Providing rehabilitation services for people with dementia through intermediate care

This article describes a Department of Health-funded study that mapped rehabilitation services--and examples of good practice--for older people with dementia in England. The findings suggest that there are potential benefits in locating rehabilitation services within intermediate care, including a higher service profile with clearer care pathways and access to a wider range of professionals across health and social care. The author concludes that a seamless range of services can be provided via intermediate care, but argues that nurses need to challenge the perception that rehabilitation cannot be achieved for people with dementia.     

Involving older people in intermediate care

BACKGROUND: Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing. AIM: This paper aims to explore the concept of intermediate care and to identify trends and existing evidence of user involvement in care. In this way it charts a possible way forward for the development of a more 'user sensitive' approach. METHOD: The following databases were searched: Medline, Cochrane Library, the Social Science Citation Index and CINAHL. Key words were 'intermediate care', 'older people', 'formal care', 'primary care', 'social services' and 'geriatrics', used in combination. FINDINGS: The findings from this study indicate that there is considerable scope for increased user involvement in service development for intermediate care. Such challenges may be more effectively met through greater clarity of the concept of intermediate care, and a bridging of user involvement at the practice and policy levels. Nurses are key providers of intermediate care in the community. CONCLUSIONS: The involvement of older people in intermediate care service development must be premised on a shared comprehension of the purpose and function of intermediate care. Nurses must be involved in shifting intermediate care from being service-focused to patient-centred. Effective participation eschews the application of global constructs for older people, while supporting greater participation at all levels and robust implementation processes.     

Integrating health care services for older people

A review of inpatient and community services for older people in Liverpool revealed that although quality services were being provided, this was only to a limited number of patients. The tracker nurses' role at this stage was to determine the factors that resulted in the emergency readmission of patients aged over 65 and attempt to prevent this. Eight months later the team began to focus on extending its services to a wider patient group by screening all emergency admissions and inpatients at a local acute hospital. The team compiled action plans for patients with complex needs, enabling discharge planning to begin as soon as possible after admission and ensuring that the needs of patients requiring intermediate care were met quickly. The average number of transfers to intermediate care trebled as a result of this change in focus.     

Improving engagement with older people

This article seeks to explore how the older person can be involved and informed in making policy at a local level. Their experience and expertise is invaluable and older people are best placed to voice where services are falling down and their needs are not being met. Government needs to engage with the older person much more effectively.     

Improving nutrition for older people

Protected mealtimes are periods on a hospital ward when all non-urgent clinical activity stops. During these times patients are able to eat without being interrupted and staff can offer assistance. This results in patients who are more relaxed and eat more, leading to better nutrition and higher chance of recovery. This article describes the introduction of protected mealtimes within Bradford Teaching Hospitals Foundation Trust.     

Epilepsy and services for older people

Although epilepsy can occur at any age, almost a quarter of people affected are over 60 years old. It is important for nurses working with older people to understand the full implications of a diagnosis of epilepsy, which can have a devastating effect on quality of life.     

Fast-tracking older people through A&E

This article explores the concept and feasibility of fast-tracking older people through A&E services to enable appropriate admission and quality responsive patient care. It illustrates how an academic assignment undertaken as part of a pre-registration programme could be adapted for publication to challenge thinking and encourage examination of potential new ways of working.     

Intermediate care and older people

Intermediate care services are taking on an increasingly significant role in the rehabilitation and care of older people. It is vital that nurses and other members of the healthcare team have a good understanding of intermediate care.     

Bowel care in older people

Bowel dysfunction not only causes considerable hardship for many older people and their carers, it is also financially costly to the health service and to the individuals affected. Despite the prevalence of constipation and faecal incontinence amongst, for example, older people in institutionalised settings, both conditions are often iatrogenic and entirely preventable. One reason why these conditions are generally not well managed is that the research base is poor: there are few robust data because of methodological weaknesses in existing studies, so clinicians and care staff are left to rely on anecdote and personal experience. Secondly, the costs to the NHS involved in providing proper bowel care for the elderly would be considerable, although recent government documents have set out a specific commitment to improve standards of care in this area. In order to address some of these issues, the College has recently published a book which gathers together and assesses research on faecal incontinence and constipation, and provides informed guidance on current best practice. The contents of the publication, including comments from older people suffering from bowel dysfunction, are outlined in this article.     

Professional perceptions of joint working in primary care and social care services for older people in Scotland

The purpose of this paper is to report health and social care professionals' perceptions on joint working for the care of older people in Scotland. Semi-structured interviews were conducted with 34 primary care and social care professionals. These professionals emphasised that joint working requires a fundamental change in thinking and a scrutiny of professional roles and identities and is influenced by the given geographical and organisational infrastructure. In order to facilitate sustained joint working knowledge and models of care bespoke to joint working need to be developed. This requires health and social care organisations to focus on the co-creation and generation of new knowledge by health and social care professionals as well as the communication and exchange of existing knowledge between services. However, joint working also needs to be based on patient views to guarantee a whole systems perspective.