Setting up a dementia specialist ward

I am a geriatrician working in Sussex. Our region has one of the highest elderly populations in the country, and as a result our geriatrics department is large and we have a large number of elderly patients in hospital, and a large proportion of these patients suffer with dementia. It has been an ongoing concern that dementia inpatients do not necessarily receive high quality, specialist inpatient care, and plans were made to create a specialist dementia ward, run by myself and a geriatrician colleague with a special interest in dementia.

Plans were initially started in spring 2024, with the primary problem finding a ward environment that fit the necessary requirements of having a room that could be used as a day room/de-escalation space as well as a room that could be used for complex conversations with families away from the chaos of the ward, as well as for MDT and discharge planning meetings. A major issue has been that all of the wards have a fire exit other than the main entrance and how that could be kept secure, if multiple patients under DOLS would be cohorted there. My colleague and I moved to a ward that it was felt might be most suitable by the matrons in October 2024.

Steps were taken to find a suitable nursing team who could take on the challenge and to organise training for them with the input of the dementia specialist nurses. I undertook the dementia masterclass too. Discussions were had with the local inpatient psychiatric team about how we could organise regular psychiatry input (with us offering one DCC a week from the geriatrics team to assist with medical problems in the psychiatry unit in exchange for one DCC of psychiatry time). However, due to psychiatry staff shortages this has not so far been deemed possible.

We have been clear that, if a dementia unit is to be possible, there would need to be assurances that nursing levels would be adequate and that escalation beds would not be put into the ward.

Since early Autumn of 2024, our hospital has been in a near constant state of over capacity. Our 23 bedded ward currently has 35 occupants with no light on the horizon currently that that will change. On a daily basis, patients with and without dementia are being cared for in corridors and A+E wait times for beds have been up to 48hrs. Talks about the new dementia unit have been put on hold, and there has been no further information about when they might restart.

The changes we were hoping to see and to be able to measure included:

• Reduced length of stay for dementia patients

• Lower rates of delirium and falls for dementia patients

• Improved family satisfaction surveys

• Reduction in burden of referrals to the dementia specialist nurses and older peoples mental health team