Working with people living with dementia and other long term conditions

1. Working with people living with dementia and other long term conditions Karin Tancock Professional Affairs Officer for Older People & Long Term Conditions

2. Background • 3 or more long term conditions (1.9 million in 2008 rising to 2.9 million by 2018) • People with several long term conditions have poorer: • Quality of life • Longer hospital stays • Poorer health care treatment and clinical outcomes (Kings Fund 2010) • Limited evidence on what high quality care looks like for this population group.

3. Multiple Long Term Conditions • Recommendations for best practice • Continuity • Access to self management approaches • Support for carers • Integrated treatments and care planning • Maybe more challenging for people with dementia: • Changing routine and making life style changes • Learning new strategies • Use of active assistive technology May be challenging for people with dementia.

4. Challenges • The range of specialist services • Communicating with many agencies. • Different funding arrangements • What is a health care need or a social care need? • Balancing the person’s needs with carers needs.

5. Overcoming Barriers • Provide stimulus (funding or other means) to support local initiatives to improve care. • Avoid a top-down policy that requires structural or organisational mergers • Remove barriers, such as differences in financing and eligibility, in the system. • Multi disciplinary teams with clearly defined roles. Kings Fund, 2014

6. Occupational Therapy: • provides practical support to enable people to overcome any barriers that prevent them from doing the activities that matter to them. • aims to increase people's independence and sense of well being. What is occupation? • Activities that allow us to live independently and give us a sense of identity.

7. Advantages of focusing on occupation: • Captures stories – the person, the carers . This identifies what motivates someone, their strengths as well as difficulties and what has meaning for that person e.g. Personal, family and community life roles. • Assesses function. This measures how symptoms or conditions impact on people day to day. Supports decisions regarding goal setting, pain and symptom management, assistive technology. • Naturally fosters partnership working

8. What are we doing as a profession • Unique perspective – work across health and social care. • Maintaining skills from dual training. • Collecting evidence. Developing outcome measures. • Broadening roles: Teaching and training, assessment and advisory roles.

9. Good examples: • Integrated health and social care teams in South Devon & Torbay- patients having faster access to services with one phone call for occupational therapists and other disciplines. • Greenwich: Occupational therapists as part of Joint Emergency Teams respond to emergencies arising within the community within 24 hours. Offers treatment at home or through short term residential care. Over 2,000 patient admissions were avoided • DH, 2013

10. References • Department of Health (2013) Integration pioneers leading the way for health and care reform • Kings Fund (2010). Managing People with long term conditions. • Kings Fund (2014). Providing integrated care for older people with complex needs. Lessons from seven international case studies.