A diagnosis of dementia will profoundly affect a person's life. According to the UK Alzheimer’s society, someone recently diagnosed with dementia can experience emotions ranging from “grief, loss, anger, shock, fear, disbelief and even relief”. Dementia also transforms the lives of those that live alongside it. These carers provide wide-ranging support, including help with activities of daily living, personal care, and managing behavioural and psychological symptoms. Some carers have work, children and other family commitments to cope with as well. Providing this type of intensive support often takes a huge toll on the wellbeing of the carer, with many experiencing an unbearable weight on their emotional, psychological and physical health, social activities and support networks, ability to work and finances. As society ages and life expectancy grows, this problem will become increasingly pervasive. We need to involve the whole of society in this effort, ensuring we provide the necessary support networks to adequately help both carers and sufferers of this devastating condition.
National Dementia Strategy
In order to implement our National Dementia Strategy. We will:
Appoint a high functioning committee comprising a Dementia Coordinator/Link Person, Consultant Geriatrician, Psychiatrists, GP’s, Allied Health Professionals (AHP’s), Nursing, Managers, Consultants, Gibraltar Alzheimer's & Dementia Society (GADS) representative and key persons from relevant government departments and agencies.
A Clinical Multi-Disciplinary Team (MDT) to address specific/key clinical work streams within their area of expertise with time frames for implementation and completion.
The Dementia Coordinator will be the focal point for people living with dementia, their families and carers with which to interact with government departments, agencies, service providers and GADS.
The Dementia Link Person will make a significant difference in guiding people living with dementia, their families and carers through the dementia care process and advise on support and services that is tailored to their requirements.
Offer a patient care pathway with systematic follow up and tailored services, delivered by skilled and experienced professionals.
Maximise and improve independence, health and wellbeing for people living with dementia.
Support people who may be reluctant to be assessed and receive a diagnosis.
Ensure that people living with dementia, their families and carers have access to and receive compassionate care and support before and after diagnosis, and through to end of life.
Establish a “Dementia Fund” with a specific, ring-fenced budget to cater for growing, future funding needs.
Dementia Awareness in Schools
Almost a third of young people know someone with Alzheimer’s and/or other dementia. Through learning, young people will become more aware of the importance of care roles and other issues connected with an ageing population.
Dementia - Data Bank
There is currently little data collected that can be used to implement a National Dementia Strategy. We will:
Ensure a Dementia Services Coordinator focuses on the day-to-day implementation of the National Dementia Strategy with, among other goals, emphasis on improved data collection and analysis.
Identify new sources of information that may provide information about the prevalence of dementia and its service delivery impact on our community. This will provide vital data for better implementation and further policy development.
Professionals need to be adequately trained to ensure all aspects of quality of care are integrated into service provision from the more basic standards. Many people are not diagnosed until the condition is already advanced and post diagnostic support is inadequate. We will:
Ensure all professionals and staff working with people living with dementia are trained and skilled in dementia so that they have an understanding of the condition, including the physical, visual and hearing challenges that it poses.
Develop and deliver training resources that enhance the knowledge and skills of participants in providing evidence-based care that is responsible, safe, effective and meaningful for people living with dementia.
Training and retaining high quality professionals in hospital, care homes and community care workers.
Launch an information campaign on dementia and develop a training programme for the relevant sectors. Raise the level of expertise among personnel and professionals.
Establish a dementia-friendly GP clinic to increase awareness and better understanding of dementia.
Ensure information and advice on dementia is provided by GPs and other health professionals as part of the Gibraltar Health Authority’s health check programme and those in need are quickly referred for further assessments.
Ensure that people with suspected dementia are evaluated, diagnosed and followed up after their diagnosis.
Encourage and grow the number of people with cognitive impairment attending weekly Cognitive Therapy activities at Bella Vista.
Allied Health Practitioners (AHPs) – Bella Vista
Currently AHPs providing Speech and Language Therapy, Physiotherapy and Occupational Therapy are employed through the service provider Meddoc. There is evidence that AHP recruitment and retention is poor. Since the opening of Bella Vista in 2017 a number of AHPs have left for professional reasons seeking employment elsewhere or leaving Gibraltar. This is detrimental to patients who for long periods do not receive the appropriate therapy such as communication/dysphagia assessments and therapy packages of care essential to help maintain independence.
AHPs are required to be registered with HCPC/GMRB (Health and Care Professions Council/Gibraltar Medical Registration Board) and with that comes a requirement to ensure professional development through supervision and training especially needed by less experienced staff. GHA AHPs work as part of GHA/Social Services clinical teams within the District/Community, Mental Health, Cancer Centre, Ambulance/Fall Team and at St Bernard’s. We will:
Ensure Bella Vista is another arm of the service provided complete with all its benefits.
Ensure the transition of dementia patients through acute services to community to day care, depending on their condition is via MDT teams both in Health and Social care work as they work in unison complementing each other.
Appoint a Community Social Worker (trained in dementia) as part of the team.
Health Care Adjustments
Health and acute care are not sufficiently adapted to people with dementia in hospital and in the community. We will:
Ensure implementation of dementia specialist nursing roles, Admiral Nurses, to provide specialist dementia support that families need, giving expert guidance and practical solutions to help families live more positively with dementia in the present and to face the challenges of tomorrow with more confidence and less fear. Admiral Nurses can enhance care quality, reduce excess stays in hospital, improve the patient’s experience and outcome and reduce costs.
Provide a dementia friendly environment in hospital, dementia-friendly staff, offer dementia-friendly support and care in admitted and non-admitted settings.
Support, respite and counselling
Many people living with dementia struggle to make sense of their diagnosis and how their life is changing. They may feel lost, confused, vulnerable or anxious; anxiety over what the future might hold is particularly common. Research suggests that counselling can play a particularly important role in helping people with an early diagnosis of dementia – for example by reducing feelings of depression. It is best practice to offered sufferers pre-diagnostic counselling to support them through this difficult and uncertain time. Families and carers get physically sick, they are emotionally drained and may even have mental health issues. They too need respite, counselling, support, advice and practical assistance from skilled professionals.
Housing – Assisted Home Living
A diagnosis of dementia does not mean that a person is incapable of living alone or with a partner. Accommodation designed for dementia users will allow them to be as functionally independent as possible with safety in mind and allow service providers/carers to cater for groups of families affected or living with dementia within a close geographical location. Living in a place that is safe, familiar and comfortable is important to everyone, not least so far people living or affected by dementia. To date no accommodation has been built specifically for people living with dementia. We will:
Provide Assisted Home Living to bridge the gap between living completely independently and living in residential care.
Introduce a referral to Living at Home Assessment Service to maximise independent activity, enhance function and maintain or adapt skills.
Build modern assisted living facilities with round the clock care for people with dementia and cognitive impairment. The design of all new buildings and modernisation projects must take account of the needs of people with dementia. (a special ring-fenced investment scheme will ensure this).
Provide round the clock care for vulnerable persons, people with dementia and those with cognitive impairment.
Offer in house services (GP’s, OT, Physio etc) to come to them rather than attending appointments in unfamiliar locations.
Promote and maintain the person’s independence; including mobility and falls risk by referring to an Occupational Therapist for assessment of the home environment and ability to perform daily activities.
Equal Standard of Care
Taking the decision to move to a care home will never be an easy one, either for the person with dementia or their family and carers. When a person living with dementia can no longer live at home, their families should have the peace of mind that their loved ones are in the best facilities we can muster. We will:
Ensure all care homes are dementia friendly with the same standard of care, facilities, skilled professionals and trained dementia staff.
Provide a high-quality care and an equal quality of care, wherever they live. There will be better checks on care homes and other services to make sure people with dementia get the best possible care.