Skip to main content
Access keys Home News Site map Site help Complaints Terms Contact us

4. Develop care and support to meet the needs of individuals with dementia, their families and other carers, to maintain independence and avoid crisis


There is a range of different types of support available to people with dementia and their families. If the condition is advanced, some will need of health and care support straight away, while others may not have reached that point yet. However, everyone will need support, advice and help to understand what it means to have dementia, what they can do to live as well as possible with the condition and to enable them to plan for the future.

Ongoing work

South Gloucestershire Council, South Gloucestershire Clinical Commissioning Group, Sirona and the Alzheimer’s Society are collaborating to offer support specifically for people living with dementia in each cluster of GP practices. This service started in summer 2016 and will be provided by a mental health nurse in Cluster 5 and dementia advisor or the Alzheimer’s Society in each of the clusters. The Alzheimer’s Society will continue to work across South Gloucestershire. The dementia advisor posts are funded for a year, by the South Gloucestershire Clinical Commissioning Group. This collaboration means that people with dementia and their carers will have a named contact that they will be able to liaise with they need support in crisis.

Future plans

Collaboration between dementia advisors, Falls Service, community connectors, integrated care practitioners, Frailty Service and health champions to develop community resources in each cluster and enable individuals to access them and thereby reduce isolation.

Early experience of the dementia advisors will help shape future provision of support for people with dementia and carers with particular regard to:

  • The scale of support people require, and the model
  • How to meet the needs of different people e.g. younger people with dementia, people from black and other minority communities and advanced dementia
  • The level of demand and potential benefit from non-pharmaceutical therapies including cognitive behavioural therapy (CBT), mindfulness and meaningful activities specifically for people with dementia

We have developed a day of specialist training for care home staff to support people with a learning difficulty and a dementia diagnosis. We are hoping to adapt this training and to roll it out to supported living providers and family carers.

We have an aspiration to develop an Extracare development which will be a life time home for someone with dementia. Enabling people with dementia to become resident during the early phase of the disease through to supporting them as the disease progresses and an advanced stage with the appropriate levels of care and support.

We should review commissioning arrangements for individuals living in the community. This should give providers discretion to deploy additional staff on a temporary basis to better manage crises, due either to changes in behaviour, or because of physical illness, thereby avoiding unnecessary hospital admissions. Any flexibility should be time limited, monitored closely and contribute towards the CCG’s personalised care target (Expanding Options report recommendation no 4).

A dementia ‘hub’ should be developed which may include at its core extra care housing and/ or nursing care, day services and emergency respite. This new facility could provide a base for out of hours/ crisis response teams (Expanding Options report, recommendation no 13).

Commissioners should keep under review the need for a crisis response team that also works outside of normal working hours, specifically for people living with dementia which also operates out of normal working hours (Expanding Options report, recommendation no 19).