Fund specialist dementia training to improve care and save money

Louise Prime

November

GP training to reduce antipsychotic prescribing
and better training for care home staff on person-centred care help to
reduce agitation in people with dementia and improve their quality of
life – as well as saving thousands of pounds a year, UK research has
shown. The authors of the UK study* published today in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association
said their results could aid commissioning decisions, and have urged
the health and social care secretary to provide funding for such
specialist training, which they said is crucial to providing
good-quality dementia care.

The research team, from the
University of Exeter, King’s College London and Oxford Health NHS
Foundation Trust, studied the cost-effectiveness of an intervention
conducted in 69 care homes, with a total of 549 residents suffering
clinically significant agitation in dementia. They compared outcomes –
including health and social care costs, agitation and quality of life –
among people under usual care, to outcomes in those taking part in the
Wellbeing and Health for people with Dementia (WHELD) training
programme.

WHELD involved providing GP training to reduce
prescribing levels of antipsychotics, as the drugs are known to
significantly increase the risk of stroke and death in people with
dementia. It also involved training two ‘carer champions’ from each care
home in delivering person-centred care, involving residents in
decisions that affect them, increasing social engagement to 10 minutes
focused on their own interests; the study authors noted that previous
research had revealed that the average care home resident engages in
only two minutes’ social interaction in a six-hour period.

The
researchers reported that compared with usual treatment, WHELD saved up
to £4,000 per care home over the nine-month study, which meant savings
of £2,000 per home even after considering the cost of delivering the
intervention itself. Most of the savings were from reductions in
emergency and routine hospital admissions and fewer GP contacts,
resulting in part from a reduction in agitation.

The study
authors also calculated that the WHELD programme cost £660 per resident
to achieve significant improvements in their quality of life. They
pointed out that when cholinesterase inhibitors were first approved for
UK use, they cost about £35,000 to achieve similar measures of
improvement. In comparison, the WHELD programme cost about £1,400 per
resident to significantly improve agitation.

They commented: “We
now know we have a programme that provides huge value in improving their
quality of life and reducing agitation – and now crucially, we know
this saves money… We must roll this out to benefit those in need.”

They
added: “As a person’s dementia progresses they will need more intensive
care and support and often residential care is seen as the best option
by those who care for them. Our research can assist commissioning
decisions around care and treatment options in these settings… The
failure to recognise and introduce such interventions in not only
ethically questionable but very costly.”

The Alzheimer’s Society
argued that as 70% of people in care homes have dementia, it is
essential for staff to have the right training to provide good quality
dementia care. The charity’s policy director Sally Copley commented:
“With many care homes on the brink of collapse and the NHS under
pressure, cost-efficient initiatives like WHELD could make all the
difference.

“But specialist training costs money, so without
government investment in social care to allow innovative solutions like
WHELD to be put in practice, it won’t be possible to provide this for
everyone who needs it. I urge Matt Hancock to take bold steps in the
forthcoming Green Paper and commit to the sustainable social care
funding that people with dementia have already waited too long for.”

Published by Residential Forum

The Residential Forum is to promote the achievement of high standards of care and support for children and adults living in residential care and nursing homes, supported housing, residential schools and colleges, hospices and hostels. It contributes to improving the quality of service to the public. Members of the Forum are people of standing and experience drawn from the public, private and voluntary sectors, as well as some who can speak for service users and carers.

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