)

• Assess mental health need/functioning/safety of client to remain at home at current time (MMSE, ACE-R, HADS, GDS, ADL assessment)

What we actually do…

• Stay involved for up to 12 weeks.

• Visit daily if needed

• Refer to other secondary mental health services if need is clinically indicated

• Signposting, advising, co-ordination of treatment, care and care services during time of admission prevention

Who we do this for• People aged 65 years or over with established diagnosis of dementia or

with a suspected dementia, and delirium or

• People under age of 65 years with established diagnosis of dementia and delirium

and

• Who are imminently at risk of admission to acute hospital due to acute illness and/or carer breakdown

and• are displaying behavioural/psychological symptoms of dementia or

delirium (agitation, aggression, increased confusion, hallucinations etc)

Where our referrals come from

• GPs

• Social Workers

• Dementia Advisors/Age UK

• Ambulance crews

• A&E Department

• Acute Hospital Wards

• Previous clients/informal carers

What we don’t do

• Assessment/Diagnosis (Referrals for this go to Memory Clinic/CMHT via Triage)

• Intensive Home Treatment

• Crisis Intervention

• Assessment/treatment of complex cases or ongoing challenging behaviours associated with dementia

How to contact us

• Monday to Friday, 9.00am to 5.00pm

• Office Landline – 01473 329820

• Referral line - 07852769172

Thank you for listening

Any Questions?