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6. Improve provision for people who can no longer live at home, supporting care homes to meet the needs of people with dementia and developing alternatives

Context

By encouraging people to live well with dementia it is hoped to reduce the number of people who will need care homes services, but knowing there is good, affordable care available to people with dementia can reduce anxiety for both carers and the person with dementia. In South Gloucestershire there is a shortage of nursing home places for people with dementia, and little or no alternative provision. On occasion this results in people being placed away from their communities.  A lack of availability of respite beds and people whose dementia is causing them to exhibit, behaviours that challenge means that they often spend longer than necessary in hospital.

Ongoing work

There is no nationally recognised training for care and support workers, providers often purchase training by a variety of providers. South Gloucestershire Council has worked with Skills for Care to develop work in this area as well as providing training for people working with people with dementia for home care, care home and other health and social care staff.

We plan to introduce person centred dynamic purchasing for care home placements.

During consultations with care home providers we heard that on occasion there was a reluctance to accept new placements into their home of people with behaviours that challenge. This was because of concerns about the safety of other residents, their staff lacked confidence in dealing with anti-social behaviours and they felt community support services did not support them if they experienced difficulties. We also heard from the care home providers who said that sometimes the only option for people exhibiting anti-social behaviour was to arrange admission to a hospital setting. Care Home Liaison at Avon and Wiltshire Partnership support care homes to manage the residents they find most challenging, most of whom have dementia. In 2015/16 the South Gloucestershire Clinical Commissioning Group made an additional investment to enable them to work with all 40 care homes. A further three year’s funding has recently been agreed to enable them to continue to do so, and to develop and deliver training programmes in the care homes. We anticipate through their intervention the lives of people with dementia and living in care homes will be enriched and stable, creating a greater confidence that people with dementia can live well in care homes and reduce the fears and anxiety of people diagnosed with dementia. From a safeguarding perspective it is hoped that improved staff knowledge about meeting the individual needs of people with dementia will reduce the number of incidents between residents.

We have developed a day of specialist training for care home staff to support people with a learning difficulty and a dementia diagnosis.

Future plans

We need to raise awareness with carers about the end stages of dementia and the way that care is given. There should be opportunities for honest and open discussion between medical professionals and family, friends and carers about any decisions to withhold or withdraw treatment.

To investigate respite support for carers of people living with dementia to make it more creative, flexible, and accessible. This should include investigating the development of “pop in”, overnight care, or evening sitting service rather than the service user being placed in a specialist respite accommodation for a number of weeks throughout the year (Expanding Options report recommendation no 6). Potentially redistributing funding from acute hospitals into community provision.

It has been calculated that one new care home with nursing that provides services for people with dementia needs to open in South Gloucestershire annually. South Gloucestershire Council has marketed three development care home development sites. We also know that three new care homes with nursing which will provide services for people with dementia are either being built, or have recently been completed in the area. To support the market South Gloucestershire Council has made a commitment to block commission nursing dementia beds for a period of years with new care home sites.

We will continue to encourage further private investment to build care homes to provide choice for people considering living in a care home.

In addition to increasing the number of care homes we need to continue developing and retaining and increasing the number of people who work in care homes and consider building a career in care homes.

Investigate mapping information to give precise details of the number, location and additional capacity needed to address the shortfall in specialist care home provision. (Expanding Options report recommendation no 7).

Investigate the development of specialist Extracare housing for people with dementia (Expanding Options report recommendation no 8).

Explore whether specialist Shared Lives placements could be an alternative to care home placements and/or emergency respite (Expanding Options report recommendation no 9).

Investigate requiring specialist care homes to become accredited to the Dementia Quality Mark for Care Homes, or similar quality mark (Expanding Options report, recommendation no 10).