Working with people living with dementia and other long term conditions

Karin Tancock

Professional Affairs Officerfor Older People & Long Term Conditions

Background

3 or more long term conditions (1.9 million in 2008 rising to 2.9 million by 2018)

People with several long term conditions have poorer:• Quality of life• Longer hospital stays• Poorer health care treatment and clinical outcomes (Kings Fund

2010)

Limited evidence on what high quality care looks like for this population group.

Multiple Long Term Conditions

Recommendations for best practice• Continuity• Access to self management approaches• Support for carers• Integrated treatments and care planning

Maybe more challenging for people with dementia: • Changing routine and making life style changes• Learning new strategies• Use of active assistive technology

May be challenging for people with dementia.

Challenges

• The range of specialist services

• Communicating with many agencies.

• Different funding arrangements

• What is a health care need or a social care need?

• Balancing the person’s needs with carers needs.

Overcoming Barriers

• Provide stimulus (funding or other means) to support local initiatives to improve care.

• Avoid a top-down policy that requires structural or organisational mergers

• Remove barriers, such as differences in financing and eligibility, in the system.

• Multi disciplinary teams with clearly defined roles. Kings Fund, 2014

Occupational Therapy:

• provides practical support to enable people to overcome any barriers that prevent them from doing the occupations that matter to them.

• aims to increase people's independence and sense of well being.

What is occupation?• Activities that allow us to live independently and give us a sense of identity.

Advantages of focusing on occupation:

• Captures stories – the person, the carers . This identifies what motivates someone, their strengths as well as difficulties and what has meaning for that person e.g. Personal, family and community life roles.

• Assesses function. This measures how symptoms or conditions impact on people day to day. Supports decisions regarding goal setting, pain and symptom management, assistive technology.

Advantages of focusing on occupation:

•Naturally fosters partnership working

•Doing things helps us to feel better!

•Occupation offers all the key elements that give life meaning- choice, control, routine, roles, stimulation

What we are doing as a profession

• Unique perspective – work across health and social care.

• Maintaining skills from dual training.

• Collecting a broad range of evidence. Developing outcome measures to reflect this.

• Broadening roles: Teaching and training, assessment and advisory roles.

Example: ReablementReablement either prevents the need for hospital admission or post-hospital transfer to long term care, or appropriately reduces the level of ongoing home care support required and associated costs

•Assessment

•Adapting the environment and assistive technology

•Goal setting- taking gradual steps to reach a person’s overall objective.

•Training and supporting reablement workers

•Involving family and friends

•Reviewing progress.

Example: Care HomesFocus on occupation: Train staff to work with residents to help them to maintain independence in self-care and mobility, enhance their daily routine and enjoy an active life.

Advice on use of space and equipment, such as seating.

Strategies to prevent falls and manage risk

Address behaviours, such as restlessness and lack of inhibition

Assess systems and process – do they support occupation?

Good examples:

• Integrated health and social care teams in South Devon & Torbay - patients having faster access to services with one phone call for occupational therapists and other disciplines.

• Greenwich: Occupational therapists as part of Joint Emergency Teams respond to emergencies arising within the community within 24 hours. Offers treatment at home or through short term residential care. Over 2,000 patient admissions were avoided

• DH, 2013

References

• College of Occupational Therapists (2013) Living well through activity in care homes toolkit. London: COT

http://www.cot.co.uk/living-well-care-homes

• Department of Health (2013) Integration pioneers leading the way for health and care reform

• Kings Fund (2010). Managing People with long term conditions.

• Kings Fund (2014). Providing integrated care for older people with complex needs. Lessons from seven international case studies.