Primary Care Today – February/March 2012 “Can home based dementia care succeed?”

What are the odds of people with end stage dementia remaining in their own homes instead of specialist dementia nursing homes?

What are the odds of people with end stage dementia remaining in their own homes instead of specialist dementia nursing homes?

Pretty good – if the care they need can be delivered around the clock and can be commissioned and supported by the local Clinical Commissioning Group or PCT. That’s precisely the type of intervention that’s taking place in homes across England where people with dementia are being cared for by “The Expert Dementia Care Package” from the The Good Care Group. The care package has seen a reduction in prescribing antipsychotic and sedative medication that all adds up to a better quality of life for the person with dementia and their family.

Zoë Elkins, Head of Care Strategy at The Good Care Group, explains, “Our carers are trained to look for side effects contraindications and the therapeutic effects of medications so they can liaise with GP’s on what is working and what’s not. GPs are receptive to having us around because normally when we get involved it is because someone has been going through problems with dementia, and it has not normally been managed particularly well before we get there.”

While GPs are experts with a medical understanding of dementia many “do not have a psychosocial model of how to manage different behaviours and that is often the reason why antipsychotics end up being prescribed, said Elkins.

GPs are interested in The Good Care Group’s approach to dementia care which involves reducing or eliminating antipsychotic and sedative medication altogether. Elkins notes, “We make sure the GP gets the feedback they are looking for because our carers are there with the person they are looking after that they know from the expression on their face, or the way they are grinding their teeth, or the words they have used, whether that person is in a good place or not so they are able to give feedback to the GP that often family visiting two or three times a week are not able to give.”

Elkins (left) says commissioners are catching on to the fact that people with dementia can be cared for in their own homes if the home is kitted out and tailored to the needs of the person. This can involve installation of a stair lift, ceiling track hoists, a profiling bed and reclining chairs. At times of crisis, the person can still remain in their home when the carers are supported by an Acute Outreach Team and district nurses. “Our experience of joint working has been good and we have managed to break down a lot of initial cynicism and the thinking that if you have dementia you really should be placed in a nursing home because your level of physical need,” notes Elkins.

More than 820,000 people are affected by dementia in the UK and this figure is set to rise to more than 1,000,000 by 2025. Currently more than 60 percent of all care home residents in the UK have some form of dementia. Latest figures show Dementia costs the UK £17 billion per year.

Elkins argues, “There is much more to caring for the person with dementia than ticking boxes and implementing a set care plan. Over three-quarters of the people we look after are living with dementia, and we are dedicated to providing a highly personalised live-in service which fully reflects the client’s emotional and physical lifestyle needs.”

Elkins’s says “The Expert Dementia Care Package enables the person being looked after not only to remain in their own home, but also to retain self-worth and some degree of control of their life. A proactive, fully individualised care plan is used to help deliver quality and some enjoyment of life for the person for whom care is provided. “This is completely different from regarding the person as a patient, who must be cared for in a predetermined, rigid way,” she says.

The Expert Dementia Care Package “puts the person with dementia firmly at the centre of care activity, with all aspects of care assessed against need and delivered to be in step with the individual’s pattern of life. Our ultimate goal is to ensure on-going emotional well-being and the best possible quality of life.”

The Expert Dementia Care Package includes:

  • Appointment of two live-in carers trained in delivering dementia care and supported at the start of a placement by leading dementia care experts.
  • Achievement of goals – a sustained sense of well-being despite cognitive decline, supported by medication reduction, weight gain, better sleep patterns, and urinary tract infection avoidance.
  • A multi-disciplinary approach to falls prevention.

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