When we research or evaluate new interventions we often tend to focus on what impact they have for people with dementia, family carers and or staff members. While there’s nothing wrong with that, and obviously it’s a very important thing to find out, we can overlook some of the more practical aspects such as how you implement it and how much it might cost. Our Namaste Care Intervention UK (NCI-UK) project is very much focused on both of these areas, and this blog looks at some of the issues around the costing side of the project.
(For those of you want a quick recap, Namaste Care is a multi-component approach that aims to improve quality of life for people with advanced dementia in care homes. It combines physical, sensory and emotional interventions such as hand massage, music, nature, hair brushing, aromas, lighting, soft blankets, food and drink. It was developed by US practitioner Joyce Simard who recommends delivering Namaste Care sessions twice a day, seven days a week.)
Why is cost overlooked?
From our experience with NCI-UK, I’d say because working out how much something costs is actually quite a tricky thing to do! Namaste Care is often called ‘cost neutral’ because it doesn’t need any extra staff, space or expensive equipment. Essentially, a lot of the resources you might use during a Namaste Care session can probably be found within a care home anyway, such as pillows, toiletries and food treats. Delivering Namaste Care may therefore be more about reallocating what already exists, but this means that many of the actual costs can be hidden. If you only looked at what you bought in new, you would seriously underestimate the true cost of NCI-UK.
Ok, this is sounding quite complicated already
Sorry! Think about it this way then: assume that you’re starting with nothing, and everything used in an NCI-UK session has to be accounted for within your costs. So staff salaries are already paid by a care home, but from a cost point of view you need to work out how much it would cost to pay them for the duration of an NCI-UK session. Similarly, you might already have pillows, but how much would it cost to buy a pillow for everyone who attended a session?
I can see why people don’t normally look at cost!
I did warn you it was a bit tricky! Basically, for NCI-UK we’ve costed all of the staff, room and consumables (e.g. pillow, moisturisers, music etc.) that you might use during a session, and put it in a big spreadsheet which is our ‘cost model’. If you know what happens during an NCI-UK session, who was present and how long it lasted, we can get the cost model to give an estimated cost for that session.
What do you do with it after that?
As part of the project five care homes have been delivering NCI-UK sessions in practice and capturing information about what they did. We can use this ‘real world’ data to feed the cost model and get a cost for each session. Combined with the impact of each session on individual residents with dementia, we’ll be able to look at the cost benefit aspect of NCI-UK too.
We’ve also considered what residents would be doing if they were receiving ‘usual care’ instead of being in a NCI-UK session. By getting a cost for this, we can also see what the difference is between NCI-UK and usual care. It’s all very well knowing how much NCI-UK costs, but unless you’ve got the usual care cost as a benchmark, you don’t really know how it compares. We haven’t quite finished our analysis yet, but hopefully we’ll get lots of interesting results relating to costs. It’s quite exciting for us, as no one’s done this before for Namaste Care!
How does it relate to other interventions?
Although the costs for individual aspects would be different as NCI-UK uses different resources to, for example, a gardening intervention, the basic process for working out the cost would be the same. Other interventions might also be simpler as NCI-UK can potentially involve quite a wide range of components, all of which had to be costed!
It sounds interesting and useful, but I’m not totally sure I’m ready to give it a go
It was a new experience for us too, and I admit it hasn’t always been totally straightforward, but it’s definitely one of those things that will be easier next time. Once you’ve tried it and got your head around how it all works, it does make sense, honest! After costing a multi-component intervention like NCI-UK, anything else will seem like a walk in the park. Hmm, going for a walk in the park – how much would that cost…?
If you want to know more about the NCI-UK cost model, please see a journal article we’ve recently had published on it.
Our other blogs about different aspects of the NCI-UK project may also be of interest: