Integrated Care for People with Dementia—Results of a Social-Scientific Evaluation of an Established Dementia Care Model
Abstract
:1. Introduction
- early diagnosis by the general practitioner and differential diagnosis by the specialist;
- information, education, counselling and advance care planning;
- a combination of medical, pharmacological and non-medical measures tailored to the client and his/her needs that are preventive and resource-oriented, geared towards principles of person-centred care (by Kitwood) and integrate early palliative aspects;
- a structure that integrates outpatient, semi-residential and inpatient care and is managed in the care (case management);
2. Objective and Methodical Approach of the Study
2.1. Objective
- (a)
- analysing and describing structure (e.g., areas, points of intersection, and transitions), processes (e.g., care processes, communication and coordination) and the general conditions of the established care model;
- (b)
- working out gaps in care and potential for development with reference to current scientific expertise and the perspectives of the target group;
- (c)
- reflecting on transferability to other regions.
2.2. Methodical Approach
2.3. The Implementation
- (a)
- Open, guideline-based interviews were conducted with the professionals of the care model. Among others, the experiences during the common development process of the setting, the main duties and the underlying concepts, care processes, interfaces and coordination processes, conditions for a successful cooperation and financing frameworks were inquired. Heads of each care section were available for repeated interviews.
- (b)
- Narrative-generating interviews were conducted with three family caregivers. The aim was to reconstruct the illness trajectory and the care context of the family member with dementia from the relative’s point of view. They had shown interest and agreement.
- (c)
- The participation of observations in the different care sections and in comprehensive team meetings took place to understand the procedures, the implementation of principles, workflows, interface management and communication between the professionals.
- (d)
- Documents such as self-descriptions, working aids or quality standards were checked and analysed.
- (e)
- During the research process, it was necessary in some cases to discuss some aspects in group discussions, e.g., the division of work in assisted living. Furthermore, based on case studies, professionals were asked to explain in writing or orally, their tasks, procedures and interactions in the care process for their clients.
3. Results
3.1. Initial Situation—Pressure Caused by the Problem, Opportunity for development and Positive Network Experiences
3.2. The Care Model with the Central Components
3.3. Conditions for Collaboration and Quality of Care
- Being all grouped into one place allows clients and family members to access a broader scope of information, counselling and help and facilitates the partners on-site to communicate, coordinate and connect. In assisted living, the time taken up for arrival and departure is reduced for out-patient services (e.g., nursing) when providing care to several residents. They use the time saved to work with the client.
- The dementia-friendly building and the design of the environment promote the independence and orientation of clients and support the work of the professionals. For example, in assisted living, the flats and common areas are connected by a circuit and the garden is accessible in the middle (atrium) and can be seen from everywhere so that the residents can move independently indoors and outdoors and the professionals also have everything in sight.
- Collaborative agreements between the partners as well as the development, implementation and regular evaluation together with practiced objectives, culture and standards are the basis of the collaboration and quality of care. The learning processes take place for the partners as early as the negotiation of the common shared objectives, culture and standards, which advance the interrelated actions in the care as well as the development of a collective identity. The agreed basic principles that guide the perception and action apply in everyday care. These include, e.g., the principles of working with the clients and their family caregivers, of cooperating with external partners such as the general practitioner, as well as of teamwork or standards of human resources development, quality assurance and public relations.
- The definition and transparency of each field of work and expertise of the partners and departments reduces the risk of duplicate structures and competition and promotes the implementation of teamwork as well as a specific routing for questions from other areas.
- Information and communication technologies, such as the digital client file of the geriatric psychiatrist with access rights for those involved in the care process or coordinated assessment and documentation systems, support a smooth information and communication flow as well as knowledge integration.
- The establishment of comprehensive exchange and development forums is, in addition to the structures of case-related interprofessional dialogue, important for the joint maintenance of the network, for the development and implementation of strategies and standards or for problem and conflict resolution. This includes, e.g., regular management meetings or quality circles. Experience in transparency, participation, appreciation, negotiating at eye level and achieving overarching goals promote a collective identity. Similarly, the collective design of the centre has proven to contribute to the sense of identity.
- The common person-centred practice, modularised service structure, case management and monitoring facilitate the provision of care tailored to needs. Defined care paths and interfaces, as well as structured transitions ensure continuous and coordinated care. The risk of gaps or interruptions in care in the course of the disease is reduced simultaneously through the comprehensive range of care services and the cross-sectoral provision of services, e.g., from home in assisted living. The geriatric psychiatrist, as a gatekeeper and case manager, in tandem with the nursing care, ensures a needs-based, coordinated and continuous provision of care.
- Care centre management supports the collaboration of partners and undertakes, e.g., tasks such as controlling, moderation of interprofessional working contexts (e.g., quality circles), public relations or the management of development processes.
- The opening of the centre in the community, on the one hand through the geriatric practice, on the other hand through offers, such as exercise groups for elderly people with or without dementia in the district as well as information events, promotes public awareness of the issue and reduces fear of the unknown.
3.4. Extended Task Profiles and Skill Requirements of the Doctor and Nursing Care
4. Discussion and Outlook
- early access to the memory clinic is encouraged through collaboration with the general practitioners and the local presence of the centre; based on this, the chance for an early and differentiated diagnostic and treatment increases;
- education and counselling, care planning and continuous progress monitoring by the geriatric psychiatrist accompany the medical differential diagnosis;
- medical and non-medical measures are coordinated on a case by case basis and adapted over time;
- the work is aligned with the principles of dementia care and focuses particularly on resource-conserving and preventive strategies, supplemented by palliative care in advanced stages;
- outpatient, semi-residential and residential structures are integrated and transitions are structured both within the care setting as well as at other local facilities;
- both the concepts and the spatial design are tailored to the target group;
- from the outset, family caregivers are involved and relieved.
Acknowledgments
Conflicts of Interest
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Richter, S. Integrated Care for People with Dementia—Results of a Social-Scientific Evaluation of an Established Dementia Care Model. Geriatrics 2017, 2, 1. https://doi.org/10.3390/geriatrics2010001
Richter S. Integrated Care for People with Dementia—Results of a Social-Scientific Evaluation of an Established Dementia Care Model. Geriatrics. 2017; 2(1):1. https://doi.org/10.3390/geriatrics2010001
Chicago/Turabian StyleRichter, Stefanie. 2017. "Integrated Care for People with Dementia—Results of a Social-Scientific Evaluation of an Established Dementia Care Model" Geriatrics 2, no. 1: 1. https://doi.org/10.3390/geriatrics2010001