How health and social care professionals can help

Health and social care professionals can offer information, advice, care and treatment to people with dementia and their carers. This factsheet sets out what help is available to someone with dementia and explains the roles of the different professionals you might see. It is useful 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 their carers. There are many different types of health and social care services, including home care and day care as well as the services provided by doctors and nurses. The services available, and the way they are organised, vary from area to area. Some services are in short supply in some areas and many have to be paid for.

Many services are arranged through the NHS or through local authority (council) social services (sometimes called adult services). Some services are also provided by private businesses and voluntary organisations. For information on what is available locally, contact your local social services department and the GP surgery as a first step. You might also try contacting Alzheimer's Society's National Dementia Helpline (0845 300 0336), or ask at your local Citizens Advice Bureau (see 'Useful organisations') or library. You can search for services online at NHS Choices: www.nhs.uk

If you decide to use someone privately, such as for help in the home or a physiotherapist, ask about the cost first and make sure they are appropriately qualified. As with other services, a personal recommendation is a good way to find a private practitioner.

You may need to be persistent to get the information and help you want. Health and social care professionals have a duty to work closely with each other and communicate with each other. However, you may sometimes find that relevant information is not passed on. It is possible that you will have to explain the situation each time you meet a new professional to make sure that they are aware of the whole picture and this may require some patience. Many people find it helpful to keep copies of forms and letters and a record of who they have seen.

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.)

GPs (general practitioners)

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

The GP may diagnose a particular condition or, if more specialist tests are needed or dementia is suspected, the GP may suggest referral to a consultant doctor (see below) or memory clinic. 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 example if the person is very ill or is approaching the end of their life. You can also keep copies of formal documents with your GP (such as copies of a Lasting Power of Attorney or an advance decision about care and treatment).

Outside normal surgery hours the GP will have an arrangement with an 'out of hours' service. The people running this service will not always have details of the person's particular circumstances and may need to be told that the person has dementia.

Consultants

Consultants are doctors who have had extensive training and experience in a particular area of 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. The types of consultant that you might see include:

• neurologists - specialists in disorders of the brain and nervous system
• geriatricians - specialists 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 - psychiatrists who have had further training in the mental health problems of older people.

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

The consultant may prescribe drugs that may reduce some of the symptoms for a certain period. These drugs are not a cure (for more information see factsheet 407, Drug treatments for Alzheimer's disease).

Nurses

Nurses work with people with dementia, and those who care for them, in a variety of roles.

Community mental health nurses

Community mental health nurses, also known as community psychiatric nurses (CPNs), are mental health nurses who work in the community (for example, in people's homes or GP surgery). 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, such as changing bandages or catheters.

The person may need a referral from the GP or consultant to access community mental health nurses, or you may be able to contact a CPN directly. Ask at the GP surgery.

District nurses or community nurses

District or community nurses are members of the primary care team. They have had extra training and provide advice and care for people at home and carry out various tests and assessments. You can contact a district nurse through the GP.

Practice nurses

Practice nurses work with GPs and other community nurses and carry out a range of nursing activities within the GP practice, such as flu jabs and check-ups. You can contact the practice nurse at the GP surgery.

GP or health centre receptionists

Receptionists are an important link between you and your GP. They should be able to arrange home visits, pass messages to the GP and, if necessary, help you book a longer appointment.

Mobility professionals

Many people with dementia need some support to stay physically mobile or active, or to help them get 'back on their feet' after an operation or fall. Carers of people with dementia may also benefit from the services of these professionals.

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 the person 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 Physiotherapy can tell you how to get in touch with a qualified 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, but there may be strict restrictions on who is eligible. 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, speech or sight can negatively impact the well-being of someone with dementia and may increase their levels of confusion or distress. The person may 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 those described below.

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. People with dementia should also have regular check-ups in case their mouth and gums change. Dentists can also advise anyone caring for someone in the later stages of dementia about how to clean the person's teeth and mouth.

If the person with dementia already has a dentist whom they know and trust, they should continue to see them for as long as possible. The dentist may be able to arrange home visits if these are needed. If not, the person may be referred to what is known as the local salaried dental service or local specialist dental service (formerly known as the community or personal dental service) for treatment at home. NHS home visits are free but charges for treatment may apply, depending on the person's income. Home visits are also free from local salaried dental services although charges may apply for dentures and bridges, again depending on the person's income.

For details of local NHS dentists and local salaried dental services, contact your local primary care organisation (England and Northern Ireland) or local health board (Wales) or ask at the 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. If possible, find an optometrist who has experience examining someone with dementia. 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. The GP may be able to refer the person, or you can contact the local speech and language department directly.

Social care staff

Many helpful care services can be arranged through your local authority (council) 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 or frozen food delivery, home care, respite or short break services, day care and care in a care home. Many local authorities offer these services in partnership with other organisations. Their role may include making an assessment and helping to build a support plan. They may also undertake monitoring and reviews to make sure that things are working out well. Many local authorities will also help people to claim welfare benefits (for more information see factsheet 413, Benefits).

The local authority cannot arrange or agree to pay for services until it has assessed the needs of the person with dementia, and/or their carer, and taken their wishes into account. They will also ask about the person's income and savings. 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 outlined below.

Social workers

Social workers have specific training and qualifications. They may be involved in assessing a person's 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 may also be referred to as 'care managers' and can be based in a variety of locations including social services departments and hospitals. 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 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' (home helps) or 'personal assistants' in the person's home, or in care homes as 'care workers'. They may help with personal care, such as getting the person up, washed and dressed, helping with continence, changing bedding and emptying commodes, doing laundry, supervising meals to make sure the person eats properly, supervising taking medication, providing company and social activities, and putting the person to bed at night. A support plan should outline what jobs or tasks are needed and who will carry them out.

Other professionals

A range of other professionals 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 - Some areas may have a continence adviser who can advise on problems associated with continence (going to the toilet). They can also give information on useful equipment ranging from commodes to incontinence pads. The GP may refer the person to an adviser, or you can get in touch directly.
• 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. The GP or consultant can arrange for a referral to a dietitian. Some dietitians may be able to offer home visits (including to care homes), while others may be based at a local health centre or hospital.
• Occupational therapists (OTs) - OTs can advise on adaptations and equipment for the home, 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 the 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 get a satisfactory result, there are more formal procedures you can use. 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 Alzheimer's Society's National Dementia Helpline (0845 3000 336) are good starting points.

For details of Alzheimer's Society services in your area, visit alzheimers.org.uk/localinfo
For information about a wide range of dementia-related topics, visit alzheimers.org.uk/factsheets

Useful organisations

Chartered Society of Physiotherapy

14 Bedford Row
London WC1R 4ED
T 020 7306 6666
E enquiries@csp.org.uk
W www.csp.org.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)

Around 3,500 locations across the UK
W www.citizensadvice.org.uk
www.adviceguide.org.uk (online information portal)

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 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 www.cot.co.uk

Provides details of independent occupational therapists in your local area.

NHS Choices

W www.nhs.uk

NHS website that allows you to search for health services near you.

Royal College of Speech and Language Therapists

2 White Hart Yard
London SE1 1NX
T 020 7378 1200
E info@rcslt.org
W 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 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 reviewed: December 2011
Next review due: December 2013

Reviewed by: Professor John Keady, Professor of Nursing, University of Manchester, Manchester and Professor Jill Manthorpe, Professor of Social Work, King's College, London