The Norwegian Dementia Plan 2015- 'making most of the good days'

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The Norwegian Dementia Plan 2015 ‘making most of the good days’

Knut Engedal

The Norwegian Centre for Dementia Research, Ulleval, Oslo, Norway Correspondence to:K. Engedal, E-mail: [email protected]

Key words: dementia; strategy; national

History:Received 5 June 2010; Accepted 8 June 2010; Published online in Wiley InterScience (www.interscience.wiley.com).

DOI:10.1002/gps.2601

In autumn 2006 the Norwegian government proposed a sub plan of the Care plan 2015 (Report nr. 15 2005/2006:

Long-term care—future challenges) called theDemen- tia Plan (Norwegian ministry of health and care services, 2007). It was debated in the Stortinget (Parliament) during the spring of 2007, and set into action autumn 2007. All political parties supported the plan. It is strategy and action plan for dementia care that aim to improve the care for persons with dementia, the family carers and professional caregivers. Actions should be taken during the time period between 2007 and 2015.

The Dementia Plan has been drawn against a report

’Forgetful but not forgotten’ made by the Norwegian directorate of Health and Social Affairs in 2005 and 2006 (Norwegian directorate of health and social affairs, 2007).

This report outlines challenges and needs and recom- mended focus area. Today about 70 000 of the Norwegian population of 4.8 million suffer from dementia (2005).

Due to longer life expectancy and changes in the age composition in the population it is estimated that twice as many; 140 000 will suffer from dementia in the next 35 years. The sharpest growth will be in 15 year. Several challenges have been identified. The Directorate has specially focussed on the need to implement good knowledge-based services, and to develop new models on how to provide services in primary health and social care (Norwegian directorate of health and social affairs, 2007).

The strategies of the Dementia Plan

The Norwegian Dementia Plan has five main strategies for meeting the future challenges: (1) improving the

quality of care through development measures and research, (2) raising the knowledge and skills of professional caregivers and increase the numbers of professional caregivers working in the municipalities, (3) improving collaboration between professions, (4) support ‘active care’, such as day care programmes of various kind and (5) support partnership between families and professional caregivers working in the municipalities.

Action programmes

The government has instructed the Norwegian Directorate of health to carry out various measures to reach the goal of the Dementia Plan before 2015.

Most of these measures will be carried out between 2007 and 2010.

Diagnostic assessment

According to a recent Norwegian study only 50% of all persons with clear-cut signs of dementia receive a diagnosis regardless the degree of dementia (Lystrup et al., 2006). Only one out of six persons is assessed and diagnosed in primary health care. The Norwegian model for diagnosing and evaluating person with suspected dementia requires collaboration between primary and specialist health care (Engedal, 2002). A person with clear cut dementia symptoms should be assessed and diagnosed in primary health care by the family physician, that should collaborate with a COMMENTARY

Copyright#2010 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry2010;25: 928–930.

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municipality dementia recourse team. It is a goal that every municipality in Norway should organise a dementia resource team, consisting of two persons (nurse and occupational therapist working part time or full time depending on the number of inhabitants in the municipality). Of the 430 municipalities in Norway dementia resource team are organised in 108 (25%) municipalities (Westerberg, 2009). Persons with dementia of mild degree or with mild cognitive impairment, or with atypical symptoms or of very young age should be assessed in a memory clinic in specialist health care service. However, there exists no national plan for how to organise memory clinics throughout the country. Today memory clinics are located in larger hospital in the south of Norway.

Some are affiliated to geriatric medicine, some to old age psychiatry and a very few to departments of neurology

During the action period from 2007 to 2010 a project is ongoing with the aim to develop models on how to assess person with dementia in primary health care and how to organise dementia resource teams in the municipalities. The project is supported by the government with approximately 6.7 million NOK, equivalent with 0.75 million Euros and 27 small and large municipalities take part in the project.

Day care programmes

All municipalities in Norway must offer (manda- tory) residential care to people with severe impairments in activities in daily living. About 40% of all person with dementia live in nursing homes, where the prevalence of dementia is as high as 80%

(Engedal and Haugen, 1993; Selbaek et al., 2007).

According to a recent national survey 130 (30%) of all Norwegian municipalities offer day care designed for persons with dementia. However, most day care centres are small and only seven percentages of home dwelling persons with dementia are offered day care (Westerberg, 2009). The goal according to the Dementia Plan is that every municipality should offer a day care programme, and these programmes should be available for a majority of home dwelling persons with dementia. During the action period from 2007 to 2010, 28 municipalities take part in a development project supported by grants from the government to develop new models of day care programmes. This project is supported with 4.7 million NOK, approximately 0.5 million Euros from the government.

Educational programmes for family carers -‘carers schools’

Several educational programmes for carers have shown favourable results for patients and carers (Mittelman et al., 1993; Pinquart and Sorensen, 2006; Ulsteinet al., 2007). Initiatives have been taken to organise such programmes throughout Norway the last 10 years, but still only 66 (15%) municipalities offer such programmes, and in most cases in co-operation with local Alzheimer’s clubs other volunteer organisations. The government’ goal is that all municipalities should offer educational program for carers of persons with dementia in 2015. During the action period from 2007 to 20101 the government therefore support a project with 4.7 million NOK, approximately 0.5 Euros, that has the aim to develop models on how to organise and carry out educational programmes for carers. In all 37 municipalities take part in this project.

Research and development measures (R&D)

According to the Dementia Plan a dedicated research programme under the direction of the Research Council of Norway will be carried out. This research programme will focus on municipal health and care service. The funding for this programme will be gradually stepped up in the years to come. In addition regional R&D centres for care research will receive grants. However, in 2009 the grants for dementia research are still very modest and has not been increased compared to 2007 and 2008.

During the programme period 2007 to 2010 the Norwegian directorate for Health will implement R&D projects for special groups of patients. The size of the grants for each project is 5 mill NOK, equivalent to 0.55 million Euros: (1) Younger persons with dementia. This R&D project focus on diagnostic assessment, use of technology and development of new services to the whole family, including children. Collaboration with other Nordic countries is wanted. (2) Persons with dementia with minority language background.

This is an area where the knowledge is sparse worldwide. The project will focus on assessment strategies and methods and development of services designed for different ethnic minorities (3) Person with dementia with Saami background is a project that also will focus on diagnostic assessment and service provision in accordance with the Saami tradition and culture (4) Treatment of persons with dementia with challenging behaviour living in residential care.

This project will focus on different ways to intervene in

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nursing home to reduce and treat behavioural and psychiatric symptoms without the use of psychotropic drugs. Methods such as Dementia Care Mapping, Person centred care and Marthe Meo will be introduced in care facilities

Educational activities of professional caregivers

Health and social care personnel that provide care for persons with dementia are often less well educated and lack knowledge in basis skills how to understand behaviour, treat and give proper care to person with dementia. Therefore the government will give grants in the amount of approximately 5 million NOK (0.55 million Euros) to the development and imple- mentation of the teaching aid called ’Dementia ABC’, a teaching aid that can be used for internal use in all municipal care facilities

Information campaign

About 1 million NOK, or 0.9 million Euros will be spent for information campaign to the public. The campaign will take place in 2010.

The norwegian centre for dementia research, education and service development

Since 1997 the Ministry of Health and care services has given economical support to a national research and knowledge centre of dementia. Today this centre is part of the Norwegian centre for ageing and health, which is a centre for research, education and service development for patients, carers an professional caregivers with dementia, psychiatric disorders in old age, functional impairments and intellectual disabilities in old age. The centre work in close collaboration with he Directorate of health to accomplish all the action programmes outlined in this paper.

Conclusion

The Norwegian government has in 2006, in agreement with all political parties proposed a care plan for persons with dementia. After a debate in the Parliament the plan was set into action in 2007. It consist of a strategy plan from 2007 to 2015 and several action programmes. The main purpose of the plan is to improve services for persons with dementia and their carers and professional caregivers working in primary care. Three priority areas are identified. In 2015 every municipality in Norway should have organised a dementia resource team that should offer diagnostic assessment in a collaboration between the family physician and the dementia team, offer day care programmes, offer educational programmes for family carers in so called carers’ school and offer an internal educational programme for professional caregivers in all municipal care facilities.

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