Yes / The prevalence of dementia is rising worldwide and many people will die with the disease. Symptoms towards the end of life may be inadequately managed and informal and professional carers poorly supported. There are few evidence-based interventions to improve end-of-life care in advanced dementia. To develop an integrated, whole systems, evidence-based intervention that is pragmatic and feasible to improve end-of-life care for people with advanced dementia and support those close to them. Design: A realist-based approach in which qualitative and quantitative data assisted the development of statements. These were incorporated into the RAND/UCLA appropriateness method to achieve consensus on intervention components. Components were mapped to underlying theory of whole systems change and the intervention described in a detailed manual. Setting/participants: Data were collected from people with dementia, carers and health and social care professionals in England, from expert opinion and existing literature. Professional stakeholders in all four countries of the United Kingdom contributed to the RAND/UCLA appropriateness method process. Results: A total of 29 statements were agreed and mapped to individual, group, organisational and economic/political levels of healthcare systems. The resulting main intervention components are as follows: (1) influencing local service organisation through facilitation of integrated multi-disciplinary care, (2) providing training and support for formal and informal carers and (3) influencing local healthcare commissioning and priorities of service providers. Conclusion: Use of in-depth data, consensus methods and theoretical understanding of the intervention components produced an evidence-based intervention for further testing in end-of-life care in advanced dementia.

No / Complete : FC 16. We aimed to develop a complex intervention to improve end of life care (EOLC) for people with advanced dementia and their carers. We collected data from 4 sources: literature review; qualitative data from health and social care professionals, carers and people with early dementia; quantitative data from people with advanced dementia and their carers; review of UK health and social care policy documents. Method and results: To develop the intervention we synthesised these data. 49 emerging statements were considered in workshops with health and social care professionals across UK to achieve consensus using the RAND Appropriateness Method (RAM) to develop components of the intervention. 1. Prior to workshops we sent invitees the RAM form consisting of 49 statements and asked them to rate these on a scale of 1-9 for appropriateness. 2. At the workshops statements rated as ‘uncertain’ or ‘inappropriate’ were discussed and all 49 items were rated again. 3. Analysis resulted in the retention of 29 statements rated as appropriate. 4. Post workshop attendees were sent the RAM form and asked to rate 29 statements for necessity. All 29 statements were rated as necessary and retained then mapped onto impact theories (Grol 2007) comprised of individual, social interaction, organisational or political/ economic context, and categorised as enablers and barriers for an intervention. Three core intervention components emerged: 1. Integrated systems and approaches to the delivery of careoperational plan 2. Education, training and support for health and social care professionals and carers - utilisation plan 3. Political and economic context dependent on reimbursement and contracting through CCG commissioning. Discussion: The next phase is to pilot components 1 and 2 of the intervention in a naturalistic experiment in one inner city and one suburban locality at different stages of development for services for EOLC for people with dementia and their carers.

The core aim of this paper is to present a business plan that aims to realize a private nursing home facility. Firstly does the author outlines the basis of current private social services environment in Czech Republic and the actual need of the project. The main part of the paper focuses on the practical execution of the plan. Several project possibilities are offered and evaluated with a supporting evidence of expected financial data. Thesis aims to present succinct yet coherent analysis on the real facility operation and differences to already existing competitors. Contrary to those, this project gives special attention to personnel (especially nurses and social nurses) who are a key success factor of the business as such.

Background: People living with advanced dementia in nursing homes often spend the majority of time alone, with little contact with anyone. The need to connect with others is a central part of a philosophy known as Person Centred Dementia Care. A significant body of literature demonstrates the effectiveness of a range of approaches that facilitate connections, yet, we know little about staff perspectives on what facilitates them to connect on a daily basis. Aim: To develop a Grounded Theory to explain what facilitates nursing home staff to connect with residents living with advanced dementia. Methods: Semi structured interviews were conducted with nursing home staff (n=21) and relatives (n=5) from seven nursing homes. Following Strauss and Corbin’s (1990, 1998) Interpretivist Grounded Theory methodology, data collection and analysis proceeded iteratively, and theoretical sampling was used to develop the emergent theory. Results: The Grounded Theory ‘making the most of time’ explains that most connections occurred during personal care. Interdependent contextual and individual factors facilitated staff to make the most of time. Effective leaders were described to create a caring culture in which informal leaders (experienced staff) acted as role models. Staff were then more likely to understand, accept and tolerate dementia, know connections were part of their role, get to know residents and express caring values. In the right physical environment, this then facilitated staff to make the most of time during personal care. Increased training and education from specialised dementia units and experiential knowledge from family engagement then supplement such contexts. Implications: Future research could empirically test the theory ‘making the most of time’

Yes / Objectives: Dementia progressively affects cognitive functioning, including the ability to communicate. Those who struggle to communicate are often considered unable to relate to other people. Frontline care workers are in a position to connect with residents. However, we know little about their perspectives. The aim of this study was to understand how and when nursing home staff meaningfully engaged with residents with advanced dementia. Methods: Semi-structured interviews, supplemented by informal conversations, were conducted with 21 staff from seven nursing homes. Inductive thematic analysis identified themes in the accounts. Results: Four themes related to how staff engaged with residents with advanced dementia (initiating meaningful engagement, recognising subtle reactions, practising caring behaviours, patience and perseverance). Two themes related to when meaningful engagement occurred (lacking time to connect, making the most of time during personal care). Conclusion: A key barrier to implementing formal interventions to improve care is lack of staff time. Staff overcome this by using personal care time for meaningful engagement with residents. Their approach, developed through experience, is consonant with person-centred dementia care. Building on this, future research should use participatory approaches building on practice wisdom to further develop and evaluate meaningful engagement with residents with advanced dementia. / The work reported in this article contributed to a PhD by the first author, with funding awarded to the Centre for Applied Dementia Studies at the University of Bradford by BUPA.