An appreciative enquiry into Community dementia care - PowerPoint Presentation

An appreciative enquiry into Community dementia care Prof Kate Irving

Background 55,266 people with dementia by 2036 National and International policy calling for ageing in place and upholding the rights of people with dementia Despite the rhetoric currently three times as much funding is directed to residential care as home care.Currently Home care workers have very little dementia training and no compulsory awareness training.

Despite this care continues… . We know that 63% of people with dementia live in the community Just under half of all the people in receipt of homecare packages in North Dublin have a dementia or cognitive impairment

Research question? In this context, what are the determinants to instances of effective dementia care?

Methodology Appreciative enquiry … Discovering: What is good and what works currently, what do we value?Aspiration: What would we like to happen? Creating a vision… Design: determining what will be…Delivery – planning what will be building the bridge between current situation and the dream

Participants 6 health care professionals (PHN, n = 2, RGN, n = 1, OT, n = 1, Physiotherapist, n = 1, Assistant Director of Nursing, n = 1) and 3 health care professionals working on the broader PCT network (Social Worker, n = 1; Home Care Worker, n = 1; Clinical Nurse Specialist in Community Mental Health, n = 1) Individual Interviews in addition with Home care workers, managers, a GP and senior community managers.

Findings Discovery phase showed great awareness and capacity for empathy, communication, authenticity and relationship building skills. In addition inter-professional communication. Another major theme was ability to read the situation and problem solve and finally advocacy skills. Vision- more proactive, fully staffed team, better educated, more team meeting opportunities, critical self aware, better use of community resources, focus on quality of life, dementia specific coordinator, specified pathway

Prioritisation Knowledge Better informed/knowledgeable Knowledge of dementia and servicesAccess to dementia expertise Create the existence of pathways & model of careAwareness of pathway through the system And a model of care Critically self-aware team membersFully resourced and staffed team across all disciplines

Action Plan Step 1 - Individual team member review of existing pathways; Step 2 - Securing protected time within existing caseloads for Group Action-Planning; Step 3 – Securing management and local GP support or “buy-in”; Step 4 – Creating methods for team collaboration: initiating a collaborative email thread; Step 5 – Planning for user/family involvement; Step 6 – Tripartite planning phases: Review Pathways; Create Checklist; and Organise Pilot; Step 7 –Gathering Resources: Existing Pathway Information, Dementia Specific Expertise/Knowledge, and Relevant Stakeholders; Step 8 – Measuring Outcomes.

Importance of pro-actice but existence of crisis driven care “FEMALE RGN/COMMUNITY NURSE”: I think specifically for dementia as well, in my experience, the earlier you intervene with services and supports, the more smooth somebody's transition is living at home with dementia, for the family as well. In terms of respite and day centres, home care packages, all that kind of stuff, for families, they don't get to that kind of crisis level of stress, carer strain as fast as somebody who has no supports in the early stages when they don't feel they need anything. Staff were really good a dealing with crisis, they knew who to involve and how to ramp up or down the involvement as required. A typical story from community physio….

Networks of care Networks have their issues … CMHN asked to assess aggression between a coupleAggression was focused around getting out of bed in the AMLewy Body Dementia, rigid in the am CMHN asked OT for a bed assessment OT visited in the afternoon and said – no bed required.OT and CMHN did another visit in the AM and OT ordered a bed!

No single point of contact I would love one person, if it was my family member, that I could ring when there is a problem, on the Primary Care Team, and that they would, could manage any, all of the problems that I might have ... A coordinator is probably what I’m saying, if it was my family, one person I can ring and I can just trust them to coordinate the care for my family. Because I am so stressed and I haven’t got the, I am just not able to ring all these people. (CMHN) Oh no, I try, [laugh] I am limited because we are specialist care I suppose as well and there’s only, I suppose, as well, and there is only a few in the team, and we cover the whole North County Dublin, so when you talk about Primary Care Teams they are one area, whereas I am touching in with so many Primary Care Teams in North Dublin, there must be thirtyish, probably. I am not sure how many there is in total, but I am not part of that, any one team. I normally just link in whenever it is a very complex situation . (CMHN)

Working with scarcity “FEMALE PHYSIOTHERAPIST”: …Today is a prime example. So all those I was ticking on earlier on, the green sheet [laugh], I'd like to see a lot more ticks present for this kind of formal training, that's what I mean by the fully-functioning, and going back to earlier, that there is cover. It's not a case of... Because at the moment, all of us are fire-fighting, em , because we have such staff shortages, so that you know if someone comes in and announces, ‘I'm expecting,' that you're not going, [group laughter], ‘That's fantastic news, but oh my God, it's another position to cover.' And that's, unfortunately, the way it is at the moment. That's being very ha [laugh] open about it. You know chances are they're not going to be replaced and you're going to have to be pulling together more.

Conclusion Staff are good at dealing with crisis The team work is complex and everyone is working very hard to ensure person centred care is carried out Currently everyone does that work repeatedly so that the person with dementia gets the benefit from specialist knowledge.Any change to the processes of care would require a change of skill /knowledge as the skills for being proactive are not the same as those for dealing with crisis.There is a call for case management but currently too much scarcity to enable this to happen Case management would require a different skill set also