Commissioned research/evaluation

The report describes the results of an economic analysis of the first four sites in the HSE & Genio Dementia Programme. The objective of the current study is to provide an economic analysis of the cost of care for people with dementia on the boundary between home care and residential care within the innovative HSE & Genio Dementia Programme. A cohort of people with dementia were identified who were living at home, but were at significant risk of admission to residential care in the medium term. By concentrating on the margin between community and residential care, it may be possible to provide some insight into the benefits of investing in personalised community-based supports for this group rather than the alternative of admission into long-stay care.

The following key points emerged from the report:

• Significant numbers of people with dementia could potentially be supported to live at home for longer as a result of the HSE & Genio Dementia Programme, thus resulting in savings to the exchequer when comparisons are made between public expenditure in the community and in residential care.
• Almost a third (32%) of the 568 people with dementia in the study were judged to be on this boundary and their care in the community cost significantly less than care in a residential setting. 
• The social cost of community based care on carers must be acknowledged and greater supports for informal carers should be provided.
• For a relatively small investment in innovative, personalised supports, lives can be transformed and residential costs postponed.
• While the analysis is focused on actual provision rather than optimal provision, the study provides valuable insight into resource use and costs of community-based care at the boundary between community and residential care.
• Local context plays a key role in shaping opportunities to age at home, particularly the willingness and ability of local government to reconfigure resources towards community-based care at earlier stages.
   

The evaluation of year two examines the workings of the HSE and Genio Dementia Programme in 2014 in its second year of operation and covers the manner in which the learning from the first year of operation were used to realign and recalibrate the supports available at each of the four sites.  

The evaluation report highlights the following key findings at each of the sites:

• A renewed commitment to empowering people with dementia in providing responses tailored specifically to their own needs that reflect the preferences of people with dementia and their families are now evident across all four sites. 
• There has been significant progress in moving the existing care system to a personalised model that respects and encourages personhood, autonomy, empowerment and social connectivity for people with dementia.
• Development of a broader range of flexible and responsive services in all sites and progress has been made towards embedding and integrating the projects within the HSE to various degrees within the sites.
• Each site has also begun to focus on mainstreaming the services developed in the demonstration site to ensure future sustainability.
• The public awareness of dementia has increased significantly over the two years of the project in each of the sites.
• The consortia have facilitated an increase in awareness through their internal and external relationships with mainstream social care provision and through their members’ direct engagement in civic, cultural and economic life. Bringing so many different groups together had a positive effect on the dementia narrative within local communities.
   

This study describes the process of implementing assistive technology supports for people with dementia across four sites which will inform future service developments and the impact of assistive technology for 24 people with dementia and their families. The four sites successfully established various pilot telecare services, such as a Memory Technology Library and a programme to loan assistive technology for clients to try. The evaluation covers risk management and other supports provided by care services or informal carers who are not present in the home, as well as in-home arrangements enabling carers to provide care to a person with dementia from another room or part of the home and its environs.

The report highlights the following key findings;

• Telecare and assistive technology provided significant benefits for many persons with dementia and family carers, with person-centred approaches with individualised technology packages working best. When effectively targeted, telecare can provide good value for money and would typically represent only a small incremental addition to the costs of a home care package.
• There is no ‘one-size-fits-all’ technological solution for the wide-ranging circumstances and needs of persons with dementia living in the community, nor is technology a panacea or a substitute for human care. 
• Dementia services should discuss with persons with dementia and their families whether telecare and assistive technology may be helpful in their circumstances. They may have great value in some cases, but be less relevant or not appropriate in others. 
• As in other areas of dementia care, ethical issues are important. Involving the person with dementia, to the greatest extent possible, in the selection and implementation of technologies can achieving best outcomes, both for them and for family carers.