Caring for dementia patients: what's best?

We are regularly bombarded with news stories about the aging population and inevitable increase in people with dementia (44% predicted increase by 2021 in Powys), and I wondered what services were available in North Powys. Just a short walk from where I am based, here at Ponthafren in Newtown, is the Fan Gorau older people’s assessment unit, a modern compact building based in Newtown hospital grounds. The unit allows a short term admission of people over 65 who need an assessment in order to provide future care, be it at home or a suitable home that is able to meet the individual’s needs. The focus is on people with dementia and related illnesses whilst those experiencing mental distress because of depression or schizophrenia, for example, are cared for through The Redwoods Centre at Shrewsbury Hospital.

A few days ago I met two of the staff at the unit – Nicki Sayce, Memory Clinic Nurse and Julie Jones, Ward Manager. I wanted to find out more about what is actually provided at Fan Gorau, and I had heard there were some changes in the way Memory Clinic services were being delivered. (You can find out more about Memory Clinics here).

Julie and Nicki are clearly passionate about the work they do, providing support not only to the people staying at Fan Gorau but their families. “Husbands and wives of those at the unit are often left at home without their partner for the first time in many years which can make it very difficult.”  There are support mechanisms in place, be that The Alzheimer’s Society locally, or the Dementia Advisor Heather Lewis (based at Welshpool), but it can still be tough.

People are assessed and diagnosed initially by doctors when referred, and all efforts are made to admit them to Fan Gorau. However, occasionally people may have to be admitted elsewhere, such as Wrexham, or even further afield. The staff explained that “Fan Gorau is a small assessment unit and relatives need to be aware that once the assessment process is completed, then the unit does not provide long term care. If the individual is not able to return home then care placements need to be made, potentially in a home which is not the first choice whilst a place is awaited in that first choice home.”

The new initiative I had heard about was the creation of a Memory Clinic nurse post. Whilst the move to provide these services in North Powys is excellent news, and in line with the Welsh Government's dementia action plan, it is just one post. In South Powys there is apparently a whole team providing this service.

I gave an update recently on the new Home Treatment Team in North Powys (again, a case of catching up with the South), and both Nicki and Julie spoke enthusiastically about the need for an equivalent service for older people with dementia. (The new HTT will provide crisis support for older people with mental health conditions but not dementia). They believe that many people with dementia should continue to live at home with their families if a strong support network is in place, including crisis support as required. However, resources for the service are focused on the inpatient service with nothing spare to resource a community service.

The irony is that in 2009 the local community fought to keep Fan Gorau open when it was threatened with closure. The Accident and Emergency Unit in the main hospital building at Newtown had already been lost… and instinct seems to keep people fighting for buildings… but listening to Julie and Nicki I had to wonder -  perhaps the best outcome for people with dementia and their families lies in developing more community based services…?

Increasingly mental health and dementia services in North Powys are focussing on community rather than inpatient services - including a Young Onset Dementia post and a new Senior Practitioner post. And then there’s the new Home Treatment Team. Should this trend continue? What do you think?