WALES. Welsh Parliament. Health and Social Care Committee
Publisher:
Wales. Welsh Parliament
Publication year:
2022
Pagination:
71
Place of publication:
Cardiff
...families and unpaid carers; patient with dementia; barriers to discharge; communication and joint working. The inquiry found that there is currently a huge problem with patient flow through hospitals. While issues around patient flow and delayed discharges have no doubt been exacerbated as a result of the pandemic, these are long standing problems. However, delayed transfers of care are only one part
(Edited publisher abstract)
This report sets out the findings of a short inquiry focusing on hospital discharge and its impact on patient flow through hospitals in Wales. We gathered evidence in writing and by holding oral evidence sessions with stakeholders, including the Minister and the Deputy Minister for Social Services. The inquiry explored Welsh Government policies; scale of the problem; impact of delayed transfers; families and unpaid carers; patient with dementia; barriers to discharge; communication and joint working. The inquiry found that there is currently a huge problem with patient flow through hospitals. While issues around patient flow and delayed discharges have no doubt been exacerbated as a result of the pandemic, these are long standing problems. However, delayed transfers of care are only one part of the picture. A whole-system approach is needed, with multi-disciplinary teams working across all sectors to achieve better integration of health and social care services and improved patient experience. The lack of social care capacity is considered the biggest contributor to delayed discharges by the majority of stakeholders that responded to our consultation. Severe staff shortages mean assessments are often delayed and services are not available for care packages to be put in place to enable safe discharge. In addition to the lack of capacity in social care, there are a number of other issues that can contribute to holding up the discharge process. including suitability of housing, delay in medication being prepared and delivered and a lack of transport where this cannot be provided by friends or family.
(Edited publisher abstract)
Subject terms:
hospital discharge, service transitions, hospitals, adult social care, housing, integrated care;
...and for the most part is a decline in opinions. Areas with the largest increase in negative results are those relating to patients' fundamental needs, such as getting enough help to wash or keep clean and to eat meals, as well as being able to get help from staff when needed. Respondents who reported having Dementia or Alzheimer's, a mental health condition, a heart problem and those with a neurological
(Edited publisher abstract)
This survey looks at the experiences of people who stayed at least one night in hospital as an inpatient. People were eligible to take part in the survey if they stayed in hospital for at least one night during November 2021 and were aged 16 years or over at the time of their stay. The results show some change in people's experience of inpatient care compared with the previous survey in 2020, and for the most part is a decline in opinions. Areas with the largest increase in negative results are those relating to patients' fundamental needs, such as getting enough help to wash or keep clean and to eat meals, as well as being able to get help from staff when needed. Respondents who reported having Dementia or Alzheimer's, a mental health condition, a heart problem and those with a neurological condition reported poorer experiences for more than half of the questions. In contrast, older people, people who were in hospital for an elective admission, those who stayed in hospital for only one night, and those considered less frail generally reported better experiences. Hospital discharge remains a challenging part of people's experiences of care. Patients were not always involved in decisions about discharge and did not always know what would happen next with their care, with both having deteriorated compared with 2020. Fewer patients said staff discussed with them whether they may need further health and social care services after leaving hospital: 79% compared with 81% previously. After leaving hospital, less than half (46%) of patients said they definitely got enough support from health and social care services to help them recover or manage their condition, which is also a decrease compared with 51% previously.
(Edited publisher abstract)
Subject terms:
surveys, hospitals, hospital discharge, integrated care, user views, patients, adult social care;
Dementia: the International Journal of Social Research and Practice, 20(1), 2021, pp.188-212.
Publisher:
Sage
Person-centred care is widely advocated when caring for people with dementia. When a person with dementia is admitted for hospital care, hospital wards are obliged to not only address the cause for admission but also provide dementia-specific care during the hospital stay. Research has shown that the delivery of person-centred care to people with dementia is often inadequate or absent...
(Edited publisher abstract)
Person-centred care is widely advocated when caring for people with dementia. When a person with dementia is admitted for hospital care, hospital wards are obliged to not only address the cause for admission but also provide dementia-specific care during the hospital stay. Research has shown that the delivery of person-centred care to people with dementia is often inadequate or absent in the hospital setting. Moreover, whilst registered nurses often wish to improve the in-hospital care of patients with dementia, there is evidence of experienced barriers. This study aimed to describe registered nurses’ experiences of facilitators for the delivery of person-centred care to inpatients with dementia. By way of systematic searches in the databases PubMed, CINAHL and PsycINFO, qualitative studies (n = 19) reporting registered nurses experience of caring for inpatients with dementia were identified. Relevant content was analysed using a method of thematic synthesis. Three main categories and nine subcategories were presented, internal facilitators (experience and knowledge; values and beliefs; professional identity; empathy), external facilitators (physical environment; organisational culture and structure) and facilitating actions (forming a holistic picture; establishing trust; adjusting routines and interventions). While facilitators did exist in the hospital setting, the findings indicate that care received by inpatients with dementia is dependent on individual registered nurses knowledge, personal aptitude and ability to compensate for structural flaws. In order to minimise arbitrary outcomes of care for patients with dementia, consistent organisational support in the form of educational interventions and allocation of resources is crucial.
(Edited publisher abstract)
Subject terms:
hospitals, dementia, person-centred care, nurses, staff-user relationships;
Dementia: the International Journal of Social Research and Practice, 20(1), 2021, pp.373-380.
Publisher:
Sage
This paper presents innovative practice in the area of interdisciplinary collaboration between pastoral care and music therapy professionals to meet the spiritual needs of people with dementia in a hospital environment. Our qualitative research identified the following themes to guide future endeavours in this area: Music has the capacity to facilitate spiritual expression; music therapy...
(Edited publisher abstract)
This paper presents innovative practice in the area of interdisciplinary collaboration between pastoral care and music therapy professionals to meet the spiritual needs of people with dementia in a hospital environment. Our qualitative research identified the following themes to guide future endeavours in this area: Music has the capacity to facilitate spiritual expression; music therapy contributes to validating the individuality of the person with dementia; collaborative work between music therapy and pastoral care is worthy of further exploration. This study is one of few to address the potential for combining pastoral care and music therapy in the care of people with dementia.
(Edited publisher abstract)
Subject terms:
spirituality, music, music therapy, dementia, hospitals;
The need to improve care for people living with dementia in the hospital setting has long been recognised. Person-centred care has the potential to improve the experience of care for persons living with dementia and their carers, and has been shown to improve the experiences of hospital staff caring for the persons living with dementia, however it remains challenging to deliver in a time...
(Edited publisher abstract)
The need to improve care for people living with dementia in the hospital setting has long been recognised. Person-centred care has the potential to improve the experience of care for persons living with dementia and their carers, and has been shown to improve the experiences of hospital staff caring for the persons living with dementia, however it remains challenging to deliver in a time- and task-focussed acute care setting. This commentary suggests that to embed person-centred care across the hospital environment, cultural changes are needed at organisational and ward levels. In particular there needs to be: leadership that supports and advocates for workforce capacity to recognise and meet both psychological and physical needs of people living with dementia, promotion of physical environments that support familiarisation and social interactions, an inclusive approach to carers and the development of a culture of sharing knowledge and information across hierarchies and roles. An evidence-based set of pointers for service change are described which highlight institutional and environmental practices and processes that need to be addressed in order for person-centred care to become part of routine care.
(Edited publisher abstract)
Subject terms:
dementia, person-centred care, hospitals, older people;
International Journal of Geriatric Psychiatry, 36(9), 2021, pp.1386-1397.
Publisher:
Wiley
Objectives: The quality of care for dementia in acute-care settings has been criticised. In 2016, the Japanese universal health insurance system introduced a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals. This study aimed to investigate the effectiveness of this financial incentive scheme on short-term outcomes (in-hospital mortality and 30-day...
(Edited publisher abstract)
Objectives: The quality of care for dementia in acute-care settings has been criticised. In 2016, the Japanese universal health insurance system introduced a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals. This study aimed to investigate the effectiveness of this financial incentive scheme on short-term outcomes (in-hospital mortality and 30-day readmission). Design and Methods: Using a Japanese nationwide inpatient database, we identified older adult patients with moderate-to-severe dementia admitted for pneumonia, heart failure, cerebral infarction, urinary tract infection, intracranial injury or hip fracture from April 2014 to March 2018. We selected 180 propensity score-matched pairs of hospitals that adopted (n = 180 of 185) and that did not adopt (n = 180 of 744) the financial incentive scheme. We then conducted a patient-level difference-in-differences analysis. In a sensitivity analysis, we restricted the postintervention group to patients who actually received dementia care. Results: There was no association between a hospital's adoption of the incentive scheme and in-hospital mortality (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.88–1.06; p = 0.48) or 30-day readmission (aOR: 1.04; 95% CI: 0.95–1.14; p = 0.37). Only 29% of patients in hospitals adopting the scheme actually received dementia care. The sensitivity analysis showed that receiving dementia care was associated with decreased in-hospital mortality. Conclusions: The financial incentive scheme to enhance dementia care by dementia specialist teams in Japan may not be working effectively, but the results do suggest that individual dementia care was associated with decreased in-hospital mortality.
(Edited publisher abstract)
Quality in Ageing and Older Adults, 22(1), 2021, pp.56-67.
Publisher:
Emerald
Purpose: Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use...
(Edited publisher abstract)
Purpose: Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use the expertise of nurses to recommend ways to care for the emotional well-being of patients with dementia that are achievable within the current hospital setting. Design/methodology/approach: A qualitative study was conducted in two long-stay wards providing dementia care in a UK hospital. Nursing staff (n = 12) were asked about facilitators and barriers to providing emotion-focused care. Data were analysed using thematic analysis. Findings: Nursing staff said that resources existed within the ward team, including ways to gather and present personal information about patients, share multidisciplinary and personal approaches, work around routine hospital tasks and agree an ethos of being connected with patients in their experience. Staff said these did not incur financial cost and did not depend upon staffing numbers but did take an emotional toll. Examples are given within each of these broader themes. Research limitations/implications: The outcome is a short-list of recommended staff actions that hospital staff say could improve the emotional well-being of people with dementia when in hospital. These support and develop previous research. Originality/value: In this paper, frontline nurses describe ways to improve person-centred hospital care for people with dementia.
(Edited publisher abstract)
Subject terms:
nurses, emotions, hospitals, patients, dementia, wellbeing, person-centred care, staff views;
Background and Objectives: Nursing homes (NHs) care for 70% of Americans dying with dementia. Many consider deaths in NHs rather than hospitals as preferable for most of these residents. NH characteristics such as staff teamwork, communication, and other components of patient safety culture (PSC), together with state minimum NH nurse staffing requirements, may influence location of death...
(Edited publisher abstract)
Background and Objectives: Nursing homes (NHs) care for 70% of Americans dying with dementia. Many consider deaths in NHs rather than hospitals as preferable for most of these residents. NH characteristics such as staff teamwork, communication, and other components of patient safety culture (PSC), together with state minimum NH nurse staffing requirements, may influence location of death. This study examined associations between these variables and place of death (NH/hospital) among residents with dementia. Research Design and Methods: Cross-sectional study of 11,957 long-stay NH residents with dementia, age 65+, who died in NHs or hospitals shortly following discharge from one of 800 U.S. NHs in 2017. Multivariable logistic regression systematically estimated effects of PSC on odds of in-hospital death among residents with dementia, controlling for resident, NH, county, and state characteristics. Logistic regressions also determined moderating effects of state minimum NH nurse staffing requirements on relationships between key PSC domains and location of death. Results: Residents with dementia in NHs with higher PSC scores in communication openness had lower odds of in-hospital death. This effect was stronger in NHs located in states with higher minimum NH nurse staffing requirements. Discussion and Implications: Promoting communication openness in NHs across nursing disciplines may help avoid unnecessary hospitalization at the end of life, and merits particular attention as NHs address nursing staff mix while adhering to state staffing requirements. Future research to better understand unintended consequences of staffing requirements is needed to improve end-of-life care in NHs.
(Edited publisher abstract)
Subject terms:
nursing homes, residents, dementia, safety, death, hospitals, end of life care, mortality;
This second volume of the World Alzheimer report 2020 presents, in case study format, the information gathered by the survey described in volume 1. The aim is to illustrate the worldwide efforts that are being made to design buildings that meet the needs and aspirations of people living with dementia and those who care for them. The 84 case studies from 27 countries are based on the self-reports...
(Edited publisher abstract)
This second volume of the World Alzheimer report 2020 presents, in case study format, the information gathered by the survey described in volume 1. The aim is to illustrate the worldwide efforts that are being made to design buildings that meet the needs and aspirations of people living with dementia and those who care for them. The 84 case studies from 27 countries are based on the self-reports of the people who provided complete information in the survey. No attempt has been made to critique them, but the overviews contained in every case study have been structured according to the principles of design that have informed much of the content of volume 1. The case studies illustrate approaches to design for day care centres; residential care centres; public buildings; and hospitals. They accompany volume 1, which offers a comprehensive and in-depth look at dementia related design and the built environment – looking at progress to date, pioneers and innovators, design principles, application, regional and cultural contexts, the importance of including people with dementia in all aspects of design, and the role of design during the coronavirus pandemic and beyond.
(Edited publisher abstract)
Subject terms:
dementia, housing, care homes, hospitals, day centres, residential care, building design, case studies, buildings, environment;
...with dementia. The review found that often people were not getting the care they need, when they need it. There were many examples of care that was undignified, inhumane and that potentially breached people’s basic human rights. While it is possible to support people well in the community, care packages are often not available; and people are frequently not receiving the hospital care that they are entitled
(Edited publisher abstract)
This report describes the current state of the care system for children, young people and adults who are subject to restrictive interventions, and who are cared for in a range of settings. While the focus of this report is learning disabilities and autism, the findings have also implications and learning for settings that support people who have a mental health condition and/or who are living with dementia. The review found that often people were not getting the care they need, when they need it. There were many examples of care that was undignified, inhumane and that potentially breached people’s basic human rights. While it is possible to support people well in the community, care packages are often not available; and people are frequently not receiving the hospital care that they are entitled to. While the use of restrictive practice is not inevitable, nearly all of the services (hospitals and adult social care services) visited as part of this review used some form of restrictive practice. Where there was evidence of people being restrained, secluded or segregated, it was claimed that this was for their own safety or the safety of others. The report makes four key recommendations: people with a learning disability and or autistic people who may also have a mental health condition should be supported to live in their communities; people who are being cared for in hospital must receive high-quality, person-centred, specialised care in small units; there must be renewed attempts to reduce restrictive practice by all health and social care providers, commissioners and others; there must be increased oversight and accountability for people with a learning disability, and or autistic people who may also have a mental health problem.
(Edited publisher abstract)
Subject terms:
autism, mental health problems, learning disabilities, community care, hospitals, restraint, inspection, challenging behaviour, physical restraint;