Promoting Health For Older Adults
The increase in the number of older adults in the United States is unprecedented. In 2019, 54.1 million US adults were 65 or older, representing 16% of the populationor more than 1 in every 7 Americans. Nearly 1 in 4 older adults are members of a racial or ethnic minority group.
Aging increases the risk of chronic diseases such as dementias, heart disease, type 2 diabetes, arthritis, and cancer. These are the nations leading drivers of illness, disability, death, and health care costs. The risk of Alzheimers disease and other dementias increases with age, and these conditions are most common in adults 65 and older. In 2021, health care and long-term care costs associated with Alzheimers and other dementias were $355 billion, making them some of the costliest conditions to society.
CDCs National Center for Chronic Disease Prevention and Health Promotion funds partners to improve the health of older adults by:
are unpaid caregivers to a person with Alzheimers disease.
Improving The Quality Of Dementia Care In General Practice: A Qualitative Study
- Department of General Practice, University College Cork, Cork, Ireland
Background: General Practitioners play a central role in caring for people with dementia. There is a growing demand for GP-led community-based dementia care, as advocated in the Irish National Dementia Strategy . However, there is a paucity of research exploring GPs’ views on dementia care since publication of the INDS. The aim of this qualitative study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice, explored from the perspective of Irish GPs.
Methods: Semi-structured interviews were conducted with GPs. GPs who completed the Dementia in Primary Care CPD module at University College Cork in Ireland were purposively recruited. Interviews were audio-recorded, transcribed, and analyzed by thematic analysis.
Results: 12 interviews were conducted with 7 female and 5 male participants. Experience in General Practice ranged from 3 to 32 years. Most GPs practiced in mixed urban-rural settings and had nursing home commitments . The average interview length was 45 minutes. Six major themes emerged from the data set, including resourcing primary care, addressing disparities in secondary care, community-centered care as patient-centered care, linking a dementia network, universal access to care, and raising public awareness.
The Role Of Primary Healthcare Services And Nhs Health Checks
Primary healthcare services offer an important pathway for non-communicable disease prevention through modifying individual behavior and lifestyle . In England, one example is the NHS Health Checks program. The program could be a potential platform for including a personalized dementia risk assessment and the potential for this has been identified in both dementia-related and public health policies . PHE also included action points aimed at providing support for people to improve their lifestyles, including marketing campaigns aimed at 40 to 60-year-olds and developing a personalized risk assessment calculator. The possible role of NHS Health Checks with respect to dementia prevention is highlighted by only one STP, but it was the most frequent action referred to in both statutory and non-statutory local strategies.
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Emerging Key Themes Throughout The Policies And Strategies
We carried out a preliminary synthesis by identifying and coding reoccurring concepts identified across action points and statements about knowledge gaps found in the included policies and strategies. The documents were re-checked once the codes had been determined to ensure systematic thoroughness. The coded extracts were then synthesized into five emerging themes. The themes identified were 1) need to identify specific risk factors 2) awareness and understanding among the general population 3) awareness and understanding among healthcare practitioners and primary healthcare staff 4) the role of NHS Health Checks and 5) initiatives for improving health and well-being. These themes were then used to structure the analysis of the ways in which dementia prevention is implemented in practice.
Tip Five: Be Persistent Not Pushy
If youre fully informed of the process and your rights, you should have confidence in your knowledge.
There are many in the health and social care sector who unfortunately lack full knowledge of Continuing Healthcare. This can impact your Checklist results. You should always pick professionals up on the following:
- Not considering your needs against moderate and high needs only looking at the C criteria.
- Your CCG dont accept the findings of the health and social care worker. But theres no obvious reason given.
- Not considering you for a Fast Track Pathway, when you feel youre suitable.
- The changing nature of your needs wasnt considered. They only looked at how things are today, not how things will be in the near future if you dont get support.
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The Description Of A Primary Health Need In The National Framework Comes From The Coughlan Case:
In a nutshell, a person has a primary health need when the nature of their care is beyond that which a local authority can legally provide. Just like in Pamela Coughlans case: her care needs were the responsibility of the NHS to fund.
So a local authority cannot take responsibility for care that is on the NHS side of the line. If it does, the local authority will be in an illegal position.
But how do you know which side of that line your care needs fall?
Essentially, by going through the NHS Continuing Healthcare assessment process.
Questions have been raised, however, about the legality of the assessment tools and eligibility criteria in Continuing Healthcare guidelines if Pamela Coughlan were assessed against them, there is some debate about whether she would actually have been found eligible.
This excellent video by Professor Luke Clements explains more.
That said, the assessment process and the Fast Track) are the assessments that people needing care do currently have to go through and so its vital to familiarise yourself with them.
Keep in mind always, though, that any assessment for NHS Continuing Healthcare must be Coughlan compliant. In other words, it must comply with the judgment in the Coughlan case and take account of that dividing line we mentioned earlier.
The National Framework itself on page 153 confirms that Pamela Coughlans needs were of a level that meant she did indeed have a primary health need:
What Is The Legal Definition Of A Primary Health Need
The term primary health need does not appear in primary legislation. This causes many problems in eligibility assessments for NHS Continuing Healthcare. After all, most adults who require a package of health and social care support do so for a health-related reason . This could be because they have had an accident or have an illness or disability. However, they do not all qualify for NHS Continuing Healthcare. It is the level and type of care needs that determine whether they have a primary health need.
The Court of Appeal ruled on the line between a primary health need and other care needs in 1999. This landmark case has come to be known as Coughlan. The key question was whether the local authority could lawfully provide nursing care for chronically ill patients. If it could, patients might have to pay for it depending on their means. If not, it must be provided free of charge by the NHS.
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What Is The Continuing Healthcare Assessment
The assessment is the second and final stage in the assessment process for Continuing Healthcare. Its a detailed review of your care and support needs performed by a multidisciplinary team.
If you meet the criteria, your Clinical Commissioning Group will pay all of your care homes fees, or for support in your home. An assessment is automatically booked once youve passed the initial screening Checklist stage.
Working with social care professionals from your local authority, a team from across health services will talk through your personal care needs. Theyll judge your need for a package of care based on something called the Decision Support Tool.
The outcome isnt determined immediately after the assessment. The information is passed on to your CCG. Theyll then get back to you with their decision this should be within 28 days.
Whats The Difference Between Continuing Healthcare And Nhs
NHS-Funded Nursing Care is a completely different funding stream to NHS Continuing Healthcare. Rather than paying for the full cost of your care, it covers only the nursing element of any care you receive.
Its really important to ensure you apply for Continuing Healthcare first, and dont accidentally end up applying for funded nursing care because of bad advice. This could result in you paying thousands of pounds in care fees that you could have had covered.
That said, if you find youre not eligible for Continuing Healthcare, applying for NHS-Funded Nursing Care is often the next logical step. This can be worth between £180.31 to £248.06 per week, depending on your needs. A significant amount towards your total care costs.
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Theme : Universal Access To Care
The services available to each GP participant varied by geography, highlighting a fragmented system of services in Ireland.
You have a memory clinic in one area, you have a geriatrician only in another area, you have a psychogeriatrician in another area. So I think that needs to be rationalized. Every area should really have access to the same secondary care.
GPs emphasized the need for uniform access to care irrespective of geography.
It shouldn’t be different in Kerry and Cork and Waterford and Tipperary. It should be a national roll out that every area has the same access to memory clinics, has the same access to community services, that it’s all uniform and fair and balanced.
The Case Management Model In Primary Care
PWD and their CGs often encounter services that are fragmented, protocol-driven and only weakly tailored to individual and family needs. Because dementia is a more or less slowly progressive disease, the needs of the PWD may change greatly over time, requiring consequently support from a complex and flexible matrix of social networks and services, as well as from family CGs who should adapt themselves to the cumulative repercussions inherent to the disease organic pathologies of their relative with dementia. In addition, the interaction of medical professionals, PWD, family, and systems barriers in primary and secondary care explain why providing timely, proactive, responsive, well-coordinated and patient-centred clinical care is so difficult .
Another study found that characteristics of case management, which negatively influence implementation, are low intensity of case management , a large case load , and a reactive approach to care . In the Netherlands, the model of case management in which case manager and client services are embedded within one type of organisation is more successful in facilitating implementation of care compared to the model where the case manager coordinates services from a range of organisations. In summary, case management for PWD may increase the use of community-based services and delay nursing home admission .
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Five Things You Need To Know About Eligibility For Nhs Continuing Healthcare
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Thousands of people across the UK need to receive ongoing care due to disability, accident or illness. For those that are eligible, the NHS funds the full cost of this care.Sound simple? Its not. The eligibility criteria are complex and nuanced, and their interpretation is open to disagreement. We help hundreds of people each week to understand NHS continuing healthcare eligibility, and to challenge funding decisions when appropriate.Here weve put together five important facts about NHS continuing healthcare eligibility that you should bear in mind when preparing for your own, or your loved-ones, assessment or considering challenging a decision.You can ask us about these points, or anything else to do with NHS continuing healthcare for free by calling our Information and Advice Line on .
1. Diagnosis doesnt guarantee eligibilityEligibility for continuing healthcare is not judged on a persons diagnosis. So, even if a person has been diagnosed with Alzheimers disease, Parkinsons disease or another degenerative condition, they may be assessed as not having a primary health need.Instead, eligibility is determined by the assessment of the persons day-to-day care needs and how those needs should be met.
For more information about eligibility for care funding, appealing decisions, and help to navigate the maze of continuing healthcare, or talk to us about your situation.
A version of this blog also appears on UK Care Guide
Implementation Of Government Policy At The Regional Level
National policies filter to the regional level through the Sustainability and Transformation Partnerships producing a Sustainability and Transformation Plan . The plan focuses on priorities including non-communicable disease prevention, general health and wellbeing improvement, social care, and a plan to join up health and social services . Within the STPs, the focus on dementia prevention varies greatly. Dementia prevention is sometimes not mentioned at all, sometimes presented as a brief example, and sometimes emphasized as a high priority . Where dementia prevention is given some prominence, the number of action points also varies in some cases, prevention is briefly mentioned in general terms while other documents include well-constructed actions with explicit outcomes, timeframes, and responsibilities . Only nine out of Englands 44 STPs cover dementia prevention, and four of these provide action points. Such limited information on dementia prevention within the STPs may have consequences for future priority setting, leading to a focus on improving overall health and well-being with less emphasis being given to dementia prevention .
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Where Are We Now
Given the expected dramatic increase in the incidence and prevalence of dementia, the development of successful prevention and treatment strategies is critical. However, the current pharmaceutical treatment of AD can only modestly improve symptoms, and cannot cure or halt clinical progression. As a result, prevention of dementia through risk factor identification and modification is of the utmost importance until truly efficacious disease-modifying agents are available.
Awareness And Understanding Among Healthcare Practitioners And Primary Health Care Staff
As with the general population, national policies have highlighted the need to increase knowledge among health care professionals but, again, this is a vague objective, even though it is considered a key aspect for dementia prevention . This was highlighted in subsequent dementia and public health policies , which included the ambition to improve health care professionals understanding of modifiable risk factors through the delivery of education and training programs. None of the STPs included this action and at the local level, it was included only in dementia-specific strategies, with 12 of these mentioning the need for education and training, particularly for frontline staff and those delivering NHS Health Checks.
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My Dad Has Dementia So Will He Automatically Qualify For Chc Funding
We are frequently asked questions along the following lines:
My father has been diagnosed with Dementia, which is a health issue, so why is he not entitled to NHS Continuing Healthcare Funding?
Unfortunately, the answer is not that simple! Read on
The Daily Mail recently ran an extended campaign highlighting the need for more social care funding for Dementia sufferers. Their articles and contributors stories told of personal heart-rending accounts how many thousands of Dementia sufferers have had to pay for their care out of hard earned savings or from the sale of their home, whilst cancer sufferers often have all their treatment paid for, free of charge, by the NHS. Whilst we applaud the Daily Mail for seeking to put pressure on the Government to increase Local Authority budgets to help Dementia sufferers, the apparent bias towards funding for cancer sufferers caused some consternation on both sides of the fence. When it comes to funded care, why should there be any distinction between these two life changing conditions?
Surely, its not just about the diagnosis of a condition as to who gets NHS funding and who doesnt?
We believe that there are many more thousands of people throughout the country, who have been diagnosed with Dementia or other conditions affecting their cognitive impairment, who could and should be entitled to CHC Funded care.
Remember, its about the overall package of healthcare needs!
How Much Is Continuing Healthcare Funding
Theres no cap on Continuing Healthcare the NHS will simply pay for the care you require although this is assessed.
And, as its from the NHS, its universally free at the point of use. That means your finances make no difference to your eligibility.
This can be confusing when looking into care options for the first time. As you may have heard about a financial assessment or means test when it comes to care funding. You may have also heard about asset thresholds, incomes assessments etc. This is only for local authority funding.
What is a Clinical Commissioning Group?
A Clinical Commission Group is your local NHS commissioning authority. Think of them as your local council, but for NHS matters. They lead the local strategy for planning how your local NHS hospitals, clinics and community health centres are run. Crucially, theyre also responsible for deciding whether youre eligible for Continuing Healthcare funding.
Another key area where Continuing Healthcare differs from local authority funding is that youre unable to top it up. It should always cover your entire care costs, based on your individual needs.
There isnt a cap on the amount you can receive. So, if youve been accepted for Continuing Healthcare but the sum youre offered doesnt meet your expectations, you should write to your Clinical Commissioning Group explaining why. Or, failing that, your Member of Parliament will be able to help you.
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Living At Home With Dementia
As Canadas population ages and chronic disease rates increase, federal, provincial and territorial governments are recognizing the need to make home care more available and accessible. About 61% of seniors in Canada with dementia live outside of long-term care or nursing homes: 69% of those younger than 80 and 58% of those 80 and older. A Common Statement of Principles on Shared Health Priorities is a recent agreement between the federal, provincial and territorial governments to provide substantial federal investment over 10 years, in part, to improving access to health care and support services at home and in the community.