Living Well with Dementia Developing the Home Care Response Oct 2011 Catherine Pascoe South West Dementia Partnership

redesign/domiciliary-care/

Where are we now? Where do we want to be? How are we going to get There? ? Domiciliary care for people with dementia

Where do we want to be? National Dementia Strategy Objective 6: Improved community personal support services.

Improving outcomes Support.Stay.Save Live in own home Maintain independence Stay active and engaged Support. Stay. Save._____________ Care and support of people with dementia in their own homes January 2011

I have personal choice and control or influence over decisions about me. I know that services are designed around me and my needs. I have support that helps me live my life. I have the knowledge and know-how to get what I need. I live in an enabling and supportive environment where I feel valued and understood. I have a sense of belonging and of being a valued part of family, community and civic life. I know there is research going on which delivers a better life for me now and hope for the future. Improving outcomes

Where are we know? Headlines 58.4% extremely or very satisfied with the care you receive Over half of all home care visits are 30mins –19% are 15mins 21% people said their carers were always or often in a rush 91.9% always or nearly always see the same care worker

Where are we know? Headlines Task- and time-focussed purchasing Majority of LA purchased provision for personal care tasks Difficulties in translating outcomes required into practical support to be delivered and in measuring progress towards outcomes 1 in 10 said poor care resulted in – avoidable admission to hospital – going into residential care earlier than expected 52% said carers not receiving sufficient support

SPECIALISTGENERIC

Amount and frequency of visits Easy access to mental health advice and support

Providing domiciliary care for people with dementia should be seen as a mainstream activity. 1/2 to 2/3 people with dementia are undiagnosed 98% Home Care Workers currently support someone with dementia You’re already doing it!

How can we move things forward? Implementing Putting People First/ Think Local Act Personal for everyone Ensuring people with dementia benefit fully Making the case (economic and quality of life) for more effective service delivery for people with dementia focussed on prevention and early intervention

Start with the person Be clear about what good dementia domiciliary care looks like Promote resilience and support to live well Plan well Identify what is important Build life story information Focus on delivering outcomes Outcomes to do with engagement and relationships carry equal wait to those about personal care Balance rights and risks, use MCA

Start with the person Be flexible Provide consistency and continuity Build on strengths Understand cognitive ability Plan for contingencies Ensure access to reablement Support Carers

– Personal qualities – Dementia “nous” – Problem solving and coping strategies – Communication skills – Behaviour management strategies – Cultural change Develop the workforce

Clear linkages with other services Crisis support Early intervention and Prevention

DON’T BE CRISIS LED! CRISIS 1 Increased agitation Increased demands on carer More resistive to support Home care increased 8- 13hrs £120-£195 CRISIS 2 Missed UTI Very poorly Hospital admission 17 days in hospital £2572 CRISIS 3 Returned home from hospital Problems now with continence and mobility Carer in despair Emergency admission for care home respite 2 weeks stay £400 a week CRISIS 4 Increased agitation General health deteriorating Fall, fractured hip Carer no longer able to accept back at home Readmission to Hospital 8 weeks in hospital £7954 YEAR DIED IN HOSPITAL

PROVIDE CHOICE AND PLAN TO STAY IN CONTROL Allocation of £200 per week for person with dementia Allocation of £1, 600 per year for carer for breaks Additional contingency support used as required Carer accesses flexible breaks Support staff spot any changes in person and seek help to investigate possible causes Primary care and other community staff promptly treat/support as required Support plans focus on well-being and resilience of person with dementia and carer YEAR

Improve contracting and procurement Personal budgets –Direct payment –Managed account (Individual Service Fund) Be clear how the provider’s ability to support people with dementia will be assessed –Dementia Quality Mark for Domiciliary Care Outcome focussed specifications Purchasing of blocks of support to meet set outcomes, to be delivered over a set time period Financial and monitoring processes must support flexible responses

Provider perspective