‘It's like a revolving door syndrome’: Professional perspectives on models of access to services for people with early-stage dementia

Abstract

As the need for services for people with dementia grows, and the benefits of early intervention become clear, it has become important to understand what factors may improve access to services for people with early-stage dementia. There are a number of models of service access, and these emphasise different areas, whether individual factors, relationships, or social context. The relevance of these models to variations in service access for people with early-stage dementia, and how well they relate to professional accounts, is not well known. In this study, 30 key professionals were interviewed about access to services for people with early-stage dementia in order to explore how different models of access were reflected in their own understandings. People with early-stage dementia were thought to have a range of complex needs, but participants felt these needs remained largely unmet. When articulating the reasons why they thought needs were unmet, participants focused on the impact of the framework within which services are delivered. The findings highlight the importance of considering relationships and socio-contextual factors, such as the impact of the framework of service delivery, when attempting to understand variations in access to services. In order to improve access to services, it will be necessary to move beyond addressing individual factors relating to access, and to consider the impact of the framework for service delivery and the relationships that influence contact with services.

Dementia Home Care Resources: How Are We Managing?

“…Similar to Pratt et al [57], we found that increasing access to services involves considering the wider social context of caregivers and their relationships with, among persons with dementia, other caregivers and professionals in order to more meaningfully understand issues of access. One model that takes social context into account is the integrated, continuing care model as proposed by Forbes and Neufeld [58].…”

Improving access to community support and services for persons living with dementia: Integration of home care services into primary care‐based memory clinics

“…Connecting PWD and care partners with home and community services early in the course of illness can facilitate access to appropriate services when required, and in a timely and efficient manner; this has the potential to prevent crisis events resulting from unrecognized care needs and inadequate support. This strategy addresses many of the barriers to services for PWD, particularly as related to awareness of available services, system navigation, and the need for PWD and care partners to repeatedly retell their stories and “push” for services. The PCCMC–H&CC partnership provides a significant opportunity to support team case management, where the unique knowledge and expertise of each interprofessional team member contributes to the coordination of dementia care …”

“…1,2 Despite the availability of many communitybased services to support PWD living at home, these services are often not accessed until late in the disease process or when a crisis situation arises. 3,4 Barriers to accessing community services include limited knowledge of available services, lack of system navigation support, duplicative assessments and long wait lists; 5,6 many care partners are left feeling that they have to "fight" to access services. 6 The Primary Care Collaborative Memory Clinics (PCCMC) model of dementia care aims to improve the quality of dementia care by providing person-centered care that includes meeting the needs of care partners.…”

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

“…Navigating the different systems of care is particularly difficult for this population, not least because they receive advice and support from health and social care and increasingly third-sector providers. 39 Previous research on continuity has identified a need to prioritise the needs of vulnerable people who are unable to negotiate their own continuity as they wish. 40 Processes of care may be further complicated for PLWD who have other comorbid health conditions.…”