Care Pathways

I saw a patient with dementia. He was wandering on evenings, couldn't manage his money any more, couldn't sort food for himself and couldn't maintain his property adequately.

He was seen by a CMHT nurse and myself. Assessment was clear. CT imaging confirmed atrophic change. A diagnosis of a neurodegenerative dementia, almost certainly Alzheimer's disease, was made. He had 16 interventions made on his care plan including Council Tax exemption, advice to sort out two LPAs, getting his will sorted, a monitored dosage system, reducing meds, benefits check, three Home Care visits a day, DVLA notification and selling his car, Social Work follow up to review care schedules, nurse visits to family for carer education and support, telecare for a pendant alarm and to alert family if he's opening doors after 10.00pm, an FP10 for galantamine, ongoing follow up for review, day Memory Therapy Services for CST, follow up with me for titration/review of Rx, advice to him/his family on local Alzheimer's Society resources. Usually we provide decent care for folk with dementia, a regional report has us as a beacon service. All well and good.

I saw a patient with dementia. He was wandering on evenings, couldn't manage his money any more, couldn't sort food for himself and couldn't maintain his property adequately.

He was seen by a CMHT nurse and myself. Assessment was clear. CT imaging confirmed vascular damage. A diagnosis of a vascular damage was made. The care pathway is then refer to Primary Care to manage, who can refer to neurology and stroke outreach if necessary (who have no social work and no community services, at all). He had 2 interventions on his care plan, basic advice given and discharge to Primary Care.

Somehow, for both people to have the same sort of experiences, yielding the same consequent deficits, but profoundly different support, stirs disquiet . . .