4 Acute hospital admission and care
home experiences
19. Over 200,000 people with dementia are estimated
to live in care homes, some 62% on average of all residents in
such settings. However, only 28% of care homes places are registered
as specialist dementia places, meaning a significant proportion
of people with dementia live in homes where staff are not appropriately
trained to care for them and meet their specific needs. Whilst
the Commission for Social Care Inspection[28]
(CSCI) has recorded an increase in the number of homes meeting
these standards, the proportion of residents with dementia is
also increasing.[29]
20. Many of the concerns about skills, training and
turnover of domiciliary care staff are also relevant to care home
staff. The challenge remains to ensure that staff recognise and
acknowledge dementia and are equipped to provide appropriate care
to meet the needs of people with dementia.[30]
21. Two out of ten care homes are not meeting the
medicines management standards and there is evidence of people
with dementia being administered anti-psychotics to manage behavioural
problems. The latter is not recommended except in short term management
of high risk situations, since the drugs have serious side-effects
and may exacerbate dementia. Care homes require more effective
specialist input from mental health services to ensure their input
and advice in the care of people with dementia and other mental
health problems, especially in the area of medicines management.[31]
22. The NAO's Lincolnshire whole system case study
of health and social care and acute bed survey demonstrates that
admission and readmission to acute hospital care can often be
avoided for people with dementia, and their lengths of stay can
be reduced by finding alternative non-acute care settings for
these patients. Ambulance staff should have access to appropriate
information to make an informed decision as to whether the person
needs to be taken to hospital or can be better treated at home.[32]
23. On admission of older patients known—or
suspected—to have cognitive impairment, acute hospital trusts
do not routinely undertake a mental health assessment. Acute trusts
usually only treat the physical symptoms which led to the admission,
so the treatment and rehabilitation of people with dementia is
not tailored to their needs to enable them to leave hospital earlier.
Preventing unnecessary admissions and reducing lengths of stay
would release resources for better care further upstream in the
dementia care pathway. The Department is undertaking work similar
to the NAO's whole system case study to identify the benefits
of early intervention and management for people with dementia
in terms of fewer admissions to acute hospital and shorter lengths
of stay. The National Audit Office's analysis of acute admissions
for fractured neck of femur also demonstrated there is a clear
financial benefit from improving the treatment of people with
dementia, as well as a quality of life improvement for the patients
concerned. At present, a person with dementia who suffers a fractured
neck of femur is over 2.5 times more likely to die in the six
months following admission and almost 18 times more likely to
be admitted in a care home following discharge than a person who
is psychiatrically well and is only half as likely to be discharged
at the end of six months.[33]
28 The Commission for Social Care Inspection registers,
inspects and reports in adult social care services, and councils
who arrange these services in England. Back
29
Q 57; C&AG's Report, paras 4.19-4.20 Back
30
Q 76-83; C&AG's Report, paras 3.13-3.14 Back
31
Qq 59-60, 100-104, 108-113; C&AG's Report, para 4.22 Back
32
Q 27; C&AG's Report, para 4.6-4.7 Back
33
Qq 27, 64, 135; C&AG's Report, paras 2.27-2.32, 4.7, 4.17-4.18;
Figure 24 Back
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