School of nursing and Midwifery, Trinity College Dublin and Department of Economics, National University of Ireland, Galway

This report presents the findings of an evaluation of the Community Outreach Dementia Project (CODPL) in Leitrim, a rural county in Ireland with a relatively high population of older people. This project is one of five projects funded under the HSE & Genio Dementia Programme to develop and test innovative individualised supports for people at an advanced stage of dementia.

Aims

Through designing and providing flexible and responsive supports, the project’s aim was to enable individuals with dementia, presenting with complex needs, to remain in their own homes longer and prevent unnecessary hospitalisation. The project also provided carer respite, educational programmes for staff and made assistive technology available. A comprehensive evaluation of the project was undertaken, using mixed methods and underpinned by the RE-AIM framework, which assessed project activity in terms of reach, effectiveness, adoption, implementation and maintenance.

Outcomes

The project supports provided to people with advanced dementia were individualised home support hours, which complemented and enhanced the home care services they were in receipt of from the HSE. A key strength of the project was its capacity for problem solving and flexibility. For some people, the project supports facilitated an early discharge home from hospital.

Thirty people with advanced dementia received project supports typically lasting 12 weeks. Of these, 29 were supported to remain at home, with at least half remaining at home for longer than 12 weeks. Family carers, who were providing the bulk of care to these people, were also supported, but the support they asked for was modest. 

Findings

A key finding was that more personalised supports could be provided when the person with dementia and their family carer were recognised and assessed as a unit of care. Families’ experiences of the CODPL supports were very positive. They found the supports to be of good quality and valued the flexibility of service delivery and the relief it gave them.

The uptake of assistive technology was lower than anticipated, indicating the limited application of such technology for people with advanced dementia. The education programmes developed by the project complemented existing programmes and were positively evaluated by participants. The evaluation found that people with advanced dementia could be supported to remain at home for an average cost to the HSE of €504 per week, and concluded that this was a good use of resources, since for the vast majority, the costs were lower than the costs of long-stay residential care.