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By Debbie le Quesne

Posts Tagged ‘care homes

Eye test may hold clue in Alzheimer’s diagnosis

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Changes in and around the eye may be able to detect cognitive impairment and Alzheimer’s disease at an early stage, the Alzheimer’s Association International Conference was told.

The Toronto gathering heard there was a strong association between thinning nerve layers in the retina of the eye and poor cognition, suggesting the potential of retinal imaging as part of early Alzheimer’s testing. It would mean a low cost pre-symptom test could be carried out.

Today, it is only possible to clinically detect Alzheimer’s relatively late in its development, when significant brain damage has already occurred.

Researchers at Moorfields Eye Hospital in London conducted a type of eye scan called spectral domain optical coherence tomography (SD-OCT) in 33,068 people aged 40–69. They measured the thickness of the retinal nerve fibre layer (RNFL), which is known to decrease with age. Participants also took part in tests of memory, reasoning, and reaction time.

A thinner retinal nerve fibre layer was strongly correlated with poorer performance on any one of the cognitive tests, as well as with the number of tests failed overall. For each additional test failed, the RFNL was thinner by 1 micrometre.

Eye tests are fairly common for older people, so there must be great potential to incorporate additional tests into their regular check-up. These tests could help to identify people at risk of dementia.

This is all very scientific and my eyes are becoming glazed over just writing this blog.

However, the information is worthy of putting out there.

The cost of dementia is staggering and our care homes are full of people – some not diagnosed – who struggle with memory loss.

The overall economic impact of dementia in the UK for 2015 was £26.3 billion. This works out at an average annual cost of £32,250 per person and consists of:

  • £4.3 billion of healthcare costs
  • £10.3 billion of social care of which:
  • £4.5 billion spent on publically-funded social care
  • £5.8 billion spent on privately-funded social care
  • £11.6 billion of unpaid care
  • £111 million on other dementia costs

Having had a personal journey caring for those with Alzheimer’s, a cure can’t come soon enough. I understand current research is looking at new treatments which could alter the course of the disease and if a predisposition to the condition could be diagnosed easily let’s hope some preventative therapy could also be found.

 

This is music to the ears

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Barbara Martin hasn’t played the piano for over 50 years.

Arthritis had crippled her fingers and tinkling the ivories seemed only a distant dream. That was until she received support from a student occupational therapist.

I caught this story in the trade press and it truly brightened my day.

A music lover from a young age, Connors House resident, Barbara, used to enjoy all things symphonic from playing the piano to singing in choirs.

With family life keeping her busy, she stopped playing years ago, and now, after two strokes and developing arthritis, she never thought she would play again.

Care Industry News, the online trade magazine, reports: “Barbara has recently been working with an occupational therapist student called Corin, who is on a placement from Canterbury Christ Church University. Together, the pair has been working on strengthening Barbara’s hands and fingers, through a range of activities and tools.

“Music is my passion,” Barbara says, “I can clearly remember singing around the piano as a family when I was younger, my children and grandchildren were all musical too. My first date with my husband, John, was to the BBC Proms! Corin and I got talking and I told him about my love for music and the piano.

“I honestly never even dreamt I would play the piano again. I always used to play Beethoven’s Für Elise and now I can’t believe I can play it again. Corin was so patient with me and has really helped my confidence grow, although I’m not ready to play for other people just yet. When I’m sitting in that big empty room and I can feel the sound coming from my fingers, it really is music to my ears. I can barely believe it is me playing it, it’s a real sense of achievement.”

How wonderful is this story! It’s a delightful antidote to so much gloom in the sector and again a great example of care excellence. Good care does exist. It tends to be only the media that fails to find it.

 

Discharge delays again: New measures needed to fix problem

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The Government body for scrutinising value for money on public spending has concluded “patients and the NHS have a right to expect better” on the issue of hospital discharge delays for the elderly.

The recent Public Accounts Committee report challenges the Government to address the scale and cost of the problem.

It urges new measures to tackle discharge delays, which are bad for both patients’ health and the financial sustainability of the NHS and local government.

I have campaigned long and hard on this issue and clearly made known my views that in many cases hospitals are really not that switched on to getting the elderly back into the community or care homes. Discharge managers need to have a good understanding of how care homes deal with admissions and how care packages are processed.

The Committee found there was a poor understanding of the scale of discharge problems, with official data substantially under-estimating the range of delays and the number of older patients affected.

There is unacceptable variation in local performance on discharging such patients, said the Committee, finding that while good discharge practice is well understood, “implementation is patchy across local areas”.

It concluded poor sharing of patient information is a significant barrier to improving performance, while “the fragility of the adult social care provider market” exacerbates discharge difficulties.

All this is true, but there is I believe a bigger problem. Care costs money and the sanctioning of care packages becomes, it appears, more and more protracted. It’s not just a case of finding a step-down bed or a care or nursing home, the big issue is getting it funded.

However, while the Committee recognises there is pressure on funding, it does not accept this necessarily blocks efforts to make further improvements and urges a greater commitment to step up the pace of change.

It concluded: “NHS England shows a striking poverty of ambition in believing that holding delays to the current inflated level would be a satisfactory achievement.”

Harsh words.

Those regions which are doing best are the ones where “all the local system owns all of the problem” but this practice is all too rare. NHS and social care sing off the same hymn sheet, but who’s going to be choirmaster to create some harmony here?

Here we go . . . the reports adds: “The Department, NHS England and NHS Improvement have failed to address long-standing barriers to the health and social care sectors sharing information and taking up good practice. The result is unacceptable variation in local performance.”

West Midlands Care Association is available to help resolve the discharge problems. Getting the right people to talk to us . . . now there’s another challenge.

Local health and social care organisations need to work together effectively, in fully integrated systems, to make this work.

The National Audit Office (NAO) has estimated a gross cost of around £800 million a year for the NHS of older patients delayed in hospital when they no longer benefit from being there.

 

GPs a gateway to social care and more

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The role of GPs is changing. No longer are their practices just treating medical conditions and referring patients to hospitals.

Primary care is at last being driven by an integration which seeks a greater level of collaboration across frontline services – everything from companionship advice for the isolated to social service and end of life referrals.

This is the new face of primary care service, but it’s not everywhere – not yet.

Increasingly, patients are able to access GP-led hubs offering a range of services, or are given a social prescription that provides them with access to non-medical support, such as social clubs, peer networks or arts therapy.

However, even with growing evidence that these models of care can reduce long-term demand on acute services, we have still not yet seen a major national shift in this direction.

An NHS report – the General Practice Forward View – endorses this broader remit and as well as setting out detailed plans for the recruitment of more GPs, argues for a refocus of the GP’s role on to prevention rather than cure, and the promotion of community-based care and support.

Social care is getting NHS backing. Am I dreaming?

The report calls for more areas to incorporate the multi-specialty community providers (MCPs) model of care – a programme of integrated primary, out-of-hospital and preventative care that is being piloted in 14 regions of the UK. Social prescriptions should also be more frequently used, it adds, to provide patients with access to organisations that can provide advice on employment, housing, debt and other support services.

For me, this is an exciting breakthrough, and could mean GPs become the gateway to social care.

Mmm . . . which pot of money will be used to fund this?

 

New PM downgrades care minister’s role

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Theresa May has an unenviable challenge. We have the Brexit issue, the unstable British economy, welfare issues, immigration problems . . . and social care all clamoring for her attention.

What’s going on, I ask. The minister of Care responsibilities have been downgraded and are now the remit of a parliamentary under-secretary. It’s the first time in eight years this has happened and I’m hugely disappointed.

The news appears to have caught the imagination of only a few journalists, but not surprisingly, the ones at the Guardian.

“This downgrade comes at a time when there is acceptance that social care is in crisis and there is unprecedented demand on care services,” I read in the paper’s online columns.

And the article points out the obvious. As we live longer and have more complex needs in later life, it is crucial that social care remains high on the political agenda.

The downgrading appears to suggest otherwise – this is now a post on the bottom rung of the ministerial ladder. I was hoping that things would be so much better with Mrs May.

According to the Association of Directors of Adult Social Services, to maintain care at the same level as last year would require more than an extra £1.1bn. But the National Audit Office, says the Guardian, has previously reported that councils increasingly pay less than the actual cost of the care provided.

Here we beat the same old drum: It is not a financially viable a situation.

Additional pressure on care provider budgets comes with the Living Wage and the fact that demand for care is only going to increase.

Jane Ashcroft is chief executive of Anchor, England’s largest not-for-profit provider of care and housing for older people, writes: “With a rising population and longer life expectancy, the number of people over 65 is set to rise by more than 40 per cent in the next 17 years.

“This will take the number of older people in the UK from 11.4 million to more than 16 million. This demographic change is welcome; it signals improving living conditions and advances in medicine. But if the funding of services is not updated for these new demands, we are undoubtedly heading towards an age of suffering and loneliness for older people.”

Rightly so she calls for a minister of state role – “someone with the power to make real change.”

I fully understand that good social care reduces the financial burden on NHS care. It cuts hospital admissions and heads off expensive health troubles with our vulnerable and elderly. Critically, it can also cut hospital bed blocking.

According to Ashcroft these combined woes cost the taxpayer £820m a year.

Can we have our minister back please. I think we need one, urgently. The downgrading of this portfolio is a huge step in the wrong direction.

 

The haves and have-nots: Bizarre economics of care

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The UK care home sector is losing managers and failing to replace them, that was what LaingBuisson was telling the media more than 12 months ago. And guess what, it’s not changed today.

The shrinking pool of talent for the top jobs with providers of elderly care is driving manager salaries to new heights.

In the latest data I have to hand it says new-build homes are offering in excess of £60,000 a year for managers.

That means with the additional costs of National Insurance employer contributions, pension payments and other sweeteners, the source cost for providers is rapidly approaching £100,000, and a bonus scheme can easily tip this even higher.

Of course, we wouldn’t expect to see these figures being paid amongst many of our members and it’s not because they are mean employers. It’s a simple case of economics: There’s just not enough money in the pot as the region is too poor.

It’s a fact that many of the lager corporates operate in much more affluent areas than the West Midlands and unlike many here, their main trench of income is from private payers. Most of my members survive on council-funded placements and it’s their primary source of income.

Austerity measures is seeing the industry becoming increasingly polarised – the haves and have-nots.

In May last year, according to LaingBuisson Recruitment co-founder James Rumfitt, the residential care sector as a whole was struggling to find managers of competence.

I am not surprised.

According to the healthcare consultant’s Care Home Pay Survey – second edition, the average care home manager salaries at the beginning of 2015 were up 4.2 per cent above the previous year.

This was incredible 49 per cent higher than salaries seen a decade ago. Compared to an increase of just 24 per cent in median full-time employee earnings in the UK economy as a whole, it’s an eye-watering hike.

Isn’t it odd, the general care market is in turmoil, yet the economic dynamics of a shortage of good managers, pushes up their salaries at the top end of care provision. Supply and demand are hard masters.

While there will always be those who can afford private care payments and thus fund very generous salaries for the elite operators, there will be many more people receiving care on local authority rates only. Their care providers, where pay rates remain anchored to the Living Wage, will not have the privilege of top-ups to fund such salary extravagance..

But I must say this: The care I have seen in some of our struggling homes has been exemplary. Plush surroundings, teas on the terrace, matching furnishings and expensive, oak flooring, does not necessarily equate to excellence in care.

What is it about never judging a book by its cover . . .

 

Dementia – shocking findings spark new Alzheimer’s Society campaign

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Reading the Fix Dementia: NHS and Care Homes report is harrowing.

The decision to move anyone into a residential care setting is never easy and what should make this process less guilt-ridden is an assurance that, in a care setting, the person with dementia will receive at least the same, if not better, access to healthcare services.

The Alzheimer’s Society’s study, conducted in partnership with Care England, doesn’t deliver that much-needed comfort.

According to the Alzheimer’s Society, 92 per cent of people affected find hospital environments frightening and staff there appeared to be unaware of the specific needs of these complex patients.

The report also highlights that too many of these patients are falling while in hospital; too many are being discharged at night; and others are stuck on wards despite their medical treatment having finished.

Alzheimer Society Freedom of Information (FOI) requests uncovered “unacceptable national variation in the quality of hospital care across England” and in response it launched the latest Fix Dementia Care campaign.

The investigation involved FOI requests to NHS Trusts in England and a survey of over 570 people affected by dementia to gather first-hand testimony of dementia care in hospitals.

I read that in one trust, 702 people with dementia fell in 2014 –15, the equivalent to two falls a day.

Last year 28 per cent of people over the age of 65 who fell in hospital had dementia – but this was as high as 71 per cent in the worst performing hospital trust, according to the Alzheimer’s Society.

I cannot imagine how scary it would be for those with dementia being in an unfamiliar place with stressed staff who are just too busy to offer the attention they need.

The falls count is shocking and that fact that some hospital discharges were at night, totally inappropriate. What kind of access to care/nursing homes do hospital discharge officers think is available at night? It’s a time when staff numbers are generally less and coping with an ‘admission’ unrealistic.

In the worst performing hospitals, people with dementia were found to be staying five to seven times longer than other patients over the age of 65.

What is referred to as a “litany of failures” makes heartrending reading.

Just two per cent of people affected by dementia said all hospital staff understood the needs of those with the diagnosis.

Jeremy Hughes, Chief Executive of Alzheimer’s Society, said:

“Good dementia care should never be a throw of the dice – yet people are forced to gamble with their health every time they are admitted to hospital.

“Poor care can have devastating, life-changing consequences. Starving because you can’t communicate to hospital staff that you are hungry, or falling and breaking a hip because you’re confused and no-one is around to help, can affect whether you stand any chance of returning to your own home or not.

“We must urgently put a stop to the culture where it’s easier to find out about your local hospital finances than the quality of care you’ll receive if you have dementia. We are encouraging everyone to get behind our campaign to improve transparency and raise the bar on quality.”

This year Fix Dementia Care will examine the quality of care people with dementia receive in three key care settings: in hospital, in care homes and in the home.

When the report is published, remind me to get a big box of tissues. In the meantime West Midlands Care Association will continue to work closely with the local hospitals to ensure that the transition is as good as possible.

It’s heartening that some hospitals have also invested time and money to improve their knowledge and resources available.

There’s lot of good practice and people are working hard to ensure the issues highlighted in the report are not the case in the West Midlands.