Dementia Crisis Respite Service Initial Findings October 2013 – October 2014 Dr Yvonne Collins & Lesley Carver Date Thursday 26 February 2015

Dementia Crisis Support In October 2013, North West Surrey CCG launched a new service designed to better support people with dementia and their family carers at a time of crisis. The Aim of the Service is to: To prevent the breakdown of a caring situation that would normally have led to hospital admission or admission to a care home. To enable people to remain in their own homes with appropriate support, including night sitting where necessary, during a crisis period.

Dementia Crisis Respite Service Service Funded through Prime Ministers Challenge £234,200 for 1 year 24/7 Emergency respite service for people with dementia and their carers 2 hour response time from the initial referral to intervention being in place 6 week short intervention Patients supported to remain in their own homes. Aims 200 NEL admissions over a 12 month period Avoid appropriate admissions to urgent short term acute care Reduce A&E attendance

Dementia Crisis Respite Service Aims 200 NEL admissions over a 12 month period Avoid appropriate admissions to urgent short term acute care Reduce A&E attendance

Service Commissioning & Procurement The service was commissioned by North West Surrey CCG Abicare was commissioned to provide the service

Eligibility Criteria The person has a known or suspected dementia. The individual is registered with a North West Surrey CCG practice. The sudden onset of an acute episode has created a crisis situation where ordinarily a placement in a hospital or care home setting would have been sought. The carer is suddenly incapacitated and the individual requires support in the community where ordinarily a placement in a hospital or care home setting would have previously been sought.

Service Provision Practical hands on support provided in the home by specialist home care workers including 24hr care/night sits were necessary. A 2 hour rapid response time – only basic assessment information required – provider assesses need. It is SHORT TERM service designed only to cover a period of crisis or an acute episode for up to a maximum 6 weeks. Whilst receiving the service patient’s ongoing care needs will be assessed and where necessary alternative care and support arranged.

The boundary of the area lies within Surrey County Council and includes all or part of four Surrey boroughs – Runnymede, Elmbridge, Spelthorne and Woking. A very small number of the population also reside within the Guildford and Surrey Heath areas. As shown on the map, the service operated across three geographical localities of North West Surrey: Stanwell, Ashford, Staines, Shepperton, Egham (known as “SASSE”) Thames Medical Woking The service was most commonly used in Woking but referrals have stretched across the whole geographical region

Patterns of Usage 65 referrals during 1 st year. The oldest person to access the service was 99. The youngest was 68. The age group with the largest number of referrals were years. 58% of referrals coming from Surrey Adult Services.

Referred from

Referral by Area The highest number of referrals to the service were made in Woking. The lowest number of referrals to the service were made in Virginia Water.

When Referred

Why was it used? The most common reason for referral followed a breakdown of the caring situation. There were 38 referrals attributed to the needs of the carer. Whilst 27 were directly attributable to the needs of the person with dementia. 29% or 19 of those using the service lived alone. For these people it is extremely likely that a hospital or care home admissions would have signalled the end of independent living.

Household Status

Referral Reason Carer Called away emergency situation10 Carer emotionally/psychologically distressed in home14 Carer physically unwell absent from home20 Carer physically unwell in home2 Person with dementia acute mental health episode5 Person with dementia physically unwell7 End of life care0 Person with dementia found wandering5 Admitted to hospital/nursing home6 Total65

Response Times

Monitoring the service Provider held spreadsheets. Monthly monitoring meetings: ●Problem solve. ●Performance manage. ●Review and refine pathways. ●Respond to trends and need.

Learning from the Pilot The positive lessons The challenges Overview, lessons of living with dementia