Exploring skill-mix to enhance community service delivery

Introduction The number of older people in the UK is increasing and requires local authorities to consider new and innovative ways of working to meet needs. Evidence suggests that prevention and early intervention helps support individuals to maintain independent lifestyles. Methods This service evaluation outlines two case study examples of a new service delivery model in a local authority in England, combining the expertise of occupational therapists and assistant practitioners. New referrals requesting a package of care, where there were no existing services, were jointly assessed by two pairs of occupational therapists and assistant practitioners. The aim was to utilise the occupational therapy functional assessment, creative use of resources, a strengthsbased approach and knowledge of local voluntary, third sector and community resources to prevent, reduce or delay the need for funded care. Findings/ Discussion Most cases were referred for social work intervention, but benefited from equipment, adaptations and focused advice around managing conditions and daily routines. This approach is predicted to reduce the number of internal referrals to occupational therapy, preventing the need for a second assessment. It also led to significant predicted savings and maintenance of independence and wellbeing for service users. Conclusion Utilising their specialist skills and approaches, occupational therapists and assistant practitioners can work collaboratively to prevent, reduce and delay the need for funded care, and promote wellbeing for individuals. Anecdotal feedback suggests this is an empowering approach for service users which motivates practitioners and expands their knowledge. Recommendations Availability of this service has been increased with plans to implement this approach across other localities

Strategies and interventions to reduce or manage refusals in personal care in dementia: a systematic review

Background: Refusals of care in dementia are common and can create difficult situations for caregivers. Little is known about the best way to manage them. Aim: To identify possible strategies and interventions to reduce or cope with refusals of care in dementia, and determine the evidence for these.  Methods: We searched MEDLINE, CINAHL, PsycINFO, EMBASE, AMED and Cochrane Central Register of Controlled Trials databases August 2018, with an updated search August 2019. An additional lateral search was conducted. Two researchers screened all records for potential eligibility and quality. Narrative synthesis was used to combine the findings.  Results: Out of the 5953 records identified, 36 articles, relating to 30 studies, met the eligibility criteria. Twenty-eight of the studies (93%) were set in long-term care facilities, one in a psychogeriatric unit and one with community dwelling people. Fourteen out of the 30 studies focussed on general or mixed care activities, 8 bathing, 4 mealtimes, 2 medication administration, and 2 mouth care. Strategies or interventions identified as potential ways to reduce refusals included: music interventions, interaction and communication style, caregiver approach, bathing techniques, abilities focussed approaches, distraction approaches, and video-simulated presence of a loved one. There was most evidence for music interventions and different bathing techniques, and interaction and communication styles were associated with reduced refusals. There was no evidence that slow-stroke massage (mixed care activities) or aromatherapy (mixed care activities and medication administration) reduced refusals of care.  Conclusions: Some non-pharmacological interventions can reduce, but not eliminate, refusals of care, such as playing music during care or communicating positively without using elderspeak. More research evidence is needed to underpin strategies identified as encouraging such as Namaste Care or distraction techniques. Future research should address gaps identified such as, the absence of research examining non-pharmacological interventions for refusals of care in hospital settings and in community settings with home-care workers, and the limited research involving family carers. Tweetable abstract: Playing music during care and offering different bathing options can reduce refusal behaviours in dementia, whereas elderspeak and negative communication are associated with refusals

The experience of family carers attending a joint reminiscence group with people with dementia: A thematic analysis

Reminiscence therapy has the potential to improve quality of life for people with dementia. In recent years reminiscence groups have extended to include family members, but carers' experience of attending joint sessions is undocumented. This qualitative study explored the experience of 18 family carers attending 'Remembering Yesterday Caring Today' groups. Semi-structured interviews were transcribed and subjected to thematic analysis. Five themes were identified: experiencing carer support; shared experience; expectations (met and unmet), carer perspectives of the person with dementia's experience; and learning and comparing. Family carers' experiences varied, with some experiencing the intervention as entirely positive whereas others had more mixed feelings. Negative aspects included the lack of respite from their relative, the lack of emphasis on their own needs, and experiencing additional stress and guilt through not being able to implement newly acquired skills. These findings may explain the failure of a recent trial of joint reminiscence groups to replicate previous findings of positive benefit. More targeted research within subgroups of carers is required to justify the continued use of joint reminiscence groups in dementia care