CARERS AND THE MONITORING OF PSYCHOGERIATRIC COMMUNITY TEAMS

Objective: To monitor key processes and outcomes in joint health and s ocial services community psychogeriatric teams, from the perspective o f principal carers of people with dementia. Design : Interview with ca rers six months after referral of the 39 community based people with d ementia. Overall 34 (87%) principal carers volunteered but 5 refused f ollow-up. Setting: Two rural and two urban health and social services teams. All were routine service teams, rather than run for research pu rposes. District had relatively large long stay inpatient facility but low independent sector provision.Main outcome measures: Measures incl uded avoidable admissions, crises or untoward events, unmet needs, pro portion of carers experiencing severe stress assessed on the General H ealth Questionnaire, the carer satisfaction with service elements. Als o comparison of carer and keyworker assessments of carer stress. Resul ts: The majority of patients were female and few were under 75 years o ld. 93% were severely or totally impaired on the Activities of Daily L iving problem score. The principal carers were mostly spouses or child ren, 56% being female. During the six month period from referral, keyw orkers considered that there were 2 avoidable admissions and crisis or untoward events in 18 cases, the largest group being accidents (7). C arers considered needs to be met in 44% of cases. Lack of patient stim ulation and carer respite, together with needs for appropriate institu tional care, formed the major areas of unmet need, Fifteen of 26 (58%) carers completing the General Health Questionnaire had scores indicat ing the probable or definite presence of psychological distress. Howev er, keyworker assessments of carer stress showed no correlation with G HQ scores. Fourteen of 32 (43%) considered the services received as of poor or moderate quality. Accounts of problems in arranging and using services highlighted a series of issues requiring management of polic y attention. Conclusions: Carer inclusion in the monitoring of joint a gency teams is feasible and leads to the identification of a range of practical problems in service configuration and delivery. Keyworker as sessments of carer stress may not be valid and direct measurement may be necessary.