Intermediate Care for Mental Health Working with the Independent Sector

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Intermediate Care for Mental Health Working
with the Independent Sector
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Common Stereotypes of Dementia
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The old know what they want The
young are sad and bewildered
Logan Pearsall Smith 1865 - 1946
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Hospitals are good for your health
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Dementia Pathway to Chaos

• History unknown
• Observed for deficits
• Shunted about
• Poisoned with drugs
• Ignored
• Treated as a nuisance
• Assumed to be incompetent
• Loss of skills

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The Problem

• Wrong kind of beds
• Wrong People in them!
• Wrong recommendations

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The Theory

• Three Steps to Heaven
• Rescue
• Rehabilitate
• Bespoke placements

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The Solution

• Rescue
• Proactive Liaison - Dr Nurse
• Diagnosis
• Education
• Mentoring

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The Solution

• Rehabilitation
• Normalising
• Detoxifying
• Maximising residual ability

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The difference

• Acute
• Hi - tec

• I C
• Hi - spec

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The Solution

• Bespoke Placements
• Home with full care
• Very Sheltered Housing
• Specialist Care Homes

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I-C beds for Mental Health

• Joint Finance
• 300 K
• 3/12

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I-C beds for Mental Health

• 2/12 negotiating with Geriatric Medicine
• Rejected!
• 3/52 to cut a deal with Independent Sector
• 5 beds in one Nursing Home
• 5 Beds 1 free in another!
• 23K p.a. per bed

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I-C Beds for Mental Health

• Now 14 beds in one Nursing Home
• Liaison Nurse mentoring staff
• Dedicated Staff Grade sessions
• Support worker plant
• Acceptance that need gt EMI care places

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Other Inputs
Person Centred Care

• General Practitioner
• Physio
• OT
• Social Worker
• Social Care dowry
• Care and Repair

We try harder!
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Outcomes First Year

• Admissions 53
• (Intermittent Health Care 15)
• Discharges 46

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Discharge Destination
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Clinical Example 1

• 92 yr old Lady in acute hospital
• MI, At. Fib. - Confused, Aggressive,15/30
• 6 yr Hx of memory loss
• Transferred to I-C
• D/N reversal
• CEI antipsychotic
• OT Physio
• Home to Art lessons! 26/30

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Clinical Example 2

• 83 y.o. man
• Admitted off legs
• Living alone - with dog!
• Hypertension, glaucoma, diabetic
• Alzheimers 12/30 needs EMI NH - aggressive,
  wandering
• He wanted to go home I/C
• Rx Galantamine. Stopped other meds
• Discharged home in 4/52 18/30
• Man and dog happy!

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Clinical Example 3

• 74 y.o. lady acute hospital collapse
• Diabetes, Atrial fibrillation, CVA
• MMSE 10/30
• Agitated depression for EMI EPH
• I/C Stroke Vascular Dementia
• Meds stopped Rx tiny dose antipsychotic
• Home with care package 17/30 in 3/52
• I think you are smashing!

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Person centred Care
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Remember

• 15 of us will dement by 80
• We like choice!
• Hospitals are dangerous!

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Remember

• People with Dementia are-
• Sensitive
• Changeable
• Rehabilitable

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Remember

• Wrong placements-
• Lock in people
• Lock up resources

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Grow old along with me!The best is yet to
be,The last of life, for which the first was
madeBrowning 1812-89