Welcome to the RCSLT’s webinar: Dementia and the role of the SLT 8 th July 2014 #Dementia

Welcome Derek Munn Director of Policy and Public Affairs, RCSLT

Panellists: Mary Heritage Assistant Director of Quality and Professional Lead for Allied Health Professions in Derbyshire Community Health Services NHS Trust Sasha Wade Service Improvement Lead for Dementia, Kingston Hospital NHS Foundation Trust

Housekeeping  Send in chat messages at any time by using the Chat button  Send in questions by using the Q&A button.  This event is being recorded. See here for recordings:  Vicky Harris is on hand to help!

Today’s session  Dementia in context  Outcomes decision-makers are looking for  The RCSLT Dementia Position Paper 2014  How SLTs can fit in the care pathway  Person-centred care  The RCSLT Dementia Campaign & resources  Questions

Dementia: an overview with reference to RCSLT’s dementia position paper Mary Heritage Assistant Director of Quality and Professional Lead for Allied Health Professions, Derbyshire Community Health Services NHS Trust

Did you know…?

(From RCSLT’s Dementia position paper 2014) 665,000

What is dementia?  A set of symptoms, including memory loss, mood changes and problems with communication and reasoning  These symptoms occur when the brain is affected by certain diseases, including Alzheimer's disease and the damage caused by vascular changes  Each person is unique and will experience dementia in his or her own way

 Alzheimer’s disease (AD) 62%  Vascular dementia (VaD) 17%  Mixed dementia (AD and VaD) 10% (Alzheimer’s Society)  Dementia with Lewy bodies 4%  Fronto temporal dementia (FTD) 2%  Other dementias 3% There are over 100 different forms of dementia. Alzheimer’s disease is the most common form of dementia….

What ultimate outcomes do decision- makers want? The four priority areas for the Department of Health around dementia are: 1.Good quality early diagnosis and intervention for all - Two thirds of people with dementia never receive a diagnosis 2.Improved quality of care in general hospitals - 40% of people in hospital have dementia 3.Living well with dementia in care homes - Two thirds of people in care homes have dementia; dependency is increasing; over half are poorly occupied; behavioural disturbances are highly prevalent 4.Reduced use of antipsychotic medication – c.180,000 people with dementia are treated with antipsychotic drugs. In only about one third of these cases are the drugs having a beneficial effect and there are 1800 excess deaths per year as a result of their prescription Quality outcomes for people with dementia: building on the work of the National Dementia Strategy Department of Health, 2010

What ultimate outcomes do decision-makers want? Scotland’s National Dementia Strategy: Key outcomes from Scotland’s National Dementia Strategy: : 1.More people with dementia living a good quality of life at home for longer 2.Dementia-enabled and dementia-friendly local communities, that contribute to greater awareness of dementia and reduce stigma 3.Timely, accurate diagnosis of dementia 4.Better post-diagnostic support for people with dementia and their families 5.More people with dementia and their families and carers being involved as equal partners in care throughout the journey of the illness 6.Better respect and promotion of rights in all setting, together with improved compliance with the legal requirements in respect in respect of treatment 7.People with dementia in hospitals or other institutional settings always being treated with dignity and respect

How can speech and language therapy help?

RCSLT published its Dementia Position Paper to address these issues  Speech and language therapy services should be adequately resourced to provide quality care for people with dementia  Communication and swallowing are the responsibility of the whole team. The role of the speech and language therapist is to empower and educate others, as well as providing direct specialist input as appropriate  Early speech and language therapy intervention is crucial so that people with dementia and their carers have their needs met in a timely way.  Read the RCSLT Dementia Position Paper: aper aper2014

In a multi-disciplinary team, SLTs are well placed to deliver the following outcomes…

1. Diagnosis: - Analysis of associated language disorders to inform differential diagnosis - Specialist assessment of any eating, drinking and swallowing problems - Assessment of individual’s capacity to consent to treatment and care

2. Care: - Providing programmes to maximise and maintain function -Providing an optimum environment for communication and eating and drinking - Enhancing function in the later stages of the condition

3. Living well: - assisting interpersonal relationships between individuals and carers - acting as advocate for people with communication disorder - supporting the person with dementia with interactions in their community

4. Helping the person with dementia and carers by providing: - support that enables carers to care – support that maximises knowledge, skill, self-efficacy and quality of life, and minimises depression and anxiety - management strategies for people experiencing eating and swallowing difficulties - specialist input to clinical networks for policy development, risk management, ethical decision-making, research and audit

 Decreased quality of life and quality of relationships  Delay in diagnosis and/or incorrect diagnosis  Barriers to accessing other professionals  Increased level of dependence at an earlier stage  Exclusion from decision- making and service-planning  Avoidable death due to malnutrition, choking & aspiration pneumonia The risks of not providing speech and language therapy...

How SLTs can help people living with dementia Sasha Wade Service Improvement Lead for Dementia at Kingston Hospital NHS Foundation Trust

How SLTs Can Help People Living with Dementia Sasha Wade, SLT Service Improvement Lead for Dementia Kingston Hospital NHS Foundation Trust

Ways We Can Help  RCSLT Dementia Position Statement  helping to inform differential diagnosis  optimising communication and swallowing  training  research and development

My Experience  Context: Acute Care  Dementia Education  Promoting Person-Centred Care  Supporting Carers  Advocacy

Dementia Education  Varies depending on time/audience/needs  Recognition/Understanding  Communication  Can include training on behaviours that challenge  Provide practical examples  Feeding/Swallowing/Mealtime Promotion  E.g. Dining Companion Program  Emphasis on SLT role in dementia care

Person-Centred Care  Importance of unique wishes and needs of the individual’s care  Examples  Forget Me Not Scheme  This is Me  Dementia Champions  Environmental Modifications  Therapeutic Activities Program  A team effort

A Closer Look: Signage

A Closer Look: Important Things About Me

A Closer Look: Therapeutic Activities Program  Education Component  Daily 1:1 and group activities  Communication based  reminiscence therapy  singing for the brain  group reading  finish that line  familiar, interesting, function- appropriate activities  Activities How-To Guide

Supporting Carers  Person with dementia + carers are a package unit  Examples of experience supporting carers  training re: compensatory strategies, function appropriate activities  behaviour management/communication support  advanced care planning (e.g. re: swallowing decline)  Carer’s passport in acute care  Dementia navigation support

Advocacy  Dementia Action Alliance  Dementia Friends  Barbara’s Story  Dementia Awareness Week

The RCSLT Dementia Campaign Derek Munn Director of Policy and Public Affairs, RCSLT

Key Objectives/ Asks We are calling for budget holders to review their provision of speech and language therapy for people with dementia to ensure their communication and swallowing needs are met We are calling for primary care services and care homes to have appropriate access to speech and language therapy services to support people with dementia We are calling for the relevant health professionals, care home and home care staff to understand the impact of communication difficulties on dementia patients and their carers We are calling for the relevant health professionals, care home, agency and home care staff to be able to identify the early signs of eating, drinking and swallowing difficulties and know when to refer to speech and language therapy, so that people with dementia can meet their nutritional needs safely and appropriately

Audience Other health professionals Local decision makers in hospitals Decision makers in care homes/ care home providers Politicians General Public Highest priority

Hubs and Champions THEMEGRASSROOTS ACTIVITYFOCUS Diagnosis Local Influencing: meetings, letters, presentations. Enabling your CCG to meet its locally-set target for diagnosis Dysphagia Positive PR Celebrating successes of patients staying out of hospital Communication Events + Local Influencing: meetings, letters, presentations. A joint event between an RCSLT Hub and Patient Opinion or regional Dementia Action Alliance highlighting SLTs role in improving communication outcomes for patients. *GV Dementia campaign a key way to promote campaigning in Hubs! *

Who can do what? ActivityPurposeWho can be involved? Services actively encouraging and participating in a review of SLT services for people with dementia. To highlight gaps in provision and open opportunities for new/enhanced services. Adult services, acute and community. Basic training around communication and swallowing difficulties for all professionals involved in caring for people with dementia. To improve the care of dementia patients and build appreciation amongst professionals of the role of an SLT in dementia care. Adult services. SLT students? Awareness raising events, displays and news stories. To increase professional, political and public understanding of the role of SLTs in dementia care. All SLTs and all SLT students!

Campaign Resources Local Activity Menu of campaign ideas Leaflet for awareness raising Briefing for decision makers Dementia and SLT awareness poster Available at Now available

Find out more… RCSLT dementia campaign: RCSLT dementia campaign: r2014 Dementia resources: Dementia position paper: r2014http://givingvoiceuk.org/dementia/ r r2014

ANY QUESTIONS?

More ‘Did you know?’ facts