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Dementia - care settings

People with dementia may require support in a range of settings including the community, hospitals or care homes. This section highlights guidance and tools which relate specifically to each of these settings.   

In other sections of the website you can also:

The resources on this page are organised under the following headings:

The resources below were last accessed on 13 February 2013. Some of them are in PDF format - see how to access PDF files.

Guidance and tools

See also the overarching resources at Supporting people with dementia.

Community care 

Alzheimer’s Society: Dementia 2013: The hidden voice of loneliness
The majority of people living alone with dementia feel lonely. Nearly two thirds (62 per cent) of more than 250,000 people with dementia who live on their own are lonely. This compares to just 24 per cent of over 55 year olds. This report is the second annual report exploring how well people with dementia are living. It found that over half of the general public (54 per cent) believe that people with dementia have a bad quality of life .

Alzheimer’s Society: Community care assessment
“If a person is confused or has dementia and needs support, their local authority social services department should carry out a community care assessment. If this assessment shows that the person needs certain services, the local authority has a duty to ensure that these services are provided”. This section of the Society’s website provides FAQs and a factsheet on Community care assessment.
The system and services in Scotland are described by Alzheimer Scotland at Community care and assessments.

Alzheimer’s Society: Living alone
This factsheet from the Society covers what needs to be thought about when a person with dementia lives on their own including the kind of help and benefits that are available.

Department of Health (2011) Dementia Commissioning Pack
The Dementia Commissioning Pack provides commissioners with a range of service specifications, tools and templates to help deliver these changes. It sets a standard of what good, integrated dementia care should look like for commissioners, providers, people with dementia and carers alike. Guidance is provided for community-based services for people living with dementia. View the guidance (PDF 163KB).

Healthcare at Home: Understanding out-of-hospital dementia care report 2011
This report, written by a panel of some of England’s leading experts in dementia care, sets out an approach to home-based dementia care focussing on practical steps that commissioners and providers can take to improve dementia care. It defines a service model that aims to provide more efficient home-based care and reduce avoidable admissions to hospital.

NICE Pathways: Dementia overview
The pathway includes recommendations for the identification, treatment and care of people with dementia and the support of carers. There is a section on Integrated and coordinated care.

Hospital care

Examples of work being done in a number of different NHS trusts to improve care of people with dementia can be found in this resource at Best practice examples.

1000 Lives Plus (2010) Improving dementia care (How to guide)
This guide, published as part of the 1000 Lives Plus improvement programme in Wales, is arranged according to five key drivers and describes the interventions for each driver which have been shown to be effective. Two of the key drivers are improvement of the quality of care in general hospital wards and improvement of discharge planning. There is also a separate driver around improvement of the quality of care in NHS mental health in-patient units for people with dementia. A third driver is the improvement of community care (including in care homes) which includes reduction of inappropriate use of anti-psychotic medications. Examples of local practice are included.

Alzheimer’s Society: Care on a hospital ward
This factsheet from the Alzheimer's Society looks at the kinds of help and support that are required if a person with dementia is admitted to a general or specialist hospital ward either following an accident or as part of a planned admission. The factsheet is designed for friends, family and caring professionals.

Alzheimer’s Society and Royal College of Nursing (2013) This is me 
A booklet designed for people with dementia which can provide a ‘snapshot’ of the person as an individual such as needs, preferences, likes, dislikes and interests to help staff to provide individual care. This updated version is now relevant for people with dementia who are receiving professional care in any setting.

Daily Mail (2013) Inside the hospital that's leading a kindness revolution
This article describes the care of people with dementia in a ward at Nottingham's general hospital. It presents some of the ideas behind a new approach to care of the elderly resulting from the  changing context of care of the elderly -  "the reality of caring for the elderly has changed radically", but "nursing and nursing resources are simply not geared up to this reality".
The work done at Nottingham is also described in one of the Best practice examples in this resource - see Louise Howe, Advanced Practitioner of Occupational Therapy and Simon Hammond, Clinical Nurse Specialist for Dementia and Sarah Goldberg, Trial Manager, Nottingham University Hospitals NHS Trust.

Dementia Action Alliance (DAA): The Right Care: creating dementia friendly hospitals 
This is a call to action for the improvement of care for people with dementia in acute hospitals. The goal of this work is that by March 2013 every hospital in England will have committed to becoming a dementia friendly hospital, working in partnership with their local Dementia Action Alliance. To support hospitals in becoming dementia-friendly, the DAA and the NHS Institute for Innovation and Improvement have produced a useful ‘getting started’ resource that covers five key areas that Trusts can focus on, including self-assessment audit questions, suggested measures and signposting to resources and case studies. Visit: D:KIT - the NHS self assessment resource for creating dementia friendly hospitals.
See also resources supporting the RCN's Commitment to the care of people with dementia in hospital settings.

Dementia Partnerships (2012) Dementia Care in Hospital: Building on Strengths. A compendium of positive practice
The South West Standards for Dementia Care in Hospital were developed in response to the many concerns expressed about poor quality care experienced by people with a dementia when they are in hospital. This compendium brings together a selection of some of positive developments and practices initiated to improve the quality of dementia care in hospitals across the South West of England.

Department of Health: Dementia self-assessment framework
This tool was developed to ensure implementation of the nursing contribution to dementia care, including the 6Cs and dementia pathway. The self-assessment framework was created by nurses and care staff to compare current dementia care with the best practice criteria. It is for use by health and social care staff, as well as wider teams and organisations.

Department of Health (2011) Dementia Commissioning Pack
The Dementia Commissioning Pack provides commissioners with a range of service specifications, tools and templates to help deliver these changes. It sets a standard of what good, integrated dementia care should look like for commissioners, providers, people with dementia and carers alike. Guidance is provided for commissioning hospital services. View the guidance (PDF 65KB).

GM-HIEC: Getting to know me
This training programme was developed with funding from the Greater Manchester Health Innovation and Education Cluster (GM-HIEC). The project took place during 2010-2013, and was a collaboration between the University of Manchester, Royal Bolton Hospital NHS Foundation Trust and Greater Manchester West Mental Health NHS Foundation Trust. The aim of the project was to pilot and evaluate dementia awareness training for staff working with people with dementia in general hospitals. The “Getting to Know Me” training materials are free to download and use. It can be targeted at staff of all grades who have regular contact with hospital patients who may have dementia.

King's Fund: Enhancing the Healing Environment (EHE): Environments of care for people with dementia
This is one of the programmes commissioned by the Department of Health to improve the patient experience through enhaning care environments. This programme involves 23 teams from acute and mental health NHS trusts who are working on a range of projects across the dementia care pathway and seeking to make acute general hospital environments less alienating for people with cognitive problems. Using the expertise and data from the programme the King's Fund is developing a range of resources that can be used in the hospital setting to help staff and those with dementia and their carers identify where improvement in the physical environment is needed. In addition there will be practical tips for making simple and cost effective design changes that have been proven to make a real difference.
For general information about the EHE initiative and directory of completed projects see Enhancing the Healing Environment.

Music in Hospitals
This charity aims to improve the quality of life for adults and children with all kinds of illness and disability through the joy and therapeutic benefits of professionally performed live music in hospitals, hospices, day care centres, special schools, nursing and residential homes.

NHS Education for Scotland have developed e-learning resources for the acute care setting. See the e-learning heading at Dementia: Learning resources.

Nursing Standard (2010) Improving quality of care for people with dementia in general hospitals
"What happens in general hospitals can have a profound and permanent effect on individuals with dementia and their families...". This guide looks at the impact of hospitalisation on a person with dementia and what can be done to better support a patient with dementia.

Royal College of Nursing: Dignity in dementia; improving care in general hospitals
The RCN has led on a national project about the care of people with dementia in general hospitals. The project has involved surveys about how to improve care, as well as consultation with a range of other organisations and key people. Following on from this a commitment to the care of people with dementia in general hospital settings, and resources to support it, have been launched.
You can read more about the commitment and access the resources to join us in putting the commitment into practice. Make SPACE for good dementia care is an easy way of remembering the commitment.

Royal College of Nursing e-library: relevant articles - the care environment
This is a list of selected articles from a search made in British Nursing Index on the care environment for people with dementia with a particular focus on the hospital environment. There is also information on how you can do the search yourself for a more comprehensive listing.

Royal College of Nursing (2012) Safe staffing for older people - RCN full report and recommendations (PDF 718KB) 
Hospital care for older people is currently an area of intense public concern across the UK. This report sets out guidance and recommendations for the provision of good quality, compassionate and safe nursing care for older people in hospital. The report builds on the existing RCN guidance and the series of recommendations published in Mrach 2012 to address issues such as diluted skill-mix on older people's wards. It draws on further evidence from the RCN safe staffing for older people survey 2011, nurse focus groups, a panel of expert nurses from across the UK, stakeholder consultation and a literature review.

Royal College of Nursing (2012) Safe staffing for older people's wards: RCN summary guidance and recommendations (PDF 412KB)
RCN evidence suggests that older people, despite often having the most complex needs, regularly suffer from a severe shortage of nurses and health care assistants (HCAs), coupled with an inappropriate skill mix of HCAs to nurses, and reports from various sources have highlighted concerns about older people’s human rights, dignified care and hospital experience. This document draws on the further evidence gathered through a survey of nurses who work on older people’s wards, nurse focus groups, a panel of expert nurses across the UK, stakeholder consultation and literature review. It sets out a threshold of staffing levels below which care becomes compromised on older people’s wards and provides guidance and recommendations for the provision of good quality compassionate and safe nursing care for older people in hospital.
The publication is part of the RCN Older People's project. Information about the project and supporting resources are available at Older people.

Royal College of Psychiatrists: National Audit of Dementia
The National Audit of Dementia is working with hospitals in England and Wales that provide general acute inpatient services, to measure criteria relating to care delivery which are known to impact on people with dementia admitted to hospital. The first round of audit took place in 2010, finding that hospitals in England and Wales were falling short in the care given to dementia patients, with not all hospital staff having the skills to cope with the demands of some dementia patients. View: Report of the National Audit of Dementia Care in General Hospitals 2011 (PDF 3.1MB). An executive summary (PDF 493KB) is also available.

The second report of the National Audit of Dementia has found that while some improvements have been made in hospital care for patients with dementia, more needs to be done. The audit warned that too few patients had their mental state assessed. The report called for all hospital staff to receive training in this area, and for specialist dementia nurses to be employed in all hospitals. View the full report: National Audit of Dementia Care in General Hospitals 2012-13. Second round audit report and update (2013) (PDF 1.6MB).

Care homes

Alzheimer Scotland: A positive choice: choosing a home
This section of the Alzheimer Scotland website is about arranging long-stay care for a person with dementia in Scotland and provides a checklist for choosing a home.

Alzheimer's Society (2013) Low expectations: attitudes on choice, care and community for people with dementia in care homes
This report updates and builds on the Home from home report, published in 2008. Findings show that up to 80% of care home residents have dementia or severe memory problems; while excellent quality care does exist, pessimism about life in care homes is leading to people settling for less; 70% of the general public would be worried about going into a care home and two thirds (64%) don't think the sector is doing enough to tackle abuse. It calls on the government and care homes to demand better minimum standards and more effective regulation.

Alzheimer’s Society: Selecting a care home
This factsheet explains what to look for when choosing a care home. It describes the different kinds of homes, how to go about choosing a care home and advises on what to look for.

Care and Social Services Inspectorate Wales (2009) Older people with dementia
This handbook provides advice to inspectors implementing regulations and minimum standards in relation to care homes in Wales for people with dementia, and refers to relevant legislation and guidance.

Care Commission and Mental Welfare Commission (2009) Remember, I’m still me (PDF 2.11MB)
This joint report on the quality of care for people with dementia living in care homes in Scotland reports on the findings from visits to 30 care homes and to individual people with dementia who lived in them. It presents ten key messages around important areas of dementia care and makes a series of recommendations. The work of the Care Commission is now carried out by Social Care and Social Work Improvement Scotland and the report is made available by SCSWIS.

Care Fit for VIPS
This resource is based on the nationally recognised VIPS Framework of Dementia Care. It consists of a real-time assessment tool; a searchable toolkit and an improvement cycle. Resources in the toolkit include videos, leaflets, websites, reports, and other materials that can help in providing person-centred dementia care.

Department of Health: Dementia self-assessment framework
This tool was developed to ensure implementation of the nursing contribution to dementia care, including the 6Cs and dementia pathway. The self-assessment framework was created by nurses and care staff to compare current dementia care with the best practice criteria. It is for use by health and social care staff, as well as wider teams and organisations.

Department of Health (2011) Dementia Commissioning Pack
The Dementia Commissioning Pack provides commissioners with a range of service specifications, tools and templates to help deliver these changes. It sets a standard of what good, integrated dementia care should look like for commissioners, providers, people with dementia and carers alike. Guidance is provided for commissioning care home services. View the guidance (PDF 163KB).

ENRICH - Enabling Research in Care Homes: a toolkit for care home research
The ENRICH website has been designed as a toolkit which aims to be a practical guide for researchers, care home staff, research funders and research network staff. It has been developed by the Dementia and Neurodegenerative Diseases Research Network (DeNDRoN) and draws on work from the NIHR School for Social Care Research (SSCR). The website brings together information, tools, case studies and further resources for facilitating research in care homes. Although focussing on dementia, the resources have been designed to be applicable to other disease areas. For information about the network see Dementia and Neurodegenerative Diseases Research Network.

International Longevity Centre (2011) The last taboo: a guide to dementia, sexuality, intimacy and sexual behaviour in care
Aimed at care home workers and managers, the guide provides essential information on sexuality, intimacy and sexual behaviour in dementia care and offers practical advice to support current work-based practices. It also provides a possible pathway for care home managers to develop a guiding policy on sexual expression in dementia.

My Home Life
My Home Life is a collaborative programme aimed at improving the quality of life of those who are living, dying, visiting and working in care homes for older people, including people with dementia. My Home Life works in partnership with the care home sector undertaking a range of educational activities to assist everyone in this field to share best practice and enhance quality of care.

NICE Pathways: Dementia overview
The pathway includes recommendations for the identification, treatment and care of people with dementia and the support of carers. There is a section on Accommodation and hospital care.

Nursing Standard (2009) Living well with dementia in a care home: a guide to implementing the National Dementia Strategy
This booklet outlines the Department of Health's national dementia strategy and highlights key issues from the strategy for care homes. It looks at the implications for providers and managers of care home services and illustrates with some good practice examples. 

Royal College of Nursing (2012) Persistent challenges to providing quality care: an RCN report on the views and experiences of frontline nursing staff in care homes in England (PDF 412KB)
Care homes are struggling to provide high quality care for residents with complex medical conditions, against a backdrop of a severe funding, equipment and staff shortages. The report identifies a lack of training for staff, inappropriate admissions and extreme pressure on the workforce leading to poor staff morale. It also highlights the key issue of funding and admissions.

Torbay Dementia Action Alliance (2014) Supporting people with dementia in a care home
'The majority of people with dementia are looked after at home – but about a third live in a residential care or nursing home setting'. This free booklet has been put together as a guide for staff who provide regular care and support within this setting as part of the Purple Angel Dementia Awareness Campaign.

Stories and good practice examples

Practitioners have shared improvements they have made in the delivery of dementia care and services describing what changes occurred as a result of their initiatives and what they learned from the experience. The stories have been arranged according to the five key ingredients in the Commitment to the care of people with dementia in general hospitals. To read these improvement stories see Best practice examples.

Healthtalkonline 
This is a database of personal and patient experiences compiled from qualitative research on different health conditions undertaken by the Health Experiences Research Group at the University of Oxford. Carers of people share their experiences on: Arranging residential care and Becoming a resident.

My home life
This collaborative programme includes a series of films which look at the challenges of dementia and other mental health issues in residential care.

SCIE Dementia Gateway, Dementia Good Practice Exchange: ‘Marie’ in residential and hospital care
This project describes the Senti model and uses a case study to illustrate the outcomes and benefits when applied in hospital and residential care practice.

Hilderstone Hall new ownership and care practice
New care practices and management structures were introduced when a residential home was acquired by a new owner. The case study describes how the owners involved staff, carers, residents and health care professionals in making changes to deliver resident centred services.

Improving the residential care of older people with dementia
A group of care homes, already demonstrating good practice evidenced through inspection etc,remained concerned about the quality of life for residents with advanced dementia. This account tells how staff changed their own practice to gain better outcomes for residents, using formal observational techniques and solution finding.
 
Person-centred services for older people with dementia and mental health issues
This example describes how moving to a new purpose-built residential care home gave the opportunity to develop person-centred approaches. The project involved designing and equipping a new facility and relocating existing residents en masse to the new facility adopting a consultative approach.

Challenging behaviour in older people’s residential care
Northumberland, Tyne and Wear NHS Trust Community Mental Health teams have developed a support service for older people's care homes to enable residents with challenging behaviour avoid hospital admission.

SCIE Social Care TV
Social Care TV is an online channel providing video-based training resources and general interest programmes for everyone involved in the social care sector. See: Living in a care home: a positive outcome for a person with dementia which shows how a woman with dementia coped with moving into a care home.

Ten Glorious Seconds
This resource includes a short film about a gentleman in the late stages of dementia who is living in a care home and how his wife tries to connnect with him.
There is also a short clip in which Dr Graham Stokes discusses the value of 'meaningful moments' and how to create a sense of wellbeing from everyday actions and through objects, smells and textures. The discussion takes place in a care home where there is a sensory garden and where carers and relatives make use of memory boxes see 'Meaningful moments'.

Standards

NICE quality standards: Dementia standard
See statement 8.
 
Scottish Government: Standards of care for dementia in Scotland