Patchy dementia care puts patients at risk of unnecessary suffering, says CQC

http://www.theguardian.com/society/2014/oct/13/care-quality-commission-review-dementia-care

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Nine out of 10 care homes and hospitals in England have aspects of care for people with dementia that are variable or poor, making those with the condition likely to receive substandard treatment at some point, according to an important review by the NHS regulator.

In Cracks in the Pathway, published on Monday, the Care Quality Commission (CQC) says it found more good care than bad in its assessment of 129 care homes and 20 acute hospitals, but given that issues were widespread, most dementia sufferers can expect to be affected by them.

It deemed the situation unacceptable, while the Alzheimer’s Society described the findings as “staggering”.

The charity’s chief executive, Jeremy Hughes, said: “This report highlights the plight that many people with dementia face. The inconsistency of care found here means many people are rightly worried about being admitted to hospital or having to move into care. Carers have told us that their loved ones have gone for hours without food or water in hospital or that they were in pain but no one realised. Staff can also find communicating with people with dementia extremely challenging, and wards and a new care home can be disorientating to navigate.”

The charity estimates that there will be 850,000 people with dementia by next year, a figure it expects to rise to more than 1 million by 2025 and more than 2 million by 2051 if action is not taken, demonstrating the scale of the challenge facing the health system.

In the foreword to the report, the CQC says that most of the 400,000 people living in care homes have dementia or a similar impairment and about 40% of people over the age of 65 in hospital beds have the condition. It found that in approximately 29% of care homes and 56% of hospitals patient assessments did not identify all of a person’s needs.

One of the issues highlighted was pain management, as people with dementia may not be able to tell staff about their discomfort. The CQC found that some care plans did not include information about how individuals communicated that they were in pain, leaving staff to rely on their own judgment. Patients were thus put at risk of suffering without respite or receiving inconsistent pain relief if their agitation was wrongly attributed to their dementia.

One-third of care homes and 42% of hospitals were found to have aspects of care that were variable or poor regarding how they met people’s physical and mental health, emotional and social needs.

In more than half of hospitals visited and a quarter of care homes, they found aspects of variable or poor care regarding staff’s understanding and knowledge of dementia care and there was often poor or variable sharing of information when people moved between services, leading to their needs not being met.

In some of the places visited, staff did not respond to a change in a patient’s behaviour such as shouting or screaming, common in dementia sufferers feeling confusion, anxiety and/or frustration, the CQC said. The inspectors also found examples of a failure to manage known risks such as falls, urinary tract infections and malnutrition.

The CQC’s chief inspector of adult social care, Andrea Sutcliffe, said: “Our review found some great care, delivered by committed, skilled and dedicated staff. But this is not the case everywhere or even within the same service, meaning too many people are at risk of poor care. This has got to change.

“A wealth of guidance exists to drive the delivery of excellent care for people living with dementia. We need to make sure that every care home and hospital achieves the high standard of care we see in the best services.”

The regulator said it would beef up its assessment of dementia care and that future hospital reports would include a separate section on the subject.

The health secretary, Jeremy Hunt, said there was no excuse for poor care. “We are focusing on improving the lives of dementia patients and their families as never before,” he said. “That’s why we’ve trained thousands of NHS staff to recognise the signs of dementia and invested in dementia-friendly care homes and hospital wards.”