Initiatives to support people living with Dementia and their carers which will reduce unnecessary admission and length of stay in hospital.

Dementia Advance Care Planning

Consequent on the diagnosis of dementia will be a discussion about end of life care.  An advance care planning discussion may result in one or more outcomes:

• Statement of Preferences and Wishes
• Advance Decision to Refuse Treatment
• Appointment of a legal advocate- Lasting Power of Attorney

The recommendations included:

• Advance care planning and conversation skills training
• Completion of the ReSPECT form (Recommended Summary Plan for Emergency Care and Treatment) following diagnosis, which records all information concerning emergency care planning including resuscitation status. It also records the existence of other relevant ACP documents (Advance statement, LPA, ADRT) and where to find them.
• GP training on the identification and management of dementia.
• Mandatory adult safeguarding training to include specific mention of dementia, in particular loss of capacity issues.
• When ACPs have been made it is important that those who are involved in the individual’s care know where they are kept. Key information should also be stored on an individual’s electronic health or care records.

West Yorks and Harrogate Health and Care Partnership have produced the following video to help explain it further:

Old Age Mental Health Teams

The care homes pilot found that those most likely to be admitted to psychiatric hospital were as follows:

• Younger (average age - 74)
• More Mobile
• Physical aggression towards staff
• Physical aggression towards other residents
• Risk of self-neglect
• ‘Eating too little’
• No formal dementia diagnosis
• From a nursing home

The recommendations included:

• Identifying those in high risk categories that require more in-depth interventions
• Increase presence day to day in care home
• Clarity in remit of Care Home Liaison
• Multi-disciplinary working
• Expansion of resources

COVID-19

Throughout COVID-19, we have learned that we can make considerable, meaningful changes, and at pace, to the way in which our systems and services are delivered without having to undertake major restructures to do so. Recognising the energy released into the systems when there was a single, clear goal that everyone was working towards, and identify further opportunities to develop a shared operating model particularly as we move into the next phase of the pandemic.

COVID-19 has presented huge challenges to care homes across the country, and the impact of these will last well beyond the ‘end’ of the pandemic. We are acutely aware of the difficult balance needed between being optimistic and enthusiastic about possible changes, and the need for time to grieve. In particular, we recognise that our recommendations rely on greater cross-working between care homes and external agencies, and this may not be met with usual openness, as the risk of infection from outside workers still looms large.

With respect to this, we note that the COVID-19 pandemic has brought some opportunities, one of which is the use of technology. We recognise how the use of tools such as tablets and conferencing software can be hugely beneficial when face to face contact is not possible. We are aware that a number of our assessments, and to some extent, interventions and training can be offered online. There are still some barriers to this, including care home wi-fi and availability of staff that otherwise need to be on the ‘shop floor’ – particularly when the staff numbers are depleted due to self-isolation or sickness. However, we suggest that digital technologies could be hugely useful, and we are looking to exploring this further in the coming months.

During COVID-19, the CCG developed an information and support leaflet aimed at people living with dementia and their families carers. You can find the leaflet here.