Alzheimer's Society

Health and social care professionals can offer advice and services to people with dementia and their carers. This factsheet sets out what help is available to someone with dementia. It is always a good idea to seek help while the dementia is still at an early stage, so that you know where to turn when the need arises.

What help is available?

A wide range of health and social care services are available to people with dementia, and to those who care for them. The services available, and the way they are organised, vary from area to area. Most are arranged through the NHS or through social services, although some are provided by voluntary organisations. For information on what is available locally, contact your local social services department and your GP surgery as a first step, or ask at your local Citizens Advice Bureau (see 'Useful organisations') or library.

In addition, some services may be available privately. If you decide to use someone privately, check on fees first and make sure they are appropriately qualified. A personal recommendation may be the best way to find a good private practitioner.

You may need to be persistent to get the information and help you want. Health professionals and care professionals have a duty to work closely with each other and communicate amongst themselves. However, you may sometimes find that relevant information is not passed on. Try to tactfully explain the situation each time you meet a new professional to make sure that they are aware of the whole picture.

Doctors

Doctors provide a range of services to people with dementia. (For details of how dementia is diagnosed and changes are assessed, see Factsheet 426, Diagnosis and assessment.) The key roles are as follows:

GPs (general practitioners)

The GP is responsible for a person's general health. If you are worried about your own memory, or concerned about someone close to you, the GP is your first point of contact.

The GP may make a diagnosis or suggest referral to a consultant (see below) for more specialist advice or tests. You can also ask for a referral to a consultant if you feel it would be helpful. The GP can also provide information on helpful services or refer you to other professionals.  For more information, see Factsheet 425, How the GP can help.

Consultants

Consultants are qualified doctors who have had further extensive training and experience in a particular specialty. The specialty of the consultant will depend on the age and symptoms of the person being diagnosed, and on how services are organised in your area. For example, the consultant may be a specialist in neurology, geriatrics or psychiatry.

• Neurologists specialise in disorders of the brain and nervous system.
• Geriatricians specialise in the physical illnesses and disabilities of old age and the care of older people.
• Psychiatrists diagnose and treat a wide range of mental health problems.
• Old age psychiatrists are psychiatrists who have had further training in the mental health problems of older people.

The consultant works with a number of qualified doctors who are at various stages in their medical training. You may be seen by one of these doctors rather than the consultant. They also work with other professionals, including nurses, psychologists, social workers and occupational therapists, as part of a team. Nevertheless the consultant will be ultimately responsible for your care.

The consultant may prescribe drugs. These drugs are not a cure but may reduce symptoms in the short term (see Factsheet 407, Drug treatments for Alzheimer's disease and Factsheet 408, Dementia: drugs used to relieve behavioural symptoms).

Nurses

Nurses work with people with dementia, and those who care for them, through a range of roles. These include:

Community mental health nurses

Community mental health nurses, also known as community psychiatric nurses (CPNs), are mental health nurses who have had further training to work in the community. They provide treatment, care and support for people with mental health problems and dementia. They carry out assessments of people at home and can advise people with dementia and their carers on ways of coping, and of improving their health and quality of life. They do not normally carry out physical nursing tasks.

You may need a referral from your GP or consultant, or you may be able to contact a CPN directly. Ask at your GP surgery.

District nurses and community nurses

District and community nurses are members of the primary care team. District and community nurses have had extra training in order to nurse people at home. You can contact a district nurse through your GP.

Health visitors

Health visitors are nurses who have had further training to advise people in the community on preventing illness. They can provide information on local services and suggest ways of keeping well. They can also help you press for appropriate services, and may sometimes initiate services such as carers' groups, when they identify a need.

Health visitors generally work alongside GPs, who should be able to tell you how to contact your local health visitor.

Practice nurses

Practice nurses work with GPs and other community nurses and carry out a range of nursing activities within the GP practice. You can contact the practice nurse at the GP surgery.

Mobility professionals

Many people with dementia, and those who care for them, need some support in staying physically mobile. Professionals in this field include:

Physiotherapists

Physiotherapists can advise on exercise for people at all stages of dementia. They can also advise carers on safe ways of helping someone to move. Home visits can be arranged.

The GP or consultant can refer you to the community physiotherapy service or the hospital physiotherapy department. Some physiotherapists are in private practice. Look for the letters MCSP and/or SRP after their name to ensure that they are professionally qualified. The Chartered Society of Physiotherapists can tell you how to get in touch with a private physiotherapist (see 'Useful organisations').

Chiropodists

Healthy, pain-free feet are important in maintaining mobility. NHS chiropody (also known as podiatry) services can be accessed through your GP. To find a private chiropodist or podiatrist, contact the Society of Chiropodists and Podiatrists (see 'Useful organisations').

Ears, teeth, eyes and speech professionals

Problems with hearing, teeth or sight can undermine the overall well-being of someone with dementia, and may increase their levels of confusion. They may also be unable to tell others that they are in discomfort, so it is important to make sure these areas are checked regularly. Professionals within these areas include:

Audiologists

Audiologists check for hearing problems and can fit a hearing aid, if appropriate. Once fitted, hearing aids should be checked regularly. Hearing tests, equipment and equipment checks are free on the NHS. Ask the GP for a referral to the nearest NHS hearing centre, preferably while the dementia is at an early stage.

Dentists

Professional dental advice should be obtained as soon as dementia is diagnosed because dental treatment may become more difficult as symptoms progress. Dentists can also advise anyone caring for someone in the later stages of dementia about how to clean their teeth.

If the person with dementia already has a dentist who they know and trust, they should continue to see them for as long as possible. The dentist may also be able to arrange home visits, if this is needed, but if not, the community dental service (CDS) can cater for people who need treatment at home. NHS home visits are free, but the normal charges for treatment may apply, depending on income.

For details of local NHS dentists and your local CDS, contact your local primary care trust (address in the phone book) or ask at your GP surgery. If you wish to consult a dentist privately, check first on fees for treatment and the cost of home visits. Many NHS dental practices also do private work.

For more information, see Factsheet 448, Dental care and dementia.

Optometrists

Problems with sight can add to the confusion of someone with dementia. The person's eyesight should be checked regularly by an optometrist, who will also examine the eyes for signs of glaucoma, cataract and other eye and medical conditions. You will need to find an optometrist who understands what examining someone with dementia may involve. Some will carry out a home visit. People aged over 60, and some under-60s who have dementia, are entitled to a free NHS eye examination. Ask at your local GP surgery for advice.

Speech and language therapists

Speech and language therapists can advise someone with dementia and their carer on ways of communicating more effectively, and on relieving any swallowing difficulties. Your GP may be able to refer you, or you can contact your local speech and language department directly.

Social care staff

Many helpful care services can be arranged through your local social services department. How services are organised, and the kinds of services offered, differs from one local authority to the next, but services often include equipment and adaptations, meals on wheels, home care, respite services, day care and care in a care home.

The local authority cannot arrange services until it has carried out an assessment of the needs of the person with dementia, and/or their carer. For more information on an assessment, ask your social services department (the address will be in the phone book under the name of your local authority) or see Factsheet 418, Community care assessment.

The roles of professionals within social care are as follows:

Social workers

Social workers have specific professional training and qualifications. They may be involved in assessing needs for services, and in planning, co-ordinating and advising on services. They can also offer support if you need to talk things through. Social workers are also referred to as 'care managers', and may be based in social services departments, hospitals and care homes. To talk to a social worker, contact your social services department (the address will be in the phone book under the name of your local authority) or ask a nurse at your GP practice or hospital.

Social care workers

Social care workers work in a wide variety of settings, and are known by a variety of names. For example, some work as 'home care workers' or 'care attendants' in the person's home, or in care homes as 'residential care workers'. They may help with personal care, such as getting the person up, washed and dressed, changing bedding and emptying commodes, doing laundry, supervising meals to make sure the person eats properly, and putting them to bed at night.

Other professionals

There is a range of other professionals who work with people with dementia and those who care for them. They include:

• Clinical psychologists − Clinical psychologists assess memory, learning abilities and other skills, and offer support. They often work with consultants in memory clinics, as part of a team.
• Continence advisers − Most areas have a continence adviser who can advise on problems associated with incontinence. They can also give information on useful equipment ranging from commodes to incontinence pads. Your GP may refer you, or you can get in touch direct. Your district nurse or health visitor will advise you on managing the use and disposal of pads.
• Dietitians − A dietitian can provide advice and guidance about food, nutrition and issues such as a poor appetite, weight loss, weight gain, vitamins and food supplements. A professionally qualified dietitian will have the letters 'SRD' (State Registered Dietician) after their name. Your GP or consultant can arrange for a referral to a dietitian. Some dietitians may be able to offer home visits, while others may be based at a local health centre, GP practice or hospital.
• Occupational therapists − OTs can advise on adaptations and equipment, and on ways of maintaining independence for as long as possible. Some OTs work for the health service, and some for social services. If you think an OT might be helpful, ask your GP, consultant or social services. Some OTs work privately. To find an OT privately, contact the College of Occupational Therapists (see 'Useful organisations' below).

Complaints

If you have a complaint about a service, try to deal with the problem informally if you can. However, if you are unable to obtain satisfaction there are more formal procedures you can pursue. Most organisations have their own complaints procedure. However, these are sometimes complex, so seek advice first. Your local Citizens Advice Bureau (see 'Useful organisations') or the Alzheimer's Society Dementia Helpline are good starting points.

Your local Alzheimer's Society branch will always be willing to talk to you and offer advice and information to support your needs.

For more information, Dementia Catalogue, our specialist dementia information resource, is available on the website at alzheimers.org.uk/dementiacatalogue

Useful organisations

Bladder and Bowel Foundation

SATRA Innovation Park
Rockingham Road
Kettering NN16 9JH
T 0845 3450165 (specialist continence helpline, 24-hour answerphone
   01536 533 255 (trained counsellor helpline, 9am-5pm weekdays)
E info@bladderandbowelfoundation.org
W http://www.bladderandbowelfoundation.org/

National organisation (formerly Incontact and the Continence Foundation) that provides information and support to people with bladder and bowel problems, their carers and health professionals that look after them.

Chartered Society of Physiotherapy

14 Bedford Row
London WC1R 4ED
T 020 7306 6666
E enquiries@csp.org.uk
W http://www.physio2u.co.uk/

The professional, educational and trade union body for chartered physiotherapists, physiotherapy students and assistants. Provides contact details of private physiotherapists in your area.

Citizens Advice Bureau (CAB)

Various locations

W http://www.citizensadvice.org.uk/
     http://www.adviceguide.org.uk/

Your local CAB can provide information and advice in confidence or point you in the right direction. To find your nearest CAB look in the phone book, ask at your local library or look on the citizens advice website (above). Opening times vary.

College of Occupational Therapists

106-114 Borough High Street
Southwark
London SE1 1LB
T 020 7357 6480
E info@cot.co.uk
W http://www.cot.co.uk/

Provides details of independent occupational therapists in your local area.

Royal College of Speech and Language Therapists

2/3 White Hart Yard
London SE1 1NX
T 020 7378 1200
E info@rcslt.org
W http://www.rcslt.org/

The professional body for speech and language therapists and support workers. Promotes excellence in practice and influences health, education and social care policies.

Society of Chiropodists and Podiatrists

1 Fellmongers Path
Tower Bridge Road
London SE1 3LY
T 020 7234 8620
E use the enquiry form on the website (see below)
W http://www.feetforlife.org/

The professional body and trade union for registered podiatrists. Provides patient information on common foot problems and details of private practice podiatrists.

Factsheet 454

Last updated: July 2008
Last reviewed: July 2008

Reviewed by: Polly Hauxwell, Head of Service Development, Alzheimer's Society