Roles and responsibilities in integrated care for dementia

Care Process in Iranian Nursing Homes: A Grounded Theory Study

Introduction: The need and use of long-term care services for older people has increased with their rising population and there is little information about the state of serving in nursing homes. This study aimed to identify the caring process in Iranian nursing homes.

Methods: This qualitative study was conducted in three Iranian nursing homes using grounded theory approach. The participants included 28 individuals (14 older people and 14 caregivers). The data were collected using unstructured interviews up to data saturation, and analyzed by constant comparative method.

Results: Fragmented care emerged as the core variable. The main factor for developing the core variable was ‘experience-based caring’. Other factors included ‘inappropriate structure for care’ as contextual factors in the nursing homes environment and ‘keeping instead of caring’, ‘dismal life’, and ‘up and down of the path’ as strategies and consequences.

Conclusions: The most common type of care was the routine and unplanned one with focusing on physical aspects. To improve a delivery care system for older people in nursing homes, proposing a care plan with focus on an integrated model of care in nursing homes, provision of instructions for treatment, as well as supervision and training caregivers to provide better care are necessary

Integrated dementia care: A qualitative evidence synthesis of the experiences of people living with dementia, informal carers and healthcare professionals

BACKGROUND

In order to provide improved care provision, integrated care services are being developed. However, little is known about how people living with dementia, their families and healthcare professionals experience integrated care. Therefore, the purpose of this review of the qualitative literature was to examine the experiences and perceptions of integrated dementia care.

METHODS

This qualitative review synthesised findings from included studies identified from a comprehensive literature search. Searches included: five electronic databases, journal handsearching, and reference list searching of relevant literature reviews and the final included studies.

FINDINGS

Three overarching themes were identified: 1) Ways of working which facilitate the delivery of integrated dementia care; 2) Informal carers as equal partners in care provision and decision making; and 3) Challenges leading to fragmented and disjointed integrated dementia care. For integrated care to be successful, communication and collaboration between healthcare professionals, and the involvement of informal carers is needed. Multidisciplinary teams and employing case managers to coordinate care provision can improve communication and collaboration. However, distrust between healthcare professionals and a lack of a central database to access and share information often hinders the development of integrated dementia care service provision.

CONCLUSION

Integrated dementia care can be successful and well received by people living with dementia and their families when certain conditions are met. However, given the negative consequences fragmented and disjointed care can have on people living with dementia and their families, action is needed to further support the development of integrated dementia care services.

Mapping post-diagnostic dementia care in England: an e-survey

Purpose

Post-diagnostic dementia care is often fragmented in the United Kingdom, with great variation in provision. Recent policies suggest moving towards better community-based care for dementia; however, little is known on how this care is delivered. This study aimed to map the post-diagnostic dementia support provided in England a decade after the introduction of a National Dementia Strategy.

Design/methodology/approach

A mixed-methods e-survey (open Nov 2018–Mar 2019) of dementia commissioners in England recruited through mailing lists of relevant organisations was conducted. The authors descriptively summarised quantitative data and carried out thematic analysis of open-ended survey responses.

Findings

52 completed responses were received, which covered 82 commissioning bodies, with representation from each region in England. Respondents reported great variation in the types of services provided. Information, caregiver assessments and dementia navigation were commonly reported and usually delivered by the voluntary sector or local authorities. Integrated pathways of care were seen as important to avoid overlap or gaps in service coverage. Despite an increasingly diverse population, few areas reported providing dementia health services specifically for BME populations. Over half of providers planned to change services further within five years.

Practical implications

There is a need for greater availability of and consistency in services in post-diagnostic dementia care across England.

Originality/value

Post-diagnostic dementia care remains fragmented and provided by a wide range of providers in England.