A model of service delivery in caring for people with Dementia

ABSTRACT
The increasing number of people with dementia in aged care facilities is reported to have a high burden
of care among staff. The Nurse Practitioner role can be benefi cial in the provision of dementia
care particularly when diffi cult and aggressive behaviour is being displayed. The model of service
described in this paper is designed in such a way to make the outreach team contribute to staff
sustainability. Such a service is different to other outreach services and focuses on a number of key
deliverables. In practice, the service ensures that recommendations made by the team at the initial
assessment are implemented. In addition, they work with the staff in managing the resident’s behaviour,
train and model suggestions for practice in interventions. Evaluation of the service is a work in
progress and will highlight important aspects about the workforce for the improvement of quality of
life for residents with dementia.

INTRODUCTION
This paper introduces a new and innovative
model of service delivery for residential
aged care facilities that has been referred to as the
Dementia Outreach Service (DEMOS); led by
the fi rst Nurse Practitioner (NP) specialising in
dementia care in Queensland, Australia. A brief
background to the historical development of the
NP role, both internationally and in Australia,
and the benefi ts of this role will be provided
before focusing more specifi cally on the role of
NPs in aged care, particularly in relation to care of
older people suffering from dementia. Following
on from this, a description of DEMOS as a contemporary
model of dementia care and how it is
conceptualised, planned and implemented by a
NP is provided, together with vignettes of some
intervention successes by way of illustrating how

the service works. This model advances the role of
the NP in the provision of care to residential aged
care facility (RACF) residents with dementia.
The model aims to have signifi cant impact on the
workforce in RACFs, specifi cally for the provision
of care to residents with dementia.
Research undertaken in Australia has indicated
there is a high burden of care among staff
in RACFs, with nursing staff consistently reporting
heavy workloads (Tuckett, 2007a; Tuckett
et al., 2009; Tuckett, Parker, Eley, & Hegney,
2009; Venturato, Kellett, & Windsor, 2007).
For example, research conducted in Queensland
indicated that infl uxes of older people into nursing
homes are causing increased workload pressures
on staff, leading to concerns about stress,
pay and emotional and physical demands among
staff (Eley et al., 2007). The problems caused by a
lack of available staff are intensifi ed when considering
the phenomenon of an ageing population,
which is being experienced in many developed
nations and has important consequences for the
future care of older generations. In the Australian
context, population ageing is leading to a rapid
increase in the number and proportion of people
who have dementia (Access Economics, 2009, p.
231). Projected fi gures indicate that the number
of people with dementia in Australia is set
to rise from approximately 230,000 in 2008, to
465,000 in 2030 and to over 730,000 in 2050
(Access Economics, 2009, p. 231). This will
lead to an increased care burden among residential
aged care staff, with the hours of direct care
required for residents with dementia set to rise
dramatically over the next 40 years, specifi cally in
relation to the care provided by staff with lower
qualifi cations (Access Economics, 2009). It has
been estimated there will be a shortage of 58,887
paid dementia care staff (full time equivalence
[FTE]) by 2029 (Access Economics, 2009). The
impacts of increased workloads for a workforce
that is already under pressure could have serious
implications.
The DEMOS discussed in this paper has
evolved out of a NP marshalling the resources to ….A_Nurse_Practitioner


 

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