PREVENTING ADMISSION TO HOSPITAL AND RESIDENTIAL CARE FOR PEOPLE WITH DEMENTIA

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PREVENTING ADMISSION TO HOSPITAL AND RESIDENTIAL
CARE FOR PEOPLE WITH DEMENTIA
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SKILLS FOR CARENew Type of Worker Initiative

• The drivers for new social care roles include
• User focused service design with staff able
  to provide more generic individualised services
• Improving strategic human resource and
  operational management of the workforce
• A reduction in the actual number of staff
  required to deliver services to a person using
  them
• A more skilled and independent high quality
  workforce able to manage services at the point of
  delivery
• A blurring of some long established
  demarcations between job roles.

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The drivers particular to Bracknell Forest
Borough Council were to make an impact on the
following performance indicators

• To increase the number of older people helped to
  live at home
• To decrease the number of admissions of people
  over 65 years to residential and nursing care
• To decrease the number of emergency admissions of
  older people to hospital

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The Project Management Team consisted of
stakeholders whose job roles contributed to the
successful operation of the project
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In order to provide a cost effective domiciliary
care service enabling people with dementia to
remain in the community, the following areas were
considered and addressed

• The nature of the support that would be available
  to service users
• The structure within which the service would be
  provided and managed
• The terms and conditions under which support
  workers would be employed
• The training that would be available to support
  workers

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As the project developed, it became clear that
there was a considerable impact on

• The relative-carers of service users
• Staff sickness and retention levels
• Implications for inter-agency collaboration
• The involvement of project stakeholders
• In-patient levels in the local hospital dementia
  ward

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The nature of the support that would be
available to service users

• Assessments would involve and represent the views
  of service users and relative-carers
• An Outcome Based service would be provided based
  on Care Plans that focussed on outcomes rather
  than service levels
• Focus on improving and maintaining the
  relationship between the service user and their
  relative-carer
• A service user would receive consistent support
  from one main Support Worker
• Social Policy Research Unit at the University of
  York

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Examples of Outcomes for the service user which
the Care Plan may include

• Increased physical abilities
• Increased confidence or skills
• Improved mental health
• More social opportunities
• Have finances in order
• Essential physical needs met
• Quality of life maintained
• Cleaner/safer environment
• Changes in behaviour
• Risks reduced or removed

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The structure within which the service would be
provided and managed required Support Workers to
have additional responsibilities to those
normally undertaken by Domiciliary Care Workers
which included

• Encourage service users to regain lost skills
• Encourage participation in and transport service
  users to a variety of activities including
  shopping, day centres, outings, hospital
  appointments etc
• Offer personal support, advice and encouragement
  to service users and relative-carers
• Help service users maintain contact with family
  and friends
• Provide practical support and intimate personal
  care as well as household tasks to relieve some
  of the work carried out by relative-carers

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Further tasks were required which were to raise
the professional status of Support Workers

• Undertake specialist tasks under the supervision
  of professionally qualified team members
• Record information on Observation Sheets
• Submit written and verbal reports to the
  Community Psychiatric Nurse
• Take part in monitoring, reviewing, decision
  making and care planning

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This led to modifying the Person Specification
for Support Workers to include

• Able to use initiative and deal with emergencies
• Organisational skills
• Recording and reporting skills
• Able to undertake and benefit from specialised
  training
• Stable
• Self reliant
• Stress tolerant

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Raising the professional status of Support
Workers was also achieved by

• Employing workers on a salaried rather than an
  hourly paid basis
• Employing workers to work flexible hours at their
  own discretion
• Giving workers the autonomy to respond to
  situations as they found them
• Providing professional supervision both
  individually and as a team
• Providing professional training in dementia (UCL)
• Provide a structure enabling workers to
  communicate with one another, cover for each
  others absences and maintain continuity of care
• Provide opportunities to achieve NVQ at level 3
  and above (compared with the normal expectation
  of domiciliary care workers achieving NVQ level
  2).

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Referrals to the Project Team took account of the
following criteria

• Diagnosis of dementia
• Known to local Mental Health team
• At risk of the home situation breaking down
• Reluctant or resistant to accepting traditional
  domiciliary care services

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Referrals to the Dementia TeamMarch 2005
March 2006 13 months
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The range of needs identified included

• Dementia and alcohol abuse
• Forgetting to take medication
• Withdrawal of carer-relative due to change in
  work pattern
• Unable to maintain personal care/clean
  environment/ suitable diet/financial control
• Relative-carer unable to cope with increasing
  demands due to dementia
• Challenging behaviour due to dementia
• Weight loss

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Number of Hours Support Received per Week from
Dementia Team
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Financial Savings Over 13 monthsHospital Care
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Financial Savings Over 13 monthsResidential/Nursi
ng Home Care
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Outcomes Significant to Service Users

• The areas of the service provided by the
  dementia team which elicited the highest
  satisfaction ratings were
• Support Workers took account of my views
• Improvements in my emotional and mental health
• The help I receive fits in with my life and
  routine
• My relationship with my relative-carer has
  improved
• I feel that I have been treated with respect

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Outcomes Significant to Relative-Carers

• I feel treated with respect
• The Support Worker takes account of my views when
  deciding what help to provide
• The Support Worker understands my individual
  needs and circumstances very well
• The Support Worker was very helpful in providing
  information about other services available
• 57 of relative-carers reported improvements in
  their general health
• 64 of relative-carers reported improvements in
  their emotional and mental health
• 85 of relative-carers felt that the help they
  received fitted in with their life and routine

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A Selection of Comments from the Support Workers

• More time not rushing with the service user
• Feel you have achieved things
• Building relationship with service user and
  relative-carer
• Intensive work
• Im knackered!
• Good team rapport and trust
• Communicate with each other, management and
  relatives
• Knowledge of service user gives you more
  satisfaction
• Empowering encouraging service user to regain
  skills in everyday activities
• Make phone calls in the evening to relatives
• Good understanding of team-mates work

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MAJOR OUTCOMES AFTER 3 YEARS

• Hospital waiting list reduced to zero
• Dementia ward is now only 50 full
• All of the original support workers remain in
  post
• Only 2 weeks of genuine sick leave taken
• The Dementia Team is now a mainstream service and
  is to be tripled in size
• This model of service is to be extended to other
  areas e.g. people with long term conditions
• The Dementia Team won the Skills for Care
  Accolades in 2007

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Corpus LtdSocial Care Consultants0118 988 6987

• David Shinegold