www.england.nhs.uk

• Tuesday 9th December 2014

• 10:00 – 16:00

Aiming For Excellence: Care

Home Diabetes & Dementia

Dr Rob Moisey

Overview What is diabetes?

Symptoms and signs

Diagnosis

Management

Diabetes in care homes

What is Diabetes?

Elevated blood glucose (sugar) level

Normal glucose is 4-6 mmol/L

High glucose is poisonous to the body (particularly the very small blood vessels).

Insulin & the pancreas

The pancreas is normally very good at keeping glucose levels very stable by producing insulin.

What goes wrong?

Not enough insulin

Resistance to insulin

Why get diabetes? Two main types

Type 1 – insulin insufficiency

Younger people Auto-immune Need insulin injections

Type 2 – insulin resistance (and deficiency) Older people Overweight Diet, tablets, insulin

Type 1 DM Less common (8% of all

diabetes)

Insulin producing cells killed off

Need insulin for rest of life

Risk Factors for Type 2diabetes

Age

Lack of exercise

Ethnicity

Family history

Weight

6-7%

25% in care homes

Symptoms of diabetes There may be no symptoms – often picked up on

routine screening or as part of blood tests

Symptoms include: Tiredness Lethargy Weight loss Excess thirst Passing lots of urine Blurred vision Recurrent infections

Complications and harm from Diabetes. Immediate:

Symptoms ± harm when glucose high or low

Long-term:

Eye damage

Kidney damage

Nerve damage

Cardiovascular disease

Eye damage

Neuropathy

Kidney damage

Cardiovascular disease.

Managing diabetes Regular checks (at least once a year)

Blood tests Target HbA1c <50

Urinalysis

Blood Pressure

Weight + BMI

Smoking status

Foot check

Eye screen

Treatment of Diabetes

Tablets

Injectables

Statins

Bp control

aspirin

Managing diabetes Tablets:

Insulin Once a day long acting

insulin

Humulin I

Glargine

Twice a day mixed insulin

Humulin M3

Novomix 30

Humalog Mix 25

Are you aware of the ‘Guidelines of Practice for Residents with Diabetes in Care Homes’ available at the Diabetes UK website?

Managing diabetes in care homes

Do you assess a resident’s knowledge of hypoglycaemia (low blood sugar) using a standard protocol?

Do you have a nominated member of staff with a designated responsibility for diabetes management?

Care Planning

Designated responsible staff member

Designated GP

Named urgent contact

Structured quality control process for CBG meters

Annual screening

Nutrition – dietary plan

BM monitoring

Individualized BM targets

Recognising and managing hypoglycemia

Managing diabetes in dementia and frailty

Risks vs Benefits, highs vs lows “perfect” control glucose: 4-7mmol/l

Older people and people with dementia may not have

typical symptoms of hypos- or high glucose level

Increased risk of harmful hypoglycaemia Under nourished Unpredictable eating Renal function Greater dependency on health care staff to manage their

diabetes

Managing hypoglycaemia

Do you have a written policy for managing hypoglycaemia (low blood sugar)?

High BM Low BM “hypo”

Tiredness

Lethargy

Weight loss

Excess thirst

Passing lots of urine

Blurred vision

Confusion

Slurred speech

Pale, shaking

Poor coordination

Fall

Targets for diabetes Avoidance of symptoms of high BMs or low BMs

Individualised targets for glucose control BMs 5-15mmol/l HbA1c 60-70

Less importance of tight control to avoid long-term

complications

When to test the BM On tablets only – generally

no regular testing required.

Test 1-2 a day if poorly

On insulin – generally 1-2 a day.

Possible hypoglycaemia

Summary What is diabetes?

Symptoms and signs

Diagnosis

Management

Diabetes in care homes

www.england.nhs.uk

Aiming For Excellence: Care

Home Diabetes & Dementia

Presentation 2

Foot care for patients with diabetes December 2015

Paul Cotton MSc

Podiatrist Calderdale and Huddersfield NHS Foundation Trust

Diabetic foot Screening?

Who does it? Why do we do it:

Who?

GP practice or Podiatry Services

Why?

Annually:

• one in 20 people with diabetes develop a foot ulcer

• One in 10 foot ulcers result in amputation of a foot or leg

What is a foot screening?

The purpose of a diabetic foot screening is to identify the risk to the patients foot.

What is the Patient Risk Category?

• Foot pulses (present / absent)

• 10g monofilament test (present/absent)

• Foot deformity (yes / no)

• Footwear

Diabetic Foot Risk Classification

• low risk (normal sensation, palpable pulses)

• increased risk (neuropathy or absent pulses)

• high risk (neuropathy or absent pulses plus deformity or skin changes or

previous ulcer)

• ulcerated foot within the preceding 12 months

Risk Classification

So What?

Diabetic foot Integrated Care Pathway Kirklees PCT (Effective from April, 2012)….derived from NICE, 2004

GP staff

New patient and low risk screening

Pulses Palpable Sensation ok (10g

monofilament)

Sensory neuropathy And / or Absent pulses

Sensory neuropathy and or absent pulses and foot deformity

Foot emergency Acute foot Ulceration

Low current Risk (Do)

Increased Risk (D1)

High Risk (D2)

Acute Foot (D3)

Screening Managed by primary care staff

Refer to Podiatry Service

Refer to Podiatry service

Refer to Podiatry Emergency Foot team …………….Foot Protection Team…………….

Low risk with No podiatry need :

ie normal nail care only.

- Personal care therefore done by carers.

Daily care: Feet should be washed and moisturised

Weekly care: areas of hard skin/dry skin and nails should be carefully filed

When attending to the feet review for breaks in skin, discolouration and areas of thickened hard skin.

At Risk / High risk

These are patients that have been identified through annual screening to be at an increased risk of developing foot problems related to the complications of diabetes affecting the feet.

Should be under care of podiatry team.

However, daily / weekly maintenance and review by carers should continue as set out by treatment plan set out by the podiatrist.

Complications of Diabetes affecting the lower limb

• Peripheral Neuropathy

• Peripheral Arterial Disease

• Infection

Other factors including: smoking, foot deformity, HbA1c, ill fitting footwear, trauma

….can all destroy the foot in diabetic patients

Diabetic foot ulcer (sensory neuropathy)

Photos Courtesy of: Louise Stuart, Consultant Podiatrist, NHS Manchester

To conclude…….

• Diabetic foot complications are common

• At risk / high risk feet should be referred to a foot protection team (Podiatry)

• Acute / ulcerated feet should be referred to a multidisciplinary foot care team (via Podiatry)

Podiatry contact No. 0800 0158222

Remember:

Daily footcare / review is down to a patients carer.

Podiatry will provide care for those with a foot health need as determined by the condition of the feet and a patient’s Risk status.

Any questions?

www.england.nhs.uk

Aiming For Excellence: Care

Home Diabetes & Dementia

Presentation 3

Quest for Quality

in Calderdale Care Homes

Rhona Radley

Senior Service Improvement Manager

(NHS Calderdale Clinical Commissioning Group)

Eileen King

Quest Matron

(Calderdale and Huddersfield NHS Foundation Trust)

A Local Focus on Good Practice

Why Quest? - Background

Strategic Overview:

3 domains of Quality:

Patient Safety, Effectiveness, Experience

o Health and Social Care Strategic

Review

o GP Practice Leads identified as

key priority in 2012/13

o Reactive vs proactive approach

o Celebration of partnership

working

o Best in class

o Better Care Fund

National & local response to

failings in the care sector:

Winterbourne View – Serious

Case Review

Mid-Staffordshire Hospital –

DoH Review

Serious Case Reviews

The Care Bill 2013

Why Quest?

What do we know?

Statistics for hospital attendances and admissions from care

homes were very high.

The top 5 reasons up to November 2013 for emergency

admission from care homes were identified as:

1. Urinary Tract Infections (UTIs)

2. Respiratory Infection inc. Pneumonia

3. Fractured Neck of Femur

4. Senility

5. Syncope and Collapse

Why Quest? – Continued...

What do we know? Variation in practice and inconsistency across care homes – a need to standardise

practice and up-skill staff

High rates of A&E attendances and hospital admissions from care homes

High rates of falls/ UTIs, Fractured Neck of Femurs etc

When moving to a care home, residents:

• Can loose contact with the NHS, such as access to specialised care, with little

contact with Geriatricians and Old-Age Psychiatrists (nationally 40% of residents

were identified as having dementia in a care home setting)

• Can receive reactive care from GP’s

• Can be at risk of malnutrition

• Could receive inappropriate prescribing

Aims of the project:

To improve quality of care

To maximise independence and dignity

To reduce unplanned demand on GPs

To reduce avoidable A&E attendances; and avoidable admissions

and readmissions to hospital

To improve medicines optimisation through regular reviews,

modifications and clinical interventions both in and out of hours

To improve end of life care

What is Quest?

3 key stages of the Quest for Quality in Care Homes project:

Stage 1 – Deployment of IT systems across the care

homes in order for clinicians (GPs and Quest

Matrons) to access real-time clinical records of

residents

Stage 2 – Deployment of Assistive Technology across the

care homes (Telecare; and Telehealth)

Stage 3 - Multi-disciplinary team supporting the care

homes

24 Care Homes included in the project

Lower Valley North Halifax South Halifax Upper Valley

· Elm Royd Nursing &

Intermediate Care

Home

· Ingwood Nursing Home

· Lands House Residential

& Nursing Home

· Rastrick Grange &

Rastrick Hall Residential

& Nursing Homes (x 2

homes)

· The Manor House

Residential & Nursing

Homes (x 2 homes)

· Woodfield Grange

Nursing Home

· Bankfield Manor

Residential and

Intermediate Care

Home

· Cedar Grange

Residential Home

· Valley View Residential

Home

· Fernside Hall Residential

and Intermediate Care

Home

· Park View Nursing and

Intermediate Care Home

· Saville House

Residential Home

· Summerfield House

Residential & Nursing

Home

· Trinity Fold Residential

Home

· Pellon Lane—Bracken

Bed Nursing &

Intermediate Care

Home

· Asquith Hall Nursing

Home

· High Lee Barn

Residential Home

· Mill Reed Lodge Nursing

Home

· Waterside Lodge

Residential & Nursing

Homes

· White Windows Nursing

Homes

· Bankfield Care Home

· Ferney Lee

Stage 2 - Telecare

Currently over 750 telecare items across the care homes

Stage 2 - Telehealth

Myclinic2 and peripherals

50 myclinics across the Quest care homes

Stage 3 – MDT rollout

Integrated social and clinical approach – person-centred

A single point of contact for non emergencies

Anticipatory care planning, prevention, early intervention and proactive management Support and advice for staff in care homes - provide training to care homes where

identified Responsive, timely interventions

Specialist input for advice and support

Consistency across the care homes

Works alongside existing services to promote the health and well-being of residents

To be the common platform to aid complex decision-making and communication

Advance Care Plans; Self Management Plans; Complex medications review

The Quest team

Operational:

• 6 Quest Matrons

• Consultant Geriatrician

• Pharmacist

• Therapy team

• Psychology rep

• Palliative care rep

• Links to Speech and Language Therapy, Tissue Viability, Infection Control, Safeguarding, Dietetics and GPs

• 2 managers

• Dedicated Performance and Quality Officer

• Dedicated admin post to support performance officer, and the MDT

Governance:

Monthly Contract meeting

Quest in action

Matron cover 7 days a week, 365 days a year - 10am – 6.30pm

Pharmacist support – 5 days a week

Consultant Geriatrician - 2 afternoons per week

Community location Full MDT meets once a week to discuss approx. 10 cases.

Also Consultant Geriatrician & Matron/s meet once a week to visit complex patients.

All information entered onto clinical systems and communicated to relevant partners, and

access to ICP Triage Manager (readings from telehealth) Working alongside:

GP’s; Social services; Community Nurses; Support and Independence Team; Specialist Nurses – Palliative Care; Parkinson’s Disease; Respiratory; Heart Failure etc.

Emphasis on integrated working with other members of the MDT

How will success be measured?

• Questionnaires

• Focus groups/ feedback

• Monthly Contract Report including x2 case studies

• Monthly Dashboard

Performance Management

Referrals:

• 1195 referrals to the MDT so far:

52% non-urgent (response within 2 days)

45% urgent (response within 4 hours)

3% routine/ planned

Feedback from Primary Care:

• Initial feedback from Primary Care that unplanned demand on GPs is significantly reducing

A&E Attendances:

• Increased by approx. 10% compared to last year

Hospital Admissions:

• 25% reduction in hospital admissions compared to last year:

– April - October 2013 = 813

– April - October 2014 = 612

Length of Stay in Hospital:

• April - October same as last year = 11 days

Cost of Stay in Hospital:

• October 2014 was £235k compared to £255k in October 2013 = reduction of 8% = saving of £20k for October.

• Total cost April - October 2014 = £1.5m, compared to April – October 2013 which was £1.9m = 22% lower = saving of £400k

Impact

Case studies

Case Study 1 • Resident with Dementia became less mobile and not eating. Care home staff requested

supplements.

• Quest Matron reviewed the individual, undertook a holistic assessment and established they

were constipated - suffering with faecal impaction.

• Quest Matron administered 2 enemas during the day and instructed care staff about fluid intake

and aperient administration.

• Within 24 hours, the individual was up and walking again, and was eating and drinking normally

within 4 days.

Outcome:

- Immediate action to resolve impaction

- GP visit avoided

- DN visits avoided

- Prescribing of supplements avoided.

Case Study 2

19 May

• Quest Matron was asked to review an individual with a history of falls, agitation and unresponsive for up to 6 hours in the day.

Patient had previously been admitted to hospital twice, and attended A&E once due to falls

• Comprehensive assessment carried out and emergency care plan put in place.

• Telehealth monitoring initiated

• Quest Matron checked care home staff familiar with nursing an unresponsive adult eg airway safety, positioning of patient etc.

• To discuss at MDT meeting

21 May

• Staff at care home concerned as to how they can manage the resident

• Detailed discussions of events and past medical history along with review of tests done in the past

• MDT concludes these daily episodes appear to be from recurrent seizures with no obvious trigger

• MDT suggests to titrate the medication for seizure that was overdue; start an episode/ fit chart to monitor response; continue

telehealth; weekly review of progress at MDT; ensure DNAR in place; stop non essential medications.

• Quest Matron liaise with G.P. to ensure medication changes were agreed

28 May

• Staff at care home able to cope better as understand why the episodes happen, and maintaining the episode/ fit chart.

• Still having daily episodes of the same pattern.

• Increased titration of medications in a week and report to next MDT.

4 June

• No further episodes - patient much improved and mobilising well

• Good feedback from family and care home staff able to manage the situation better

• Titrate medications as planned

• Report to MDT in 2 weeks unless problems

15 months left of project

Already seeing significant benefits for patients and services

Impact in primary care

Practice becoming more robust and consistent across care homes

Support to care homes

Summary

Any questions?

www.england.nhs.uk

Aiming For Excellence: Care

Home Diabetes & Dementia

Presentation 4

Title to go here Subtitle to go here

The Role of Primary Care

Dr Judith Parker

The Primary Care Team

GP

Nurse Practitioner

Practice Nurse

Practice Manager

Reception Team

Extended Primary Care and Community

Teams

Primary

Care Team

District Nursing Team

Diabetic Specialist Nurses Heart Failure Nurse

Community Matron

Hospice Podiatry

Tissue Viability Nurse Mental Health

What you might expect from the GP

• Organising and agreeing care plans

• Where appropriate annual review or more likely interim

reviews

• Providing emergency care for the acutely ill patient with

Diabetes

• Secondary Care referrals as appropriate

• Liaising with Out of Hours providers

Expertise in Primary Care

• Variable within practices

• Plans locally to up skill all general practice clinical

staff in Diabetes Care.

• Plans to improve access to DSN’s and consultant

expertise within the community setting

www.england.nhs.uk

Aiming For Excellence: Care

Home Diabetes & Dementia

Presentation 5

Managing Diabetes in

Nursing Homes-

Hypoglycaemia and

Hyperglycaemia

Jo Bissell and Kathryn Jolly

Diabetes Specialist Nurses

Dewsbury Hospital

Blood Glucose

• The normal blood

sugar (glucose) range

is 4-7 mmols

• The aim of treatment

is to keep the blood

sugar level as close

to this range as

possible

Low Glucose or Hypoglycaemia

A hypo (hypoglycaemia) can

occur when the blood glucose

falls below 4mmols

A hypo can ONLY happen if

insulin OR certain oral tablets

are taken for diabetes

E.g Gliclazide / Glimepiride

The elderly have added risk

factors/ signs may be first

noticed by a carer

Hypoglycaemia –

Signs and Symptoms

Hunger

Dizziness

Palpitations

Trembling

Low blood glucose – below 4

Sweating

Hypo Symptoms

As blood glucose levels continue to fall the following may occur:

• feeling disorientated

• feeling aggressive

• difficulty with speech

• loss of concentration

• visual disturbances

Hypo Treatments

• Lucozade (100-120 mls/approx half a tea cup)

• Fruit juice (150-200mls/approx one tea cup or a small carton)

• Cola (150-200mls/approx one tea cup full)

• Five to six glucose tablets

• Glucogel

If symptoms do not improve within 5-10 minutes, repeat treatment

Follow-on hypo treatments

•half a sandwich

•fruit

•a small bowl of cereal

•biscuits and milk

•the next meal if due

Moderate hypoglycaemia

• confused

• requires another person to assist in

treatment.

Treatment options:

1. Lucozade; Cola

2. GlucoGel (or treacle, jam or honey)

applied on the inside of the cheeks

and gently massaged on the outside

of the cheeks.

Severe hypoglycaemia • semi conscious or

unconscious

• unable to swallow anything given by mouth

Treatments:

1. Glucagon can be injected (prior training is required). *

2. Call 999

If the patient is unconscious –

place in the recovery position

What causes hypoglycaemia

(hypo)? •Too much diabetes medication/insulin •Missed or delayed a meal or snack •Not eaten enough carbohydrate •Unplanned or more strenuous exercise than usual •Drinking alcohol •Hot weather •Some medications

•Poor injection sites

High blood glucose or

hyperglyacaemia

Blood glucose levels

persistently over 13 mmols

Symptoms = as undiagnosed

Causes

• Diet

• Compliance

• New medication

• Virus

• Progression of disease

Sick day rules

• Never stop taking insulin or tablets

• Monitor glucose more often

• Type 1 – test urine for ketones

• Drink more liquid (sugar free)

• Rest

• Vomiting – Type 1 - if accompanied by rapid deep breathing + drowsiness – dial 999

• If BG persistently raised – insulin dose may be increased temporarily – ring DSN/GP

Sick Day Rules

• If unable to eat - replace solid food with alternatives such as:-

• Lucozade

• Milk

• Coca-cola

• Fruit juice

• Ice cream

• Jam or honey

Case Studies

June

You’re a little late in calling to see June to make her

lunch. She’s grumpy when you arrive and becomes

more and more aggressive.

What could be the problem?

How can you help?

Ethel

You notice that Ethel’s

appetite is decreasing.

She’s started only eating

the ham in her

sandwiches and leaving

the bread.

What are the risks?

What can you do?

Frank

You notice that Frank

is very thirsty and

sleepy after attending

day care.

What could be the

problem?

How could you help?

Sheila

You notice that Sheila appears clammy and trembles when sat waiting for her tea – especially if it’s late.

What could be the

problem?

What could you do?

Fatima

Fatima tells you that

she wants to fast for

Ramdam.

What are the risks?

How could you help?

I’m not sure

what other

services may

help

I can’t

keep up

with all

these

new

drug

therapys

What on earth am I going to

do with this patient?

I haven’t got

the time to

support this

person

I don’t know enough

about this

We are here to help- a brand

new service

Refer to us using the

Dewsbury Diabetes

Nurse Specialist

Primary Care Clinic

Referral form

THANKYOU

Thankyou

Any Questions??

www.england.nhs.uk

Aiming For Excellence: Care

Home Diabetes & Dementia

Presentation 6

Caring for elderly people

with diabetes

Lifestyle & Diabetes

Nina Jackson

Diabetes Specialist Dietitian

Diabetes Centre

Dewsbury & District Hospital

01924 512388

Managing diabetes

Diet

Activity

Weight management

Medication

Recommended Dietary Modifications

Eat regular meals

Space your meals evenly throughout the day.

Include some starchy foods

Particularly the wholegrain varieties e.g. bread, potatoes,

breakfast cereals, chapattis, rice, pasta.

Aim for at least 5 portions of fruit and veg each day

Whether fresh, frozen or tinned (400g in total). A portion is about a

handful sized amount. Limit fruit juice to one small glass per day.

Eat more fish

Aim for two portions of oily fish a week such as mackerel, herring,

sardines, salmon and pilchards.

Cut down on the fat

Everyone needs some fat. Cut back on saturated fats- like butter

and cheese, red and processed meats, cakes and pastries.

Eat more beans

Beans, lentils and pulses are low in fat, and high in fibre. May

help to lower cholesterol. Try kidney beans, chickpeas, green

lentils, and even baked beans, hot in soups and casseroles, and

cold in salads

What about sugar?

It is not a sugar free diet! But try to keep sugary foods and drinks

for an occasional treat. Try using artificial sweeteners when

sweetening food & drinks. Choose low calorie, diet or sugar free

squashes and fizzy pop in place of ordinary versions

Avoid “diabetic” foods.

These are no better than standard versions.

Be aware of portion size.

It’s not just what’s on your plate, but how much.

Drink sensibly.

If you drink alcohol, have no more than 2-3 units daily (women) or 3-4 units daily (men) with 2 alcohol free days a week. Alcohol is high in calories so try to limit the amount you drink.

Reduce your salt

Cut down on salt and salty foods, these can raise your blood pressure. Limit the amount of processed foods and use herbs and spices to flavour foods.

Hydrate

We all need to stay hydrated by drinking 8–10 glasses of fluid per day. Water is best, but milk, tea and coffee, herbal teas and some foods, particularly fruit and veg, all contribute to this total.

Dehydration is more common in elderly

Try to increase exercise or activity levels

Even small changes are beneficial, but aim for a 30 minute at least 5 times a week

Elderly & diabetes

• Dietary advice may differ from general

recommendations

• Not always appropriate to reduce the fat,

salt and sugar

• Additional concerns in elderly in residential

care:

• ~ half are undernourished

• ~ 1/5 are underweight

Underweight & malnutrition

• Longer length of stay in hospitals &

increased mortality. Pressure ulcers,

delirium & depression

• Dietary restrictions is not warranted

• High energy-high protein diet may be

appropriate.

• May need to adjust diabetes medication

Nutritional risks

• Small appetite - less mobile/ less active or due to an

underlying illness.

• Chronic disease- impacts on day-to-day living

• Increased needs for energy and nutrients – e.g. recent

illness, surgery or wounds healing

• Mouth, chewing and swallowing problems

• Medications

• Poor sight, hearing, taste or smell may reduce

enjoyment at mealtimes

• Poorer communication skills

What happens if malnourished?

This can lead to:

• An increased risk of infection

• Poor or slow wound-healing -particularly of ulcers and

bedsores

• Slow recovery after operations

• Skin problems and sores

• Breathing difficulties

• Muscle weakness, making tasks of daily living more

difficult

• Tiredness, confusion and irritability.

Nutrition support

• Food first approach to be used

• May need more intense Diabetes management

• Consider referral to Dietitian

• Include 3 small meals & 2-3 snacks a day

• Have snacks handy & ready to eat

• Try make mealtimes a relaxed & positives experience, e.g. eat together, use background music

• Have food & drinks separate to meals

• Aim to offer a variety & foods that they enjoy

• Encourage more on good days

• If permitted to stimulate appetite try a small amount of alcohol before meals

• Increase activity levels- get some fresh air

Poor appetite?

• Full fat foods rather than diet (creamy soup, yogurts,

puddings)

• Fortify foods

– Butter/spread on bread, potatoes, veg

– Grated cheese into mash, veg, beans, soups,

stews

– Add double cream to soups, desserts, mash, fruit

• Offer nourishing drinks (milky coffee, hot chocolate,

horlicks etc)

• Consider supplements?

Making the most of foods eaten:

Elderly & overweight

• BMI 25-30 healthy for people aged >70

more likely to live longer than older people

who are underweight.

• BMI >30 Health problems associated with

overweight become more serious

• important to keep weight issues in

perspective- promoting healthier lives more

important

Considerations

• necessary to lose

weight?

– health and mobility

affected?

– Weight stable?

• intervention may be

counterproductive &

impact quality of life

• Is weight increasing

rapidly?

– Gaining weight rapidly

& consistently

– Intervention to

maintain weight?

• Recent changes in

lifestyle?

– E.g. less active

Practical tips for weight loss /maintenance

• Aim for 5 a day fruit & veg- offer as snacks

rather than biscuits or crisps etc

• Reduce portion sizes- use smaller plate?

• Keep occupied with hobbies & activities

• Help keep active/ increase activity

Summary

• Malnutrition is common in care homes

• General dietary recommendations for diabetes may not be appropriate for elderly

• Promoting healthier lives rather than a certain body size

• Higher protein and higher energy intake foods may be needed to improve nutritional and functional status

• Care plan to be individual

• Access to a dietitian

www.england.nhs.uk

Aiming For Excellence: Care

Home Diabetes & Dementia

Presentation 7

we help to improve

social care standards

December 2014

Skills for Care update – Diabetes event

Angela Thompson - Area Officer

Aim of today…

• Explain who Skills for Care are

• Provide you with a taster of the

resources we can offer you…helping

you to develop your workforce to

support people with dementia and

diabetes

• Mention the key changes happening in

the sector

Who we are and what we do…

• Sector Skills Council for Adult Social Care in

England, our main sponsor is DH

• We are employer-led and work with the

thousands of social care employers (of all

sizes) to develop and improve the skills,

knowledge and behaviour of their workforce

• We work in 6 Area Teams and provide: local

Area Officers, information, advice, practical

tools and resources, funding, and research

• We write qualifications and quality standards

• L2, L3 and L5 Diplomas replaced NVQs in 2011 when

the Qualifications Credit Framework (QCF) was

introduced, e.g. L2 Diploma in Health and Social Care

• The Diplomas can be generic or follow a specific

pathway, e.g. in Dementia or Learning Disabilities

• Single Units of the above qualifications and smaller

qualifications (Awards and Certificates) were released,

providing a huge choice of accredited training

• To support occupational competence plus the continuing

development of staff at all levels

Qualifications for the social care

workforce..

Qualifications for workforce supporting

people with diabetes, and with dementia

• L2 and L3 Award in Dementia Awareness

• L2 and L3 Certificate in Dementia Care

• L2 Award and L3 Certificate in Activity Provision

• L3 Award in the Mental Capacity Act

• L2 and L3 Award in End of Life Care

• L3 and L5 Certificate in End of Life Care

• L2 Award in Basic Awareness of Diabetes

• L3 Certificate in Working with Individuals with

Diabetes

Funding for these qualifications

• All the units within the L2, L3 Health and Social Care

Diplomas, L5 Diploma in Leadership for Care

Services are funded by Workforce Development

Funding (WDF)

• So all of the qualifications mentioned on the

previous slide (and many other qualifications)

• WDF pays at £15.00 per credit achieved, e.g. a L2

Diploma has 46 credits = £690.00

• All social care employers are eligible but must first

join a WDF Partnership and complete the National

Minimum Data Set for Social Care (NMDS-SC) each

year

Resources for workforce to support

people with diabetes, and with dementia

• Common Core Principles are available in:

self care, dementia, dignity, end of life care,

mental health

• A set of clear standards for each topic area

that show the behaviours required by the

workforce to provide quality and responsive

care and support

• Useful for designing or purchasing training,

and for use in supervision and appraisal

Learn from Others

• A free online resource, where you can

download learner workbooks, trainer packs

and case studies to use with your own

workforce

• Resources produced using Workforce

Development Innovation Funds

• Workbooks available to support a range of

QCF units in Dementia, End of Life Care,

Diabetes and the Mental Capacity Act

Key changes for the sector now

through to April 2015

• Care Act implementation - Learning

and Development free suite of

resources

• Care Certificate replaces Common

Induction Standards

• CQC new inspection process (key

lines of enquiry) and introduction of

Fundamental Standards

Contact Details for your local

Area Officer

Rachael Ross – Area Officer for Calderdale

Telephone: 07815 429170

Email: rachael.ross@skillsforcare.org.uk

Jeanette Cookson – Area Officer for Kirklees

Telephone: 07969 762864

Email: jeanette.cookson@skillsforcare.org.uk

Any questions?

Thank you for listening…

www.england.nhs.uk

Aiming For Excellence: Care

Home Diabetes & Dementia

Presentation 8

Diabetes Champions Programme

Introduction

• Since 1984 Orchard Care Homes has provided award winning care to the elderly

• We are a national company with Residential, Specialist Dementia, Nursing and EMI registrations

• Orchard Care Homes and Larchwood

Why screen our residents?

Up to 1 in 4 people in a care home setting have Diabetes and a similar proportion may have undiagnosed Diabetes

- Institute of Diabetes for Older People Audit 2012/13

Why screen our residents?

• Diabetes UK estimates that 1 care home resident is admitted into hospital every 25 minutes due to failings in screening and training for Diabetes

• There are thought to be more than 13,500 care home residents who suffer unknowingly

• The majority of care homes fail to provide any screening at all

Our Objectives

• To offer a screening for Diabetes to every existing resident within our homes

• To offer a screening to every new resident within 14 days of arrival

• To work in line with local Healthcare teams and professionals

• To raise awareness of Diabetes including the types, symptoms and associated complications within our Care Home teams

How?

• Diabetes Awareness training programme for all staff within the Homes (care and auxiliary)

• Diabetes Champion in every home who has successfully completed extensive training

• Blood Glucose kit and folder in every home

• Monthly reports to Head Office

Facts

• Number of Homes with Champions: 70

• Number of screening taken place: 970

• Number of referrals : 90

Benefits to our residents

• A more competent staff team

• The option to be screened within 14 days of admission and annually thereafter

• Individualised care plans and better control and management of the disease

• Regular Podiatrist visits and great foot care

Benefits continued

• A varied and healthy menu is offered freshly cooked in each home every day

• All residents are encouraged to be involved in exercise including those residents who remain in bed

Any questions?

www.england.nhs.uk

• All presentations will be posted on the SCN website. If you require the presentations in an alternative format please leave your details at the registration desk.

Aiming For Excellence: Care

Home Diabetes & Dementia