Windows of opportunity: prevention and early intervention in dementia

Interventions: Prevention - Case studies

• Flexible Care Support Worker Service (Knowsley) Open

  The Flexible Worker Support Service provides flexible, time-limited support to older people with mental health needs in their own home and has the ability to respond to crises and sudden or fluctuating changes in need. The workers liaise with Care Managers to monitor the health and well-being of individuals to ensure timely interventions that enable people to remain independent.

• Intensive Support Teams Open

  Intensive Support Teams provide time limited enabling support to facilitate older people with dementia or a mental illness to remain in their own homes and/or to support hospital discharge. One of the innovative features of the service model is that it provides some evidence that a re-ablement approach can work well for older people with mental health needs – who have previously tended to have been excluded from re-ablement services. Key features of this intervention include:

  • helping people ‘to do’ rather than ‘doing for’ them
  • supporting people at a time of crisis
  • outcome focused support from care workers with defined maximum duration
  • subsequent ongoing care packages not defined by a one-off assessment but through observation over a reasonable period (typically around 6 weeks)

• Leeds Home Support Service Open

  The Home Support Service for Older People in Leeds is aimed at those with moderate to severe and enduring mental health problems who are living in their own homes. It is provided by a voluntary organisation that delivers a range of housing and community support services. A team of support workers offer a wide range of social, emotional and practical support to older people. Interventions may include:

  • Maintaining and enhancing daily living skills
  • Alleviating isolation and loneliness through linking people with community networks and groups
  • Maximising coping strategies
  • Help in tackling problems
  • Facilitating access to other services
  • Providing support and advice to informal caregivers.

  HSSOP is an innovative model for providing long-term support to sustain community living. It seeks to create a form of support in respect of later life mental health that enables older people who have multi-dimensional problems to maintain an ordinary life in ordinary communities. Networking with community resources is viewed as part of the process of expanding access, of developing relationships of trust between agencies and of enhancing the resource repertoire for individuals.

• Support to Carers Open

  The Carer Support (Dementia) service is designed to:

  • provide advocacy, advice, information and signposting tailored to individual need
  • emotional support (often by telephone)
  • develop and deliver training in dementia care to staff within voluntary, community and statutory services
  • to facilitate the expansion of a network of dementia cafes, including contributing to the sustainability of the network by providing training for volunteers and ongoing specialist support.

  The service faces outwards and into the community to increase understanding of dementia, reduce stigma and secure local involvement in expanding the dementia café network; and facing inwards to mental health services to contribute to more co-ordinated provision for people with dementia and their caregivers to sustain an ‘ordinary life’.

  The Carer Support (Dementia) service is illustrative of a high impact, low intensity service. There are four specific features of its high impact:

  • First, it is perceived as accessible and responsive, particularly at a critical point in the care giving trajectory – around the point of diagnosis – supporting people through practical problems such as accessing benefits, advice and advocacy
  • Second, it provides a link into other services and support – through its own in-reach and out-reach work.
  • Third, it offers an ear to carers at points of stress, providing emotional support and assistance in acknowledging the need for, and accepting help.
  • Fourth, it both acknowledges and responds to the specific needs of caregivers and the relational needs of the care giver/care receiver dyad.

• Supported Hospital Discharge Open

  The Hospital After Care service’s primary objective is to enable timely acute discharge, with support assistants providing practical and socio-emotional support in the transition from hospital to home and to re-integrate people into the routines of everyday life.

  The model is based on a conception of enabling support - doing with rather than doing for. It encompasses practical help and advocacy within and outside of the person’s home with the aim of building confidence following an in-patient stay. Employing a goal orientated and task centred approach, workers identify with individuals what is important to them. They then agree an action plan with achievable goals toward the objective of them regaining independence, contributing to well-being and recovery and re-establishing social networks. The service is targeted specifically at older people with mental health problems.

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