Care staff struggling to meet dementia needs, warns CQC

Care home residents with dementia far more likely to have avoidable hospital admissions than those without, and then face longer stays and higher mortality rates, says regulator.

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Health and social care staff are struggling to adequately care for people with dementia, meaning those with the condition are more likely to be admitted to hospital, stay longer there and die there.

That was the warning today from the Care Quality Commission, based on an analysis of hospital statistics in England from July 2011 to June 2012.

The regulator found that:-

  • Care home residents with dementia were admitted to hospital with “avoidable conditions” significantly more frequently than people without dementia in 52% of primary care trust areas. Avoidable admissions include urinary infections, dehydration, pressure ulcers and severe malnutrition.
  • In 29% of hospital admissions for a person with dementia, the dementia was not recorded for their most recent admission by hospital staff, despite having been recorded in the past.
  • In 96% of NHS acute trusts, people with dementia stayed significantly longer than those without the condition when admitted in an emergency.
  • In 70% of trusts, people with dementia were readmitted significantly more than people without the condition.
  • In 85% of trusts, people with dementia were significantly more likely to die in hospital than those without the condition.

Lack of training

Commenting on the CQC’s findings, Alzheimer’s Society said they showed care home staff were not being trained adequately to support people with dementia and suggested the NHS was not commissioning adequate healthcare services to meet the needs of care home residents with dementia.

This was leading to residents deteriorating and being admitted to hospital, where a lack of knowledge and training on the part of NHS staff resulted in their dementia not being identified or their needs not being appropriately met.

“This report lays bare the scandalous extent to which the NHS is failing people with dementia,” said Alzheimer’s Society chief executive Jeremy Hughes. “Hospitals are supposed to be places of recovery but people with dementia are going in too often, staying too long and dying in a hospital bed much more than those with any other condition.
“A quarter of hospital beds are occupied by someone with dementia. Staff better trained in dementia care will reduce the length of hospital stays and save the NHS millions of pounds.”

The CQC’s findings on dementia were published as part of its latest Care Update bulletin on the state of regulated health and social care services in England, focusing on the results of inspections from April-December 2012. 

Overall improvements in adult care

Overall adult social care services had improved; as of 31 December 2012, 80% of all services inspected since the introduction of the new regulatory regime in October 2010 were meeting the essential standards they had been inspected against, up from 72% as of 31 March 2012.

Nursing and residential homes improved across a wide range of CQC standards, however the regulator said that this was from a “very low base” in some cases. This included the proportion of homes meeting the standard on assessing needs and providing the care and support residents needed, which rose from 72%, among nursing homes inspected in 2011-12, to 82% among those inspected from April-December 2012; and from 82% among residential homes inspected in 2011-12 to 88% among those inspected from April-December 2012.

The CQC also highlighted the performance of independent learning disability and mental health services in the light of the focus on this kind of provision due to the Winterbourne View hospital scandal. Again, it said progress had been made since 2011-12 but not as quickly as the CQC would have expected, and from “a very low base”.

For example, the proportion of such services meeting the standard on supporting staff through training, supervision and appraisal rose from 81% in 2011-12 to 89% from April-December 2012.

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