my grandmother suffered from Alzheimer's disease, and as the disease progressed, it was very difficult to live with it and to provide it with adequate care. We have long resisted the fact that we have to put it in a nursing home until the time has come. We placed it in Arija nursing home , https://www.arija.rs and I must admit that we were overwhelmed. unfortunately my grandmother died, but employees in nursing home Arija in Belgrade Serbia, they took care of her better than we did.
Specifically, the US did develop and pay for and continues to, short term rehabilitation, and the "retrograde government" placed these services in nursing homes that no one wanted to go to. They then claimed that they did not give the "nursing home physician" the right to keep them there, and never told the public (current, 2015) they cut off private physician access.
On the development of home and community-based services, which regretfully is associated with "one categorical population group", Long-term care services and supports (LTSS) has been fought "tooth and nail" by the "hospital system" (member "hospitals" charged and exposed, Christmas in Purgatory) from the beginning. Indeed, in 2015, the group blocked on several occasions, including deleting the word long-term services and supports (LTSS) from wikipedia.
Hello from the US, and the book which just "came" in, is Public Administration and Disability: Community Services Administration in the US (Racino, 2014) at http://www.crcpress.com/9781466579811
This author has met Professor David Guttman of geriatric psychiatry back at Northwestern University Medical School. He was indeed "piloting community day care" at their associated hospital and was affiliated with the multi-service agencies, similar to all universities and colleges for internships and field placements. I've found the entire approach to "dementia" (often permanent, irreversible changes to the brain) to result in relatively little positive life changes, and the brain research has not indicated significant changes either.
However, the research gates "allowed" in instead "retrograde practices" (e.g., behavioral instead of competency-based) back into the community (LTC not LTSS groups) for population groups with "cognitive disabilities" (Racino, 1994). This term refers to populations of intellectual disabilities, mental health, and brain injury; Alzheimers and dementia groups were "not involved" (at the state categorical level) in community services development for the other population groups (but affiliate with diabetes and cancer groups).
The latter was courtesy of the World Institute on Disability (Racino, 1999) which does not provide services (i.e., advocacy base) and is not recommended as a primary "service provider" for that population group. However, its affiliates are independent living service providers which obtain funds through a federal allotment that does not include the "cognitive disabilities" as of inquiry in 2015.
If I ever can find my own position, albeit free of the entire groups and departments, and universities and science centers, and professions involved, I personally do believe in a solid community system with a community lead in "health and human services". And the US government does, too, but believes it has that right now. The latter should not be health as I will control lifestyles in homes and communities. And the next step is government in the US should be cuts starts especially when it has not reduced infant mortality, engages in political control, and has increased prison rates.
Best wishes for a wonderful 2015 holiday season!
Again I simply want to add my words of thanks to Prof Oliver who I met for the first time at the recent 'Innovations for Older People' Kings Fund event in June.
I am so glad that the responses to his sensible and balanced words have been positive in favour of retaining choice of care for older old people including residential 24/7 support - the 'take the worries away' principle as I see it and often describe to those older folk and families with ambivalence and uncertainties about care homes, mostly based on the persistent adverse media attention ( I won't condone poor care of course but the 'Anita' Factor - the so called care staff who was at the centre of the Old Deanery scandal featured on Panorama) is the extreme outlier in a care system that is based on being kind and helping people laugh and have fun in the main. By and large we are talking about the over 80 yr old population - in Devon we have over 50,000 in this age group - many living full, active, meaningful and sociable lives at home with family and friends ensuring they remain in good health and spirits but many more lonely, anxious and enduring difficulties not met by the system and who we are seeing being admitted to hospital too easily too often, staying too long there, not doing well there and too many dying in hospital due to problems of onward care restrictions . I am a strong advocate for the KPOOH principle Prof Oliver alludes to - keeping people out of hospital but do agree that we must make sure the right to treatment and access to all NHS care is provided to all those needing it - I do say ( with a tin hat on however) that no one with dementia should EVER die in hospital and we still are struggling to address the 50/50 chance of a hospital death that most of us can look forward to unless we see a sizable shift in current policy, philosophy and commissioning practices. sorry about a long reply but this issue is very important and needs an elevated status as we head for the general election in May 2015 not long away
Also because we have to deal with the world as it currently is and not some utopian fantasy of adequately funded social care, housing, carer support etc before we start closing all our care home capacity.
I realise that live in nursing care can be a great thing and can make the difference that helps someone stay out of long term care, but we also have to be realistic that it doesnt come cheap and that few people can afford it, let alone secure NHS continuing care funding to pay for it. Also that whilst 78% of all people over 75 may say on surveys that they would hypothetically rather receive care in their own home this is very different when people actually have become frail, dependent or demented or when carers can no longer cope - you dont know how you will react till you are in that position or your parent or spouse is. (And of course its often the carers calling the shots because the older person being placed no longer has mental capacity regarding their ongoing care needs)
I also agree broadly with the "keep people out of hospital and get them out of hospital view" but with the important rider that older people with complex needs have a statutory entitlement to the full facilities of the general hospital and should not be denied those - its about having access to high quality acute care when you need it and then leaving as soon as you don't. Though i re-iterate, i see dozens of older people who actually want to stay in (or whose families want them to stay in) and are hard to persuade to leave. They often feel safer in a bed based facility with staff around. This extends to end of life care. People may have a better experience of end of life care in their own home or in hospices on surveys but in my practice, i always offer people the choice to be supported at home to die and work with first rate palliative care teams to achieve this but many people make a positive choice to stay on the ward where they feel safe and supported
Finally, though i do feel we underfund social care including long term care and that through an accident of history we have managed to turn dementia and frailty into social rather than health problems and therefore means test for them, there are still many care homes which do deliver person centred care, good environments, caring staff and more choice and control than might be available with a poorly funded care package at home. They arent all Panorama specials
However, care home residents tend to be "out of sight, out of mind" for health services - the residents are entitled to the full range of primary., community and mental health services and as the BGS "failing the frail" report outlined, they arent consistently getting them. This is a shameful situation which we should rectify. There are three times as many people in care homes at any time as there are in general hospital beds. No integrated locality plan is adequate without factoring in their needs
Older people should be able to choose how they want to live, spend their days and who provides them with care and what that looks like. If care homes don’t exist within the next 50 years it should be only because people are choosing alternative care be it in their home or alternative options like a move to a supported living environment not because policy and decision makers have decided it’s time to close the shutters on our care homes.
Residential care services provide excellent care for people who have many very challenging health issues and if they were not in a residential care setting, they would have to be supported in hospitals.