The Mental Welfare Commission for Scotland today published a report from its first ever themed visits to people with dementia in community hospitals.
The report found that care and treatment provided is generally good, and community hospitals are valued by patients, and by carers.
However, it highlights issues with the dementia-friendliness of the environment, care planning, activities provision and staff training.
The Commission visited 287 people with dementia, or who were being assessed for dementia, in community hospitals across Scotland, and heard from 104 family carers.
Kate Fearnley, Executive Director (Engagement and Participation), at the Commission said:
"We were pleased to see that generally, carers and patients were positive about care and treatment; but we are concerned that there is a lack of focus on patients' needs related to their dementia.
"Over half the patients we saw had been in a community hospital for a month or longer, and this means that people with dementia are often spending long periods in an environment that may not be dementia-friendly.
"Care plans were thorough in relation to physical care, but only a few said how a patient was to be supported with personal care, and how they would be encouraged to maintain their skills and independence as much as possible."
The Commission found that, while staff could often call on more specialist help, not enough staff had been provided with their own dementia training.
Kate Fearnley added, "The key point is that these aren't dementia-specialist services, but about a quarter of their patients have dementia, so we think more attention needs to be paid to their needs."
The report makes 12 recommendations for Integrated Joint Boards (IJBs). IJBs are partnerships between local authorities and health boards, responsible for health and social care services.
Key findings include:
- Only a third of wards had carried out a dementia-friendliness audit of the environment.
- Care plans recorded physical health care interventions well, but there was a lack of care planning for care and support focusing on the patient's dementia.
- In about 53 cases, patients were ready to be discharged, but arrangements had to be made for the provision of home care support. In about a quarter of these cases (12), patients were waiting for a decision to approve funding for home support, while in about three quarters (41), delays were caused by the need to organise support. In many of these 41 cases, the patient had been receiving support at home before their admission to hospital, but the package of support was automatically cancelled after a short period of hospital admission.
- While we saw examples of good practice, we feel that more can be done to develop activity provision, and that community hospitals, which are almost all based in local communities, have opportunities to develop links with communities to enhance activity provision.
- When we discussed rights-based issues with staff, often we felt they were not familiar with incapacity and mental health legislation.
- Two fifths of the wards had no-one with training in managing stress and distress. There was a lack of clarity about different levels of knowledge and skills required by staff in relation to Scotland's Promoting Excellence dementia skills and knowledge framework.
The report also found that there was regular input from occupational and physical therapy in most wards, but access to psychiatry, pharmacy and psychology was more limited.