1. Assessment in averting crisis admission Gayle McKee CPN Ann Scott Nurse Consultant

2. What is a crisis? It’s hard to sum up!

3. Case Study One Mr A, recent admission for acute episode and medication review Discharged into his wife’s care who is the main carer Moderate/advanced Dementia with communication severely compromised Increased behavioural concerns, hitting out at wife and carers Evidence of increased psychosis What would you suggest as plan of action?

4. Case Study Outcome Previous history of constipation and back pain Checked with wife, no bowel movement for 2 weeks and then diarrhoea/loose stool GP confirmed gross constipation Same treated and behavioural issues reduced Education regarding constipation and overflow

5. Case Study Two Miss B long history of slow cognitive decline with eccentric behaviour Increased reports of acute confusion, paranoia and disturbing neighbours at all times of day and night Calling emergency services, police and ambulance on a daily basis

6. Case Study Outcome Admitted to general hospital with raised calcium CT brain scan showed evidence of recent stroke, same treated and rehab given Confusion reduced client back at home

7. Best Practice GP assessment to rule out physical cause e.g. delirium, acute confusion Gather information, client, relative, carers, GP, Psychiatrist and other professionals involved Identify triggers, risk, carer stress and need for carers assessment Options – Treatment at home - Step-up - Respite - Admission, ideally planned to reduce stress to client and family/carers Education – e.g. dehydration and constipation for carers, professionals and care homes

8. Bamford review Started in 2002 and completed 2007 Looked at law, policy and provisions which affect people with mental health and learning disabilities in Northern Ireland Aim to promote equality, social inclusion and positive mental health

9. Compton Report Released November 2011 5 year implementation plan reviewing local health and social care Transforming your care Client centred, integrated working Services regarding home as the hub Closing long-stay units with focus on care in the community Shifting resources from hospital to community 10 major areas – long term condition Quality and outcomes

10. Dementia Strategy Launched 2011 Minister Poots ‘I want to ensure that people with Dementia are treated with awareness and respect, especially by those providing services and that they are supported to maintain their independence for as long as possible.’

11. Nothing Ventured Nothing Gained Risk guidance for people with Dementia Guidance on the best practise in assessing, managing and enabling risk for people living with Dementia Balance between being over protective (in an attempt to eliminate risk altogether) while respecting individuals freedom Managing risk in a positive and constructive way by enabling and supporting people with Dementia and their carers.

12. Gold standards What is ‘Best practise’? Specialist practitioners Single point of access 24/7 Crisis response for known and unknown clients Liaison / behavioural specialist for care homes Northern Ireland Single Assessment (NISAT) Education for clients, families and health professionals

13. Current Gaps in Services Increasing aging population and number of people with DementiaIncreasing aging population and number of people with Dementia Lack of community resourcesLack of community resources Lack of understanding within health and social care professionalsLack of understanding within health and social care professionals

14. Summary Assess physical cause Pre-empting carer stress and breakdown Improving community services available Best practise