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Care system 'struggling' to cope with dementia

Death rates for people with dementia was higher than all other conditions in majority of hospitals

Mark Gould

Tuesday, 12 March 2013

People with dementia living in care homes are more likely to be hospitalised with avoidable conditions such as urinary infections than similar people without dementia, according to a new survey by the Care Quality Commission, which concludes that services are struggling to provide appropriate care.

It says that once in hospital, they are more likely to stay longer, be readmitted, and die there than similar people who do not have dementia.

The report, a themed review into dementia care, showed that the rate of people with dementia dying was higher than all other conditions in 85 per cent of hospital trusts. It also found that people with the condition in care homes are going into hospital for avoidable reasons significantly more than those without. Once in hospital, people with dementia are staying too long, being readmitted too often and ultimately dying there.

In over half (78 out of 151) of primary care trusts, people with dementia in care homes were admitted to hospital for an avoidable reason significantly more than people without dementia.

In almost all (96 per cent) of hospital trusts people with dementia stayed significantly longer than those without the condition after being admitted in an emergency. In three quarters (76 per cent) of trusts they stayed significantly longer when admitted for any reason.

In 70 per cent of hospitals people with dementia were being readmitted significantly more than people without the condition.

It concludes that those services involved in caring for people must do more to make sure people get safe, quality care that identifies and meets their needs.

Jeremy Hughes, the chief executive of the Alzheimer’s Society said the report "lays bare the scandalous extent to which the NHS is failing people with dementia".

He said hospitals are supposed to be places of recovery "but people with dementia are going in too often, staying too long and dying in a hospital bed much more than those with any other condition".

"A quarter of hospital beds are occupied by someone with dementia. Staff better trained in dementia care will reduce the length of hospital stays and save the NHS millions of pounds. Tolerating inaction on dementia care even a day longer is tantamount to playing Russian roulette with the lives of people with the condition. If we’re to avoid the next Mid-Staffs we need hospitals to commit to improve care now."

The CQC Care Update also says that services for people with mental health issues or learning disabilities provided by independent hospitals and community services still have some way to go to provide a good quality of care.

The disparity between the quality of healthcare in independent acute and community services which continues to be high, and the quality of mental health and learning disability services, is still wide and is not improving quickly enough, says CQC.

The Care Update is based on more than 20,000 inspections carried out between 1 April and 31 December 2012.

CQC chief executive David Behan said: “The majority of services are delivering good quality care, however care providers must do more to make sure that care is based on people’s individual needs. This Care Update draws attention to two areas where this is not happening.

“The people in charge of care homes and hospitals must work better, individually and together to ensure the right services are in place for people with dementia and their staff must be trained to identify dementia.

“It’s six months since recommendations were made following the abuse of people with learning disabilities at Winterbourne View. While there has been some improvement by those delivering services for people with mental health problems and learning disabilities, there is still some way to go and CQC expected improvements to be made more quickly. We are still seeing too many independent mental health and learning disability services not delivering care that puts people first.

“A patient-centred culture of care needs strong leadership, openness and transparency, and CQC will look closely at this in the coming year, particularly in those services caring for some of the most vulnerable people in our society.

“We will also be using and sharing the evidence of what works well to drive change in those providers and services that need to improve.”

Sarah Pickup the president of the Association of Directors of Adult Social Services (ADASS) said unnecessary admissions to hospital can be related to a lack of training in care homes and community teams, difficulty in accessing community services, or difficulty in identifying or diagnosing particular conditions or pain when someone has communication problems related to dementia.

“The findings highlight the need for more and better dementia training among a wide range of staff across health and care services. People with dementia suffer from the same conditions as those without the condition. The person that treats an infection, or deals with a toothache, or treats a hip fracture, needs to understand how to do this when the patient has dementia.

“The condition being treated may be the same as someone without dementia but a different approach may well be needed,” she said.

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