Living with dementia magazine December 2012/January 2013

A whole range of organisations need to be involved in improving hospital care for people with dementia. Danny Ratnaike speaks to people leading change within and beyond hospital walls.

Hospitals play an important role in many people's journeys with dementia, and Dementia Action Alliance has announced a new call to action to encourage them to become more dementia friendly.

About a quarter of people staying in hospital are thought to have dementia. They are at greater risk of dehydration and falls while in hospital and experience more delays in being discharged.

Some hospitals have adapted wards to better suit the needs of people with dementia. Bradford Royal Infirmary has won national awards for its dramatic recent refurbishment of two wards, including cinema-style seating for people to watch archive films, a reminiscence café and memory boxes.

Debbie Beaumont, Matron for Elderly Care says this has had real benefits,

'We have seen a decrease in disorientated patients, and people appear less anxious and more stimulated during their time in hospital.'

As well as looking at hospital environments, individuals and organisations need to find new ways of working to improve hospital care.

Changing care

Professor George Tadros is a Consultant in Old Age Psychiatry at Birmingham Heartlands Hospital. By changing the way he and his colleagues work, he has taken a lead in making sure that people with dementia get the right care.

He says,

'What we have done is what people have wanted to do for a long time to bridge mental and physical health. Traditionally, liaison psychiatrists sit outside the hospital. They visit the hospital when needed and mostly get called to deal with younger patients.

'We set up a new team called RAID, which stands for Rapid Assessment, Interface and Discharge. This is a large team including psychiatrists, psychologists and nurses who provide a strong presence within the hospital. They have changed care for people with dementia.

'The team was created to see patients from A&E within an hour, within four hours from the medical assessment unit – where people are assessed to see if they need to be admitted – and within 24 hours from the wards. Previously people had to wait a long time to be seen by a psychiatrist.

'We also provide a lot of training about dementia to hospital staff, including two days' training in the "Four Ds" – dementia, delirium, depression and dignity. We can give a great deal of hands-on training to staff as we’re working alongside them. The point is to make dementia the business of everyone in the hospital.'

Saving by improving

George says,

'The team has been able to respond quickly and dementia diagnoses have risen by 20 per cent within the hospital, with reduced lengths of stay and fewer readmissions. A London School of Economics evaluation found we were saving 44 beds per day. This is saving money not by cutting services but by improving care.

'People usually stay in the medical assessment unit for 24 hours to see if they need to be admitted, but if we can meet them at the front door and put them on the right pathway we can avoid them having to stay in hospital at all.

'Dementia has been a neglected area for a very long time and I'm delighted that it is coming to the front line. I get a huge reward from providing care for people with dementia – they can't always thank you themselves, and other people have often given up on them.'

Getting people together

Much can be achieved by various professionals changing how they work within hospitals, but others also need to be involved.

Willie Cruickshank is Director of the Norfolk and Suffolk Dementia Alliance, a partnership of hospitals, community and mental health trusts, local authorities, universities, residential care providers and others including Alzheimer's Society.

He says,

'On average people with dementia stay 44 per cent longer than they should in hospital. However this is often not the fault of the hospital or its staff.'

Discharge can be delayed by procedures to transfer care to social services, more so if an assessment for continuing care is needed.

The Norfolk and Suffolk Dementia Alliance has introduced Dementia Intensive Support teams to speed up transfer of care, and is funding a senior nurse to co-ordinate dementia care in each hospital.

'Dementia is not a speciality anymore but core business for everyone. This means that all hospital staff need to be suitably trained, which is why the alliance includes further education and higher education providers.'

Willie says that bringing this range of organisations together has led to real improvements in ward environments, staff competence and processes that contribute to reducing lengths of stay in hospital.

'You need to ask, "If someone has dementia, who is involved in their care?" Get them around the table. Get people together to address this issue. A hospital can't do this on its own.'

To find out more about Dementia Action Alliance and its call to action to improve hospital care, visit their website.

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