Dementia care: special report

Dementia care: special report

New guidance on dementia for social care and health staff is welcome but unlikely to be fully implemented, according to campaigners.

Integrated working between social care and health agencies, support for carers and more training are all emphasised as vital ways to improve services in the joint guidelines.

The Alzheimer’s Society and Carers UK both say that the best practice set out in the guidance is often not achieved – and that poor co-operation between agencies and a lack of training are two of the main reasons for failure.

The document was issued by the Social Care Institute for Excellence and the National Institute for Health and Clinical Excellence this week. For the first time, social care staff will follow the same guidance as NHS workers.

Everyone wants integrated working but its “success is variable,” says an Alzheimer’s Society spokesperson.

More specific targets, a timetable and funds are needed to turn “words in the guidance into action,” she added.

“Integrated social care and health is critical for dementia care – but we are a long way away from it,” says Madeleine Starr, strategic project manager for Action for Carers and Employment, led by Carers UK.

“There is a huge gap between the guidance and current practice,” believes Starr. The document has nothing to say on supporting carers who work, which is a huge omission, she notes.

The Alzheimer’s Society has campaigned for more dementia care training for many years and is pleased to see it highlighted in the guidance.

Training care home staff about dementia reduced disruptive behaviour by residents, and subsequently cut down on their medication, research by the society published this year found. Three quarters of people in care homes have dementia but only 10 per cent of staff have adequate training, according to the charity.

The Alzheimer’s Society has attacked Nice for “confused policy making”, by issuing the guidance on improving care on the same day as its decision to restrict access to Alzheimer’s drugs.

Guidance summary

Integrated working

The guidance says:

• Agencies should work in an integrated way.

• Social care and health managers should co-ordinate and integrate working across all agencies including jointly agreeing written policies and procedures

• Joint planning should include local service users and carers

• A combined care plan should be agreed by health and social services, operated by named staff, endorsed by service user and carers. It should be reviewed, at a frequency agreed between professionals, service users and carers.

• In principle, integrated services should lead to a simpler route to access services and a more co-ordinated delivery of services.

• Integration should also cut the number of professionals with whom people and their carers have to come into contact with and remove the need for repeated assessments by different services.

• An integrated service should make more rational decisions about the funding of health and social care services, for example funding more intensive home support for people with dementia in order to avoid the need for admission to an acute hospital.

Carers

The guidance says:

• Health and social care professionals should ensure that people with dementia and their carers are given up-to-date information on local arrangements (including inter-agency working) for health and social care, including the independent and voluntary sectors, and on how to access such services.

• Carers who experience psychological distress should be offered talking therapy. Carers’ right to an assessment of needs should be upheld.

• Care plans for carers of people with dementia should involve a range of tailored interventions. To include – peer support, phone and internet support, training, a comprehensive range of respite/short break services.

Training

The guidance says:

• Staff working with older people in the health, social care and voluntary sectors should receive dementia-care training “consistent with their roles and responsibilities”.

Challenging behaviour

People with dementia developing challenging behaviour “should be offered  an assessment at an early opportunity. Individually tailored care plans to address behaviour should be developed, recorded and reviewed”.