How health and social care professionals can help
Health and social care professionals can offer information, advice, support, care and treatment to people with dementia and their carers. This factsheet sets out what help is available. It explains the different types of professionals that you might see or hear from and what each of them do. It covers most of the health professionals you may meet in either the community or a hospital (eg doctors and nurses), as well as social care professionals (such as social workers, care home or homecare staff).
You might not feel you need help right now, but it can be useful to know that there are people who can provide support when necessary. It is generally better to seek help sooner rather than later. Earlier treatment and support often has better results and might stop some problems becoming worse.
What help is available?
A wide range of health and social care services are available to people with dementia and their carers. Many are provided by the NHS or arranged through local authority (council) social services, sometimes called adult social services. Some services are also provided by private businesses (such as care homes or agencies offering care at home) and voluntary organisations (eg Alzheimer's Society and Age UK). What is available, and the way services are organised, may vary from area to area. Certain services are in short supply in some areas, which may mean having to wait for support, and some services you will need to pay for.
For information on what is available locally, contact your local authority social services department or the GP surgery as a first step.
You might also try contacting your local Alzheimer's Society office (if you have one) or Alzheimer's Society's National Dementia Helpline (0300 222 11 22). Alternatively you can ask at your local Citizens Advice Bureau (see 'Other useful organisations') or library. You can also search for services online at NHS choices: www.nhs.uk
If you decide to use a private health and social care professional, ask about the cost first and make sure the practitioner is appropriately qualified. A recommendation from a friend or relative is often a good way to find a private practitioner.
It can be time-consuming to get the right information and support, and often you will have to speak to a number of different people, but do keep trying. 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, as well as a record of who they have already talked to or seen.
Health professionals in the community
The following professionals provide medical services to people who are living in the community - that is, in their own home or in a care home, rather than a hospital ward. Some of these services will be provided in a person's home - for example home visits by a district nurse. Others may be accessed in a GP surgery or other community health setting.
Health professionals in the community include GPs, practice nurses and health visitors. These form part of a primary care team - a group of health and social care professionals who form the first point of contact with the health service.
Generally, these professionals provide treatment and care for dementia as well as other illnesses that someone with dementia may also have. It is vital that these conditions, which can include depression, high blood pressure, diabetes, breathing or heart problems and arthritis, are managed appropriately. Poor management of these other conditions may speed up the progression of dementia and reduce wellbeing.
GPs (general practitioners)
GPs are local family doctors and are frequently the first point of contact for any concern about a person's general health. They have an important and growing role in the assessment, treatment and support of people with dementia, as well as providing support to carers. As a result of this, an increasing number of GPs have taken a particular interest or additional training in dementia. Some GP practices now work closely with dementia or mental health specialists such as those based in memory services and have set up specific processes or services in their practice for people with dementia.
If you are worried about your memory, or concerned about the memory or unusual behaviour of someone close to you, the GP is usually your first point of contact. The GP may ask questions about the nature of memory loss or loss of abilities, perform physical examinations and investigations, and assess a person's mental abilities. For more information on assessment see factsheet 426, Assessment and diagnosis.
If more specialist tests are needed, or if dementia is suspected, the GP may suggest referral to a consultant doctor (see below) or memory clinic. Alternatively, you can ask for a referral to a consultant yourself if you feel it would be helpful. After diagnosis, the GP will carry out follow-up appointments.
As well as playing a role in assessment and diagnosis, the GP and primary care team around them should play an active role in overseeing and co-ordinating all stages of the care of a person with dementia. The GP is ideally placed to do this because they will often know the person and their family situation well. The primary care team - GPs, nurses, health visitors or healthcare assistants and other staff - will also often be in charge of the management of other conditions (eg high blood pressure, heart problems or diabetes), which the person might be living with.
The GP can also provide information on helpful services (eg stopping smoking or continence advice) or refer someone to other professionals within health or social care - for example, if they are very ill or approaching the end of their life. They will also keep copies of formal documents (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 a person's particular circumstances and may need to be told that someone has dementia.
For more information see factsheet 425, How the GP can support a person with dementia.
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 in care homes, as well as carrying out various tests and assessments.
They can help with things such as taking medication, giving injections, checking blood pressure, cleaning or dressing wounds. You can contact a district nurse through the GP. If you're concerned about your memory, or that of a relative, you can also mention this to a district nurse.
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 (immunisations) and check-ups. They can also advise on matters such as controlling blood pressure, maintaining a healthy weight and stopping smoking. You can contact the practice nurse at the GP surgery.
Community mental health nurses
Community mental health nurses are sometimes also known as community psychiatric nurses (CPNs). 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 about ways of coping, and ways of improving their health and quality of life. They do not normally carry out physical nursing tasks, such as changing bandages or catheters.
You may need a referral from the GP or consultant to access a community mental health nurse, or you may be able to contact one directly - ask at the GP surgery. How you access mental health services will vary according to your age, location, and the severity and urgency of mental health condition.
Community palliative care nurses
Community palliative care nurses can provide support for people with advanced dementia who have symptoms such as pain or agitation. They can support carers in a hospice or with respite care at home.
Admiral nurses are specialist dementia nurses who can support people with dementia and their carers in the community. Admiral nurses are available in selected areas of the UK and also have a national helpline and website.
Hospital and clinic-based health professionals
You may have to go to a hospital as part of the diagnosis, assessment or treatment of dementia. For example, you may be referred by your GP to a memory clinic based in a hospital outpatient department for assessment.
Alternatively, you may be admitted to a hospital inpatient ward for treatment of possible complications related to dementia, such as acute confusion (delirium), or after a fall. You may also be admitted to hospital for something unrelated to dementia, such as breathing problems or cancer. This type of care is sometimes referred to as 'secondary care' and is provided by a number of different health professionals based in hospitals and clinics.
You will probably have contact with doctors at who are at different stages of training, and doctors with different specialties.
Consultants are the grade of doctor with the most training and experience in a particular specialty. The specialty of the consultant you see will depend on your age and symptoms, and on how services are organised in your area. The types of consultant that you might see about a memory problem 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 - specialists in the diagnosis and treatment of 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 your clinical care.
Nurses and healthcare assistants provide most of the day-to-day care in a hospital. They are responsible for administering medications, carrying out routine investigations, checking temperature, blood pressure and pulse rate, setting up drips and changing dressings. Most hospital wards will have a nurse who is in charge of the running of the ward.
Registered nurses may also co-ordinate assessments for eligibility for NHS continuing healthcare. For more on continuing healthcare see Alzheimer's Society booklet 813, When does the NHS pay for care?
Dementia specialist nurses
Many hospitals also have dementia specialist nurses who carry out cognitive assessments and provide support for patients on hospital wards. They may also run outpatient clinics such as memory clinics.
Some hospitals have a member of staff (usually a nurse) who makes sure a person is safely discharged from hospital. The discharge co-ordinator works with the medical and nursing teams, as well as with the person's carer, and may help to find a suitable nursing home or residential placement on discharge.
Healthcare assistants work alongside nurses and help with washing, bathing, feeding, preparing beds and serving meals.
Psychologists are healthcare professionals who deal with the way the mind works. Clinical psychologists aim to reduce psychological distress and improve mental wellbeing. They offer support for a variety of mental health conditions, such as depression or anxiety, and provide talking therapies. For more information see factsheet 444, Depression and anxiety, or 445, Talking therapies (including counselling, psychotherapy and CBT).
Psychologists may also play a part in the assessment of memory, learning abilities and other skills. They often work with consultants in memory clinics as part of a team. Neuropsychologists are a type of specialist psychologist. They are involved in the assessment and monitoring of cognitive difficulties in dementia and other neurological conditions.
Accident and emergency (A&E)
In situations that need immediate medical treatment (such as loss of consciousness, sudden confusion, chest pain and breathing difficulties), it may be necessary to go to your nearest accident and emergency department. Accident and emergency staff will assess the severity of a condition, provide any necessary treatment and then decide whether to admit you to hospital or discharge you back to your GP.
Other health professionals
You may meet other health professionals (known as 'allied health professionals'), either in your home, a care home or in hospital. They can support you with difficulties with hearing, sight, continence, getting about (mobility), keeping independent and eating and drinking that may develop with dementia.
Independence and mobility
Many people with dementia need some support to stay physically mobile or active, or to help them get their mobility back after an operation or fall. Carers of people with dementia may also benefit from this support, as being mobile is integral to being a carer. People with dementia may also need special equipment or adaptations to their home, as well as tailored support, to stay independent and mobile.
Occupational therapists can offer advice on ways of maintaining ability and independence in daily activities for as long as possible. This may include information about assistive technology (products that help people with cognitive problems, such as location monitoring devices) and adaptations and equipment for the home (to help with mobility and physical difficulties, such as stair-lifts). Some occupational therapists work for the NHS and some for local authority social services. If you think an occupational therapist might be helpful, ask the GP, consultant or social services.
For more information on assistive technology see factsheet 437, Assistive technology - devices to help with everyday living. For more information on equipment to help with mobility and physical difficulties see factsheet 429, Equipment, adaptations and improvements to the home.
Physiotherapists can advise on exercise and mobility for people at all stages of dementia. They can advise on reducing the risk of falling and on correct positioning for people with more advanced mobility problems. They can also advise carers on safe ways of helping someone to move or exercise. 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 also in private practice. Look for the letters MCSP 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 'Other useful organisations').
For more on exercising and mobility see factsheet 529, Exercise and physical activity.
Healthy, pain-free feet are important for maintaining mobility. NHS chiropody (also known as podiatry) services can be accessed through your GP, but there may be restrictions on who is eligible. To find a private chiropodist or podiatrist, contact the Society of Chiropodists and Podiatrists (see 'Other useful organisations').
Vision, hearing and speech
Problems with sight, hearing, oral health or speech can reduce the wellbeing of someone with dementia and may make them feel more confused or distressed. The person may not be able to tell other people that they are in discomfort, so it is important for carers to make sure these areas are checked regularly. Professionals working within these areas include those described below.
Problems with sight can make a person with dementia more confused. 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 home visits. 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 or optician for advice.
Audiologists check for hearing problems and can fit a hearing aid, if appropriate, or offer other help. 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.
Speech and language therapists
Speech and language therapists can advise both someone with dementia and their carer on better ways of communicating, and can help with any swallowing difficulties. They can teach new exercises to strengthen the muscles used in speech and swallowing, and also advise on suitable diets. The GP may be able to make a referral, or you can contact the local speech and language therapy department directly (ask your GP practice for details).
Music therapy is a type of therapy that uses things that a person with dementia may still have, such as a sense of rhythm or lyrics they remember. It encourages the person to take part in a shared musical experience, through listening, singing, moving or making music. It aims to reduce the symptoms associated with dementia, such as anxiety, depression and restlessness. It may allow the person to express themselves more fully, be more socially engaged and stimulated, and will also give them a chance to reminisce. To find a registered music therapist, see the Health and Care Professionals Council (see 'Other useful organisations' below).
Oral health, nutrition and continenceDentists
Dental advice should be sought as soon as dementia is diagnosed, because treatment may become more difficult as symptoms get worse. You should also have regular check-ups in case the health of your mouth and gums change.
Home visits from NHS dentists are free but the treatment itself may not be. For details of local NHS dentists and local salaried dental services, contact your local NHS clinical commissioning group (England), local trust (Northern Ireland) or local health board (Wales), or ask at your GP surgery.
For more information, see factsheet 448, Dental care and oral health.
A dietitian can give advice and guidance about food, nutrition and issues such as 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 make refer you 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.
Some local areas may have a continence adviser who can advise on problems associated with continence (using the toilet). They can also give information on useful equipment ranging from commodes to incontinence pads, which may help keep someone independent and clean. The GP may be able to make a referral, or you can get in touch with an adviser directly by calling your local hospital or the Bladder & Bowel Foundation (see 'Other useful organisations' for details).
For more information see factsheet 502, Managing toilet problems and incontinence.
Social care professionalsA person with dementia may benefit from a number of other services, including:
- home care
- day care
- care in a care home
- specialist equipment and adaptations to the home
- the delivery of frozen meals at home
- respite care (also known as 'replacement care') designed to give carers a break from their caring duties
- short break services such as companionship ('sitting') or social activities.
Many of these services can be arranged through your local authority (council) social services department. How these services are organised, and the kinds of services offered, will be different from one local authority to the next.
Most local authorities offer these services by making arrangements with other organisations or care providers, rather than delivering the care themselves. The role of social services, or the partnership organisation, may include assessing a person's needs and helping to make a support plan for them. They may also monitor and review a person's situation to make sure 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 a person's care, or agree to pay for services, until it has assessed the needs of the person with dementia and/or their carer, and has taken their wishes into account. They will also ask about the person's income and savings.
Under the Care Act, all carers are entitled to an assessment should they want one. 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, Assessment for care and support in England; W418, Community care assessment in Wales; or NI418, Community care assessment (specifically for Northern Ireland).
The roles of professionals within social care are outlined below.
Social workers have specific training in order to assess what services a person needs, and will plan, co-ordinate and advise them on care and support. They can also offer support and the opportunity to talk things through. Social workers may also be known 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 homecare or domiciliary 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 helping the person to get into and out of bed, get washed and dressed, and with meals and laundry. A support plan should be made which outlines what jobs or tasks are needed and who will carry them out.
Homecare workers and personal assistants are often employed by private companies (care agencies) and paid for using a 'personal budget', a person's own money, or both. For a list of registered private agencies, contact your local social services or the UK Homecare Association. Some people choose to employ their own homecare worker. You can do this using your own money or a local authority direct payment. For more information on assessment see factsheet 473, Personal budgets.
If you have a complaint about any service provided by a health and social care professional, try to deal with the problem informally if you can. However, if you are unhappy with the result, there are more formal procedures you can use. Most organisations have their own complaints procedure. However, these are sometimes complicated, so seek advice first. Your local Citizens Advice Bureau (see 'Other useful organisations') or Alzheimer's Society National Dementia Helpline (0300 222 11 22) are good starting points.
Individual hospitals each have a Patient Advice and Liaison Service (PALS), who can be contacted regarding complaints and other concerns.
For those in Northern Ireland, the Patient and Client Council can be contacted about complaints and other concerns. See 'Other useful organisations' for details.
You may also contact Healthwatch, a consumer watchdog for health and care services. See 'Other useful organisations'.
Other useful organisations
Bladder and Bowel Foundation
SATRA Innovation Park
Northants NN16 9JH
Charity providing help, information and support for all types of bladder and bowel related problems. They can tell you about local continence services and put you in touch with a continence advisor.
80 London Road
London SE1 6LH
Consumer watchdog for health and care services who may be contacted in the event of a complaint about care.
Health and Care Professions Council
184 Kennington Park Road
London SE11 4BU
T 0845 300 6184
The body that regulates many allied health professionals, including physiotherapists, podiatrists, dietitians, practitioner psychologists, social workers, speech and language therapists and music therapists.
NHS ChoicesW www.nhs.uk
NHS website that allows you to search for health services near you. It also has information on NHS continuing healthcare.
Patient and Client Council (Northern Ireland)T 0800 917 0222
Offers help and advice to someone making a complaint about health or social care services in Northern Ireland.
Last reviewed: July 2015
Next review due: July 2018
Reviewed by: Professor Gillian Manthorpe, Professor of Social Work, King's College London; Dr Corina Naughton, Senior Lecturer in Adult Nursing, King's College London; and Nicky Hayes, Consultant Nurse, King's College Hospital
This factsheet has also been reviewed by people affected by dementia.