Improving Care in Care Homes

Application of the Newcastle Model in Dementia Care

Ann Scott

Practice Development FacilitatorHomefirst Community Trust

Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel

Current standard of care is poor• 17 homes surveyed in the North of England

all rated as requiring much or radical improvement (Ballard et al, 2001)

Why?

challenging behaviour beyond scope of care staff

Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel

Impact of Challenging Behaviour

Admission to the dementia assessment unit

Move to another facility

‘problem’ is moved on - staff miss opportunity to learn

High mortality rate within first year of move (Aneshenel, 2000)

Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel

Practice Development

CPN’s shared vision to develop efficient service

‘new ways of working’ (DHSSPS, 2006)

‘The Newcastle Team’

The Martha McMenamen Memorial Scholarship

Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel

Thoughts

Behaviour Appearance

Need

‘The Newcastle Model’Pre-Morbid Personality

Mental Status Life Story

Environment

Medication

Cognitive Status

Physical Health

Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel

Frequency & Severity of Behaviours & Caregiver Distress

frequency &severitycaregiver distress

Neuropsychiatric InventoryCaregiver Distress (NPI – D)

Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel

£71,344

£81,536

£11,852

£0 £20,000 £40,000 £60,000 £80,000 £100,000

Cost of G grade CPN for 5 months

Cost of hospital stay (4 patients x average length of stay x daily bed cost)*

*Does not include cost of retaining bed in care home or transportation costsNumber of admissions prevented = 4 patients.

Cost of hospital stay x 1 patient over a one

year period

Cost Benefit Analysis

Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel

Stakeholder AnalysisClaims Concerns Issues• Meeting needs =

decrease in behavioural difficulties

• Reduction in use of medication

• Unnecessary moves avoided

• Increased quality of life

• Carers job satisfaction increased

• Workload will increase for staff in homes

• Can service be implemented throughout the trust

• Will care homes still have access to Tardree House if required

• Can model be used in wards

• Funding required to secure service

• 3 Behavioural Sciences nurses