Commissioners Network12th Jan 2011

Domiciliary Care workstream updateCatherine Pascoe

South West Dementia Partnership

Improving domiciliary care for people with dementia

Objectives

• To gain a greater understanding of what best practice commissioning looks like in terms of domiciliary care for people with dementia and their carers

• To learn more about how to promote person centred planning and delivery

• To understand more about the role of specialist services, what they are, when they are appropriate and the costs and benefits of specialist versus more generic approaches

• To identify what actions can be taken forward to improve practice and ensure that domiciliary care services best meet the needs of people with dementia

Where are we now?

Where do we want to be?

How are we going to get

There?

?

Domiciliary care for people with dementia

Where do we want to be?National Dementia Strategy

Objective 6: Improved community personal support services.

•Provision of an appropriate range of services to support people with dementia living at home and their carers. •Access to flexible and reliable services, ranging from early intervention to specialist homecare services, which are responsive to the personal needs and preferences of each individual and take account of their broader family circumstances. •Accessible to people living alone or with carers, people who pay for their care privately, through personal budgets, or through local authorityarranged services.

How this can be delivered?

• Implement Putting People First personalisation changes for people with dementia

• Establish an evidence base for effective specialist services to support people with dementia at home.

• Commissioners to implement best practice models thereafter.

Where are we know?So far….

Engagement with Localities National programme team UKHCA and ECCA

Performance data collection Survey Reference Group National research

Products so far:• Domiciliary care key information report

– Survey findings– Headlines from

• national performance data• national service user views• CQC snapshot

• SW region data set– Underpinning national data, broken down by SW

Local Authorities– Detail of service user views by LA area in SW– CQC snapshot data

Headlines• 58.4% extremely or very satisfied with the

care you receive, in SW 54.5%-73.4%• Over half of all home care visits are

30mins– 19% are 15mins

• 21% people said their carers were always or often in a rush, in SW 10%-23%

• 91.9% always or nearly always see the same care worker, in SW 84.2%-93.6%

Specialist services• Lack of definition of what a specialist service is and offers• Limited evidence re costs and effectiveness• Specialist services more likely to have more highly skilled

and experienced staff, though not exclusively• Specialist services sometimes offer a wide range of support• Re continuity: both can provide• Funding arrangements can support greater flexibility• Specialist services tend to cost more, but not always• Capacity of specialist services is capped and does not reflect

a level of need• Inequity in terms of access to specialist services • Specialist services more likely to be linked with specialist MH

support

Costs and benefits of specialist & generic services for people with dementia: PSSRU

• Did not seem to matter in terms of cost and effectiveness whether a service was specialist or generic

• What mattered was whether the service conforms to good practice or quality standards for dementia care.

• The evidence suggests that both can offer this

PSSRU

• Amount and frequency of visits • Easy access to mental health advice and

support

Central to supporting people at home for as long as possible:

What do we need to do?

A number of challenges:

• Implementing Putting People First for everyone• Ensuring people with dementia benefit fully from

PPF• Making the case (economic and quality of life)

for more effective service delivery for people with dementia focussed on prevention and early intervention

A person’s journey with dementia

Awareness Identification, Assessment,Diagnosis, Initialintervention

Living well with dementia End of Life

Crisis response

Transition points and windows of opportunity

Voice of People with dementia

• Alzheimer’s Society community support survey (Autumn 2010). Report due Feb/March 2011

• Key themes emerging, Jan 2011, test out how people would like to see things taken forward

• Identify case scenarios for planning purposes

Domiciliary support for people with dementia and their carers

• Personalised approaches building on outcomes for individuals. – Time /task based support unhelpful– Building relationships with service users is a key part of “the work”– Maintaining a person’s resilience, both the person with dementia and

their carer is key– Initial outcome might be securing engagement– Assessment and support planning tools and processes need to support

personalised delivery– Biographies particularly important for people with dementia– Good understanding of balancing rights and risks and how this links with

delivering outcomes, including application of MCA– Contingency planning– Understanding peoples cognitive abilities and difficulties so support

plans can build on strengths– Use of telecare– Continuous reassessment of circumstances and preferences

Domiciliary support for people with dementia and their carers

• Staff competent in working with people with dementia– Personal qualities of care workers highly valued– Dementia “nous”– Problem solving and coping strategies– Communication skills– Behaviour management strategies – Cultural change, care workers more autonomous, and

have improved status

Domiciliary support for people with dementia and their carers

• Support and understanding for family members/carers– Shared responsibility with carers– Respite

• Reliability– 1/3rd people with dementia living at home live alone

• Consistency and continuity– Staff who know the person and can identify when

needs change – Building relationships requires continuity– Need to minimise hand offs

Domiciliary support for people with dementia and their carers

• Flexibility• Ability to adjust service provision quickly and

effectively– Financial and monitoring processes that

support this• Rapid response, including out of hours• Night time cover

Domiciliary support for people with dementia and their carers

• Working in partnership– What works from a provider perspective in terms of

delivering this kind of support?– Links with other services

• Transforming community services, Transforming Adult Services

• Easy access to advice and support• Liaison services

– Care coordination

Next steps• Commissioning work from UKHCA on provider

perspective on what works in delivering community support for people with dementia

• Developing Commissioning checklist for domiciliary support

• Adapting DQM for domiciliary care• Commissioning research on specialist OPMH services in

the community, evidence re what works• Learn from Wiltshire as they move forward with

implementation• Implement early intervention and prevention model