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Ireland

2013: National policies covering the care and support of people with dementia and their carers

Background information

Where people with dementia receive care and support

The following table provides estimates of the number of people with dementia living at home, in various types of residential care and in hospitals or psychiatric institutions.

Place of residence

 

YES or NO

Estimated number/

Additional information

At home (alone)

Yes

26,104 (Cahill et al., 2012)

At home (with relatives or close friends)

 

No figures available

At home (with other people with dementia)

 

No figures available

In general/non-specialised residential homes

 

 

In specialised residential homes for people with dementia

   

In general/non-specialised nursing homes

 Yes

14,266 (Cahill et al., 2012)

 

In specialised nursing homes for people with dementia

 

(some of the people included in the above figure are in dementia specific units attached to the Health Service Executive (HSE).

In hospitals, special wards or medical units

 Yes

644 (Cahill et al., 2012)

In psychiatric establishments

 Yes

456 (Cahill et al., 2012)

With regard to specialised nursing homes for people with dementia, extended care units for older people and private nursing homes (that have beds allocated to people with dementia or in the few stand-alone Dementia specific Centres similar to those run by the Alzheimer Society of Ireland) are included in the 14,266 mentioned in the above table.

There are also some sheltered housing schemes in Ireland which cater for people with dementia. Figures are not available as some are operated by local communities and do not always come under health funding.

According to the Department of Health (2011), 31.4% of residents in long stay units and 4.0% of residents in limited stay units have dementia.

However, this estimate is much higher in other reports (i.e. over 60%). In one small study in Dublin 89% of people over 65 years were reported to have some form of cognitive impairment. (Flood, 2012). These estimates apply to all people with dementia, not only those who have been formally diagnosed.

With regard to the ratio of staff to residents in various establishments where people with dementia live or receive care, the Health Information and Quality Authority (HIQA) sets standards (which are supported by regulation) and inspects these establishments. One of the standards relates to staffing levels:

“At any point in time, the number and skill mix of staff on duty is determined andprovided according to a transparently applied, nationally validated, assessment tool,to plan for and meet the needs of the residents. This is subject to regular review.

“The staffing numbers and skill mix of qualified/unqualified staff are at all times appropriate to the assessed needs of the residents and the size, layout and purpose of the residential care setting.” (Health Information and Quality Standard 23.4, 2009, p. 41)

The organisation of care and support for people with dementia

The overall organisation of care and support

The overall organisation of care and support for people with dementia is regulated by the governments (i.e. policy makers through legislation and regulations and the Department of Health/Minister of Health), as well as by the Health Information & Quality Authority (HIQA) (which inspects services) and the Health Service Executive (Statutory Body) which is responsible for delivering services. Care and support are organised as follows.

The Integrated Services Directorate manages all hospital and community public health services in Ireland and has responsibility for the delivery of all health and personal social services across the country including hospital, primary, community and continuing care services. This also includes management of an overall budget of over €13bn and a statutory and voluntary sector workforce of 105,000.

The range of health and personal social services provided by the HSE and its funded agencies are managed within four Regions. Each of the HSE's four administrative areas has a Regional Health Forum, which includes representatives from the city and county councils within that area.

The HSE's 4 Regions are divided into HSE Areas. Each HSE Area has an Area Manager who is responsible for managing all of the public health services in their area of operation. HSE Areas include all Hospital Services and Local Health Office services, integrated into one seamless health service for the people living in that area.

 Clinical strategies and programmes have been established to improve and standardise patient care throughout the organisation by bringing together clinical disciplines and enabling them to share innovative solutions to deliver greater benefits to every user of HSE services.

The directorate has established a number of National Clinical Programmes which are based on three main objectives, namely to improve the quality of care delivered to all users of HSE services, improve access to all services and improve cost effectiveness.

The National Clinical Programme for Older People includes people with dementia through the Model of Care for Specialist Geriatric Services.

This initiative is aimed at significantly improving access for frail older patients to specialist geriatric teams (doctors, nurses and therapists), day hospitals, specialist inpatients beds and rehabilitation beds. This will improve the quality of care received by older patients and shorten the length of hospital stay.

The Model of Care for Specialist Geriatric Services, Acute Service Provision, is Part 1 of a two part model of care. Part 1 describes the patient’s journey within the acute hospital as an inpatient or outpatient in specialist clinics or ambulatory day hospital.

Part 2 of the model of care will address services for older people in general practice, primary and community care and is due for completion in 2013.

The components of acute Specialist Geriatric Services (SGS) include:

  • The establishment of specialist geriatric teams
  • Dedicated in-patient specialist geriatric wards
  • In-patient rehabilitation facilities (both on and off the acute hospital site)
  • Community outreach to nursing homes
  • Ambulatory day hospital services
  • Access to home supports
  • Access to long-term residential care

Further information about the Model of Care and the Specialist Geriatric Services can be found at: http:www.hse.ie and www.hse.ie/eng/about/Who/clinical/natclinprog/OlderPeople

How specific aspects of care and support are addressed

A large number of relevant national policy documents/Health Service Strategies and Plans have shaped the way that services have developed over the years and on how they will develop into the future. The following are some examples of such documents. This is not an exhaustive list.

  1. The Years Ahead (1988) Policy for Older People Services
  2. Quality & Fairness (2001) Strategy for Health Services (10 year strategy)
  3. Primary Care Strategy (2001)
  4. National Health Promotion Strategy (2005)
  5. Vision for Change (2006) (Government Publication) Strategic Direction for Mental Health Service in Ireland
  6. Report of the Interdepartmental Working Group on Long-Term Care (2008)
  7. Tackling Chronic Disease - A Policy Framework for the Management of Chronic Diseases (2008)
  8. The National Women’s Strategy (2007 – 2016)
  9. National Men’s Health Policy (2008 - 2013)
  10. HSE Population Health Strategy (2008)
  11. Action Plan for Health Research (2009 - 2013)
  12. National Guidelines on Physical Activity for Health (2009)
  13. Changing Cardiovascular Health: National Cardiovascular Health Policy (2010-2019)
  14. Review of the Recommendations of Protecting Our Future: Report of the Working Group on Elder Abuse (2010)
  15. Future Health – A Strategic Framework for Reform of the Health Service 2012-2015.
  16. Summary of the public consultation for the Dementia Strategy (2012)

The first stage of the process was to assemble the research and evidence upon which the strategy will be developed. This was completed in 2012 and the report of the findings Creating Excellence in Dementia Care: a Research Review for Ireland’s National Dementia Strategy (Research Review) was published. A guide for the general public, Future Dementia Care in Ireland: Sharing the Evidence to Mobilise Action was compiled to disseminate the report’s findings and to give a better understanding of dementia. This is available at: www.doh.ie.

  1. Programme for Government (2011-2016).
  2. The National Action Plan for Social Inclusion 2007 – 2016
  3. The NationalHousing Strategy for People with Disabilities2011–2016
  4. National Carers Strategy (2012)
  5. National Positive Ageing Strategy (NPAS) (2013) Government Publication
  6. National Consent Policy (HSE, 2013)

The National Carers’ Strategy (2012) signals the Government’s commitment to recognising and respecting carers as key care partners and to responding to their needs, across a number of policy areas. By setting out a vision to work towards, and an ambitious set of national goals and objectives to guide policy development and service delivery, the strategy seeks to ensure that carers feel valued and supported to manage their caring responsibilities with confidence and are empowered to have a life of their own outside of caring. The four national goals for carers are:

  1. To recognise the value and contribution of carers and promote their inclusion in decisions relating to the person that they are caring for
  2. To support carers to manage their physical, mental and emotional health and well-being
  3. To support carers to care with confidence through the provision of adequate information, training, services and supports
  4. To empower carers to participate as fully as possible in economic and social life

 

The National Positive Ageing Strategy (NPAS) (2013) Government Publication also has four goals, which are to:

  1. Remove barriers to participation and provide more opportunities for the continued involvement ofpeople as they age in all aspects of cultural, economic and social life in their communities according to their needs, preferences and capacities.
  2. Support people as they age to maintain, improve or manage their physical and mental health andwellbeing.
  3. Enable people to age with confidence, security and dignity in their own homes and communities for as long as possible.
  4. Support and use research about people as they age to better inform policy responses to population ageing in Ireland.

The National Quality Standards for Residential Care Settings for Older People in Ireland (HIQA, 2009) contains a special section entitled “Supplementary criteria for dementia-specific residential care units for older people”.

The Alzheimer Society of Ireland commissioned three external experts to write policy papers in order to generate new ideas, promote cutting-edge concepts and contribute to a much more informed debate in relation to the soon-to-be-developed National Dementia Strategy.

The first was the Expert Policy Paper Series 2012, A National Dementia Strategy for Ireland: Signposting the Possibilities:  A Clinician’s Perspective (Alzheimer Society of Ireland) by Henry O’Connell

The second was the Expert Policy Paper Series 2012 Integrated Care Pathways for People with Dementia. Exploring the Potential for Ireland and the forthcoming National Dementia Strategy, by Dr Kate Irving and Ms Lisa McGarrigle, School of Nursing and Human Sciences Dublin City University.

The third was the Expert Policy Paper Series 2012 Financing Dementia by Dominic Trépel PhD. (University of York).

Training

Which social and healthcare professionals provide care and support

The following social and healthcare professionals are involved in the provision of care and support to people with dementia in residential care or living at home.

Social or healthcare professional

Involved in the provision of care and support to people with dementia in residential care or at home

Nursing staff

Yes

Auxiliary staff

Yes

Allied health professionals

Yes (mostly in Public Units)

Specialists (e.g. psychiatrists, gerontologists, neurologists)*

Specialists are mostly Hospital based.  Consultant Psychiatry for later life and teams also provide services in the community and to Residential Care on referral.

General practitioners*

General Practitioners (GP’s) in some HSE facilities are contracted to provide medical cover.

* Only if they are linked to the provision and organisation of care and support (i.e. not with regard to their role to provide medical treatment).

Concerning allied health professionals, some public (i.e. State-run) nursing homes have occupational therapists and physiotherapists, and others have access to speech and language therapists, and dieticians, social workers, podiatry/chiropody and other services as necessary. Some state nursing homes also employ hairdressers and provide access to other alternative therapists.

The type of training that social and healthcare professionals receive

Nurses and other health and social care workers have access to a specific introduction course in dementia care which was launched in 2012 (following a training needs analysis of health and social care staff working in home care and residential care and acute hospital care) through a special national dementia project which was led by the Nursing Midwifery and Development Unit. This course is open to the multi-disciplinary team. A training manual and tapes have been produced. A “train the trainer” approach has been adopted for roll out across all services.

Nurses and other healthcare professionals can also access diploma courses in gerontology and dementia care, Masters programmes in gerontology or dementia care, Dementia Mapping and on-line courses in dementia with the different universities as part of their continuing professional development (CPD). The Nursing and Midwifery Council of Ireland also facilitates the roll out of accredited courses for nurses as part of their CPD.

Many auxiliary staff have completed FETAC (please see below) Level 5 courses which include relevant caring modules. Auxiliary staff can also access the dementia specific course on caring for people with dementia, as outlined above, with access to tapes and a handbook.

The “Further Education and Training Awards Council” (FETAC) was the statutory awarding body for further education and training in Ireland. From June 2001 until the establishment of Quality and Qualifications Ireland (QQI) on 6 November 2012, FETAC made awards at levels 1 to 6 on the National Framework of Qualifications. These awards are now made by QQI.

FETAC award holders can be assured that their awards will continue to be recognised, both at home and abroad, and will enable progression pathways through the NFQ. For further information, please see: http:www.fectac.ie.

There are many other courses (not included) that health and social care staff access in order to enhance their knowledge base and equip them with the skills and competencies to care for people with dementia such as responsive behaviours and alternative therapies etc.

The need for specialised knowledge about dementia has been raised in several national policy documents such as Creating Excellence in Dementia Care (2012), Vision for Change (2006) and in policy documents of the Alzheimer Society of Ireland etc. The Action Plan for Dementia (1999) as well as the HIQA standards (2009) mentioned the need for training in their recommendations.

Education/training has been recommended in several national reports, especially for special training for GPs in dementia care and also for other health and social care professionals, especially in the acute hospital and setting and in home care services.

How the training of social and healthcare professionals is addressed

In recent years there has been a much greater focus on training in dementia care as a result of recommendations from several published reports (as mentioned above). Many organisations have undertaken their own training needs analysis with staff to establish training deficits and address same. There has also been a greater investment in staff training in order to respond to the implementation of external standards and regulatory requirements all of which aim to promote higher standards of care and improved outcomes for service users. There are now more colleges and other educational centres providing courses for health and social care staff with greater choice available to all of the multi-disciplinary team members. Some third level institutions have worked on site with service providers through person centred care programmes (using reflective practice) which had very positive outcomes/experiences for both staff and service users. This includes good access to online courses.

In 2012 Genio (part funded by HSE and Atlantic Philanthropies), who work in partnership with the HSE on specific projects, rolled out a course “Endeavour for Excellence” which included a focus on dementia care.

Support for informal carers

Support for informal carers is addressed in national policy through the National Carers Strategy which applies to all carers, including the carers of people with dementia. Several National Carer organisations have advocated very successfully, to address gaps in support services for carers (see next section on the National Alzheimer Association).

Consultation/involvement in care decisions:

The HSE is currently working in partnership with several agencies (in Ireland) including the Alzheimer Society of Ireland to develop a home grown Carer Assessment tool in consultation with INTERRAI (International) which will ensure that the needs of carers are considered in relevant assessment processes. Carers’ issues are also addressed in other policy documents listed in previous sections of this report.

National Alzheimer Association

The Alzheimer Society of Ireland provides the following services and support.

Information Helpline

x

Information activities (newsletters, publications)

x

Website

x

Awareness campaigns

x

Legal advice

x

Care coordination/Case management

x

Home help (cleaning, cooking, shopping)

x

Home care (personal hygiene, medication)

x

Incontinence help (continence promotion)

x

Assistive technologies / ICT solutions

x

Tele Alarm

x

Counselling

 

Support groups for people with dementia

x

Alzheimer cafes

x

Respite care at home (Sitting service etc.)

x

Holidays for carers

 

Training for carers

x

Support groups for carers

x

Day care

x

Residential/Nursing home care (respite care)

x

Palliative care support

x

The Alzheimer Society of Ireland also provides advocacy, policy and research, a dementia advisory service and early interventions. In addition, it supports the development of dementia friendly communities through awareness raising programme. Local branch structures within the Society support local service development initiatives and are very proactive in responding to the local needs and service demands for people with dementia and carers. The Society is also actively engaged in on-going research and in lobbying Government for improved dementia services ensuring that people with dementia receive the right service at the right time in a timely manner.

References

Cahill, S., O’Shea, E. and Pierce, M. (2012).Creating Excellence in Dementia Care: A Research Review for Ireland’s National Dementia Strategy, Trinity College, Dublin and the Irish Centre for Social Gerontology,

Cahill, S., O’Shea, E. and Pierce, M. (2012).Future Dementia Care in Ireland, Publisher

Department of Health (2011).Long-Stay Activity Statistics 2011. Department of Health (see Table B7, p.20)

Health Information and Quality Authority (HIQA). (2009).National Quality Standards for Residential Care Settings for Older People in Ireland. HIQA 

Flood, J. (2012), Mental Health: Dementia Module 173: January 2012; Forum distance learning project in association with the ICGP.Forum, pp. 1-4

O’Shea, E. (2007).Implementing Policy for Dementia Care in Ireland. The Time for Action is Now. The Alzheimer Society of Ireland.

Acknowledgements

The Alzheimer Society of Ireland

 

 
 

Last Updated: Tuesday 25 February 2014

 

 
  • Acknowledgements

    The above information was published in the 2013 Dementia in Europe Yearbook as part of Alzheimer Europe's 2013 Work Plan which received funding from the European Union in the framework of the Health Programme.
  • European Union
 
 

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