Crisis management for people with dementia at home: Mixed‐methods case study research to identify critical factors for successful home treatment

Abstract

Best practice in dementia care is support in the home. Yet, crisis is common and can often result in hospital admission with adverse consequences. The objective of this mixed‐methods case study research was to identify the critical factors for resolving crisis for a person with dementia living at home. The research was an in‐depth investigation of what happens during crisis for people with dementia and how it is managed by a Home Treatment Crisis Team to resolution and outcome at 6 weeks and 6 months. The methods were; observation of crisis management for 15 patients with dementia (max three observations per patient, total 41), interviews with patients with dementia (n = 5), carers (n = 13) and professionals (n = 14, range one to six interviews per person, total 29), focus group (nine professionals), and extraction of demographics and medical history from medical records. Analysis focused on the identification of factors important for crisis resolution and avoidance of hospital admission. Critical factors for the Home Treatment Crisis Team to enable successful crisis resolution were: immediate action to reduce risk of harm, expertise in dementia care and carer education, communication skills to establish trust and promote benefits of home treatment, shared decision‐making, medication management, addressing the needs of carers independently of the person with dementia and, local availability of respite and other community services. The Home Treatment Crisis Team integrated the seven factors to deploy a biopsychosocial systems approach with embedded respect for personhood. This approach enabled crisis resolution for a person with dementia by creating a system of services, treatments, resources and relationships, ‘Safe Dementia Space’, in the community with avoidance of hospital admission in more than 80% of referrals. The identified critical factors for crisis resolution are important considerations in the design and delivery of home treatment services for people with dementia.

Chatting: Family Carers’ Perspectives on Receiving Support from Dementia Crisis Teams

“…Family caregivers undoubtedly appreciated a ‘chat’; however, this appreciation needs to be seen in conjunction with their more critical estimations of crisis team involvement. Here, this criticism, which has been noted in other studies [ 18 ], is set within caregivers’ accounts of caring.…”

“…To the extent that crisis teams fulfill the policy goal of enabling more people to live for longer in their own homes, carrying this out simultaneously assigns greater numbers of caregivers to a precarious equilibrium made vulnerable and stressful by having to constantly respond to a person’s changing and sometimes challenging needs and behaviors. Seeing how caregivers attach such great significance to ‘just’ chatting with a healthcare practitioner indicates how socially isolated [ 18 ] and emotionally vulnerable their situation becomes within the care system [ 19 ]. This helps explain why Mrs Brown rejects what she characterizes as the crisis team’s attitude that ‘everything is fine now, off we go’ when the social contact she found so valuable was simply removed and not sustained.…”

WHO, WHEN, HOW: a scoping review on flexible at-home respite for informal caregivers of older adults

“… X X X Hesse [ 54 ] Germany 2005 Empirical study (quanti.) X X Hopkinson et al [ 55 ] U.K. 2021 Empirical study (mixed) X X Ingleton, Payne, Nolan & Carey [ 56 ] U.K. 2003 Empirical study (quali.) X Kelly & Williams [ 57 ] U.S. 2007 Empirical study (quali.)…”

“… Proposing respite [ 17 , 18 , 44 , 46 , 50 , 51 , 57 , 58 , 64 , 66 , 67 , 71 , 73 , 75 ] …offers respite services from a wide range of respite options or multi-respite packages. Pacing respite [ 17 , 21 , 53 , 55 , 57 , 60 , 65 , 68 , 78 ] …introduces respite services to the dyad progressively. Determining respite [ 14 , 17 , 18 , 21 , 44 , 45 , 47 , 50 , 52 – 55 , 57 , 59 , 62 , 63 , 65 , 68 , 69 , 77 , 78 ] … determines the characteristics of the services with the dyad: WHEN & WHO • WHEN [ 17 , 18 , 44 , 45 , 50 , 54 , 65 , 68 , 7...…”

Crisis Management and Resilience – The Case of Small Businesses in Tourism

“…The first group contends that a crisis is an unexpected and unpredictable event that leads to adverse outcomes (Coombs, 2007;Mitroff, 2005;Paschall, 1992;Sawalha et al, 2013;Jaya et al, 2020). The other group states that a crisis is a process that can be predictable (Pauchant and Mitroff, 1992;Pearson and Clair, 1998;Roux-Dufort, 2007;Hopkinson et al, 2021). However, none of the scholars believes that a crisis can be an event and a process simultaneously, which may help produce more precautions that lead to successful crisis management.…”