This project will support people living with dementia in Kent and Medway to remain in their own homes, including care homes, avoid unnecessary admission to hospital and reduce the prescription of antipsychotic drugs.

Background

• In a recent analysis of inpatient admissions to mental health beds for older people in east Kent, 50% of admissions came from care homes. People admitted from care homes had longer lengths of stay and were more likely to have a readmission. It is well known that moving someone with dementia from a familiar environment increases levels of anxiety, confusion and challenging behaviours.
• People will also often be admitted to acute hospital beds, both from their own homes or from care homes.  Again, this increases levels of confusion etc and often means that people cannot return to their own home, but are discharged to long term care in a care home.
• When people with dementia exhibit challenging behaviours, whether in their own home, a care  home or hospital, they may very often be prescribed antipsychotic drugs which can then have an adverse effect on the physical health of people with dementia.

Objectives

• To ensure that intermediate care services are available to people with dementia.
• To avoid unnecessary hospital admissions for people with dementia.
• To reduce length of stay for people with dementia.
• To reduce the prescription of antipsychotic drugs.
• To promote better working between community and secondary care services.
• To enable people with dementia to retain activities of daily living for as long as possible.

Deliverables

• Training to care homes across Kent and Medway
• Newcastle Model training recruit a band 7 registered metal health nurse to provide training to the Community Mental Health Teams in the Newcastle Model.
• Training to intermediate care teams recruit 3 clinical practitioners who will be embedded in intermediate care services to increase the competence of intermediate care/rapid response teams to support people at home, preventing crisis (including support for the carer)
• Geriatrician outreach support will be targeted to those care homes or areas with the highest level of need. The role will include medication reviews and provision of urgent geriatric assessments. End of life issues will also be addressed as these areas are very often neglected in people with dementia, in particular advanced care plans, anticipatory care plans and palliative care. There will also be an opportunity to provide training to care home staff.

Anticipated outcomes

• People with dementia living in care homes will be treated with dignity and respect.
• There will be reduction in anxiety for people with dementia and a reduction in the prescription of antipsychotic drugs.
• Residential care home and community staff have the skills and values to work with people with dementia. They understand dementia; what can help alleviate distress; how to manage different behaviours and prevent crisis.
• Staff know how to get expert advice, and are able to access help and advice when they need it.
• Independence will be maintained for longer.
• Leadership will be improved in care homes.
• Staff will have greater job satisfaction.

Progress update

The excellence in Kent project is up and running and some data collection has been agreed.

The Newcastle model has started, but is still in its early stages.

The up-skilling of intermediate care and community hospitals has been delayed due to recruitment difficulties.

The geriatrician support is at different stages, partly due to recruitment difficulities and agreeing with CCGs the model to be used.