Changing Practice in Nursing and Care Homes

1. Changing Practice in Nursing and Care Homes National Dementia Learning Event 29th September 2011 Jillian Torrens, Adult Services Manager, Glasgow CHP - South Sector Jean Hannah FRCGP, Clinical Director, Nursing Homes Medical Practice

2. Sharing ideas: service delivery models Variety of NHS models support people living in care homes: • Standard GP registration • Local Enhanced Schemes • Dedicated services • Retained GPs

3. Successful joint working • Care Home Services - Care Home Liaison Nurses, Dietician, SLT, Clinical Pharmacy Team, Admin. Team, PM, NHMP GPs, CD & Adult Services Manager • 70(58) nursing homes & ~ 3500(2650) residents • Central Practice • 1050 patients – 67% dementia • 10% ≤ 65 years – 36% dementia

4. Assessing the Prevalence of Dementia. Audit and Cognitive Screening in Glasgow Nursing Homes Stephen Lithgow. Dementia Clinical Studies Officer. Specialist Occupational Therapist. NHSGGC Sept. 2010. Objectives: 1. Audit care plans and establish existing levels of dementia diagnosis in nursing homes. 2. Use cognitive assessment to establish levels of possible undiagnosed dementia. 3. Update care plans and GP records with cognitive test results 4. Inform GP’s of residents who may have undiagnosed dementia.

5. Methods & results • Random selection 1 in 6 residents • 48(49) NH & 403/422 nursing home residents Glasgow City • Standardised Mini Mental State Exam (SMMSE) • If difficulty participating, Functional Assessment Staging Tool (FAST) used • 89.9% had scores in dementia ranges

6. QoF Disease Prevalence /1000 Patients (Central Team n = 1018)

8. Provision of palliative care forpeople with dementia & their carers • New patient registration – hospital liaison • Supportive & Palliative Action Register (SPAR) • Early identification of those who may need palliative care • Advance/anticipatory care planning, including anticipatory prescribing • Liverpool Care Pathway for the Dying • Accessibility to patient, carers and staff vital – encourage open communication • Finding out about how we can do better

9. Preferred place of care • Majority of nursing home patients and their carers hope that death will occur in nursing home • Standard GP: 7-8 deaths per annum frailty or dementia, and total approx. 20 deaths per annum

10. Out of Hours Contacts Annual Total (Oct-Sept) Calls/Patient/Yr •  2008-09 872 0.3 •  2009-10 1118 0.4 •  2010-11 1105 0.4 Contacts for deaths: 15% 2009 to 7% 2011

11. Hospital contacts

12. The future care and support of peoplewith dementia living in care homes • Early diagnosis and support – how and who by? • Standardisation of GP support i.e. clear specification with supporting IMT screens and reporting requirements • Continue to strengthen evidence base for what works well and what does not • Use this to support appropriately resourced services to individuals, families and carers

13. Workshop discussion point 1 Dementia diagnosis: views vary from “Anyone can diagnose dementia” to “Everyone with possible dementia should have a diagnosis made by a specialist (memory clinic or old age psychiatrist)” For discussion: barriers & supports to diagnosing dementia and the impact of getting it wrong.

14. Workshop discussion point 2 Early dementia diagnosis: Many patients in care homes have undiagnosed dementia and are cared for in a variety of care home settings. What would the desired outcomes and benefits of early diagnosis be? What changes to support, care and service provision would be needed to realise these?