The quality of dementia care in hospitals has featured in many newspapers. The Times reported that campaigners have said, “Patients with dementia are staying too long in hospital and receiving ‘disgraceful’ care that worsens their condition.” The Daily Telegraph said that “one in three never go back to their own homes and are discharged to a nursing home instead.”
The news stories are based on a report from the Alzheimer’s Society, which surveyed a large number of carers, nursing staff and nurse/ward managers on the quality of care given to people with dementia. Although the report gives the current opinion of a broad cross section of these groups of people, it cannot be considered a consensus. The figures that have been quoted by the newspapers should also be considered as the collective opinion of those surveyed.
However, the people who were surveyed are among the most experienced in the care of people with Alzheimer’s, and their overwhelming opinion is that hospital care needs to be improved. The society has made several objectives to achieve this aim.
The news stories are based on a report called Counting the Cost , which was commissioned by the Alzheimer’s Society. The charity reports that there are 700,000 people with dementia in the UK and that their care varies considerably. This report is part of the charity’s 'Putting Care Right' campaign, which aims to improve the quality of care for people with dementia.
The Counting the Cost report surveyed 1,291 carers, 657 nursing staff and 479 nurse/ward managers from general wards in hospitals across England, Wales and Northern Ireland. All members of the Alzheimer’s Society (about 21,000 people) were also asked to participate. The ward manager/nurse survey was sent to all ward managers and nurse managers who were identified from two databases.
People who agreed to take part completed questionnaires on the quality of care given to people with dementia. The majority of respondents were from England (91% of carers, 89% of nursing staff and 86% of the nurse managers).
The report also used evidence from national reports, a systematic review of dementia care in hospital general wards, and other published research.
The report is extensive and only a summary of its main findings are presented here:
This report offers a broad cross section of the current opinion of carers and healthcare providers on the state of hospital care for patients with dementia. However, it cannot be considered a consensus as it is not clear exactly what proportion of those professional staff who were asked to participate did so, although the report says that the response level was high.
The report also notes that carers who responded to the questionnaire may have been more likely to have had a bad experience and, therefore, may not represent all carers’ views. Because of these factors, it is difficult to say exactly how representative these figures are of dementia care as a whole in England, Wales and Northern Ireland. Despite this, the report has identified key areas where improvements in care for people with dementia are needed.
Although the survey looks at hospital care, it doesn’t take into account each individual’s situation. For example, various medical and social situations may influence decisions of whether to discharge a person from hospital to their own home or to another place of care. In many cases, it is not until a person with dementia is admitted to hospital that medical and social services become aware of their situation and recognise that they may need additional care. Admission to a care home should not always be assumed to be a bad thing. In some cases, it may lead to an improvement in the care of the person and give them opportunities for increased social interaction and a better quality of life.
In many cases, the medical reason for the person’s admission to hospital (e.g. infection or fall) and the unfamiliar environment may lead to some deterioration in both their physical and mental state. Although the carers’ survey identified many areas of dissatisfaction in the quality of nursing care provided, this should not be assumed to be intentional neglect by the healthcare professionals. Survey responses by nursing staff identify many of the challenges that they face in providing care. Recognition of these challenges provides an opportunity to address these issues.
The charity states that it aims to: