Dr Suzanne Timmons, Consultant Physician in Geriatric Medicine
Dementia Clinical Nurse Specialist
Research Support Officer
What is Genio?
Genio support individuals that are disadvantaged while enhancing their quality of life within the community. Genio work with the Department of Health and the Health Service Executive, supported by Atlantic Philanthropies. The Genio charitable trust provides innovation funding, and a Cork consortium, including many Mercy University Hospital staff and led by Dr. Suzanne Timmons, has received €500,000 to improve the integration of dementia care in the Mercy and the surrounding Cork community, called the Cork-IDEAS project. More information at www.genio.ie.
Cork IDEAS Project
Integrated DEmentia Across Settings (IDEAS)
The Cork IDEAS project is an initiative to improve and integrate dementia care in Mercy University Hospital and the community. Care provision for people with dementia will be person-centred, with alternatives to admission where possible, improved links between hospital and community and better supports for those caring for the person at home. Nursing care in Mercy University Hospital will be directed by the Dementia Nurse Specialist, who has been appointed as part of the Cork-IDEAS project.
As the project progresses, we hope to reduce waiting times in the emergency department (ED), provide alternatives to the ED and limit the number of ward and bed changes during hospital stay for patients with dementia.
The Cork-IDEAS project will promote screening for dementia in the ED which is important because dementia is under diagnosed but affects about 30% of older people admitted to the Mercy. It is reported that 25% of all acute hospital beds are occupied by a person with dementia at any time. As the population ages, this percentage will continue to rise.
Other key aspects of the project include making minor environmental changes which support the person with dementia, led by an Occupational Therapist, improving discharge supports and facilitating families/carers who wish to continue caring for the patient in the hospital. Developing a “patient passport” (a concise write-up about the person including their likes / dislikes for when patients can no longer express this for themselves) will be an important feature in the care of patients with dementia, facilitating person centred care in a dementia friendly environment.
Mercy University Hospital will shortly introduce volunteers to support the care of patients with dementia,
in particular providing company, sitting and chatting or accompanying a person for a walk to the shop or canteen.
Educating and training staff is key to the success of these initiatives and will be ongoing for the duration of the project.
A community care co-ordinator will lead in the development of an integrated care pathway for people with dementia between community and hospital and back to community. The co-ordinator will improve links between acute hospital staff and key community stakeholders in an effort to ease the patient's journey when they need acute hospital care. A priority of the project also includes supporting families and carers to continue caring for their relative in the community.
Dementia Clinical Nurse Specialist
The Dementia Clinical Nurse Specialist (DNS) is a key member of the inter-disciplinary clinical team, leads the provision of nurse-led dementia care, working in partnership with the older person, to improve the experience of the person with dementia who is admitted to Mercy University Hospital, and improve the experience of the family / carer of the person.
The DNS plays a key role in the development of a robust dementia service through the implementation of theNational Dementia Strategy in partnership with the inter-disciplinary team.
The DNS provides a service in both specialist and non-specialist wards and across services, developing practice, providing expert skills and knowledge and offering support where needed. A key role of the DNS is the development of the acute hospital component of an integrated care pathway for the patient with dementia.
The Dementia Nurse Specialist will be a resource for colleagues, as well as patients and their families, offering specialist advice, education, expert knowledge and support. The DNS will play an important role in the development of quality initiatives, patient assessment and early patient discharge planning by working with the interdisciplinary team providing optimum care for inpatients and outpatients.
These quality initiatives include the development and implementation of a vision for the future of dementia care, taking into account the National Dementia Strategy and working across services and communities.
As part of the interdisciplinary team, the Dementia Nurse Specialist will:
- Assess, plan, implement and evaluate dementia care and treatment using specialist clinical knowledge and clinical skills in an individualised and holistic manner.
- Support early discharge planning with the patient and family / carer.
- Actively promote the liaison and co-ordination of care for patients between the hospital and the primary care setting.
- Take a pro-active role in the formulation of evidence based policies, protocols and guidelines for practice.
- Demonstrate leadership ability and good communication skills.
- Act as a patient advocate, utilising communication and negotiation skills to represent the values of patients, while making decisions in collaboration with the patient / family, interdisciplinary team and community resource providers.
- Be aware and know how to access existing resources / services, which help patients and their families / significant others, e.g. social services, support groups, entitlements.
- Assist in the development and delivery of dementia training programmes.
- Play an active role in teaching all grades of nursing staff and other disciplines with a particular focus on the recognition of dementia and the management of patients with dementia.
- Provide support to all nursing staff by means of regular meetings to discuss particular patient cases, which have been found to be stressful.
- Provide evidence-based care.
- Participate / contribute to research relevant to care of patients with dementia.
- Promote research awareness among colleagues demonstrated by dissemination of research findings and continual updating of nursing practice in line with best practice.
- Maintain records to assist auditing and retrospective analysis.
- Act as positive and accountable role model for all staff in the clinical environment.
- Establish alliances with key statutory and non-statutory organisations actively involved in service provision for people with dementia.
- Act as a resource for the development of and strategic planning of dementia services provided by the hospital.
Raising general awareness of dementia among all hospital staff is an important aspect of improving the hospital experience for a person with dementia; and existing staff will be offered various levels of education on dementia. The educational initiative consists of three main strands:
- Raising Dementia Awareness
A 45-minute programme to raise awareness about dementia will be available to all Mercy staff.
- Enhanced Staff Training
A 4-hour programme, “Enhancing Well-Being for the Person with Dementia in the Acute Hospital: An Introduction” (based on a National Dementia Training Programme) will be rolled out shortly for nurses and health care assistants who care for people with dementia on a regular basis.
- Dementia Champions
A more intensive dementia training programme, delivered in the Mercy in collaboration with Dublin City University (DCU), prepares staff to become “dementia champions.” Dementia Champions have a special interest in dementia and enhanced skills, and can help other staff when they are unsure how to care for a person with dementia. A Dementia Champions Forum has been established so that trained champions can support each other and continue to learn together.
Dementia Friendly Hospital / Environmental Changes
An occupational therapist works closely with MUH staff to make simple environmental changes hospital-wide that support a person with dementia (e.g. simpler signage; orientation cues such as clocks; more welcoming areas for walking and sitting).
As part of the IDEAS project, the hospital environment was audited and a number of areas were highlighted that needed addressing.
People with dementia do not always find adjustment easy, particularly when in hospital with an illness. They can forget where they are and why they are in hospital. Disorientation and bewinderment are a common experience for people with dementia and it can be very distressing and frightening.
To reduce the challenges that patients with dementia face while in hospital, a number of changes for St. Mary's Ward have occurred.
Please click here to view photos.
Integrated Care Pathways
An integrated care pathway for the person with dementia is currently in developmental stages to promote coordinated care from community to hospital and back to community. This will minimise delays, improve communication, and support patients and families during hospital admission and discharge.
This initiative is led by the Dementia Clinical Nurse Specialist (acute / hospital component) and the Community Care Coordinator (community component).
The researcher is evaluating the interventions and changes that are occurring as a result of the Cork IDEAS project. This research will help other hospitals to roll out similar improvements, and will assist in the evaluation of what works well and what may not work so well.
If you are interested in learning more about this research, please contact the Research Support Officer.
Community Dementia Care Coordinator
The community dementia care coordinator links together existing community resources to ensure all needs are met in a coordinated way. The role of the community dementia care coordinator is crucial to the successful integration of care between the acute hospital setting and the community. Increasing the ability of people with dementia to live well with increasing help and support in the community, and eventually through end-of-life and dying well with dementia, requires a range of interventions.
Integrating care between the acute hospital and the community is a vital component to the success of the Cork IDEAS project. The development of an integrated care pathway for dementia is, therefore, a key element of this project.
Creating an integrated care pathway will ensure capacity to provide alternatives to hospital admission, accelerate supported discharges from hospital and divert persons with dementia from presenting to the emergency department, through advanced planning, with appropriate community-based health and social care supports. The integrated care pathway aims to ensure when access to acute hospital is required, it is appropriate, planned with clearly defined pathways into and out of acute care.
Key elements of the Community Dementia Care Coordinator's role, include:
- Family carers are well supported in their caring role.
- Family carers are informed of their entitlements and carer support groups and carer courses.
- Providing advice and guidance around aids and assistive technologies which can enhance and enable the person with dementia to continue living safely in their own home.
- Supporting family carers during transitions of care, be it admission to and discharge from hospital or eventually to long-term care.
- Identifying the critical points when the person with dementia and family carer require alternative or additional interventions and harnessing the contribution of all available community resources, both statutory and voluntary to ensure their needs are met.
- Linking existing supports together, advocating for enhanced supports to ensure the person with dementia is cared for in the most beneficial and appropriate setting.
- Highlighting gaps in service provision, especially relating to the dearth of services for persons with young onset dementia, advocating for more flexible and individualised, person-centred, home supports and averting crisis situations and carer burnout by funding extra respite supports on a short-term basis.
- Raising awareness of dementia among all community-based staff is an important aspect of improving the experience of the person with dementia and their family carers.
- Identifying and responding to staff training needs, and recommending and providing training initiatives where identified.
- Working as part of a joint MUH - outreach / community in-reach team, comprising of dementia nurse specialist, discharge coordinator, public health nurses, community occupational therapist, geriatricians, psychiatry of old age team, and in partnership with the person with dementia and their family carer, to promote excellence in dementia care.
Volunteers have been introduced to provide social support for patients in the hospital (not just for people with dementia, however). If you would like to become a volunteer, please visit the Volunteer Service - Friends of the Mercy section of this website.
Also, MUH has been chosen as a pilot site for the Support and Advocacy Service for Older People (known as SAGE), where specially trained volunteers will be able to support vulnerable older people in hospital who do not have family support or an advocate available. This service has worked well in residential care and is now being rolled out to acute hospitals.