Norwich care home which was shut could reopen to cope with rising dementia need

The need for extra beds for the growing number of people in Norfolk with dementia means a Norwich care home which shut two years ago could be revamped and reopened.

Mountfield Care Home, in Millcroft to the north of the city, was one of four care homes which closed when a new £19m care village opened in Bowthorpe.

Residents moved out of Mountfield in 2016 to be re-homed at Bowthorpe Care Village. That has an 80-bed specialist dementia care home run by NorseCare and a 92-apartment housing with care scheme run by Saffron Housing Trust.

But NorseCare, an arms-length company of Norfolk County Council, now wants permission to revamp, refurbish and extend Mountfield to help cope with demand for dementia care.

Karen Knight, managing director of NorseCare, said: “With the current high demand and projected increase in the number of people who will require residential dementia care across the whole county, Norsecare are confident that this home will be well placed to provide quality care for people who require our specialist support.”

The proposal, lodged with Norwich City Council, is to refurbish and extend the existing, currently empty, 39-bed care home to create a 46-bed care home, 44 of which would be en-suite rooms.

The existing care home is two storeys high and the extension would also be two storeys in scale, but designed with two gabled wings.

NorseCare has not said how much the project will cost, but documents lodged with the city council state that it would need 16 full-time staff and 29 part-time staff.

If planning permission is secured, the home could be ready to welcome residents by autumn next year.

The city council will make a decision on whether to grant permission in due course.

Of the other three care homes which were closed, Heathfield, in Cannell Green, has already been turned into student accommodation having been sold for £701.000.

Somerley House, in Somerleyton Gardens, which was sold for £1.1m, is also being turned into homes for students.

And the city council last year gave the go-ahead for Philadelphia House, in Penn Grove, which sold for £610,000 to be turned into 18 apartments.

SOURCE: Eastern Daily Press, Dan Grimmer

It's good to see that they are making use of available resources where possible and putting them to good use.

Phone checklist can detect clinical changes in patients receiving home care

A simple phone checklist completed by carers can help detect important real-time changes in the health status of people receiving care at home, according to the findings of a pilot study in the US.

The idea, said researchers from Harvard Medical School, was to prevent complications before they became serious enough to require hospital admission.

The study, published in the Journal of the American Geriatrics Society, involved carers recording changes in the status of home care recipients during a telephone call at the end of each shift.

Care givers answered simple questions about the care recipient’s condition during a telephone-based “clock-out” at the end of each shift, prompted by an automated message.

The message included a list of questions pertaining to changes in mental, neurologic, gastrointestinal, urinary and other indicators.

The responses were electronically captured in software that the caregivers also used to “clock-in,” manage care, and “clock-out” on every shift.

Any changes reported via the automated system were immediately dispatched to a manager at the home-care agency office for further assessment and triage.

Analysis of the data collected over a six-month period across 22 home care offices revealed that changes in clinical status were relatively common – occurring in 2% of all shifts and affecting.

The majority of changes were in behaviour and skin condition, followed by changes in eating or drinking behaviour and ability to stand or walk.

The researchers said the results underlined the potential of real-time monitoring systems to spot problems and avert complications before they escalated enough to require hospital admission.

Patients who may benefit the most include those with long-term conditions, in whom even seemingly innocuous changes could indicate serious problems, highlighted the researchers.

They cited one particular example that emerged during follow-up interviews with staff, which involved a diabetes patient whose caregiver reported a foot ulcer via the phone-based checklist.

Treatment started immediately after the patient’s nurse was contacted, resulting in the wound healing one week later. Normally, the ulcer would not have been reported until the end of the week, said the study authors.

Over the course of the six-month trial, 14% of the home care recipients were admitted, they noted.

The researchers cautioned that it remained unknown whether their system could prevent admission, but noted that the fact a basic phone questionnaire could capture important clinical indicators suggested its value for monitoring those receiving care at home.

They highlighted that the idea was also the subject of an ongoing randomised trial across 400 home care locations in the US.

Frontline cares play a critical role in monitoring, reporting and preventing serious complications among patients with chronic conditions, added the researchers.

SOURCE: Nursing Times, Steve Ford

What a good idea, not only recording and montoring any change in their condition but also highlighting where intervention was needed.

Charity finds 'stark variation' in quality of care homes in England

Older people are victims of a postcode lottery when it comes to the quality of their care homes, with the North West being the worst performing region and London being the best performing, according to a new report.

The analysis, based on CQC inspections of care homes, by Independent Age, the older people’s charity, revealed that the North West contains seven of the eight worst performing English local authorities on care home quality, with one in three care homes across the region performing poorly.
In the North West, 33.6 per cent of care homes perform poorly, in Yorkshire and The Humber, it is 32.2 per cent and in the South East, it is 28.2 per cent.
The best performing regions are London with 20.3 per cent of care homes being rated highly by the CQC, the East of England with 20.8 per cent and the South West with 21.1 per cent.
Simon Bottery, director of policy at Independent Age, said: “No one should be forced to live in an unsatisfactory care home but our analysis shows this is the grim reality in some parts of the country.

“The market is simply not providing a decent choice for older people and their families but there is little indication that local authorities or the Government are giving the problem the attention it deserves.”
He believes the reasons for the poor quality homes are a lack of funding as well as low pay and difficulty in recruiting staff and the lack of a good support mechanism for improving care homes that are struggling.
“The Government has an opportunity to address this in its upcoming Green Paper on social care but, in the meantime, councils must demonstrate that they understand the reasons for care home failures and are working to resolve them,” he added.
The difference between various regions can be huge
Stockport, Salford, Tameside, Manchester and Kensington and Chelsea have over more than half of their care homes rated as Inadequate or Requires Improvement.
While in the Isles of Scilly, Islington, Rutland, Richmond upon Thames and Thurrock, less than five per cent of their homes are rated Inadequate or Requires Improvement.
In response to the report, Martin Green, chief executive of Care England, said it "clearly shows that in areas dominated by local authority funded care, the level of funding is having a significant impact on quality".

However, Caroline Abrahams, charity director at Age UK said that lack of funding cannot be used to excuse poor quality care and added: “It is horrible to think that in some areas the choices are so limited.
“This is a frightening situation for older people and their families who above all want their loved one to be somewhere caring and safe – and this really shouldn’t be too much to ask in an advanced economy in the twenty first century.
“In the worst affected areas the social care infrastructure is now so threadbare that there's a real risk of vulnerable older people and their desperate relatives waiting endlessly for a good and affordable local care home place that no longer exists.”
Independent Age wants the Government to tackle variation in care home quality in its forthcoming Green Paper on social care.

In addition, it wants local authorities to look at the drivers for variation in the different areas.
Independent Age offers a free advice guide, ‘How to find the right care home’. The guide looks at what to consider and essential questions like location and cost, what you want from a home and whether a care home is actually the best option.

SOURCE: carehome.co.uk, Sue Learner

In dementia, care from multiple health systems poses drug safety risks

Dementia patients who get prescriptions from multiple health systems may face a higher risk of drug mix-ups or unsafe interactions than people with cognitive problems who get all their medications from one place, a study of U.S. veterans suggests.

Researchers examined data on more than 75,000 veterans with dementia and found that among patients who received all of their care at Department of Veterans Affairs (VA) facilities, 39 percent had potential safety issues with prescribed medications.

Among those who got some care at the VA and some treatment elsewhere, however, 59 percent had possible drug safety issues, the study found.

"Generally speaking, older adults are at greater risk of having adverse drug events," said lead study author Joshua Thorpe, a researcher at the VA Pittsburgh Healthcare System. "These risks are exacerbated in persons with dementia."

The average dementia patient has four other chronic health conditions and receives care from five different providers in a typical year, researchers note in the Annals of Internal Medicine.

All of these medical conditions come with prescriptions - at least five different drugs for a typical dementia patient and up to nine or more different medicines for 16 percent of these patients, the authors write.

Federal policy shifts over the past decade have made it easier for elderly veterans to access care outside the VA and get prescriptions from doctors working for other health systems. Most recently, the Veterans Access, Choice and Accountability Act expanded access to non-VA facilities to veterans who couldn't get seen within 30 days or who lived more than 40 miles from the nearest VA providers.

To see how expanded access to care outside the VA might influence medication safety for veterans with dementia, researchers studied patients who qualified for care through the VA as well as through the Medicare Part D drug benefit.

Overall, 44 percent of the patients in the study had prescriptions that carried risks for dementia patients, either when taken alone or when used in combination with other drugs patients got at the same time.

Veterans using the VA as well as other health systems had more than double the risk of being exposed to powerful "anticholinergic" medications - drugs that make dementia drugs less effective and increase the risk of memory problems, dizziness and falls.

Dementia patients with prescriptions from inside and outside the VA system were also more likely to receive antipsychotics, which are known to increase mortality in people with dementia.

One limitation of the study is that researchers lacked data on over-the-counter medications, which can also pose safety issues when taken by dementia patients or mixed with other drugs.

Still, the authors suggest a policy fix - implementing electronic health information exchanges and medication therapy management services that can connect data from the VA to other health systems.

The study highlights one way that efforts to increase access and choice may boost the risk of unintended drug safety issues, Dr. David Gifford, a researcher at Brown University in Providence, Rhode Island, writes in an accompanying editorial.

"We have known for a while that making sure we know the medications a person is currently taking compared to what they used to be taking when they transition between providers such as being discharged from a hospital to the community is an important task to prevent medication related errors," Gifford said by email.

"We also have known that the lack of information on a person's medication and allergies at the time of being prescribed new medications can increase the risk of receiving medications that may cause an adverse event or interact with other medications," Gifford added.

The best thing patients and families can do is carry a list of every prescription and over-the-counter medication or supplement they take - and show it to every new provider or pharmacist they see, Gifford said.

SOURCE:Reuters, Fox News
So this is quite worrying to hear and makes you wonder how the health providers can possibly keep track of patients medications when they is clearly some crossover of provider. The very nature of their illness makes it likely that they wont know themselves what their prescription is for. The veterans taking antipsychotics and dementia medication are already vulnerable people. 

How to interact with someone who has dementia

Family members and caregivers often have a very difficult time communicating with someone with dementia. Many times, miscommunication actually creates negative behaviors. It is important to remember that people who have dementia are not being deliberately difficult. They can be reacting to stress or a frustrated attempt to communicate with you. If you don’t know how to connect and communicate with them, frustration will affect you as a caregiver and in them. It is our job to provide comfort and to learn how to connect with each person we meet who has any type of cognitive decline.

Dementia robs the person of speech, dignity and so much more. We will add more to their list of losses if we do not know how to communicate and connect.

As caregivers, we must step into their world of dementia. Pulling them into our reality will only create mistrust and potential behaviors. One common mistake is in handling a resident who continuously asks for his mother. If we tell him his mother is dead, we make him angry, depressed, upset and mistrustful. However, if we step into the dementia world instead and say, “Your mother called, and she will be here at 6:00 this evening,” this proves to cause less stress and makes them more comfortable.

I have had many people tell me that they could not possibly “lie” to the person. My response is, “This is not about you. It’s about the resident.” When that response is finally absorbed, staff and even family members become more connected and at ease. The resident may continue to ask this question 20 times a day, but when everyone provides the same answer, the resident can move on and have a better day, participating in activities and interacting with others.

Tips to improve communication

·         Create a calm environment. Take things slowly and smile whenever possible. If the resident seems upset, show care and concern.

·         The tone of your voice and your facial expression are very important, since residents pick up on nonverbal cues easily. Try not to over-react to a situation.

·         Always assume residents can understand what you are saying. Never talk about the person as though he/she is not present. If you do, a behavior could occur and then you have more issues to deal with.

·         Avoid quizzing the person on names and dates. Not knowing the answer can be very embarrassing for them. This quizzing also can increase distrust and the belief that you are “testing” them. Often when we give a cue, the confused person can answer.

·         Draw their attention by providing a gentle, reassuring touch on an arm or shoulder, or by holding hands. When you provide touch, you demonstrate security, a caring nature and your compassion.

·         Get down on their level—sit next to them, bend down or kneel down so you are not hovering over them.

·         Try lowering the pitch of your voice. Do not shout but deepen your voice as it appears easier for them to understand.

·         Make eye contact and slow down. Do not talk too fast and do not rush them. This in itself will create a behavior.

·         Observe the resident’s body language and imagine what he/she might be feeling or trying to express. Is she hungry, tired or in pain?

Using interactions to preserve dignity

·         Be reassuring but never be condescending. Praise their actions but do not patronize. Appeal to their sense of humor—but never laugh “at” them.

·         Do not argue or correct their “facts.”

·         Do not speak for them. So often, this occurs due to time constraints or with family present. However, if we always speak for them, they will eventually cease speaking altogether.

·         Give them adequate time to respond. Dementia can slow down response time and being rushed through a response or choice just causes additional frustration.

·         Do not do everything for them. If they need assistance with activities of daily living, find a way to keep them involved in the process. For example, if they can no longer dress themselves, let them point to the clothes they want to wear. I do not recommend showing an entire closet, but perhaps two articles of clothing that they can even point to. This offers them choices and provides the feeling of having some control over their lives.

·         Tell the resident it is time for her shower instead of asking if she wants to take one. Many times, you will get a negative answer if you ask a yes/no question. Be sure to have everything ready for the shower or bath though ahead of time.

·         Do not treat them like children or as if they are stupid. Giving them respect is crucial to a successful connection.

·         If they become angry, do not respond with anger. Be calm and try to get them involved in something they enjoy, like music, a change of environment or a snack.

·         Take the time to listen to them even if you cannot understand them. They still have something to say, and they still want to express themselves and be heard. As dementia progresses, speech becomes more and more difficult to understand.

We often chastise the negative behaviors from those with dementia. In all actuality, we are the ones instigating many of their frustrations and behaviors. If we learn to step into the world of dementia and remember that our residents only live “in the moment,” quality of life and care will increase for them every day. Those days of frustration for you as a caregiver will be minimal.

SOURCE:iadvanceseniorcare, Diane Mockbee

Maybe 'living in the moment' is something we should all think about doing as we miss so much of what is present in our daily lives and going unnoticed. Taking more time to listen, even when communication is really difficult and frustrating for all concerned, allowing someone the time they need without being pressured is essential. Learning to see things from their point of view is surely the way forward in improving interaction.

Young and old come together to help dispel dementia myths

Schoolchildren visited residents at a care home as part of an inter-generational project aimed at dispelling the myths and stigma associated with dementia.

A class of 30 eight and nine-year-olds from St Peter and St Paul Primary School visited Hartismere Place care home in Eye, near Diss, as part of the Archie Project – an initiative set-up by the charity Reminiscence Learning and introduced by Care UK at the home.

The pupils took time throughout the afternoon to work with residents on arts and crafts projects and talk about what life had been like when those living at the care home were at school.

The afternoon concluded with the children performing an entertaining rap, which put a smile on everyone’s faces.

The Archie Project is a dementia awareness programme linking schools and care homes together.

It is centred round a brightly knitted scarecrow called Archie, which has been designed to help pupils understand how the condition can affect older people.

Customer relations manager at Hartismere Place, Angela Hodge, said: “The pupils and residents had a wonderful time getting to know each other and sharing stories.

“We believe it is important to learn about dementia from a young age and hope that this project will raise awareness of the condition for pupils, as well as their parents, teachers and the local community.

“We look forward to working with pupils at St Peter and St Paul Primary School on future projects and hope to build on the friendships which have been forged.”

SOURCE: Eastern Daily Press, Andrew Papworth
What a  great idea to promote awareness from such a young age about dementia related illness, particularly in their local community.

Blood-thinning drugs 'can reduce risk of dementia by up to 48%'

Research ‘strongly suggests’ that patients taking anticoagulants for irregular heartbeat could be protected against dementia and stroke

Blood-thinning drugs could protect against dementia and stroke in people with an irregular heartbeat, research suggests.

A study found that patients being treated for atrial fibrillation (AF) were less likely to develop dementia if they were taking anticoagulants. Their risk was reduced by up to 48% compared with others with the same condition who were not prescribed the drugs.

Scientists analysed health record data from more than 444,000 Swedish AF patients.

While the findings could not prove cause and effect, they “strongly suggested” blood-thinning pills protect against dementia in patients with the condition, the team said.

Atrial fibrillation increases the risk of stroke and blood clots, which some experts think may appear in the brain and help trigger dementia.

Dr Leif Friberg from the Karolinska Institute in Stockholm, Sweden, who co-led the study, said: “As a clinician I know there are AF patients who have a fatalistic view on stroke. Either it happens or it does not. Few patients are fatalistic about dementia, which gradually makes you lose your mind.

A new study shows that doctors are actually quite bad at estimating the benefit and harm associated with treatments they prescribe. It’s a wake-up call for doctors, but patients can also play a role in getting better treatment

 “No brain can withstand a constant bombardment of microscopic clots in the long run. Patients probably want to hang on to as many of their little grey cells for as long as they can.

“In order to preserve what you’ve got, you should take care to use anticoagulants if you are diagnosed with AF, as they have been proved to protect against stroke and, which this study indicates, also appear to protect against dementia.”

The researchers identified everyone in Sweden who had been given a diagnosis of AF between 2006 and 2014. Monitoring each person’s progress provided 1.5m years of follow-up during which 26,210 patients were diagnosed with dementia.

Prescribed blood thinners include the drugs warfarin, apixaban, dabigatran, edoxaban and rivaroxaban. Their protective effect was greater the earlier treatment started after a diagnosis of AF, the scientists found.

Friberg said patients should begin taking the drugs as soon as possible and continue using them.

He added: “Doctors should not tell their patients to stop using oral anticoagulants without a really good reason. To patients, I would say don’t stop unless your doctor says so.”

The study, published in the European Heart Journal, found no difference in dementia prevention between the older blood-thinning drug warfarin and newer anticoagulants.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, said: “Strokes caused by a clot blocking the blood vessels in the brain are a major cause of dementia, and atrial fibrillation is an important risk factor as it increases the chances of these clots forming.

“By treating AF patients with blood-thinning drugs, you reduce the risk of both stroke and dementia.”
Dr Carol Routledge, head of science at Alzheimer’s Research UK, said: “The findings highlight a need to investigate this link further, but the nature of the study prevents us from firmly concluding that anticoagulants reduce the risk of dementia.
“It will be important to see the results of other ongoing studies in this area, as well as teasing apart the exact relationship between anticoagulants and the risk of different types of dementia.”

SOURCE: The Guardian
This was a really interesting read for me because Ive recently been reading about some research that looked at the correlation between worsening mental health and dementia related illness and the incidence of stroke, heart disease and cancers. In particular they were looking for links with a raised level of cortisol in the blood, stress hormones and heart problems. 
It would appear that from the study printed above the doctors in this instance are advocating long term use of anti coagulants in patients with AF. They are finding as a result that this also protects against the risk of dementia.

Dementia carers must be heard People who care for those with dementia need to have a voice

Dementia Carer Voices provides a platform where the voices of carers of people with dementia can be heard. 

The project is managed by the Health and Social Care Alliance Scotland – the Alliance – and can also be used to influence practice and policy.

As part of the project’s Carers’ Rights Day celebrations last month we shared and celebrated the 11,000 pledges made by people across the country who have pledged to make a difference to the lives of people with dementia and their carers. Dementia Carer Voices has embarked on a campaign entitled You Can Make a Difference over the last two years, and has gathered pledges from Health and Social Care Professionals and students over the course of 500 talks, where Project Engagement Lead Tommy Whitelaw has engaged with 60,000 people.

You Can Make a Difference offers carers of people with dementia a chance to have their stories told, and encourages participants to reflect on what they have learned and pledge how they can make a difference to the lives of people with dementia and their carers. The project has also collected multimedia case studies, asking people with dementia, carers, and staff what matters to them, ultimately promoting a person centered approach to care.

As part of the project’s awareness raising activities, we also aim to empower people through the Charter of Rights for People with Dementia and their Carers which was launched on 8th October 2009. It had the backing of both Scottish Government and the Cross Party Group on Alzheimer’s and Dementia. The Cross Party Group argued a charter was necessary to tackle the stigma and discrimination people with dementia faced, and the exclusion of carers as decision makers in care. Using a simple approach, the Charter sets out the rights of people with dementia and those who support them to ensure that they, and the wider community understand their rights and that they are respected.

With the Carers (Scotland) Act agreed this year in Parliament, the theme of this year’s Carers Rights Day was extremely pertinent. Dementia Carer Voices champions a rights based approach to health and social care, and is pleased to share the commitment of people across the country to making a difference to people with dementia and carers. Advancing the rights of people with dementia, and their carers who sometimes face extraordinary challenges and barriers in communicating their needs and wishes, is a just cause.

The simple message is that dementia is everyone’s business.

SOURCE:Falkirk Herald

Lack of exercise might invite dementia

Parking yourself in front of the TV may make you as likely to develop dementia as people genetically predisposed to the condition, a Canadian study suggests.

In a study of more than 1,600 adults aged 65 and older, those who led a sedentary life seemed to have the same risk of developing dementia as those who carried the apolipoprotein E (APOE) gene mutation, which increases the chances of developing dementia.

Conversely, people who exercised appeared to have lower odds of developing dementia than those who didn't, the five-year study found.

"Being inactive may completely negate the protective effects of a healthy set of genes," said lead researcher Jennifer Heisz, an assistant professor in the department of kinesiology at McMaster University in Hamilton, Ontario.

However, the study didn't prove that lack of exercise caused dementia risk to increase. It only found an association between the two.

The APOE mutation is the strongest genetic risk factor for vascular dementia, Lewy body dementia, Parkinson's disease and, especially, Alzheimer's disease, the researchers said.

People with a single APOE "allele" may have a three to four times increased risk of dementia than non-carriers, the study authors said.

How exercise may reduce the risk for dementia isn't known, Heisz said.

These study results, however, suggest that your physical activity level can influence your dementia risk as much as your genetics, Heisz said. "You can't change your genes, but you can change your lifestyle," she added.

The kind of exercise that's best isn't known, although the people who were physically active in the study reported walking three times a week, Heisz said.

"Which means you don't have to train like an Olympian to get the brain health benefits of being physically active," she said.

The report was published Jan. 10 in the Journal of Alzheimer's Disease.

Dr. Sam Gandy directs the Center for Cognitive Health at Mount Sinai Hospital in New York City. He said the study findings aren't "really a surprise, but it is good to see it proven."

Other scientists showed some years ago that people with the APOE mutation could virtually erase the risk of developing amyloid plaques in the brain if they became regular runners, Gandy said. Amyloid plaques are one of the hallmark signs of Alzheimer's.

"That was an amazing report that, I believe, has been underpublicized," Gandy said.

However, this new study suggests that if you are blessed with genes that lower your risk for Alzheimer's, you could lose that benefit if you don't exercise, he said.

"I cannot understand why the fear of dementia is not sufficient to induce everyone to adopt a regular exercise program," Gandy said.

"I tell all my patients that if they leave with one, and only one, piece of advice, that the one thing that they can do to reduce their risk of dementia or slow the progression of dementia is to exercise," he said.

About 47.5 million people around the world are living with dementia, the researchers said, and that number is expected to surge to 115 million by 2050. With no known cure, there's an urgent need to explore, identify and change lifestyle factors that can reduce dementia risk, the study authors said.

SOURCE: Steven Reinberg, wflx.com