Counting the cost: Caring for people with dementia on hospital wards

8/14/2019 Counting the cost: Caring for people with dementia on hospital wards

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www.alzheimers.org.uk

Counting the costCaring for people withdementia on hospital wards


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1. Background to the research

2. The research

3. The findings4. Recommendations


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Background to the research



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Provide detailed evidence

Support ongoing work and move beyond

recent achievements All hospitals to be at standard of the best


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The research


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People with dementia and

carers

4. What was positive and what do you think can be doneto improve things?

1. About the ward

2. Quality of dementia care on the ward

3. Leaving hospital


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People with dementia and

carers

4. What was positive and what do you think can be doneto improve things?

1. About the ward

2. Quality of dementia care on the ward

3. Leaving hospital

1,291 responsesSupplementary evidence

and informationalso provided


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Nursing staff and nurse

managers

5. Any examples of good practice?

1. Training and work-based learning

2. Working with people with dementia key challenges

4. What could be done to support the improvement of

dementia care?

3. What would help you to care for people with dementia?


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Nursing staff and nurse

managers

5. Any examples of good practice?

1. Training and work-based learning

2. Working with people with dementia key challenges

4. What could be done to support the improvement of

dementia care?

3. What would help you to care for peole with dementia?

657 nursing staff responses

479 nurse manager responses


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The findings



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A good experience

They treated him in a very person-centred wayand were always checking on him and helpinghim. All staff members were very aware of hisdementia. They spoke very slowly and calmlyand never rushed him. The nurses wereamazing and there was nothing they didnt havetime for.



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She had fallen out of bed and I asked the nurse howthis happened and the nurse replied: I have 16 other patients to look after. She never left her bed again.

We asked for the jug of water to be filled and the staff member said no, thats not my job. Once, I foundthat her pad was sopping wet and her legs were raw.


A very different experience


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Why are people with dementia inhospital?

Up to a quarter of beds occupied by people with dementiaaged over 65.

Admitted to hospital for a range of acute physical conditions:following a fall, broken/fractured hip, urine infection (includingUTI), chest infection, stroke.

Prevalent in a variety of wards: elderly care, surgical, general

medical, orthopaedic, rehabilitation. 97% of nurses work with people with dementia.



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Human cost to being in hospital Variation in the quality of dementia care provided - 77% of carers

dissatisfied with quality of dementia care Over one third went through complaints system 47% said being in hospital had a negative effect on health

54% said being in hospital had a negative effect on dementia 77% of nurses said that antipsychotic drugs were used. Up to a quarter

thought they were not appropriately prescribed 53% not offered additional support on leaving hospital Over a third of people who went into hospital from their own homes

were discharged to a care home.



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Lack of recognition and understanding of dementia

A lack of person-centred care

Lack of help with eating and drinking Not as much involvement in decision making as

would like

Few opportunities for social interaction Not treated with dignity and respect

Quality of dementia care


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89% of nursing staff found working withpeople with dementia challengingOver half of nursing staff not received pre-registration or work-based training

Over a third have some but not enoughKey challenges are: managing difficult andunpredictable behaviour; communication; notenough time to provide one to one care;wandering and ensuring patient safety

Nurses concerns


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What would help nurses?

More access to specialist advice and help - 91%

More staff/time on wards 90% Good leadership in dementia care 87% More involvement with family carers 84%

Learning and development opportunities 83%



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Length of stay Majority of nurse managers felt people with dementia

have a longer stay in hospital.

Half of carers said that the hospital stay was longer thanthey expected it to be.

The longer the stay, the worse the effect on dementiaand health; discharge to a care home more likely andantipsychotic drugs more likely to be used.



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People with dementia are in hospital longer than the median length of stay for all NHSpatients for same reason for admission.

Urinary tract infection median length of stay for all NHS patients is 4 days

86% of people with dementia stay one week or more (at least median plus 3 days)

53% of people with dementia stay two weeks or more (median plus 10 days)

30% of people with dementia stay one month or more (median plus 26 days)

Dementia is leading to reduced throughput and capacity



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Economic cost

Additional financial pressure is being placed on the NHS bypeople with dementia staying in hospital longer.

Supporting people with dementia to leave hospital one weeksooner can result in savings of at least 80 million andpotentially hundreds of millions of pounds.

Urinary tract infection 123,273 cases in 07/08; up to a quarter of these likely to have dementia (30,800 people).

Excess day tariff for UTI is 176, leading to savings of 38m

This could be more effectively reinvested.



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Recommendations:Meeting the challenge of dementia


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1. Recognise that dementia is a significant, growing and costly problem,which lies at the heart of the agenda to drive efficiency and qualityimprovement

2. Reduce the number of people with dementia being cared for in hospitals

3. Identify a senior clinician

4. Commission specialist liaison older peoples mental health teams

5. Ensure there is an informed and effective acute care workforce



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6. Reduce the use of antipsychotic drugs to treat peoplewith dementia on a hospital ward

7. Involve people with dementia, carers and family in

decisions, care and treatment8. Make sure that people with dementia have enough to eat

and drink

9. Begin to change the approach of care to one of dignityand respect.



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Thank [email protected]


www.alzheimers.org.uk/countingthecost

Documents

Counting the cost: Caring for people with dementia on hospital wards