Drawing on the experience of looking after 50 patients with dementia, this paper describes a practical approach by one GP to making a difference for people with dementia in care homes especially at the end of life. Included is the use of advance care plans and enhanced annual reviews drawing on GSF prognostic indicator guidance. Using case studies, the following topics are discussed: pain assessment, end of life care, emergency situations, hospital admission avoidance, swallowing difficulties, acute agitation and cardiopulmonary arrest. The forms and protocols which have been developed to support decision making in these situations, along with details of the website on which they can be found, are discussed. The potential benefits of significant event meetings and a GP practice to care home alignment model are also outlined.
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