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Service Portal News Bulletin from FACS-ADHC : Thursday, 12 December 2013

Published

Interaction between Hospital and Community Based Services

Alzheimer’s Australia NSW, University of Canberra and University of NSW have completed research on the perceptions of carers of people with dementia, and community-based service providers, who had experienced, in some capacity, the transition from hospital to home.

The findings suggest that the hospital experience and subsequent discharge has a significant impact on the experience of transition from hospital to home for a person with dementia and their carer. Carers met their responsibilities with a high degree of stoicism but many expressed the impact of physical and emotional stress. Carers found access to services was often limited and inappropriate to their needs and they valued informal networks, such as other carers, as a source of information about service availability.

Many community-based service providers agreed that services to assist the person with dementia and their carer during the transition from hospital to home were complex and difficult to navigate, due to lack of coordination. Service providers spoke of the need for a dementia-specific case worker to guide carers through the process of selecting and evaluating services during the transition time and beyond.

Carers told us that the transition from hospital to home should be: easily navigated; reduce the risk of re-admission; and ensure both the person with dementia and their carer are given maximum opportunity to have their needs met. Therefore, people with dementia require specific care and support to facilitate good outcomes regarding their care, modes of communication and treatment.

There is an evident need to increase dementia specific training for hospital staff that incorporates knowledge about the nature of dementia, the consequent care required and availability of specific community services. This will ensure appropriate and timely discharge planning begins at the point of admission and continue throughout the hospital stay.

A better, person-centred, transition process from hospital to home is urgently required. Better coordination and consultation between hospital staff, carers and community–based service providers is essential to support carers as they navigate the complex and copious number of service options available to them.




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