Changing Practice in Nursing and
Care Homes
National Dementia Learning Event
29th September 2011
Jillian Torrens, Adult Services Manager, Glasgow CHP - South Sector
Jean Hannah FRCGP, Clinical Director, Nursing Homes Medical Practice
Sharing ideas: service delivery models
Variety of NHS models support people living in
care homes:
• Standard GP registration
• Local Enhanced Schemes
• Dedicated services
• Retained GPs
Successful joint working
• Care Home Services - Care Home Liaison Nurses,
Dietician, SLT, Clinical Pharmacy Team, Admin. Team,
PM, NHMP GPs, CD & Adult Services Manager
• 70(58) nursing homes & ~ 3500(2650) residents
• Central Practice
– 1050 patients
– 10% ≤ 65 years
– 67% dementia
– 36% dementia
Assessing the Prevalence of Dementia. Audit and
Cognitive Screening in Glasgow Nursing Homes
Stephen Lithgow. Dementia Clinical Studies Officer. Specialist
Occupational Therapist. NHSGGC Sept. 2010.
Objectives:
1. Audit care plans and establish existing levels of dementia
diagnosis in nursing homes.
2. Use cognitive assessment to establish levels of possible
undiagnosed dementia.
3. Update care plans and GP records with cognitive test results
4. Inform GP’s of residents who may have undiagnosed dementia.
Methods & results
• Random selection 1 in 6 residents
• 48(49) NH & 403/422 nursing home residents
Glasgow City
• Standardised Mini Mental State Exam (SMMSE)
• If difficulty participating, Functional Assessment
Staging Tool (FAST) used
• 89.9% had scores in dementia ranges
QoF Disease Prevalence /1000 Patients
(Central Team n = 1018)
AF
124.8
13.1
47.2
56.8
Asthma
Cancer
13.6
CHD
43
CKD
29.2
COPD
Dementia
186.6
104.1
116.9
22.8
636.5
5.7
Diabetes
Epilepsy
NHMP
GGC
76.6
151.3
39.4
64.8
7.9
Hypertension
Hypothyroid
29
LD
8.8
4.6
Mental Health
9.3
Stroke
355.6
125.9
20.2
99.2
79.6
187.6
Provision of palliative care for
people with dementia & their carers
•
•
•
•
New patient registration – hospital liaison
Supportive & Palliative Action Register (SPAR)
Early identification of those who may need palliative care
Advance/anticipatory care planning, including anticipatory
prescribing
• Liverpool Care Pathway for the Dying
• Accessibility to patient, carers and staff vital – encourage open
communication
• Finding out about how we can do better
Preferred place of care
• Majority of nursing home patients and their carers hope that
death will occur in nursing home
Central
Practice
Hospital
%
Nursing %
Home
Total Deaths
per GP
2008
57
20
227
80 284
37
2009
57
20
233
80 290
38
2010
62
20
246
80 308
40
• Standard GP: 7-8 deaths per annum frailty or dementia, and total
approx. 20 deaths per annum
Out of Hours Contacts
Annual Total (Oct-Sept) Calls/Patient/Yr
• 2008-09 872
0.3
• 2009-10 1118
0.4
• 2010-11 1105
0.4
Contacts for deaths: 15% 2009 to 7% 2011
Hospital contacts
North Glasgow
Year
A&E
2008-09
460
2009-10
332
20010-11
320
Total
South Glasgow
1112 – 65% admitted
Month
Admissions
June 2011
8
July 2011
8
SPARRA
July 2011
936 patients post code for NHMP
385 dementia (41%) of which 70 Alzheimer’s
The future care and support of people
with dementia living in care homes
• Early diagnosis and support – how and who by?
• Standardisation of GP support i.e. clear
specification with supporting IMT screens and
reporting requirements
• Continue to strengthen evidence base for what
works well and what does not
• Use this to support appropriately resourced
services to individuals, families and carers
Workshop discussion point 1
Dementia diagnosis: views vary from
“Anyone can diagnose dementia” to “Everyone
with possible dementia should have a diagnosis
made by a specialist (memory clinic or old age
psychiatrist)”
For discussion: barriers & supports to diagnosing
dementia and the impact of getting it wrong.
Workshop discussion point 2
Early dementia diagnosis:
Many patients in care homes have undiagnosed
dementia and are cared for in a variety of care
home settings.
What would the desired outcomes and benefits of
early diagnosis be?
What changes to support, care and service
provision would be needed to realise these?