Service providers feel they are being asked to do more for the same money these days. The DSDC is focussed on dementia and in order to achieve the aim of our founding charity the Dementia Services Development Trust we have to “improve services for people with dementia and their carers”.
It is a tricky business. Because the work of the DSDC is based on research evidence about what is practical and achievable and affordable we can show we are trying to live in the real world. We advise on design changes that can reduce the cost of care and have built a virtual on line care home to give that information away for free. We seek after grants like Comic Relief, the Big Lottery, and other Trusts so that we can offer education that is free from the point of view of the employer, or the worker.
As a non-profit organisation we make sure that everything is done as efficiently as possible because we are realistic about the cost. Our training is not about vague notions of “dementia awareness” or “respect” but about practical stuff like how to avoid adverse incidents such as falls, infection, dehydration, disturbing behaviour, delirium and depression. And it is about really practical ways of making a care service joyful and respectful when most of the people have dementia.
However, although we are trying to reduce the cost for providers, we actually have no idea, because the information is not there, about how much it SHOULD cost to care for a person with dementia in a care home or in their own home. Local authorities pay their staff in many cases more than other providers, for the same work. Charities, subsidised by fundraising spend more on each service user in many cases than other providers. Staffing levels are determined and facilities are required to make changes and improvements in one geographical care inspection area in a way that other care inspection areas don’t require.
Experienced managers with established relationships can argue their case better than others on matters that seriously influence the cost of care. And if the model of care is one where people are looked after, rather than re-enabled, it costs less to herd residents together than it would to get them to look after themselves, maintaining their personal skills and capacity. The question is not just about how much care costs, but how much the right kind of care delivered by the right kind of people in the right kind of setting costs.
So my plea is this. Can we please measure how much it costs to provide care in different settings – not just measuring what is currently spent, but calculating what it should cost if people were doing the right things? Without this information we are all stabbing in the dark...and we know how dangerous that is.... And if people want to drive up standards in the mean time, can we start with a serious discussion about education?
It can be fast and inexpensive, and really makes a difference.