Dementia in Care Homes Lorraine Smith Advanced Practitioner Nursing Home Support Team

1. Dementia in Care Homes Lorraine Smith Advanced Practitioner Nursing Home Support Team July 23rd 2014

2. • Two thirds of people living in care homes have Dementia. • 45% of care home residents have moderately severe to very severe cognitive impairment. The excellent care provided by some homes can make a huge difference to residents quality of life.

3. Long term care is about living ones life. • Primary task of care homes is to provide good quality care to people living with dementia • Expectations of the quality of life that can be experienced by people needs to be higher • Good care homes have a good atmosphere and warm relationships among residents, staff and relatives

4. What are some of the challenges • Provision of meaningful activities and occupation • Treating residents with dementia with dignity and respect • Relationship between care homes and relatives/friends • Support from external services variable

5. What needs to be done to GET IT RIGHT? Training for care home staff. Improve on Life stories. An understanding of challenging behaviours. Working closely with the MDT-Not forgetting the patient and family at the centre of care. Recognising end of life.

6. Person with DEMENTIA PERSON with dementia

7. Inspectors views The CQC found that care homes were not preventing, detecting or properly treating problems such as dehydration, pneumonia, malnutrition and urinary infections in people with dementia in care homes in 78 out of 151 primary care trust areas of England (52%). Care home staff are also missing pressure sores, lower respiratory tract infections and broken bones in residents with serious memory loss, CQC inspectors found. Care homes and hospitals 'failing people with dementia' –Guardian 12th March 2013

8. Reasons for Frequent hospital admissions Dehydration Pneumonia Malnutrition Urinary tract infections Pressure Sores

9. Consequences Increased bed days Disorientation May inappropriately be diagnosed with challenging behaviour Confusion Change of routine.

10. IMAGINE You are sat in unfamiliar clothing, beside a bed in a room with 3 other beds and lockers, you think it might be a hospital but it is strange and unfamiliar... You cannot recall how you got here ... You don’t know what is about to happen, but you have a sense of dread... The smells, noises, sights and people – those who appear ill and those in uniform moving about with purpose – are all puzzling and unsettling... You recognise no-one... You are hungry and thirsty... Occasionally, you summon the courage to call out to people who walk close by. Many ignore you, those who stop and speak to you talk quickly in a language you can make no sense of, and then they swiftly depart... When you get up your movements are unexpectedly slow and laboured... Finally, when you try to seek a way out of this strange and unfamiliar place, a person in a uniform prevents you leaving…

12. The more you know about a person the more likely you are to understand a persons behaviour before it becomes challenging. LIFE STORIES

13. My Involvement Providing dementia training to care home staff. Support with symptoms in end of life care Advanced Care Planning. Life Stories essential part of the assessment. Support with Pain tools. Setting up Nursing home forum. Environmental factors.

14. IT DOESN’T COST LOTS OF MONEY TO DELIVER GOOD CARE AND SHOW EMPATHY. THIS MAY BE YOUR PARENTS/FAMILY/FRIENDS WE NEED TO GET IT RIGHT