Windows of opportunity: prevention and early intervention in dementia
Interventions: Protection - Case studies
Assistive Technology Open
Assistive technology, also known as telecare, can make a significant contribution to enabling an individual to carry on living at home through reducing some of the risks associated with memory problems.
A combination of sensors and alert alarms can be tailored to individual need to provide appropriate responses to a very wide range of risks. These include detection of temperature extremes, smoke or gas, flooding. Property exit sensors can be used to alert carers when an individual leaves the house, and these can be combined with GPS technology to support safe, purposeful walking. Movement and fall sensors can be used to identify altered patterns of activity and prompt an emergency response. Telecare can also be used to prompt actions on the part of the individual, for example medication reminders.
Effective use of telecare can support individuals to carry on living where they want to and can also represent significant savings to local authorities.
Examples of the use of assistive technology can be found at:
Dementia Out of Hours Support ServiceOpen
The purpose of the service is to offer short-term support, advice, assessment and onward referral to people with dementia, and to support carers. Key objectives of the service are:
- to prevent hospital admission and other disruption to life,
- to prevent emergency admissions to residential care,
- to reduce the unnecessary use of the ambulance service
- to provide reassurance to older people, enabling them to retain their independence in their own homes
- to provide reassurance to carers, enabling them to feel confident to care for people with dementia at home.
The service is an example of close partnership working between social services and the local mental health partnership trust. Two part-time nurses and one physiotherapist are employed by Social Services and managed within the SSD Emergency Duty Team. Team members receive clinical supervision from the mental health partnership trust.
The service is available between 6pm and midnight during weekdays and between 2pm and midnight at weekends and on Bank Holidays. Options for delivery of such a service are within the specialist mental health provider or integrating it with other 24-hour unplanned care services in order to include a specialist dementia element within them.
Sheltered and extra-care housing have great potential to support people with dementia. Scheme managers can play a vital role in acting as advocates for residents. Extra-care housing can offer people with dementia an alternative to residential care, offering a combination of flexible and responsive home care and support, maximum independence, improved safety and security and managed risk. Schemes will differ, but can offer:
- Staff who have training in dementia care and can offer flexibility in response to changing needs
- Access to personalised activity, short breaks and day services
- Access to peer support networks established within housing schemes
- Responsiveness to crisis situations through use of telecare
- Supported housing that is inclusive of people with dementia
- Respite or carer breaks that provide a valued and enjoyable experience, such as through the provision of extra care guest rooms
The Dementia Care Partnership in Newcastle provides several supported living houses across the city, which offer shared living in “ordinary houses on ordinary streets”. On-site care and support is based on the Partnership’s PEACH philosophy of person-centredness, empowerment, attachment, continuity and hope.
Developed by the Dementia Care Partnership:
Person-led - all services are tailored to the individual’s needs and preferences
Empowerment - people with dementia and their carers retain control over their lives
Attachment - a sense of security is gained through the presence of a trusted person or the familiarity of a place
Continuity - support is provided by a small team of workers and continuity with the individual’s lifestyle, history and routines is maintained
Hope - people with dementia continue to live their lives as active, valued and participating members of their community.
For more information see Dementia Care Partnership: More Than Bricks and Mortar case study (PDF file).
Floating Support ServicesOpen
In the South West, several Supporting People authorities have jointly commissioned a floating support service for people with dementia. Delivered by Rethink, a membership charity, support workers provide assistance to people with memory problems to maintain their tenancies with benefits advice, help with finances and ensuring the safety of their home. They also provide support with maintaining social networks, and helping their clients to access other services if needed.
Intermediate Care Out of HoursOpen
The service offers short-term support, advice, assessment and onward referral to people with dementia, and supports their carers. Key objectives are:
- Preventing hospital admission and other disruptions to life
- Preventing emergency admissions to residential care
- Reducing unnecessary use of the ambulance service
- Providing reassurance to older people, enabling them to retain their independence in their own homes
- Providing reassurance to carers, enabling them to feel confident to care for people with dementia at home.
Two part-time nurses and one physiotherapist are employed by the Social Services department and are managed within the Emergency Duty Team. They receive clinical supervision from the local Mental Health Partnership Trust.
The service is available between 6pm and midnight during weekdays and between 2pm and midnight at weekends and on Bank Holidays.
The social care Joint Improvement Partnership (JIP) in the East of England has funded a project manager to facilitate the development and enhancement of the processes that enable people with dementia to receive and manage a personal budget or direct payment.
Currently, many services for people with dementia are pre-purchased by local authorities and people are often “slotted into” large scale services or offered short periods of support, sometimes as little as 15 minutes and in many cases with a different carer visiting on a daily basis. This type of support can be detrimental to people with dementia who rely on routine and consistency of care in a familiar environment. Cash payments can provide the type of personalised support which will enable people to remain in their own homes, stay in control of the type of support they receive and have the flexibility of care that meets the fluctuating needs of the illness. Individualised care can also help people with dementia remain active and healthy longer with resources becoming available at any given point along the “dementia journey”.
There are challenges to providing this type of support to people with dementia, in particular “risks”. However, these risks are often “perceived potential” risks that can be managed and minimised by a comprehensive risk assessment, while still promoting independence, dignity and choice.
The project manager linked with key partners to create a shared agenda. These have included Dementia Choices, regional groups working on workforce development and training, and work on personal health budgets.
The project manager has facilitated positive risk taking through:
- the adaptation of a person centred risk assessment
- designing and producing a process chart in relation to the new Direct Payment regulation for practitioner use – this clarifies issues in relation to capacity
This work has been undertaken in collaboration with the Social Care Institute for Excellence (SCIE).
The project manager has increased knowledge and understanding of opportunities created by individual budgets for people with dementia and their carers. This has been achieved through linking with regional and local Alzheimer’s workers, including the newly appointed Dementia Advisers; with regional leads and carers groups across the region; with carers training. Some of this work has been with a carer who supported her husband at home with the support of Direct Payments, Independent Living Fund and carer’s Direct Payments, and who is willing to share her experience with groups of carers and professionals. Carers have been very keen to learn about what support is available and how to access this and this has highlighted the need for information for carers on what is available.
Visit the Joint Improvement Partnerhip for the East of Englamd for documents and reports on their dementia workstreams.
The Peterborough Palliative Care Group exists to provide a peer support network for a wide range of professionals in primary and secondary care and the care home sector. It:
- provides a local focus for leading on and supporting the implementation of national strategies in relation to palliative care in dementia.
- develops and disseminates expertise on working with people with dementia at the end of life in particular in nursing and residential homes, also in hospital wards and community settings.
- sets and improves standards in relation to this.
- provides an education and training function through a series of symposia, presentations at conferences, publications and websites.
Through the work of the group there is clear evidence of increased confidence and improved practise in care staff, which has improved quality of care and reduced emergency care home admissions. An audit of emergency acute hospital admissions in 2008/9 showed a significant drop in emergency admissions and a rise in the numbers dying in care homes as opposed to hospital from around 55% to 75%.
More information about the Peterborough Palliative Care Group can be found on the Jenner Health Center's website.