The cost of the plan

The cost of care for the various recommendations is shown in Table 12.15. The costs relate to the expenditure necessary over the next three years to improve services for people with dementia in this country. Cost is divided into current and capital items for the various services. Some of the recommendations have no cost implications. Continual care payment for carers is obviously the major revenue implication of the plan, amounting to £68 million. Under current arrangements this cost would be borne by the Department of Social, Community and Family Affairs. The current revenue implications of the service component of the plan amounts to £27.5 million over three years.

Capital spending associated with health and social care facilities comes to £18.6 million. The basis of the current and capital estimates is projected investment in services and facilities multiplied by the appropriate wage and capital costs. The absence of much published information on costs means that some of the

estimates are based on the personal communication of people working in particular services and, therefore, best placed to provide information on these costs.

The cost of developing Psychiatry of Old Age services is just under £1million per service. The costs shown in Table 12.1 are based on the assumption that five additional services will be introduced annually over the next three years, in addition to the five new services already sanctioned. Costs include the

personnel costs and capital costs associated with day hospital provision, acute

in-patient psychiatric beds and long-stay psychiatric beds. Nine million pounds has been allocated for the expansion of home support services for people with dementia over the next three years. This should allow services to be delivered to an additional 2,000 people each year over the course of the plan. The per capita cost of this expansion of services spread across recipients is just under £30 per week, which is very good value in comparison to residential care costs. The importance of early diagnosis is seen by the allocation of £4.0 million, which covers staff time and diagnostic costs on the assumption of 4,000 new cases per annum. The overall information and training budget is close to over £5 million, reflecting the importance assigned to this area in the plan. Support for the social economy in the form of training, capital grants, and care contracts amounts to £1.5 million, including both current and capital spending. An

estimate of £3 million has been included for the development of appropriately designed small-scale specialised units for people with dementia in long-stay care. The importance of process within residential care is reflected in an allocation of close to £1 million to encourage a holistic and person-centred approach to care in this setting. A budget of £0.4 million has been allocated for experimentation with case management for vulnerable people with dementia. Table 12.1: Targets and costs

TARGETS CURRENT

(£M)

CAPITAL (£M) 1 Early diagnosis

Clinical standards and competencies for early diagnosis of dementia so that people with dementia can be informed of their condition at the earliest possible moment, unless there are strong medical or social reasons for withholding such information.

4.0 -

2 Information and training for GPs

Information and training for general practitioners to facilitate and encourage the early diagnosis of dementia.

0.6 -

3 Information, training and resources for nurses

Information and training in dementia assessment for public health nurses plus additional resources to work with in order to make identification worthwhile.

0.6 -

A public information campaign to raise awareness of dementia among the general public.

5 Development of a case management model

A case management model to co-ordinate services for people with dementia and their carers located within geographically defined catchment areas in each health board. The model should be introduced on a pilot basis in two health boards, one urban-based, the other rural- based, as soon as possible.

0.4 -

6 Carer input into decision-making

Carers to have a major input into placement decision- making and service delivery issues.

- -

7 Constant Care Attendance Allowance for carers The replacement of the Carer's Allowance by a non- means tested Constant Care Attendance Allowance based on an assessment of care recipient needs and dependency made by the relevant case manager.

68.0 -

8 Expansion of information and counselling services Information and counselling services for people with dementia and their carers.

0.6 -

9 Development of dementia-specific day care

Dementia-specific day care places in each district, or community care area, in buildings suitable for people with dementia, and with staff who are trained in the care of people with dementia.

0.3 2.1

10 Increase in day hospitals

Day hospitals for people with dementia to increase in line with the development of Old Age Psychiatry services

- See No. 14

11 Increase in respite beds

An increase in the number of respite beds in community hospitals according to a norm of 1:10,000 elderly population and the development of in-home respite services for people with dementia as a mechanism for providing relief for carers and ensuring their long-term ability to care for the person with dementia.

12 Increased provision of home support services.

The provision of flexible, continuous and legislatively based home support services for people with dementia.

9.0 -

13 More occupational therapists and social workers The expansion of community-based occupational therapy services and social work services for people with dementia living at home.

0.6

See also No.14

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14 Expansion of Old Age Psychiatry services A planning norm of one consultant in Old Age

Psychiatry per 10,000 people aged 65 years and over, each being provided with a multidisciplinary team and psychiatric facilities, including a day hospital and acute and psychiatric beds together with good access to non- psychiatric day and residential care. The target is five new services per annum over the next three years (See

No. 10, No. 11 and No. 15).

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15 Increase in community psychiatric nurses

The adoption of ratio of 1:4,500 elderly population for community psychiatric nurses.

See No. 14 -

16 Development of geriatric medicine

We recommend that geriatric medicine facilities are adequately staffed with full interdisciplinary teams, and we encourage close co-operation between geriatric medicine and Psychiatry of Old Age services.

0.9 1.5

17 Dementia awareness training for acute hospital staff Dementia awareness training for medical and nursing staff working in acute hospitals, particularly for people working in accident and emergency departments, to help them identify the symptoms of dementia in patients under their care.

0.3 -

18 Development of medical education

There should be under-graduate training in dementia for doctors, and chairs in geriatric medicine and the Psychiatry of Old Age in each of the universities.

19 Development of small-scale special care units Small-scale, domestic oriented, special care units, attached to conventional long-stay facilities, for people with dementia, but without significant behavioural problems.

- 3. 0

20 Appropriately staffed and managed residential care We recommend that social, psychological, artistic and sensory/communication needs be given equal weighting to physical needs in residential care settings, and that management structures support a holistic and person- centred approach to care.

0.9 -

21 Appropriate training for residential care staff We recommend the development of effective training programmes for staff working in all types of residential care facilities. These training programmes should be designed to facilitate a person-centred approach to care and service delivery.

0.3 -

22 Focus on early onset dementia

We recommend that particular attention should be paid to the needs of people with early onset dementia with appropriate care packages drawn up to reflect the special circumstances of people in this group and their carers.

0.5 -

23 Focus on people with Down's Syndrome

The introduction of specially designed and integrated care packages for people with Down's Syndrome and dementia, delivered within the mental handicap programme, with training facilitated by the Old Age Psychiatry and/or geriatric medicine services.

0.5 -

24 Establishment of an implementation committee

The setting-up of a committee to oversee the implementation of this plan.

0.2 -

25 National Centre for Dementia Services Information and Development

The Dementia Services Information and Development Centre at St James's to be consolidated as a national

centre for the identification and dissemination of best practice in dementia care in Ireland.

26 Legislatively based support for community care services

A renewed emphasis on meeting existing policy objectives for dementia sufferers and their carers, through legislatively based support for the equitable provision of community care services.

- -

27 Local delivery of services

Services for people with dementia to be delivered locally, in a flexible manner, within the framework of new case management structures, wherever possible.

- -

28 Expanded role for voluntary sector

The involvement of the voluntary sector in both the formulation and implementation of policy with respect to people with dementia and their carers.

- -

29 Consistent and long-term funding arrangements for voluntary providers

Consistent and longer-term funding arrangements between the health boards and the voluntary groups providing services to people with dementia.

- -

30 Integration of public and private sectors

An audit of the number of people with different types and severity of dementia in private nursing homes; an evaluation of the public subsidy arrangements for these patients, and greater integration of public and private production in the care of people with dementia.

- -

31 Enhanced teamwork

A more formal emphasis on multidisciplinary teamwork in the care of people with dementia within the integrative framework of a case management model of service

delivery.

- -

32 Nurturing of social economy

The development of the social economy and the

nurturing of social entrepreneurship at a local level as a

means of meeting the needs of people with dementia and their carers in a flexible and innovative way.

33 Development of a social insurance model for funding In the short-term, additional resources for dementia care financed from within existing health and social care budgets; in the long-term we recommend further exploration of moving to a social insurance system for the funding of long-term care.

1.0 0.5