Poor dementia care taking its toll on emergency system
A new report published by Alzheimer’s Society suggests dementia care has got worse leading to a rise in emergency admissions
A report published by the Alzheimer’s Society suggests dementia care is worsening, rather than improving, leading to a rise in emergency admissions
Coping with the increase in the number of patients with dementia is one of the biggest challenges facing the NHS.
The government has made it a priority, setting out an ambition for world class dementia-care by 2020.
But the Alzheimer’s Society is worried the support being given to people is getting worse not better – and that could be having a growing and unnecessary toll on the emergency system.
The charity’s latest report, Dementia – The True Cost: Fixing the care crisis, explores what has been happening to potentially preventable admissions.
Using the Freedom of Information Act, the Alzheimer’s Society requested data from hospital trusts in England on emergency admissions related to:
rise in preventable admissions among patients with dementia
(Source: Alzheimer’s Society)
- Urinary tract infections.
- Dehydration and gastroenteritis.
- Chest infections and pneumonia.
These were chosen on the grounds that all could be prevented with good care and support in the community.
Responses were received from 65 trusts – about half of the total. They showed that over the past five years the number of ‘avoidable’ admissions has risen by 73% to nearly 55,000.
The report accepts some of the rise could be down to better reporting, but says that does not account for the full increase.
Instead, it warns the healthcare system has abandoned people with dementia and left them to ‘fend for themselves’. It cites the squeeze on social care budgets and NHS community services as the cause.
Other groups have also been making similar points recently. NHS Providers has published a report warning that community services, including district nursing and physiotherapy, have been left ‘marginalised, underfunded and short staffed’ despite the desire by government and NHS England to move care out of hospitals.
Among community nurses alone there has been a 15% drop in numbers over the past seven years, figures show.
1 in 7
emergency admissions may be avoidable
(Source: Health Foundation)
And the Health Foundation think tank has carried out research suggesting as many as one in seven emergency admissions may be preventable.
Alzheimer’s Society chief executive Jeremy Hughes says the situation has left the most vulnerable patients in society at risk.
‘Starved of the care they need, people with dementia end up in the ED as a last resort, disrupting their home life and forcing them to struggle in crowded hospital wards. It shouldn’t and needn’t be like this.’
The charity also received evidence from paramedics. A survey of 113 trusts found half saying they were now dealing with avoidable admissions each week.
One paramedic described it as ‘utterly depressing’, saying it could turn a good shift into a sad one.
‘You have to think differently’
The squeeze on community services has not stopped Walsall investing in services to help people with dementia.
The NHS Walsall Clinical Commissioning Group has worked with local hospice St Giles and Accord, which runs a number of care homes, to fund two dementia support workers.
They work across community settings, supporting nurses and healthcare assistants with the aim of reducing emergency admissions to hospital for people living with the condition.
A lot of their work is about observing practice. They may make recommendations about improving signage or seating at lunchtime. They also run teaching sessions that aim to empower and support staff.
The support workers have made a big difference. Tested in a 12-month pilot initially, the service has since been continued. It costs £60,000 a year, but the savings from reduced admissions amount to about £1 million a year – although other initiatives may have had an influence on that decrease too.
St Giles' head of inpatient service Helen Reeves says it has made a huge difference and shows what can be achieved.
‘Community services have not got the funding they probably need, so we have had to think differently about how we work collaboratively.’
College of Paramedics trustee Martin Berry says: ‘My colleagues continue to see a rise in the number of people with dementia requiring unscheduled care. They need timely, preventive and integrated care in the community… not unnecessary hospital admissions.’
Royal College of Nursing Emergency Care Association member Justin Walford agrees with those sentiments.
‘Sadly these admissions are a daily occurrence. We have always had activities to distract children, but we are now beginning to introduce the same for older patients with dementia, things such as worry mitts.
‘As the Alzheimer's report points out it is really down to a lack of social care in the community.
‘There are good projects out there, but the problem is that they are full. The system is creaking at the seams and is therefore slow to react.’
Rapid assessment introduction
Mr Walford, who works as a charge nurse at the Royal Sussex County Hospital, says his trust has become efficient at dealing with emergency admissions among older patients, but the fact they are even ending up in hospital is bad for them.
‘At my hospital we have introduced a system of rapid assessment for these patients so a decision to admit can be made quickly. But the problem is when they do get admitted there is good evidence to show that their health deteriorates and they lose their strength with every day they are in hospital.’
drop in the number of community nurses in the past seven years
(Source: NHS digital)
Despite the criticisms, the government says progress is being made. Diagnosis rates are rising, dementia training has been rolled out to staff in the NHS and social care sectors and there is more community support in place than ever before, according to care minister Caroline Dinenage.
She also points out that extra funds are being given to councils to boost social care, while a green paper on reform of the system will be published soon.
‘A great deal has been achieved, but there is still more to do if we are to realise our ambition to be the best place in the world to live with dementia by 2020.’
‘Dementia care is broken’
Helen Jebson King’s father was taken to the emergency department twice last year after falling.
The first time he ended up spending months in hospital before he was discharged. After his second admission, he died.
Ms Jebson King says the support was simply not there to keep him safe.
‘It is so sad because it was so avoidable. If he had got the one to one care he needed Dad might still be with us.
‘It just made me realise dementia care is totally broken.
'People with dementia should be protected and supported in their home, not ending up in an emergency department – it’s not the place for them, stuck on a ward with no specialist support, feeling restless and confused.’
- Alzheimer’s Society (2018) Dementia – The True Cost: Fixing The Care Crisis
- The Health Foundation (2018) Emergency Hospital Admissions in England: Which May Be Avoidable and How?
- NHS Providers (2018) Community Services: Taking Centre Stage. The State of the Provider Sector.
Nick Evans is a freelance health writer