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New care model boosts dementia care in nursing homes

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A new care model designed to help nursing homes manage the complex needs of residents with advanced dementia has led to improvements in care planning and pain management, according to an evaluation.

The COMPASSION model, which was developed in consultation with people with dementia, carers and health and social care professionals, sees an “interdisciplinary care leader” (ICL) spearhead efforts to improve joint working between nurses, doctors and others.

“It encourages and co-ordinates local health and care professionals”

Kirsten Moore

The ICL also provides advice and training to staff and family carers, and works with them to identify ways to improve care.

This includes carrying out holistic assessments of residents’ needs with nurses, healthcare assistants and family members.

It also involves establishing regular multi-disciplinary meetings and discussions to include nurses and other clinicians directly involved in caring for someone with advanced dementia, as well as wider services including district nursing, tissue viability, social care, physiotherapy and specialists in care of the elderly and old age psychiatry.

The approach was tested in two north London nursing homes over six months, as part of a wider three-year research programme funded by the charity Marie Curie.

In setting up the study and interviewing staff, researchers from University College London found both nursing homes were initially “characterised by poor knowledge in dementia and end of life care”.

“Training needs were identified in: pain management, clinical observation and needs assessment, communication with family and residents, advance care planning, person-centred care, psychological aspects of dementia and transition planning,” they said in the journal BMJ Open.

“This model offers a way for every day and specialist healthcare teams to work together in the nursing home setting”

Kirsten Moore

There were particular concerns raised both by staff working in the homes and external healthcare professionals about nurses’ ability to deal with difficult and sensitive end of life conversations with residents’ families.

“Often these conversations are quite difficult to conduct and it needs time and it needs some background knowledge and…no disrespect to the nurses here, I just don’t think many of them would have the depth of knowledge and skills to actually do that,” said one geriatrician, interviewed for the snapshot study.

The study focused on the care of nine residents with advanced dementia. Four family members were interviewed and 28 nursing home and external healthcare professionals were interviewed at different stages during and after the trial.

The researchers found the approach had led to improvements in advance care planning, pain management and person-centred care.

However, they also found the quality of care nursing homes were able to provide was greatly dependent on support available from other local health and social care services.

“A key aspect of the COMPASSION model of care is that it encourages and co-ordinates local health and care professionals, involving them in the care of patients in the nursing home,” said lead study author Dr Kirsten Moore.

“It makes them aware of what support is needed and enables them to meet with nursing home staff to discuss the needs of patients,” she said.

“With the number of people living with advanced dementia only set to increase, it is vital that commissioners are clear on the role health and social services can play in caring for people in nursing homes and help make this possible by providing the appropriate resources,” she said.

University College London/Marie Curie

New care model boosts dementia care in nursing homes

Kirsten Moore

Even where nursing are well-supported by local services, “there still appears to be a widespread lack of co-ordination between professionals”, she added.

“This model offers a way for every day and specialist healthcare teams to work together in the nursing home setting as they would in a hospital setting,” said Dr Moore.

It cost £18,255 to employ the independent ICL for six months. While the ICL in the study came from a social care background, researchers said this role could equally be done by a nurse or allied health professional.

“The ICL role requires a broad range of skills including clinical experience in care of frail older people and those with dementia, particularly towards end of life, ability to educate staff and talk empathically with family carers, and sensitivity to identify and minimise poor care practices,” stated the research paper.

A palliative care nurse or dementia nurse specialist “may have brought different skills to the role and focused on different goals and care issues”, it added.

The ICL could also be a nurse already working in a nursing home and a separate study is looking at the success of that approach.

The UCL research team has developed a free manual to enable other UK nursing homes to implement the Compassion model of care themselves.

 

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