IMPROVING HEALTH SERVICES FOR EUROPEAN CITIZENS WITH DEMENTIA

Transcription

1 IMPROVING HEALTH SERVICES FOR EUROPEAN CITIZENS WITH DEMENTIA Best Practice Strategies for Transition from Home Care to Long-term Residential and Nursing Care (RightTimePlaceCare) UK TEAM David Challis, Caroline Sutcliffe, David Jolley, Sue Tucker, Ian Bowns, Brenda Roe, Alistair Burns., University of Manchester On behalf of the RightTimePlaceCare Consortium Personal Social Serv ices Research Unit at the Univ ersity of Manchester

2 Purpose and design To examine different approaches to the support of people with dementia and their carers in 8 countries A focus on development of best practice strategies for the transition from home care to long-term care WP1 Management WP2 Health Care Structure WP3 Survey WP4 Economic Evaluation WP5 Best Practice WP6 Dissemination

3 Participating institutions University of Manchester (UK) University of Tartu (Estonia) University of Turku (Finland) University of Toulouse (France) Witten University (Germany) Maastricht University (Netherlands) University Hospital Barcelona (Spain) Lund University (Sweden)

4 WP2: Health Care Structure To explore the experiences of people with dementia and their carers and of care providers in relation to dementia care Undertook focus groups in 8 countries: with people with dementia and their carers with professional staff

5 WP2: Focus group findings Key themes (international findings) Provision of information throughout the stages of dementia Single point of contact and continuity of care Psychological therapies and emotional support Key themes (UK findings) Improved care of people with dementia in acute hospitals Access to regular respite and day care More flexible and creative care services

6 Interviews with people with dementia, informal and formal carers WP3: Survey To identify factors influencing the decision to enter long-term care Group 1: recently moved to long-term care (between 1-3 months) Group 2: living in the community receiving home care services but judged at risk of moving to long-term care

7 WP3: Survey findings I 2,014 interviews with people with dementia & carers Factors associated with home care v. long-term care Group 1 Long-term care setting 791 recent care home entrants Less likely to be married More cognitive impairment More dependent in ADLs Group 2 Home care setting 1,223 home care recipients Less likely to live alone More behavioural & psychological symptoms More carer distress

8 WP3: Survey findings II Group 2 Home care setting 1,223 home care recipients 3 month follow-up 126 moved from home care to longterm care Predictors of admission to long-term care Living alone Lower cognitive functioning More severe behavioural symptoms of dementia More depressive symptoms An informal carer reporting higher levels of carer distress

9 WP4: Economic evaluation To estimate the costs of care received by people with dementia in both care settings across 8 countries Using information on service receipt and informal care provision collected in WP3 Exploring cost differences between settings and across countries

10 WP4: Economic evaluation findings Key points Cost per month significantly lower in home care setting ( 2430) compared to long-term care setting ( 4490) Informal caregiving the biggest cost element in home care setting ADL dependency the most important cost predictor

11 WP5: Best practice To investigate variations in margins of care and consider alternative care options both within and across 8 countries using a Balance of Care approach Expert practitioner workshops Create appropriate support package/care plan Costing the alternative support package/care plan

12 WP5: Best practice findings Key points Enhanced community services may divert around 25% of people with dementia currently admitted to long-term care Greater availability of standard services could reduce demand for long-term care assuming care quality could be assured

13 Main messages Whilst delaying admission to long-term care may be cost-reducing for European health systems, governments considering strategic shifts towards home care face varying challenges and opportunities Any such shift may have implications for the health and well-being of the person with dementia and their informal carer

14 RightTimePlaceCare Publications ServiceArrangementsandIntegration/RightTimePlace Care