Contained and confined: Lifting the lid on dementia care in UK hospitals
Working in the specialist area of dementia care for many years has given our team stark insights into insufficient dementia care within the NHS, which has recently come to light on a national level via a landmark review revealing a worrying “culture of containment”.
The report, by academics at the University of West London, involved analysing months of observations across nine NHS wards in England, along with more than 1,000 interviews with healthcare professionals.
National news outlets report disturbing findings where people living with dementia have been admitted to hospital and routinely kept contained through sedation or measures to prevent them leaving their beds, sometimes for weeks at a time.
Independent to imprisoned
Raised bedside bars are typically used to stop people from getting out of bed in the first instance but patients can be physically restrained, labelled as aggressive and given sedatives or antipsychotic drugs if the situation escalates, leading to further consequences like social care packages being withdrawn.
The outcome of removing these packages of care can mean that people are never able to return to independent living at home or return to their care home.
Sadly, authors of the report said that patients felt they were being imprisoned or held hostage in some cases. Almost every patient with dementia observed had experienced some kind of restraint.
Practices were found to have become normalised on wards, with staff not seeing the measures as restrictive because of their routine use. Some asked how else they could otherwise look after patients with dementia in ways that would keep everyone safe without resorting to these practices.
Lead author, Professor Andy Northcott of the University of West London, is quoted by the Guardian as saying: “These are people. We think about dementia being a kind of end-of-life stage but these are often people living pretty independently at home with their partner who come in with a fairly mundane illness like a urinary tract infection. If they had not got that they would have lived at home with their families for years.”
Prevention through person-centred care
Ambiance Care Founder Diane comments: “I have long known and observed people with dementia being poorly served with the NHS, once admitted never returning home. This is an ongoing issue and one that is completely unacceptable.
“The most effective course of action in this case, until much-needed change is established in how hospitals care for patients with dementia, is prevention of admission in the first place, which can often be achieved with quality care at home and in the community.
“Urinary tract infections (UTIs) and falls are both common causes of admission. Attentive personal hygiene care and ensuring individuals stay hydrated can prevent UTIs, while properly trained caregivers can quickly spot the signs of infection and take action before it progresses.
“Falls, meanwhile, can often be avoided by providing walking aids and adapting living spaces to suit the needs of individuals living with dementia. Simple measures such as making sure someone is wearing well-fitting shoes or slippers, removing trip hazards and adjusting dim areas of the home to keep them well-lit can make a significant difference to the risk of falls.”
Calls for guidance and change
The report continues by suggesting that the care received by patients with dementia in hospital interferes with their human rights by depriving them of liberty, and asserts that being confined to a bed for long periods can cause progression of the condition. Patients deprived of toilet breaks, meanwhile, can rapidly become incontinent, authors add.
They call for a raft of changes, including:
- Restrictive measures to be recorded and justified by the NHS
- Support for staff to recognise patient distress in the hospital setting compared with their typical presentation of dementia
- Guidance that allows staff to support patients to leave bed without fear of liability
Diane adds: “All too often we see much-loved clients deteriorate rapidly on admission to hospital, undoing all the good work of committed home caregivers who have helped that person retain their independence for years in a matter of just a couple of weeks.
“It’s heartbreaking to witness and high time for a complete overhaul of NHS dementia care. We must move urgently to a new, improved system that sees every person as an individual and treats them with the respect, care and dignity they deserve.”
To find out more about our dementia care at home services covering Stockport, South Manchester and East Cheshire, contact us today.