Table 7.

Practice recommendations for domain 6 “services and policies” with steps to implement the recommendation

PR 6.1 Services for the evaluation, management, and care of people living with HVC impairment should collaborate to establish communication and shared care pathways	All 3 disciplines should work together to develop assessment and interventions and build care pathways by means of cross-discipline training (TF)
	All healthcare workers in the broader fields of older adult care need heightened awareness of added risks and burdens from overlapping cognitive and sensory impairments [13]
	Joint working is essential to maintaining individuals independence and QoL and ensuring the most appropriate forms/holistic rehabilitaion and support (PC/PPI). It can be undertaken through [53] (TF)  Direct referrals for specialist assessments  Joint assessments  Community consultation service with a “named worker” specialising in the alternate field acting as liaison between HVC teams  Knowledge transfer: shadowing of each other’s practice, team presentations, training, and skills
PR 6.2 Health and care settings should have appropriate environments and adapted procedures to support people living with HVC impairment	Consider the patient and care partner journey/experience within your service setting or clinic for each type of appointment/engagement; taking into account how that journey/experience may be impacted by HVC impairments. Look for ways to improve or mitigate systems and processes so that people with HVC impairments can access your services and get the most from them (TF)
	All 3 disciplines can adapt procedures for health appointments to support HVC (TF) (PC/PPI)  Adapting appointment letters to have adequate font size and prompts to bring sensory-corrective devices if use them  Availability of supportive equipment (i.e., low-cost amplification/acuity devices) in clinics to support the needs of people with HVC  Consider whether additional time is needed for appointments, or whether more than 1, shorter appointments would be preferable - discuss options with PwD and their care partners  If domiciliary visits are feasible within local funding models/service pathways, make sure people living with HVC are aware of this option  Increase training of all staff patients will come into contact with regarding awareness of patients’ needs (see PR 1.1)
	Review environments and make changes to ensure fully accessible to people with HVC impairments, including both inside and outside of clinical environments (communal spaces, waiting areas etc) [70] (PC/PPI)  Clean, pleasant, bright, comfortable, quiet, minimise hard surfaces, and disruptive noises  Ensure adequate signage/directions to support people with HVC, that is, they should large, at appropriate height with good contrast
	Ensure all HVC health records are up to date and are available to clinicians and care providers working across the 3 fields as well as transfers to hospitals and care homes (PC/PPI)

QoL, quality of life; PC/PPI, professional consortia and/or patient and public involvement groups; PwD, people living with dementia.