Joined up Strategy Needed to Improve Care for People with Dementia
Thursday, May 28th, 2009
on behalf of Care Inspectorate
Care homes across Scotland need to significantly improve the care they offer to people living with dementia.
A joint report – Remember, I’m Still Me – by the Care Commission and the Mental Welfare Commission highlights a range of concerns, most notably the excessive use of drugs used to control behaviour and the lack of regular medication reviews.
The report also highlights a lack of staff knowledge about the life history and individual needs of people in their care and tells how many people rarely leave their care home – all of which highlights the importance of not ‘forgetting’ the person inside dementia.
A range of recommendations to improve the position – including a call for everyone with an interest in dementia to work together – are made in the report.
The findings are based on a series of unannounced visits to 30 care homes across Scotland, carried out jointly by the Care Commission and Mental Welfare Commission between August 2008 and March 2009. Up to 67,000 people in Scotland have dementia and about 40% are in care homes or hospitals.
The review – which included interviewing care home managers and staff, speaking to people living in care homes and reviewing residents’ personal plans and medication records – revealed:
- 75% of people were taking “psychoactive” drugs, given for behaviour problems, depression or insomnia.
- Concerns that many people had been on the same medication for long periods with no regular reviews.
- 20 people (1.5%) had been given covert medication. In the nine care homes where this was happening staff didn’t know enough about how to do this lawfully and safely.
- Very few people had a planned yearly health check by their GP.
- None of the homes had a system for recording medicines to the required standards.
- Evidence of some GPs prescribing medicine without seeing the person first.
- No records of clinical pharmacists visiting care homes.
- Only 24% of people had an adequate record of their life history, a key factor in helping to treat dementia. In one case, the sum total of a person’s life history was: ‘likes cats; likes milk’.
- Around half of all people never left their care home and not enough people get to take part in activities that reflected their needs or interests.
- The law on medical treatment of people who lack capacity is not being used properly.
- Some staff did not have knowledge and training to deal with people with dementia.
- People’s money is not being used to improve their quality of life.
Susan Brimelow, the Care Commission’s Director of Healthcare Regulation, said: “Older people living with dementia are among the most vulnerable people in society. Care homes should ensure that they give people with dementia the good quality care they need to live as independently as they can and to lead as meaningful a life as possible.
Heartening examples of good dementia care
“Although there are some heartening examples of good practice, such as homes providing sensory gardens, a putting green and a 1940s-style lounge, our findings reveal that the overall quality of care being delivered needs to improve significantly.
“There is some uncomfortable reading in this report, but we must highlight what needs to change if we are to get improvement. Everyone working in the care home sector must work together to ensure that the quality of care for people living with dementia meets Scotland’s National Care Standards.
“We hope this report will raise awareness about best practice and ensure a multi-agency commitment to help care homes, doctors, pharmacists, health boards and local authorities to deliver the quality of care that everyone with dementia has the right to expect both now and in the future.”
Dr Donald Lyons, Director of the Mental Welfare Commission, said: “There is a certain irony that it is often the services that deliver care that seem to ‘forget’ the person inside the dementia. One of the key findings of this report is that care homes provide a “one size fits all” service for people with dementia – with care plans that pay little attention to the life the person has lived.
“Our findings around medication are part of this picture. If you don’t understand someone’s life history, you are less able to understand their needs, less able to interpret behaviour and less able to design ways to address it that don’t involve drugs. Where drugs are used, it is vital that this is done for their benefit and in a way that respects their rights under the law.”
10 Key Messages for good dementia care
In the 30 homes they inspected, the Care Commission made 78 requirements and 235 recommendations for improvement. These included the requirement for care homes to improve the way medicines were managed, improve the use of personal plans, improve the standard of care for people with dementia and better training for staff.
The Care Commission and Mental Welfare Commission have drawn up 10 key messages for care homes across Scotland to follow. These include fully understanding the needs of individuals with dementia, providing a comfortable environment for them and improving the way that medication is recorded and administered. All care homes in Scotland will be sent a copy of the report.
Both organisations will also lobby the Scottish Government to use the Remember I’m Still Me report to inform the development of a National Dementia Strategy – and will recommend improving systems to monitor the prescription of medicines in order to highlight any inappropriate or overuse of medication.
In addition, the Care Commission will check that all care homes are improving during inspection activity in 2009-10. It will also appoint a dedicated Rehabilitation Consultant for Older People who will help people in care homes with dementia to enjoy better quality of life.
The Mental Welfare Commission will make sure every care home receives information about how to manage money and how to look after people who cannot make their own decisions about care and treatment. They will also check that care homes are responding to the recommendations in the report through their on-going visits to individuals with dementia and scrutiny of individual care plans.
Issued on behalf of the Care Commission and Mental Welfare Commission by Holyrood Partnership. For more information, call Raymond Notarangelo: 0131 561 2244 or [email protected]