Don’t you (forget about me)

This week I visited Erskine Care Home where my former colleague Derek Barron (@dtbarron) is now Director of Care. Janice McAlister, Dementia Nurse Consultant Ayrshire & Arran (@janicemcalister) also came along for a catch up and look around. To be honest the promise of cake was an offer to good to refuse…

The main reason for the visit was to chat about staff education with a focus on dementia and delirium.

I’m not sure what the public perception of care homes is but I had very little clue about them until my Registrar training in 2005. At the time we were supposed to go out on domiciliary visits with Consultants, minor problem was that no one was doing them anymore. An interesting development some 10 years later is the emergence of ‘Hospital at Home’ and other parallel rehab/ assessment at home services. Change never stops I suppose….

I had always thought of care homes being filled with people with complex medical and nursing problems e.g. stroke, dementia, Parkinson’s Disease. Frail people.

I also made assumptions that the staff caring for them would know all about their medical history and why they were on certain drugs. Somewhat naively I thought that each resident’s GP would visit on a regular basis.

Now I don’t want people to misunderstand or misinterpret this as a criticism as people were doing the best they could. However the staffing levels and the lack of regular medical input was something that both shocked and baffled me.

So I decided to spend time with a group of GP’s who took over a cluster of care homes in Glasgow. It was hands down the most enlightening experience of my entire Registrar training. I saw first hand the care and dedication of the staff looking after the residents. However the volume of work was huge. The most challenging aspect was in caring for those with cognitive disorders.

In 2013 The Alzhiemer’s Society published a report that indicated that ~80% of people in care homes have dementia or some kind of memory problem (1). This is a significant rise from the previously cited 44% in 2009 in the BUPA report (2).

What is poorly understood is the prevalence of delirium as a complicating factor. Some studies have quoted 8 – 15%. One study however quoted 39.7% as having sub-syndromal and 6.5% having full delirium on admission to nursing home (3). That last statistic really resonated with me. One of the difficulties in recognising delirium in a care home setting is that the tools previously available are actually quite complicated and time consuming. Plus there is little to no training available.

More recently I spent some time visiting care homes in Ayrshire to talk to staff about delirium. I needn’t have bothered in some respects. They knew all about it. What was frustrating though was that they had little in the way of training to articulate the problem or tools to help support the management of it.

There have been attempts to produce resources for care homes – PitStop looks at how (4)

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Going back to the Alzhiemer’s report it’s interesting to note that 44% of people considered the training available to staff as an important reason in choosing a care home.

So with this in mind I would like to suggest we have much more robust training and education available to care home staff. Not only will it help in the care of the people in the homes it may actually drive recruitment in this area. Something that if you read the report published by Independent Age (5) is going to be crucial for the future…

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