Tackling Dementia Care as a Whole System Paul Forte The Balance of Care Group

2 Pre admission AdmissionDiagnosisTreatmentDischargeRe-admission Social details alone, carers, residence Risk factors: age, drugs, co- morbidities, psychiatric/ dementia, falls Preventative care Disease management Managed populations Source of referral Time Waiting time Route Decision maker Reason for admission Alternatives to acute admission setting Admission diagnosis Inpatient diagnosis Delays in diagnosis Chronic disease Alternative access for diagnosis Delays in therapy Alternative settings for therapy (especially rehab) Discharge planning Delays in planning Delays in execution Alternative sites for discharge Revolving door Avoidable e.g. chronic disease management Alternative sites for readmission A whole system perspective

3 The Lincolnshire bed usage survey To identify the number and types of inpatients currently receiving hospital care (acute and non-acute) who might potentially have: –been treated elsewhere and avoided admission –required admission, but could now be treated elsewhere –particular emphasis on people with dementia

4 The Lincolnshire bed usage survey To identify the number and types of inpatients currently receiving hospital care (acute and non-acute) who might potentially have: –been treated elsewhere and avoided admission –required admission, but could now be treated elsewhere –particular emphasis on people with dementia Point prevalence survey on 29 November 2006 –All medical and orthopaedic inpatients (667) –All intermediate care inpatients (121) –All OPMH inpatients (75)

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12 Appropriateness Evaluation Protocol On admission Severity of illness eg unconscious, unable to move (fall), acute bleeding Intensity of service eg surgery + general anaesthesia, regular monitoring, IV therapy On day of care Medical services Nursing services Patient condition eg acute confusion, other acute states, coma, fever

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17 Some Key Points 111 out of 863 patients surveyed (13%) had a recorded dementia diagnosis 65 were in acute hospital There may be substantial under-diagnosis or under- recording of dementia Majority of acute hospital patients with dementia were outside AEP criteria on the day of the survey Potential alternative care settings cover a wide range of services; specialist coordination may be needed Demand for rehab support for people with dementia