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AS: Shocking variation of hospital care for people with dementia exposed
92% of people affected by dementia found hospital environments frightening.
Too many people with dementia are falling while in hospital, being discharged at night or being marooned in hospital despite their medical treatment having finished, finds an Alzheimer’s Society investigation.
Freedom of Information (FOI) requests have uncovered unacceptable national variation in the quality of hospital care across England. In response, we are launching a new campaign, Fix Dementia Care.
The investigation involved FOI requests to NHS Trusts in England and a survey of over 570 people affected by dementia to gather first-hand testimony of dementia care in hospitals.*
In one trust, 702 people with dementia fell in 2014 -15, the equivalent to two falls a day. Last year 28% of people over the age of 65 who fell in hospital had dementia - but this was as high as 71% in the worst performing hospital trust.
Independent analysis has shown that, on average, if a person with dementia falls in hospital they spend nearly four times as long there and the resulting complications increase the likelihood of being discharged into residential care.**
Worryingly, the FOIs unearthed that people with dementia are being inappropriately discharged at night. In the three worst performing hospitals, four-five people were being discharged overnight per week - only six hospitals don’t discharge overnight.
Discharge at night is considered inappropriate as it is unsafe and disorientating for people with dementia who are less likely to be able to access care and support (e.g. care homes often closed at night), leave without relevant information and/or the correct medication.
In the worst performing hospitals, people with dementia were found to be staying five to seven times longer than other patients over the age of 65.
'A litany of failures'
Key findings from our survey of people affected by dementia include:
- 92% thought hospital environments are frightening for people with dementia
- Only 2% reported that, in their experience, all hospital staff understood the specific needs of people with dementia
With a quarter of hospital beds occupied by people with dementia***, an estimated £264.2 million of public money is being wasted on poor dementia care (2013/14).
Hospitals have a duty to be transparent and accountable to their patients, and to continually monitor and improve dementia care.
While there are notable examples of excellent care across the country, the difference from one hospital to the next is far too great and there is inconsistent understanding of the needs of people with dementia.
Our campaign is making the following recommendations to fix dementia care:
- All hospitals to publish an annual statement of dementia care, which includes feedback from patients with dementia, helping to raise standards of care across the country
- The regulators, Monitor and the Care Quality Commission to include standards of dementia care in their assessments
Jeremy Hughes, Chief Executive of Alzheimer’s Society, said:
“Good dementia care should never be a throw of the dice – yet people are forced to gamble with their health every time they are admitted to hospital.<o:p />
“Poor care can have devastating, life-changing consequences. Starving because you can’t communicate to hospital staff that you are hungry, or falling and breaking a hip because you’re confused and no-one’s around to help, can affect whether you stand any chance of returning to your own home or not.
“We must urgently put a stop to the culture where it’s easier to find out about your local hospital finances than the quality of care you’ll receive if you have dementia. We are encouraging everyone to get behind our campaign to improve transparency and raise the bar on quality.”
Over the course of 2016, Fix Dementia Care will look at the quality of care people with dementia receive in three key care settings: in hospital, in care homes and in the home.
Alzheimer’s Society is calling on people to back the Fix Dementia Care campaign by signing up at www.alzheimers.org.uk/fixhospitalcare
* Freedom of Information requests were submitted to 163 NHS hospital trusts in October 2015. We received responses from 87 trusts (53 per cent). Inconsistent data coding at hospital trusts meant that trusts did not hold figures for all requests. As a result, some calculations used in this report are based on smaller sample sizes, particularly those comparing the experiences of people over the age of 65 and people with dementia. The following table details the responses used in each issue area. While a greater response would have been welcome, the sample size does not detract from the shocking variation in the quality of dementia care found across the country and examples of poor care.
Responses following data cleansing
Length of stay
Discharge to care home
A Facebook survey was conducted in August 2015. There were over 570 respondents including people with dementia, their families and carers. It was a self-selecting sample that provides a snapshot of the experiences of people with dementia in hospital rather than a definitive evaluation.
** Alzheimer’s Society commissioned CHKS to provide an updated version of An economic analysis of the excess costs for acute care for patients with dementia. Calculations were made using Hospital Episode Statistics data from 2013/14. The report notes that inconsistent hospital coding of dementia means the calculations are likely to be an underestimate.
*** Informal reports suggest this is a gross underestimate, with some hospitals stating that 40 to 50 per cent of their patients have dementia.
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