Aims of the service:
Providing specialist assessment and treatment for care home residents, and advice, support and education to care home staff and to the families, and GPs and generic agencies working with care home residents.
Improve the quality of life for residents of care homes with mental health problems. Improve awareness of good practice in end of life care for people with dementia by participating in a training programme established by the Macmillan service.
Description of Actions or Practice:
Provided education on mental health issues. Assessed care home patients who display mental health symptoms and provided specialist treatment as appropriate. Supported staff and GPs to differentiate between physical and mental health issues. Developed person centred intervention plans for care home staff to implement. Monitoring / reviewing medication. Prevention of move to different homes or hospital admissions. Developed strong liaison with Macmillan services and hospice enabling people with dementia in care homes to have better end of life care and patients known to mental health service to access the hospice. An agreement has been reached with the Acute Trust that in exceptional circumstances the CHL worker can access an inpatient bed there without going via the GP by directly contacting the Consultant Physician or Ward Manager.
What are the resource implications of this example? How has it been funded?
Provided by Tees Esk Wear Valley NHS Trust, funded by Hartlepool PCT.
What have been the challenges and solutions in setting up and maintaining the innovative practice?
Initial challenges were over-reliance on this role from nursing home staff expecting the CHL worker to perform some of the basic physical assessments that the GP etc should perform. This has been resolved by some excellent liaison working with GPs and the Opt in team and also by educating the care home staff regarding what physical issues may result in a mental health presentation and when to contact the GP.
Outcomes :
Admissions to mental health inpatient unit from care homes have reduced. In year previous to this post being established there were 13 admissions to mental health inpatients. This has reduced to 5 admissions to mental health inpatients in the three years since the post was established, an average of 1.6 per year.
Plans for the future:
Rolling programme of training has been commenced in two homes with a plan to role it out to all homes over the next 12-18 months.
There is scope to further develop the model to ensure pro-active and ongoing rolling training programmes are developed, also would like to provide additional support in non-pharmacological ways of managing challenging behaviour. One idea is to use dementia care mapping and formulations to identify issues in terms of person centred care and then implement more intensive education and support to improve quality of care and reduce reliance on antipsychotic medication for people with dementia in nursing homes. In order to implement this there would be a requirement for additional nursing support, psychology and OT.