Alzheimer’s Scotland Link Workers

What was the issue you were addressing or working on?

To improve the support available to people living with dementia, their families and carers pre and post diagnosis.


What you did?

Following analysis of the roles and tasks of Health & Community Care Staff working with people living with dementia, their families and carers, an area for improvement was identified in the post diagnostic period.  Working in partnership with Alzheimer’s Scotland the Partnership has developed and implemented Link Worker roles to support people living with dementia, their families and carers in the period immediately after diagnosis and beyond.

3 Post Diagnostic Link Workers were appointed and based within the Older Peoples’ Mental Health Team in Perth City (OPCMHT).  Their role was to support the model of early identification and diagnosis by the OPCMHT by working with individuals diagnosed with dementia and their families and carers, advising on management of behaviour, monitoring medication, assisting in crisis management, liaising with consultants and other relevant professionals, identifying desired outcomes and helping support their achievement by advising and arranging suitable supports.

However, when these posts were reviewed it was identified that the Link Workers were spending the majority of their time involved in key worker activities for a small number of clients who had complex support requirements.   As a result of this their role was altered.  The keyworker role was taken away and people with complex support requirements, pre or post diagnosis, were allocated to a CPN or social worker.  This allowed the link Workers to focus on support people and their families in accordance with the ‘5 pillars’ model.  It also meant that one worker could cover Perth City, North Perthshire and South Perthshire.  Therefore support from a link worker is now available across Perth & Kinross.


What were the outcomes - benefits or otherwise?

The Link Workers posts are funded through the Change Fund initially for a two year period.  An annual review of the service was undertaken in May 2013 with the changes made as indicated above.  This review has evidenced that the link workers are supporting people living with dementia, their families and carers achieve the outcomes indicated below.  The final evaluation of the service will commence January 2014 again using quantative and qualitative information to identify the full contribution and impact the service has made.  Recommendations will be made to the Board on whether they should continue to invest or disinvest.

  • Reduced isolation of carers and people living with dementia
  • Reduced feelings of stress
  • Reduced incidence of depression amongst carers
  • Increased awareness of dementia
  • Increased awareness of sources of support
  • Increased knowledge of managing symptoms
  • Increased social interaction
  • Increased control of support
  • Improved quality of life for person living with dementia and carer
  • Increased peer support
  • Increased stimulation
  • Delayed admission to permanent care

Contacts - to find out more

Fiona Cole, Service Manager, Alzheimer’s Scotland,  FCole@Alzscot.org   01738 215101