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Dementia care

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VOL: 97, ISSUE: 18, PAGE NO: 36

Suzanne Wightman, RMN, is coordinator, continuing care team, Dewsbury Health Care NHS Trust

Our specialist team was formed in response to the increasing number of referrals to elderly mental health services for community psychiatric nurse input, home visits, outpatient appointments and because of a rise in admissions to mental health wards from nursing and residential homes.

Our specialist team was formed in response to the increasing number of referrals to elderly mental health services for community psychiatric nurse input, home visits, outpatient appointments and because of a rise in admissions to mental health wards from nursing and residential homes.

Launched in January 1999 by Dewsbury Health Care NHS Trust, the team includes two CPNs, two occupational therapists, a community support worker, a consultant psychiatrist for old age, a doctor and a secretary. A physiotherapist attends weekly meetings to take referrals and a dietitian works on a sessional basis.

Patients from nursing and residential homes were, in many cases, admitted to hospital for longer periods than patients admitted from their own homes. Residents often required a placement review, and a move to specialist care would follow. It was felt that a multidisciplinary team could assess residents without the distress caused by hospital admission.

A recent team audit revealed a substantial reduction in hospital admissions from nursing and residential homes, which dropped from 61 in 1997 to 45 in 1998, 10 in 1999 and 13 in 2000.

The team has an open referral policy and responds, subject to the agreement of the resident's GP, within five working days. We get referrals for people with a wide range of mental health problems but many have dementia. Staff in homes often have difficulties managing the symptoms and challenging behaviour associated with dementia.

The Audit Commission (2000) found that a third of all admissions to specialist homes were from nursing and residential homes, implying that they were unable to cope with these patients. Its report suggested that support for residential and nursing homes from specialist mental health professionals could help to reduce admissions that are potentially detrimental to residents' well-being.

The team works intensively with each patient for an average of six to eight weeks. It adopts a flexible response, offering crisis support over a 24-hour period, subject to certain criteria and staff availability. Referrals are allocated for assessment to the most appropriate team member. A key worker and a co-worker are allocated to each referral, but other specialists from the team may also be involved. The doctor reviews medication if necessary and works closely with the patient's GP. A full risk assessment, using the Dewsbury risk assessment tool, is carried out on each referral. The family and home staff contribute to care planning and patient reviews.

In addition to working holistically with individual clients in care homes, the team works proactively with staff to offer support, training and education. This takes the form of individual training sessions, formal group sessions and events, including a conference, workshops and exhibitions. The most recent event was a project presentation day, where home staff were invited to present activities or projects undertaken with residents to maintain their health or skills in some way. This was an opportunity to promote good practice across all the homes.

'Activity not passivity' has been adopted as the theme and title for organised events. The team has strong links with other groups that offer support to nursing and residential homes, such as the National Association of Providers of Activity for Older People, the Chair Activity Network and the Reminiscence Support Group.

The Forget Me Not report (Audit Commission, 2000) emphasised the benefits of dementia care mapping, an observational method used to evaluate the quality of care in formal settings. DCM assesses the quality of care in relation to personal well-being rather than cognitive ability or disability. The team has used this technique to monitor care and then provide feedback for care staff.

Social services make an increasing number of referrals and the team is often involved in the review of care placements. It works closely with the resident, family and care staff to ensure a smooth transition between one placement and another (see case study). Good working relationships with care home managers are also evident. During a recent audit one care coordinator said: 'The advice, support and reassurance from the team was excellent during a difficult time with a poorly client.'

The team emphasises good communication, teamwork, education and support. We meet twice a week to allocate referrals and all members have time to give feedback about residents they have assessed or to liaise with other team members for specific advice, support or further specialist assessment. All members work together to improve their understanding of each other's professional roles while retaining strong links with their own professional groups. The team's focus is on person-centred care, with individual team members' specialist knowledge and skills enhancing the work of the team and quality of life for care home residents.

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