Rising admissions to A&E for people with dementia due to ‘threadbare’ social care system, charity warns
An Alzheimer’s Society investigation has discovered tens of thousands of people with dementia each year are being admitted to A&E because inadequate social care is leaving them unprotected from falls and infections.
The investigation, which involved FOI requests to NHS Trusts in England and a survey of frontline paramedics, revealed a sharp rise in emergency admissions over the last five years - up 70% since 2012, with more than 50,000 avoidable emergency admissions of over-65s with dementia in the last year alone [1].
While an ageing population and better data recording in hospitals has contributed in part to the rise, much of the 70% increase is thought to be due to inadequate care in the community piling pressure on A&E and ambulance services. In a similar time period there has been a 40% cut to council budgets responsible for social care funding, and the number of people accessing support has been steadily dropping, despite more people living with dementia than ever before [2].
The charity released the startling figures today in its report ‘Dementia – the true cost: Fixing the care crisis’ [3] detailing the far-reaching impact of the broken social care system on people with dementia, ahead of the Minister of State for Care’s address to Alzheimer’s Society Annual Conference next week.
With no drugs to cure or slow down the condition, it’s social care not the NHS that people with dementia rely on every day. But lack of time and training among the overworked and underpaid care workforce means people with dementia aren’t getting the support they need, either in their homes or in residential care, leading to emergency admissions.
From the woman rushed to hospital four times in a year with dehydration and urinary tract infections, to the man hospitalised by a pressure sore from sitting in a chair 24 hours a day, people with dementia are being hit hardest by the social care crisis.
Helen Jebson King told how her father, who had dementia, was hospitalised twice by falls – initially getting stuck on the ward for months and the second time tragically passing away in hospital. Helen said: “It’s so sad because it was so avoidable, if he’d got the one to one care he needed in the home Dad might still be with us. It just made me realise dementia care is totally broken. People with dementia should be protected and supported in their homes, not ending up in A&E – it’s not the place for them to be, stuck on a ward with no specialist support feeling restless and confused.”
Frontline staff confirmed the rise in avoidable emergency admissions of people with dementia, with three quarters (75%) of paramedics surveyed reporting that the problem has become more common in recent years. Half (50%) reported dealing with instances every week, and 1 in 5 (21%) said they see the situation every single day [4].
One paramedic expressed frustration at taking people with dementia to hospital for things which could have been spotted and treated much earlier, calling it “utterly depressing” and “one of the key things that can turn a good shift into a sad one”. Another told of “the torture of travelling to hospital” for someone with dementia, and a third said they get regular calls from nursing homes who want people with dementia admitted because they cannot cope. Others said they “often feel powerless… like I am letting people down”, and described their frequent experience of the issue as “soul destroying, especially as it is so unnecessary”.
Alzheimer’s Society Chief Executive Jeremy Hughes warned: “Successive governments have shirked the issue of our threadbare social care system. Starved of the care they need, people with dementia end up in A&E as a last resort, disrupting their home life and forcing them to struggle in crowded hospital wards. It shouldn’t and needn’t be like this.”
College of Paramedics Trustee Martin Berry added: “Paramedics and Urgent & Emergency Care colleagues continue to see a rise in numbers of people with dementia requiring unscheduled care in the community. Often vulnerable, these patients require timely multi-agency support for their health and care needs. The College of Paramedics welcomes Alzheimer's Society’s report and strongly supports its recommendations of timely, preventative and integrated care, to manage more patients safely in the community and prevent unnecessary hospital admissions.”
The figures underline the false economy of poor access to social care, in addition to the level of distress it can cause for people with dementia. Alzheimer’s Society calculations estimate that last year avoidable admissions are estimated to have cost the NHS between £300-400 million [5]. Only two thirds of people with dementia have a diagnosis [6], and hospitals fail to recognise a third of those patients with a diagnosis [7], so the cost is likely to be a conservative estimate.
The charity’s report, based on testimony and evidence from people affected by dementia, social care professionals and dementia lead nurses, outlines urgent areas for Government to address:
- Access – everyone with dementia to have access to timely, preventative and integrated care and support
- Quality – all health and social care workers to be provided the training and support they need to deliver quality dementia care
- Cost – the cost of additional care charges for a health condition such as dementia to be covered by the state
Alzheimer’s Society Chief Executive Jeremy Hughes continued: “One million people will have dementia by 2021 – the Government must work out how it will deliver high quality social care to everyone with dementia who needs it, and at a fair price.”
This year Dementia Awareness Week has been changed to Dementia Action Week (21-27 May). While raising awareness will always be important, we must go further, so Alzheimer’s Society is urging everyone to take action to effect change and unite against dementia. Find out how you can take a small action to make a big difference and help fix dementia care at www.alzheimers.org.uk/daw.
