The term ‘model of care’ is used in a number of ways, often without definition or explanation. Here the term ‘model of care’ is being used to describe an overarching design for the provision of a service, based on a number of dimensions:
- theoretical concepts about the condition or disorder and the person living with it
- the nature of a condition or disorder – e.g. what is its course, what effects does it have, is it debilitating, does it affect mind and/or body?
- the person living with that disorder (in this case, dementia) – e.g. are they fundamentally changed by the disorder, do we conceptualise them as individuals or part of a system, do they have capacity to make decisions?
- service aims and type of provision – e.g. should it provide treatment, advice, hospital or home-based care?
- evidence or consensus around the effectiveness of treatment and interventions – e.g. what helps to prevent and manage problematic behaviours?
- guiding principles and ethical considerations that underpin the model
A clear model of care can improve clarity of purpose, improve quality and outcomes, and mean better use of resources. Implications for a refreshed model of care for dementia include:
- the whole model needs to be rethought – not just one or two elements
- a range of community- based, mainstream services, that are easily navigable by those who need them, should be the default
- interventions and support need to be early, proactive and effective
- services need to be person-centred
- specialist services, including inpatient care, need to be limited to times of greatest need and have a clear focus and remit, and
- carers are essential partners in delivering services, and need and have a right to support.