Community Engagement Toolkit for Care Homes

This How To Guide will give care home managers and staff guidance on how to create a community within care homes. The guide will explain how to bring members of the local community into the home to volunteer, befriend, run activities and form friendship groups | Alzheimer’s Society 

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Image source: http://alzheimerweb.prod.acquia-sites.com

Alzheimer’s Society has been running the Airedale Social Movement Programme in Airedale, Wharfedale, Craven and Leeds since August 2016.  The programme aims to bring local communities into the care home, and put the care home at the heart of the community.

One of the objectives of the programme is to spread the programme so that others can replicate the work that has been undertaken, and the Alzheimer’s Society have launched resources to support this including a How To Guide for Care Home staff.

Letter and poster templates are also available to download here

More detail at Alzheimer’s Society

Full guide: How to engage with the community: A care home guide

GP visits to care homes reduce hospital admissions by nearly 40%

Transforming health care in nursing homes. An evaluation of a dedicated primary care
service in outer east London | Nuffield Trust

transforming primary
Image source: http://www.nuffieldtrust.org.uk

The Nuffield Trust was commissioned by the Barking and Dagenham,  Havering and Redbridge Clinical Commissioning Groups to evaluate a new primary care service that was being piloted in four nursing homes in the London Borough of Havering that had previously had difficulty accessing GP services.

The service’s main features were the assignment of a single GP practice to all residents; access to health care professionals with expertise in caring for older people with complex needs; extended access beyond normal GP hours; care guidance to nursing home staff; improved medicines management; and new approaches for managing people who are at the end of life.

The evaluation suggests that there are benefits in providing proactive primary care for nursing homes, delivered by a consistent GP within a service that specialises in older people with complex care needs.

This report assesses the impact of the new service on hospital attendance, and details the experiences and views of staff in the nursing homes and health care professionals delivering the new service.

This related article from the Guardian reports on the success of the £400,000 pilot scheme in which a dedicated primary care practice provides 431 residents of care homes with 8am to 8pm, seven-days-a-week GP support.

 

Costs of potentially inappropriate medication use in residential aged care facilities

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This review found that the use of potentially inappropriate medications (PIMs) for older adults in residential care facilities is high and that these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes.

Harrison, S. L. et al | Costs of potentially inappropriate medication use in residential aged care facilities | BMC Geriatrics; 2018; vol. 18 (no. 9)

Person-centred care improves quality of life for care home residents with dementia

A person-centred care intervention for people with dementia living in care homes improved their quality of life, reduced agitation and improved interactions with staff. It may also save costs compared with usual care | National Institute for Health Research 

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Image source: discover.dc.nihr.ac.uk

The WHELD intervention involves training staff in person-centred care, with a focus on improving social interactions and appropriate use of antipsychotic medications. An early study suggested it could halve antipsychotic use.

This larger-scale NIHR trial conducted across 69 UK nursing homes focused on exploring the effects on quality of life and other symptoms. WHELD gave small-scale, but important improvements. It didn’t reduce antipsychotic use, as this was low to start with, which is in line with policy to limit use.

It supports the feasibility of the intervention, but there is a need to understand which components are most effective and could be implemented on a wide scale with sustainable effects.

Further detail at National Institute for Health Research

Full reference: Ballard C, Corbett A, Orrell M, et al. | Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial. | PLoS Med. 2018;15 (2)

The state of hospice services in England 2014 to 2017

The state of hospice services in England 2014 to 2017 presents findings from the Care Quality Commission’s programme of inspections.

The CQC inspected hospice services in England between October 2014 and January 2017.

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Image source: http://www.cqc.org.uk

The results found that Hospice care across England has the highest percentage of health and social care services that are rated outstanding (25%), and a further 70% are rated good.

The inspections found that hospice leaders and frontline staff displayed a strong commitment to providing truly person-centred, compassionate care and support to people using their services, and their loved ones. They also developed strong relationships with other services in the area.

However, the report makes the case that there is more to be done to make sure that everyone, regardless of their background or circumstances, can access high-quality end of life care. Hospice services rated as outstanding were striving to overcome such inequalities and share their expertise to drive better care in other services.

Full report: The state of hospice services in England 2014 to 2017. Findings from CQC’s initial programme of comprehensive inspections of hospice services 

Family visits in care homes

Bruce Walmsley & Lynne McCormack | Severe dementia: relational social engagement (RSE) during family visits | Aging & Mental Health Vol. 21 , Iss. 12,2017

Abstract:

Objective: Few studies have utilised observation to investigate retained awareness when individuals with severe dementia interact with family members. Seeking evidence of retained awareness in those with severe dementia, interactive family visits in care homes were observed and analysed.

Method: Five family groups (14 individuals) completed 10/15-minute video recorded family interactions. Speech and non-speech interactions were analysed using Thematic Analysis.

Results: One superordinate theme: Distinctive family bonds; overarched two subthemes, in-step and out-of-step describing positive and negative familial interactions. In-step interactions revealed family groups reciprocating social support, having fun together, and willing to go on the ride together. Out-of-step interactions characterised social frustration, non-reciprocity, and sidelining of members with dementia. Although awareness fluctuated, complex awareness was observed in the speech/non-speech expressions of those with dementia. In response, visitors appeared to treat those expressions and behaviours as understandable. Observed outcomes were out-of-step when visitors sought to retain the familiar and in-step when visitors sought to optimise all communication possibilities.

Conclusion: Video recorded family interactions and analysis revealed: (a) awareness was retained in the participants with severe dementia beyond assessed levels; and (b) Relational Social Engagement (RSE) occurred within family groups despite positive or negative interactions. Implications are discussed.

Physical function and depression in nursing home residents with dementia

Among elderly people in general, better physical function is associated with lower incidence of depressive symptoms. It is also related to better mental health, quality of life and well-being | BMJ Open

https://www.flickr.com/photos/simajr/4182166296/
Image source: sima dimitric – Flickr // CC BY 2.0

Objectives: The primary aim of this study is to describe depression and physical function in nursing home residents with dementia, as well as to examine the associations between depression and balance function, lower limb muscle strength, mobility and activities of daily living. The secondary aim is to examine the differences in physical function between the groups classified as depressed and not depressed.

Results: Nursing home residents with dementia are a heterogeneous group in terms of physical function and depression. By applying the recommended cut-off of 8 on CSDD, 23.5% of the participants were classified as being depressed. The results revealed significant associations between higher scores on CSDD (indicating more symptoms of depression) and lower scores on BBS (95% CI −0.12 to −0.02, p=0.006), 30 s CST (95% CI −0.54 to −0.07, p=0.001) as well as maximum walking speed (95% CI −4.56 to −0.20, p=0.003) (indicating lower level of physical function).

Conclusion: Better muscle strength, balance and higher walking speed were significantly associated with less depressive symptoms. The potential interaction of dementia with poor physical function and depression indicates an area to explore in future epidemiological studies with a prospective design.

Full reference: Kvæl, L.A.H. et al.  (2017) Associations between physical function and depression in nursing home residents with mild and moderate dementia: a cross-sectional study. BMJ Open. 7:e016875.

Dementia Assessment Referral to GP

DeAR-GP (Dementia Assessment Referral to GP) | Health Innovation Network | Alzheimer’s Society

DeAR–GP, developed by the Health Innovation Network and supported by Alzheimer’s Society, is a simple paper based case-finding tool which has been designed for use by care workers to identify people who are showing signs of dementia or confusion and refer them to their GP or healthcare professional for review.

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Image Source: http://www.dear-gp.org

Once completed, DeAR-GP acts as a communication aide between care workers and GPs and supports NICE ‘Dementia: support in health and social care’ (QS1) quality statement 2: ‘People with suspected dementia are referred to a memory assessment service’.

A diagnosis will aid the understanding of care workers and family members and friends; leading to better care and support of the person with dementia.

The DeAR-GP resource can be downloaded here

An adapted mindfulness intervention for people with dementia in care homes

Clarke, A.C. et al. International Journal of Geriatric Psychiatry. Published online: 7 February 2017

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Objective: Depression and anxiety are common in dementia. There is a need to develop effective psychosocial interventions. This study sought to develop a group-based adapted mindfulness programme for people with mild to moderate dementia in care homes and to determine its feasibility and potential benefits.

Conclusions: The intervention was feasible in terms of recruitment, retention, attrition and acceptability and was associated with significant positive changes in quality of life. A fully powered randomised controlled trial is required.

Read the full abstract here

Nutrition and dementia care

Murphy, J L et al. | Nutrition and dementia care: developing an evidence-based model for nutritional care in nursing homes | BMC Geriatrics. | DOI: 10.1186/s12877-017-0443-2 | Published: 14 February 2017

Background: There is a growing volume of research to offer improvements in nutritional care for people with dementia living in nursing homes. Whilst a number of interventions have been identified to support food and drink intake, there has been no systematic research to understand the factors for improving nutritional care from the perspectives of all those delivering care in nursing homes. The aim of this study was to develop a research informed model for understanding the complex nutritional problems associated with eating and drinking for people with dementia.

Methods: We conducted nine focus groups and five semi-structured interviews with those involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (nurses, care workers, catering assistants, dietitians, speech and language therapists) and family carers. The resulting conceptual model was developed by eliciting care-related processes, thus supporting credibility from the perspective of the end-users.

Results: The seven identified domain areas were person-centred nutritional care (the overarching theme); availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information.

Conclusions: This collaboratively developed, person-centred model can support the design of new education and training tools and be readily translated into existing programmes. Further research is needed to evaluate whether these evidence-informed approaches have been implemented successfully and adopted into practice and policy contexts and can demonstrate effectiveness for people living with dementia.