Case studies

End of Life Care Service for People with Dementia Living in Care Homes in Walsall

Case study summary

NHS Walsall Clinical Commissioning Group commissioned the role of Dementia Support Workers to provide specialist evidence-based advice, development sessions and support to care home staff across Walsall. Their role is to actively promote best practice approaches to dementia and end of life care. They work with care home staff, residents and their families and identify areas for potential improvement which will provide a positive outcome for residents and their families.

 

Innovative end of life care service in Walsall has been initiated through collaboration with Pathways 4 Life (partnership between the Accord Group and Age UK Walsall) and St Giles Walsall Hospice.

There is a well-documented pressing need to improve care within settings where people with dementia are living. Providing good quality end of life care, especially for people with dementia in care homes, can prove particularly challenging. This includes enabling people to die in their own home rather than in acute hospitals, which is still the experience of many.

Solution

Two Community-based Dementia Support Workers (DSWs) provide specialist evidence-based advice, development sessions and support to care home staff across Walsall. Their role is to actively promote best practice approaches to dementia and end of life care. They work with care home staff, residents and their families and identify areas for potential improvement which will provide a positive outcome for residents and their families. The service has a strong joint working ethos. The DSWs not only work in partnership with people in the care home but also alongside hospice staff, nursing case managers, ambulance teams, community groups, occupational therapists and the voluntary sector.

The DSWs begin their engagement with a care home by carrying out a series of observation studies. During these observations they look for signs of person centred care, effective communication from staff and whether homes utilise assistive technology to better support their residents. They then deliver a series of in-depth development sessions focusing, for example, on supporting care staff to develop their existing skill set and working practices. Together with care home managers, they will work on formulating an improvement plan for homes using Care Fit for VIPS www.carefitforvips.co.uk.

The DSWs also make recommendations on how to improve the environment (such as the use of appropriate signage and orientation aids) and to increase opportunities for socialisation, activity and meaningful engagement. They will promote and support care homes to adopt the Namaste care approach www.namastecare.com and to ensure that they are providing care which is fully person centred. They can deliver tailored development sessions for care home staff and work towards improving their understanding, their approach and their communication skills through role modelling activities. If signs of pain or depression are observed, information is passed on to GP.

These guiding principles help to steer the service:

  • make sure that the people with dementia are always at the centre of everything
  • maximise partnership working
  • utilise an evidence based practice approach
  • empower and engage volunteers, staff and family to maximise their contribution.

Effects the Service is Having Evidence of Impact

Findings from an ongoing evaluation study are providing evidence that the service has led to:

  • a decrease in unnecessary admissions to hospitals
  • an increase in engagement activity among many residents with dementia
  • care home staff feeling more confident in their abilities
  • strengthened links between Health and Social Care
  • an improvement in continuity of care across the borough by increasing communication between care homes and other relevant services
  • staff having a better understanding of what constitutes an emergency and what does not
  • the introduction of more effective and efficient documentation / paperwork.

Case Example – Beryl

Beryl has: a diagnosis of mixed dementia limited communication with others only ever used one word – “Birmingham” lacked confidence to socialise with others within the care home appeared to be very frustrated and anxious within herself.

Challenges: Staff at the Home where Beryl lives had a lack of understanding of the importance of activities, in particular music, lacked confidence to deliver activities, lacked confidence in identifying ways in which they can communicate with Beryl, did not have an in-depth understanding of Beryl’s dementia, did not have a good knowledge about her interests, past history or likes and dislikes, were risk adverse.

Changes Made Included:

  • DSWs spend time with staff to help support a deeper understanding of Life Story work and the benefits this can bring
  • each staff member being asked to identify one piece of important information about Beryl and from this information being able to each introduce a meaningful activity
  • discovering that Beryl loves music
  • DSWs providing a wide variety of activities around music, i.e. music quizzes, musical instruments offering Beryl an iPod.

Outcomes

Beryl immediately took to ‘Le Fabuleux Destin d’Amelie Poulain’ soundtrack and continues to listen to this a lot she is now communicating much more, asking others:  “Can you hear this?”, “Listen to this with me”, “This is fantastic!” – whilst clapping her hands and tapping her feet Beryl is now making friends for the first time since moving into the care home she has started smiling.

In addition, all staff, from senior nurses to domestics, are showing a much greater interest in what the Activity Co-ordinators are doing and, as a result, now have a much better awareness about what meaningful activity should and can entail.

Michael Hurt Head of Older People and Dementia said:  “We are very pleased with the positive difference these workers are making in Walsall. This service, together with the Personal Assistants: Dementia were commissioned after a consultation in which people with dementia and their carers were asked to rag-rate Walsall services against national dementia quality statements. The consultation identified concerns around planning for the future and end of life. These services address those concerns and are supported by the Prime Minister’s Challenge on Dementia 2020. NHS Right Care data showed that too many people are dying in acute hospitals. This service is supporting care homes and the wider community to improve on that and provides the opportunity for more people to die in their own home, which may be a care home.”

For further please contact information:

Michael Hurt
Head of Older People and Dementia
NHS Walsall Clinical Commissioning Group / Social Care and Inclusion – Walsall Council
Jubilee House
Bloxwich Lane
Walsall
WS2 7JL

Telephone: 01922 602457
Email: michael.hurt@walsall.nhs.uk