dementia - The Health Foundation

Report
The main drivers
• Compassion - Compassion is the emotion that one feels in
response to the suffering of others that motivates a desire to help
• Dignity - Moral, ethical, legal, and political discussions use the
concept of dignity to express the idea that a being has an innate
right to be valued and to receive ethical treatment
• Respect - a feeling of deep admiration for someone or
something elicited by their abilities, qualities, or achievement. due
regard for the feelings, wishes, or rights of others
The reports that showed this
was lacking:
•
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The Counting the Cost report (2010)
Nurses not recognising or understanding dementia;
Lack of person-centred care;
Not being helped to eat and drink;
Lack of opportunity for social interaction;
Not as much involvement in decision-making as wished for
The person with dementia being treated with a lack of dignity and respect.
The Royal Free Long Stay Audit (2011)
41.8% of delayed discharge patients developed an acute medical condition after being approved
for discharge
19% of patients died.
•
-
The National Dementia Strategy (2009)
identified the need to improve the discharge process from the Hospital setting, stating ‘there is
often a lack of co-ordination between hospitals and care providers at the point of discharge;’ (DH,
2009).
How My Discharge addressed:
Compassion - Dignity - Respect
 Patients would be facilitated to make and influencing decisions for their own
care
 What matters to the patient would remain priority
 Predicting where it might go wrong and planning ahead
 Promotion of positive risk-taking
 Considered approach to the persons ongoing needs
Original proposal
•
A supported 48 hour discharge if
required – including –
–
–
•
•
•
•
•
•
Home assessment
Start/ restart a provisional package of
care (this can be covered by our PACE
team for 5 days if there is a delay)
Referral to rehabilitation unit if required
See each patient an hour before
discharge.
Travel with patients home from
hospital.
Pick up basic supplies for the patient.
Re-settle the patient and hand over to
carer or family.
Based between HSEP wards (8 West
and 9 North)
Flexible
approach
Proposed outcome measures
•
•
•
•
Number of referrals to the service
Length of stay for patients
Readmissions within 30 days.
Re-attendances to A&E
Patient and carer
feedback
Which patients were
appropriate?
• Have a diagnosis/ suspected
diagnosis of dementia?
• Have they been admitted from
their own home?
• Does the patient or their family
want them to return home?
• Is there concerned about how they
might manage at home because
of their dementia?
• Is permanent placement being
considered because of their
dementia?
The main differences:
Pro-active case
management model,
facilitating safe, sustainable
and timely discharges for
those with confirmed or
suspected dementia
Follow-up
input/management
as required
Bespoke, personalised
service in partnership
with patients and their
carers
Thorough in-patient
assessment of
needs and
implementation of
therapy plan
Signposts/ coordination of
developing
community
infrastructure for
on-going care
100 patients seen through the
project
Significant outcomes
Average length of stay reduction by 2.6 days per person
85% patients discharged home – 94% directly, 6% via rehab/ respite
26% reduction in re-attendances to A&E in addition to unexpected
benefit of readmission avoidance through intervention in A&E
34% patients at risk of permanent placement discharged home
with My Discharge support
Most important outcome…
“If Mum could
thank you herself
I’m sure she’d give
you a big hug”
100% positive carers feedback of carers
acknowledging the effectiveness of the personalised
approach to My Discharge
Our learning:
Keep Compassion - Dignity – Respect as the focus
•
•
Sustainability
Skills gap noticeable between staff
•
A case managed approach is key to managing complexity of physical and
social issues in this population
•
Essential to bridge the gap between acute and community settings
•
Empowering carers to manage their loved ones in a supportive and
proactive way
•
Robust data collection needed
•
Regular feedback to inform change
Moving forward
 We are now a permanent service!
 The team has expanded
 We are bridging the skills gap
 We are developing a dementia pathway
 Compassion - Dignity – Respect remain the focus
If you want to know more:
Becky Lambert
Dementia Lead, Royal Free London NHS foundation trust.
02079740500 bleep 4045
[email protected]
Danielle Wilde
Dementia Specialist Occupational Therapist
Dementia Lead, Royal Free London NHS foundation trust.
[email protected]
#THFCompassion
Compassion, dignity and respect
in practice
• What do I want to know more about?
• What are the implications of this for my /
our work?
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