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Living Well with Dementia
Developing the Home Care Response
Oct 2011
Catherine Pascoe
South West Dementia Partnership
South West Dementia Partnership
http://www.southwestdementiapartnership.org.uk/system-redesign/domiciliary-care/
Where are we now?
Where do we want to be?
How are we going to get
There?
?
Domiciliary care for people with dementia
Where do we want to be?National Dementia Strategy
Objective 6: Improved community personal support services.
Improving outcomes
Support.Stay.Save
• Live in own home
• Maintain independence
• Stay active and engaged
Support. Stay.Save._____________ Care and support ofpeople with dementiain their own homes
January 2011
• I have personal choice and control or influence over decisions about me.• I know that services are designed around me and my needs.• I have support that helps me live my life.• I have the knowledge and know-how to get what I need.• I live in an enabling and supportive environment where I feel valued and understood.• I have a sense of belonging and of being a valued part of family, community and civic life.• I know there is research going on which delivers a better life for me now and hope for the future.
Improving outcomes
Where are we know? Headlines
• 58.4% extremely or very satisfied with the care you receive
• Over half of all home care visits are 30mins– 19% are 15mins
• 21% people said their carers were always or often in a rush
• 91.9% always or nearly always see the same care worker
Where are we know? Headlines
• Task- and time-focussed purchasing• Majority of LA purchased provision for personal
care tasks• Difficulties in translating outcomes required into
practical support to be delivered and in measuring progress towards outcomes
• 1 in 10 said poor care resulted in– avoidable admission to hospital– going into residential care earlier than expected
• 52% said carers not receiving sufficient support
Providing domiciliary care for people with dementia should be seen as a mainstream
activity.
1/2 to 2/3 people
with dementia are undiagnosed
98% Home Care Workers currently
support someone with dementia
You’re already doing it!
How can we move things forward?
• Implementing Putting People First/ Think Local Act Personal for everyone
• Ensuring people with dementia benefit fully • Making the case (economic and quality of life) for more effective service delivery for people with dementia focussed on prevention and early intervention
Start with the person
Be clear about what good dementia domiciliary care looks like
Promote resilience and support to live well
• Plan well• Identify what is important• Build life story information• Focus on delivering outcomes• Outcomes to do with engagement and relationships carry equal wait to those about personal care• Balance rights and risks, use MCA
Start with the person
• Be flexible• Provide consistency and continuity• Build on strengths• Understand cognitive ability• Plan for contingencies• Ensure access to reablement
Support Carers
– Personal qualities– Dementia “nous”– Problem solving and coping strategies– Communication skills– Behaviour management strategies – Cultural change
Develop the workforce
DON’T BE CRISIS LED!
CRISIS 1Increased agitationIncreased demands on carerMore resistive to support
Home care increased8- 13hrs£120-£195
CRISIS 2Missed UTIVery poorly
Hospital admission17 days in hospital£2572
CRISIS 3Returned home from hospitalProblems now with continence and mobilityCarer in despair
Emergency admission for care home respite2 weeks stay£400 a week
CRISIS 4Increased agitationGeneral health deterioratingFall, fractured hipCarer no longer ableto accept back at home
Readmission toHospital8 weeks in hospital£7954
YEARDIED IN HOSPITAL
PROVIDE CHOICE AND PLAN TO STAY IN CONTROL
Allocation of £200 per week for person with dementiaAllocation of £1, 600 per year for carer for breaks
Additional contingency support usedas required
Carer accessesflexible breaks
Support staff spot any changes
in person and seek help toinvestigate
possiblecauses
Primary care andother communitystaff promptly treat/supportas required
Support plans focuson well-being and
resilience of personwith dementia and
carer
YEAR
Improve contracting and procurement
• Personal budgets– Direct payment– Managed account (Individual Service Fund)
• Be clear how the provider’s ability to support people with dementia will be assessed– Dementia Quality Mark for Domiciliary Care
• Outcome focussed specifications• Purchasing of blocks of support to meet set
outcomes, to be delivered over a set time period• Financial and monitoring processes must
support flexible responses