Back in 2016 we redesigned the Memory Assessment Service following feedback from the people that utilise it. They told us that they believed diagnosis was not as important as support.

Here is the story of Bert, one of the MAS service users. In this case study we take a look at Bert’s situation, how his and his loved ones were supported, and some of the principles we followed along the way. Names have been changed to protected identity.

Bert’s Background

At the time when Bert entered the care of the Brighton & Hove Memory Assessment Service he was 86 and had started showing aggressive and unusual behaviour. This was reported by his wife, who was also his carer.

Bert had a history of alcohol abuse and continued to drink 10 units of alcohol per day. Bert had worked as a pilot and was very proud of this. He was now suffering the loss of most of his sight which was something that upset him greatly.

Bert was diagnosed with Mild cognitive impairment (MCI) in April 2016 and had a reassessment in December 2016 where the nurse noted Bert’s behaviour changes and the stress this was causing his wife. Bert’s wife was starting to neglect her own mental and physical health at this point.

Understanding what’s important to everyone

What the Memory Assessment Service did for Bert and his wife

Once we were informed of Bert’s situation, two Memory Service Workers (MSW) were assigned and responded quickly to concerns, offering a home visit. This was all before Bert’s diagnosis, with the aim of offering support to him and his wife.

The MSWs spoke separately with Bert and his wife so they could speak freely about their home situation. They both felt that the recent aggressive behaviour was an isolated incident due to a chest infection and were no longer worried.

Bert’s wife was encouraged to engage with the carers centre but she did not feel that this was necessary as she felt Bert’s behaviour had returned to normal. Bert was encouraged to engage with our Brighton and Hove Wellbeing Services but did not want to do this.

Bert and his wife were given contact details for a number of local support services as well as for their assigned MSWs.

A few weeks later…

Bert’s wife called MAS a few weeks later saying she was overwhelmed and unwell herself. She explained that Bert had deteriorated and she needed support.

BERT’S WIFE: “I’m unsure of who else to contact”

Their Memory Service Workers raised a safeguarding alert and made an urgent referral to Access Point to arrange respite. Bert’s diagnosis appointment was bought forward and their MSW arranged to be present for it.

After investigation, Access Point referred their case onto mental health specialists, the Enhanced Duty team (EnDu) due to the complexity of Bert’s case.

The MSWs listened to Bert and his wife who told us they were beginning to feel overwhelmed with the number of professionals involved and so we took a step back. EnDu have now taken the lead and are offering support for Bert and his wife.

“The Memory Service Workers have given me the most support out of anyone”

Memory Assessment Principles

• You have the right to have help as you enter the service. We will help those who love/care for you to support you
• We will use the assessments and views of other professionals to help you
• We pay attention to your emotional and psychological needs
• We will hold you until we have found or helped you to find solutions to what matters to you

Without the Memory Assessment Service

• Bert and his wife would have only received support following a positive diagnosis of dementia. They would not have received any support in the time between his reassessment and diagnosis.
• During the two months between assessment and diagnosis, without input Bert’s rapid deterioration would have likely ended in crisis due to a break down in the relationship between Bert and his wife, and a deterioration of their physical and mental health.
• If MSWs were not able to visit Bert and his wife before his diagnosis, they may not have felt able to call MAS during their time of need.
• If Bert had received another diagnosis of MCI he would have been put back on MAS waiting list for reassessment and he and his wife would not have been able to access any support from MAS.

Outcomes for Bert and his wife

The Enhanced Duty team arranged temporary respite for Bert at a local care home meaning he is safe and being well looked after. Bert’s wife now reports being able to fall into a deep sleep, and sleep through the night and says she will focus on her own wellbeing. She is now in touch with the Carers Centre.

Bert’s wife visits him every day and takes him to the pub, which is something they have always enjoyed doing together. The Enhanced Duty team plan to arrange a package of care to enable Bert to return home when he and his wife feel it is the right time.