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www.alzheimers.org .uk Counting the cost Caring for people with dementia on hospital wards
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www.alzheimers.org.uk
Counting the costCaring for people with dementia on hospital wards
www.alzheimers.org.uk
1. Background to the research
2. The research
3. The findings
4. Recommendations
Background to the research
www.alzheimers.org.uk
EVIDENCE BASE
POLICY
CONTEXT National Audit Office
Local action
National Dementia Strategy for England
Strategies for Wales and NI
Royal College of Psychiatrists audit
Alzheimer’s Society research
www.alzheimers.org.uk
• Provide detailed evidence
• Support ongoing work and move beyond recent achievements
• All hospitals to be at standard of the best
www.alzheimers.org.uk
The research
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People with dementia and carers
4. What was positive and what do you think can be done to improve things?
1. About the ward
2. Quality of dementia care on the ward
3. Leaving hospital
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People with dementia and carers
4. What was positive and what do you think can be done to improve things?
1. About the ward
2. Quality of dementia care on the ward
3. Leaving hospital
•1,291 responses
•Supplementary evidence and information
also provided
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Nursing staff and nurse managers
5. Any examples of good practice?
1. Training and work-based learning
2. Working with people with dementia – key challenges
4. What could be done to support the improvement of dementia care?
3. What would help you to care for people with dementia?
www.alzheimers.org.uk
Nursing staff and nurse managers
5. Any examples of good practice?
1. Training and work-based learning
2. Working with people with dementia – key challenges
4. What could be done to support the improvement of dementia care?
3. What would help you to care for peole with dementia?
• 657 nursing staff responses
• 479 nurse managerresponses
The findings
www.alzheimers.org.uk
A good experience…
They treated him in a very person-centred way and were always checking on him and helping him. All staff members were very aware of his dementia. They spoke very slowly and calmly and never rushed him. The nurses were amazing and there was nothing they didn’t have time for.
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She had fallen out of bed and I asked the nurse how this happened and the nurse replied: ‘I have 16 other patients to look after’. She never left her bed again. We asked for the jug of water to be filled and the staff member said ‘no, that’s not my job’. Once, I found that her pad was sopping wet and her legs were raw.
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A very different experience…
Why are people with dementia in hospital?
• Up to a quarter of beds occupied by people with dementia aged over 65.
• Admitted to hospital for a range of acute physical conditions: following a fall, broken/fractured hip, urine infection (including UTI), chest infection, stroke.
• Prevalent in a variety of wards: elderly care, surgical, general medical, orthopaedic, rehabilitation.
• 97% of nurses work with people with dementia.
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Human cost to being in hospital• Variation in the quality of dementia care provided - 77% of
carers dissatisfied with quality of dementia care
• Over one third went through complaints system
• 47% said being in hospital had a negative effect on health
• 54% said being in hospital had a negative effect on dementia
• 77% of nurses said that antipsychotic drugs were used. Up to a quarter thought they were not appropriately prescribed
• 53% not offered additional support on leaving hospital
• Over a third of people who went into hospital from their own homes were discharged to a care home.
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• Lack of recognition and understanding of dementia
• A lack of person-centred care
• Lack of help with eating and drinking
• Not as much involvement in decision making as would like
• Few opportunities for social interaction
• Not treated with dignity and respect
Quality of dementia care
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•89% of nursing staff found working with people with dementia challenging
•Over half of nursing staff not received pre-registration or work-based training
•Over a third have some but not enough
•Key challenges are: managing difficult and unpredictable behaviour; communication; not enough time to provide one to one care; wandering and ensuring patient safety
Nurses concerns
What would help nurses?
• More access to specialist advice and help - 91%• More staff/time on wards – 90%• Good leadership in dementia care – 87%• More involvement with family carers – 84%• Learning and development opportunities – 83%
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Length of stay
• Majority of nurse managers felt people with dementia have a longer stay in hospital.
• Half of carers said that the hospital stay was longer than they expected it to be.
• The longer the stay, the worse the effect on dementia and health; discharge to a care home more likely and antipsychotic drugs more likely to be used.
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• People with dementia are in hospital longer than the median length of stay for all NHS patients for same reason for admission.
• Urinary tract infection – median length of stay for all NHS patients is 4 days
• 86% of people with dementia stay one week or more (at least median plus 3 days)
• 53% of people with dementia stay two weeks or more (median plus 10 days)
• 30% of people with dementia stay one month or more (median plus 26 days)
• Dementia is leading to reduced throughput and capacity
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Economic cost
• Additional financial pressure is being placed on the NHS by people with dementia staying in hospital longer.
• Supporting people with dementia to leave hospital one week sooner can result in savings of at least £80 million and potentially hundreds of millions of pounds.
• Urinary tract infection – 123,273 cases in 07/08; up to a quarter of these likely to have dementia (30,800 people).
• Excess day tariff for UTI is £176, leading to savings of £38m
• This could be more effectively reinvested.
www.alzheimers.org.uk
www.alzheimers.org.uk
Recommendations:Meeting the challenge of dementia
1. Recognise that dementia is a significant, growing and costly problem, which lies at the heart of the agenda to drive efficiency and quality improvement
2. Reduce the number of people with dementia being cared for in hospitals
3. Identify a senior clinician
4. Commission specialist liaison older people’s mental health teams
5. Ensure there is an informed and effective acute care workforce
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6. Reduce the use of antipsychotic drugs to treat people with dementia on a hospital ward
7. Involve people with dementia, carers and family in decisions, care and treatment
8. Make sure that people with dementia have enough to eat and drink
9. Begin to change the approach of care to one of dignity and respect.
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