The Care Path - Tertiary Care
Tertiary (or third level) services are appropriate for relatively few older people. Care home provision is appropriate for those users with long term, intensive and/or complex levels of need. Hospital inpatient care is usually reserved for those in mental health crisis or who need longer term assessment and/or treatment than a day hospital can provide.
The tertiary services displayed on this screen are available in most areas.
Residential and Nursing Care
it is estimated that about a third of all people with dementia live in a care home. Prevalence of dementia in care home populations; rises from 27% of those aged 65-74 to 61% of those aged 90 and over (Alzheimer's Society, 2007).
The pattern and profile of both care home residents and the care home sector has changed considerably over the last twenty years. Residents are now more dependent, more have a mental health problem particularly dementia, and most have multiple needs. Further, people are more disabled on admission than previously. Carer breakdown and stress is a key cause of admission of people with dementia.
The care home sector is now dominated by homes run by independent agencies e.g. BUPA. Homes are also larger; the average size of a home in England is 34 beds. A large number of homes have closed as a consequence of the combined effect of the fact that full costs of care, the implementation of national regulatory standards and staff recruitment problems.
One consequence of home closures is that some areas have shortages of nursing homes and specialist care homes for older people with mental health problems, especially dementia.
Service Example:
Meeting the needs of older people from minority communities The manager of a Midlands residential care home with a single Asian resident was proud of the efforts they had made to meet her needs, arranging for meals to be brought in for her from the local Asian day centre, and for festivals to be celebrated. As part of a plan to attract more Asian residents, the home recruited a number of Punjabi speaking staff and arranged the rotas so that there was always at least one Punjabi speaker on duty. They were astonished to see the transformation in their existing resident, who had been regarded as successfully settled in but who was now talking and laughing with staff, joining in activities and demonstrating a lively personality which had had no opportunity for expression before.
In-Patient Hospitals
A key interface in the provision of care and support to older people with mental health needs is the general acute hospital.
Older people occupy about 60% of hospital beds and are known to have a high rate of psychiatric morbidity – 40% for dementia and up to 53% for depression. Their complex needs are often beyond the skills and training of general hospital staff (NICE/SCIE, 2006).
Some areas provide a psychiatric liaison service – whereby a team of psychiatric professionals visit general wards to provide advice about the management and treatment of older patients with mental health problems.
Although psychiatric inpatient care is relatively rare it may be necessary if: an older person with dementia or a functional mental health problem becomes severely disturbed and/or they have complex physical and psychiatric problems making a community assessment impossible.
In recent years there has been a significant decrease in long stay hospital beds for dementia patients; there is also minimal access to ‘respite beds’. Both short and long term care is now provided in care homes. A key implication of this is cost to users and their families as it constitutes a shift of care from free NHS provision to charged for local authority services.