The difference these proposals could make to patients, their carers and families
In this section you can read a case study of the journey of one of our patients through our older people’s mental health inpatient service. It describes what happened, from both a patient and carer point of view, and what could have been different if they were admitted to a specialist service. Names have been changed to protect confidentiality.
Peter, aged 72 from Calderdale, had been living independently on his own for over 20 years. A retired manual worker, Peter was fit and healthy and loved gardening, a drink with his friends and reading. A quiet man who liked to be on his own, he had a relationship with June who lived a short journey away.
Peter first came into contact with the older people’s mental health inpatient service when he was detained under the Mental Health Act. Peter was living a care home in Calderdale at the time where he was being supported following a deterioration in his health due to his dementia. Peter was admitted to Beechdale Ward, Calderdale Royal Hospital, a mixed needs and mixed gender ward.
June was made aware by the care home that Peter was unwell and that he would be admitted to hospital because he had hit someone, and staff in the care home could not manage his behaviours. This had been ongoing for months, but June was worried because it was the first time she had heard there was a problem.
Staying at Beechdale Ward, Calderdale Royal Hospital
What happened:
Peter expressed that he did not like the noise and being with other people. He said a woman was ‘chasing him’ and he wanted to be left on his own. He said there was too much noise. June visited Peter, the room for visits was small and not very welcoming.
June was also upset that Peter talked about a woman trying to kiss him. She saw him once arm in arm with the woman. This upset June and she felt she was losing her partner, not only to his health but also the relationship they shared.
What could be different:
A specialist dementia ward would allow for movement as well as space for people to be on their own.
Noise levels could be reduced using the ward environment to create spaces for both activities and areas which were calm and quiet.
A specialist dementia ward would be a dementia-friendly environment. This means it would be a calmer and more engaging space.
Space for visitors, and communal spaces could be tailored and made more appropriate for patients with dementia and their families, carers and loved ones.
There would be better staffing levels on a specialist dementia ward. This would improve support and the activities available for patients.
A specialist dementia ward would be gender specific ensuring care is respectful and dignity is maintained.
A gender focused ward specialising in dementia would be more suited to gender specific approaches and activities. It will also make it less likely that patients could misinterpret relationships with one another, and make it easier to manage should this happen.
Patients who identify as gender neutral or transgender would be offered a choice of gender environment through their care planning.
Move to Ward 19, Dewsbury and District Hospital
Following an episode of behaviour that resulted in Peter becoming aggressive towards another female inpatient, Peter was moved to Ward 19 in Dewsbury where he was on a male only ward. Peter said he was happy here. He liked the fact he was with work mates and men only. He also was glad he did not have to see ‘the woman who chased him’.
June could drive in her local area but found the journey to Dewsbury daunting to start with. Family helped drive to visits until June felt confident to drive independently. June said that Peter seemed much calmer and happier at Ward 19 in Dewsbury. The visiting area was pleasant, and she was happy to travel knowing he was well cared for.
Peter’s fall whilst on Ward 19, Dewsbury and District Hospital
What happened:
During the night Peter had a fall and was transferred by ambulance to Pinderfields
Hospital, Wakefield for treatment for his fall. Peter was confused by this change and asked to see June constantly. Peter was cared for as an inpatient on a general ward at Pinderfields Hospital for two weeks.
The care Peter received was good. He had his own room, but his mood was up and down. June could not travel to Wakefield on her own as she did not like to travel too far and did not like using motorways.
Because of this June had to rely on friends and family to take her. This meant she could not go as often as she would have liked. Staff also reported Peter was calmer and happier when she was there, but June could not get there apart from evenings and weekends because she relied on others to take her.
What could be different:
A specialist dementia ward would have additional provision built into the ward environment to prevent falls which is more common in patients who have been diagnosed with dementia.
Ward staff would also have additional knowledge and skills around falls prevention, as well as more capacity to observe people who are a falls risk.
Improved management of falls risk could prevent admission to another hospital or ward for treatment.
Move back to Beechdale Ward, Calderdale Royal Hospital
What happened:
On discharge, the family asked if Peter could be transferred back to Beechdale Ward, Calderdale Royal Hospital which was agreed by his care team and was closer to home.
The transfer back to Beechdale Ward for Peter was not a happy one. He did not like the mixed wards and expressed that the woman who chased him was still there. He wanted to leave and go home.
Peter was near home which meant June could visit nearly every day. The contact helped them both. June came nearly every day and Peter seemed happier and calmer. Despite the improvement, June did feel that Peter needed less of a hospital environment and wanted him to move back to a care home.
What could be different:
A specialist dementia ward would have given Peter the right treatment in a gender specific ward.
More could be done to understand what the support that families and carers who may find it difficult to travel need.
There would be continuity of care which means that patients are not moved to different wards.
Specialist care in the right ward would mean that people can be discharged home, or to their usual place of residence sooner.
Moving back to a care home
Following a period of eight months Peter is now living in a local care home in Calderdale. Peter is much happier, and June gets to see him very often.