Specialist Intermediate Care Team Dementia

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Specialist Intermediate Care Team ( Dementia)
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• What we did
• LDP piloted small MDT
• Tertiary level service linked to two CMHTOPs and
  associated inpatient wards.
• Clear operational policy and strong person
  centred philosophy
• Audit criteria identified
• The focus of the service
• Maintain people in their current living situation
  and prevent inappropriate admissions
• or
• Promote timely discharge
• How we did it
• Not redoing whats already been done but
• Providing intensive input (for up to 12 weeks )
  augmenting the current care.
• Developing in depth knowledge of the client and
  their circumstances
• Positive risk management and creative problem
  solving
• Direct and indirect work with clients, families
  and professional carers

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Outcomes

• The team worked well as an integrated unit
• Right mix of staff
• Able to stick to their remit
• 12 weeks active intervention was effective
• Positive risk management possible and crucial to
  good clinical outcomes
• Achieved the hoped for outcomes
• 80 clients enabled to stay in the same living
  situation or move to a less restrictive care
  environment
• Striking finding that five long term
  inpatients were enabled to leave hospital- one
  returning to her own home
• Reduction in numbers on waiting list for OPMHN
  bed.

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So.

• Our evidence suggests that we have found an
  effective medication
• It includes the right mix of active ingredients
  at the right therapeutic dose, administered to
  the right clients, yielding the desired
  outcomes. Highly acceptable to service users and
  few if any side effects.
• It is cost effective - it could pay for itself in
  terms of bed days saved.
• The Challenge
• To ensure this model of intermediate care is
  included in the redesign of core mental health
  services for people with dementia.