Key messages for commissioners

Dementia care pathway

• Support and work more closely with homecare providers to achieve a referral and diagnosis of dementia;
• Explore and develop homecare providers’ capacity to deliver more person-centred care and support throughout the person with dementia and their carer’s pathway;
• Work closer with homecare providers around early diagnosis, interventions, palliative and end of life care;
• Building up a relationship with providers will increase greater understanding and recognition of the knowledge and abilities of the sector and the people who work within it.

Person centred service delivery

• Develop a partnership approach that includes homecare providers and informal carers to achieve a more accurate assessment of a person with dementia’s abilities;
• Utilise the skills and knowledge of providers in the care review process;
• Delegate more responsibility for care closer to the point of delivery, giving providers more autonomy;
• Aim to reduce unnecessary layers of bureaucracy, by working more closely with homecare providers;
• Planning care in ‘banks of time’ rather than allocating set times for care and support to be delivered is effective in supporting flexibility and choice;
• Short visits i.e. ‘15 minutes’ only have a place in when used to complement person-centred dementia care and support already in place.

Funding

• Develop and facilitate a relationship with homecare providers that allows for alternative funding options, approaches or solutions to be explored;
• Reduce confusion by simplifying or clarify the terminology and range of language that is being used regarding funding;
• Build in greater flexibility around finance and monitoring processes;
• Encourage, support and promote the uptake of personal budgets for people with dementia and their families;

Contracting clauses

• To improve on the provider’s abilities to deliver flexible care and support, remove punitive penalty clauses i.e. missed or late calls or visits;
• Take into consideration the effects on the homecare sector of using framework agreements or similar contracting arrangements, in terms of potential reduction in providers and social capacity and the ability to provide consistent flexible services.

Costs

• Foster closer working relationships with homecare providers to improve understanding and recognition of the true cost and implications beyond direct service user contact time of delivering good quality person-centred care and support for people with dementia.

Key messages for providers

Personalisation

• Encourage and support people with dementia to take up personal budgets;
• Clarify frameworks to deliver outcomes (thinking about identifying needs, inputs, outputs and outcomes);
• Develop monitoring and quality assurance systems that support a person-centred outcome-focussed approach.

Service delivery

• Diversify and support growth in the private market;
• Build on existing skills and resources;
• Develop more flexible and responsive person-centred care and support, based on individual needs;
• Address how you can provide more flexible weekend, evening and overnight services to support people with dementia.
• Consider extending office opening hours and use it as a base for on-call managers and staff to work from improving access to information, communication and support to care workers;
• Organise staff into smaller teams, adopt a key worker structure and consider merging traditional field and office management roles into one;
• Move towards developing new community based service initiatives and partnerships including assistive technology.

Workforce development

• Look for staff from other sectors with comparable skills, life experience and the right approach;
• Invest in developing specialist dementia knowledge and training.

Links and multi-agency working

• Continue to develop and maintain links that support mangers and care staff to provide services for people with dementia.

Everyone has to change if we are to truly achieve outcomes-focused, person-centred care and support for people with dementia. Home care providers have the opportunity to take the lead in personalisation – and should not wait to be given permission to move forward or to follow someone else’s vision.

Full report Improving Domiciliary Care for People with Dementia: A Provider Perspective is available at www.southwestdementiapartnership.org.uk/domiciliary-care/provider-perspective/