Commissioners Network 12 th Jan 2011 Domiciliary Care workstream update Catherine Pascoe South West Dementia Partnership

Improving domiciliary care for people with dementia Objectives To gain a greater understanding of what best practice commissioning looks like in terms of domiciliary care for people with dementia and their carers To learn more about how to promote person centred planning and delivery To understand more about the role of specialist services, what they are, when they are appropriate and the costs and benefits of specialist versus more generic approaches To identify what actions can be taken forward to improve practice and ensure that domiciliary care services best meet the needs of people with dementia

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. Provision of an appropriate range of services to support people with dementia living at home and their carers. Access to flexible and reliable services, ranging from early intervention to specialist home care services, which are responsive to the personal needs and preferences of each individual and take account of their broader family circumstances. Accessible to people living alone or with carers, people who pay for their care privately, through personal budgets, or through local authority arranged services.

How this can be delivered? Implement Putting People First personalisation changes for people with dementia Establish an evidence base for effective specialist services to support people with dementia at home. Commissioners to implement best practice models thereafter.

Where are we know? So far….  Engagement with  Localities  National programme team  UKHCA and ECCA  Performance data collection  Survey  Reference Group  National research

Products so far: Domiciliary care key information report –Survey findings –Headlines from national performance data national service user views CQC snapshot SW region data set –Underpinning national data, broken down by SW Local Authorities –Detail of service user views by LA area in SW –CQC snapshot data

Headlines 58.4% extremely or very satisfied with the care you receive, in SW 54.5%-73.4% Over half of all home care visits are 30mins –19% are 15mins 21% people said their carers were always or often in a rush, in SW 10%-23% 91.9% always or nearly always see the same care worker, in SW 84.2%-93.6%

Specialist services Lack of definition of what a specialist service is and offers Limited evidence re costs and effectiveness Specialist services more likely to have more highly skilled and experienced staff, though not exclusively Specialist services sometimes offer a wide range of support Re continuity: both can provide Funding arrangements can support greater flexibility Specialist services tend to cost more, but not always Capacity of specialist services is capped and does not reflect a level of need Inequity in terms of access to specialist services Specialist services more likely to be linked with specialist MH support

Costs and benefits of specialist & generic services for people with dementia: PSSRU Did not seem to matter in terms of cost and effectiveness whether a service was specialist or generic What mattered was whether the service conforms to good practice or quality standards for dementia care. The evidence suggests that both can offer this

PSSRU Amount and frequency of visits Easy access to mental health advice and support Central to supporting people at home for as long as possible:

What do we need to do? A number of challenges: Implementing Putting People First for everyone Ensuring people with dementia benefit fully from PPF Making the case (economic and quality of life) for more effective service delivery for people with dementia focussed on prevention and early intervention

A person’s journey with dementia AwarenessIdentification, Assessment, Diagnosis, Initial intervention Living well with dementiaEnd of Life Crisis response Transition points and windows of opportunity

Voice of People with dementia Alzheimer’s Society community support survey (Autumn 2010). Report due Feb/March 2011 Key themes emerging, Jan 2011, test out how people would like to see things taken forward Identify case scenarios for planning purposes

Domiciliary support for people with dementia and their carers Personalised approaches building on outcomes for individuals. –Time /task based support unhelpful –Building relationships with service users is a key part of “the work” –Maintaining a person’s resilience, both the person with dementia and their carer is key –Initial outcome might be securing engagement –Assessment and support planning tools and processes need to support personalised delivery –Biographies particularly important for people with dementia –Good understanding of balancing rights and risks and how this links with delivering outcomes, including application of MCA –Contingency planning –Understanding peoples cognitive abilities and difficulties so support plans can build on strengths –Use of telecare –Continuous reassessment of circumstances and preferences

Domiciliary support for people with dementia and their carers Staff competent in working with people with dementia –Personal qualities of care workers highly valued –Dementia “nous” –Problem solving and coping strategies –Communication skills –Behaviour management strategies –Cultural change, care workers more autonomous, and have improved status

Domiciliary support for people with dementia and their carers Support and understanding for family members/carers –Shared responsibility with carers –Respite Reliability –1/3 rd people with dementia living at home live alone Consistency and continuity –Staff who know the person and can identify when needs change –Building relationships requires continuity –Need to minimise hand offs

Domiciliary support for people with dementia and their carers Flexibility Ability to adjust service provision quickly and effectively –Financial and monitoring processes that support this Rapid response, including out of hours Night time cover

Domiciliary support for people with dementia and their carers Working in partnership –What works from a provider perspective in terms of delivering this kind of support? –Links with other services Transforming community services, Transforming Adult Services Easy access to advice and support Liaison services –Care coordination

Next steps Commissioning work from UKHCA on provider perspective on what works in delivering community support for people with dementia Developing Commissioning checklist for domiciliary support Adapting DQM for domiciliary care Commissioning research on specialist OPMH services in the community, evidence re what works Learn from Wiltshire as they move forward with implementation Implement early intervention and prevention model