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Abstract This case study gives an example of a pioneering, specialist home care service for people with dementia living in their own homes in the Borough of Poole in Dorset. Introduction The aim of the service described in this article is to provide appropriate home care services for people with dementia and their families, through the deployment of a specially trained staff team and additional, flexible support to meet individual needs. Its development was driven by a number of key strategic concerns: an increase in the number of people with dementia, bined with general frailty or specific physical disabilities or mental health problems a policy objective to help older people to stay in their own homes as long as they want and are able to manage the government target for local authorities to provide intensive support at home to a growing proportion of older people receiving services recognition of the advantages of a dedicated service with well-trained staff and the capacity to respond to a wide range of presenting needs acknowledgement of the heavy responsibilities of informal carers and the need to offer respite care and other forms of assistance to enable them to continue in a caring role.

The service The specialist home care service was originally set up by the local authority in 1997, following plaint by a carer who said that the general home care service was inadequate and the staff insufficiently trained to do the job. Her husband had had 22 carers in a single week.

The development of specialist dementia services in the Borough was included in the Best Value Review carried out in 2000. It was very much a local authority initiative and not part of any wider joint strategic plan between social services and health.

In 2005, the management and operation of the home care service have been tendered out, together with the day service for people with dementia and the specialist unit within one of the local authority residential homes. This cluster of services will in future be run by an independent care agency, Care UK.

The move is intended to preserve the specialist nature of the provision and build on its distinctive identity and style of working. It is also hoped that an independently run service will be able to attract more resources.

It was felt that these objectives could not be achieved by keeping the dementia service within the corporate structure of the local authority, where it peting priorities. The bringing together of specialist services for people with dementia in this way is unusual in local authorities.

In Poole, it is seen as a measure of the success of the home care service in particular. The frontline staff in bined service will have a generic job description and will be expected to work in all the service settings home care, residential care and day care.

The general local authority home care service is to stay in-house. Service design The specialist home care team for people with dementia is separate from the generic home care service and has its own management structure.

There are two domiciliary care managers and 35 home care assistants, split into two teams. There is a key worker system, and efforts are made to minimise the number of care assistants working with each individual or family; most have two or three main workers.

The amount of assistance provided ranges from half an hour to 28 hours a week, and most care packages start off small and build up over time as the dementia progresses, along with increasing physical frailty. In its early days, the specialist home care service focused on personal care and respite for family carers.

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