1. Making general hospitals fit for dementia care 27 th International Conference of Alzheimer’s Disease International London 2012 Rachel Thompson RCN Dementia Advisor

2. Dementia …..  Whose business is it?

3. Dementia in general hospitals: why do we need change?  Estimates suggest 25- 40% of people in hospital have a cognitive impairment stay in hospital longer have poorer outcomes 1/3 discharged to care home use of antipsychotic medication poor identification and understanding of needs Counting the Cost (Alzheimer’s Society 2009)

4. National Audit of Dementia Care in General Hospitals 2011  210 hospitals across England and Wales  Enhanced audit 145 wards across 55 hospitals  6% hospitals had dementia care pathway  32% of staff reported ‘sufficient’ training  Very few wards demonstrated a culture which was “person-centred”  15% of wards used colour schemes  Assessments incomplete for mental health status, nutrition, function, continence  40% of hospitals had clear procedure for information sharing with families  Lack of consistency in the determination of staffing levels

5. RCN Dementia Project Sept 2010- Sept 2011  Supported by Department of Health  Survey of practitioners : 712 responses  Survey with people with dementia and carers :1484 responses  Collaboration with external stakeholders  Development of ‘Commitment to the care for people with dementia in general hospitals’  Resources to support delivery

6. Improving care Strategies to improve careIdentified by practitioners as instrumental (n = 712) Valued as ‘very important’ by carers and people with dementia (n = 1484) Involving family carers71%98% Education and training for staff69%98% Individualised care planning57%97% Assessment and identification51%93% Improving mealtimes48%80% End of life care43%90% Environmental changes40%76% Dementia pathway40%79% Specialist support/clinical lead40%94% Flexible visiting times35%73% Providing activities and therapies30%72% Dedicated wards/bays26%51% Involving volunteers25%45%

7. Barriers to care Factors identified as barriers to care Practitioners (n= 712) Carers and people with dementia (n= 1484) Not having enough ‘time to care’77%97% Insufficient staffing levels/mix75%- Frequent moves49%92% Inappropriate environment43%- Lack of specialist support39%95% Poor understanding /recognition32%98% Lack of resources40%- Poor communication-96% Poor attitudes92%

8. Commitment to the care of people with dementia in general hospitals Join us in putting these principles into practice and make SPACE for good dementia care. SPACE – top five ingredients to support good dementia care 1.Staff who are skilled and have time to care. 2.Partnership working with carers. 3.Assessment and early identification of dementia. 4.Care plans which are person centred and individualised. 5.Environments that are dementia-friendly.

9. Benefits  reduction in falls  reduction in length of stay  improved recognition of the needs of people with dementia and their families  reduced discharge to long stay care  reduction in use of antipsychotic medications  improved management of continence  improved carer satisfaction rates and  a more confident and competent staff workforce

10. Learning from what works 3. Assessment and early identification 2. Partnership working 4. Care planning 1. Staff 5. Environments Dementia champions

11. Please visit our on- line dementia resources and obtain further information on the ‘Commitment for the care of people with dementia in general hospitals’ at: www.rcn.org.uk/dementia rachel.thompson@rcn.org.uk