New dementia care model

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Multidisciplinary ‘Severe Behaviour Response Teams’ will provide expert advice to residential aged care facilities that need assistance caring for residents with severe behavioural and psychological symptoms of dementia (BPSD) under a new Federal Government initiative.

The new model replaces the former dementia supplement paid to providers, which was axed in June last year following a 10-fold blow out in expenditure, and will be resourced under the previous supplement’s funding allocation of $54.5 million over four years. The response teams, which will assess the causes of a resident’s BPSD and provide care advice to staff, are expected to get underway later this year, following a competitive tender process.

What are the response teams? Read Australian Ageing Agenda’s explainer here.

The teams will initially “work closely” with the existing Dementia Behaviour Management Advisory Services (DBMAS) in each state and territory but will ultimately be integrated with the DBMAS from 2016-17, the government confirmed. In addition to the new response teams, the government announced it will conduct a review of the $130 million worth of existing programs that provide support to people with dementia and their carers to ensure “national coordination, integration and effectiveness.”

The response teams were one option put forward at the Ministerial Dementia Forum on 11 September last year, where more than 60 key stakeholders and experts were canvassed on the possible replacements to the axed supplement. Sector reaction There was mixed reaction from sector stakeholders to the government’s announcement.

While a funded replacement to the former supplement was welcomed, consumers and providers were at odds over whether the response teams were the best approach.

John Kelly, CEO of mission-based provider peak Aged and Community Services Australia, said the idea of response teams had merit but whether they could provide resources and expertise quickly enough to circumstances in regional, rural and remote areas would need monitoring.

“If this is a city-centric fix to a large problem, it will disadvantage many people with severe behaviours all across Australia,” Professor Kelly said.

Roaming teams of experts may work in the first instance but building capacity through a whole-of-workforce approach needed to be part of the future workforce development policy and funding, he said.

Professor Kelly welcomed the review into existing programs but said the government also needed to consider further funding the appropriate internal expertise to work with residents on an ongoing basis, perhaps as a component of the national workforce strategy.

Patrick Reid Leading Age Services Australia said it welcomed the government’s review of existing dementia programs but said it was concerned the new mobile teams would not help build long-term capacity within the industry.

“There is a risk that the specialist response teams will simply be a quick fix with no enduring increase in skill levels for those dealing with severe behaviours,” said CEO of LASA Patrick Reid.

Ian Yates Chief executive of Council on the Ageing (COTA) Australia said the creation of the response teams was a positive first step in improving dementia care in the industry but ensuring the new teams worked closely with DBMAS in each state and territory would be critical to their success.

“People living with dementia are core business of aged care and aged care providers have to do much better than most do now in responding positively to their needs,” he said.

“Indeed many behavioural challenges are the result of provider failings rather than resident behaviours.”

Mr Yates said the Federal Government’s commitment to review all existing dementia programs was also welcome. He said the government could also use its control over the allocation of aged care places through ACAR to direct priority to those providers with a solid track record in dementia care.

Alzheimer’s Australia supports the new measure and hoped it would lead to a reduction in the use of physical and chemical restraints in residential aged care.

The peak body’s CEO Carol Bennett said she welcomed the government’s acknowledgement that this was only one part of a longer term strategy to support people with dementia who experience severe behavioural symptoms.

HammondCare, which provides aged care and palliative care in NSW and Victoria and manages the DBMAS in NSW, said it welcomed the new teams as a good first response, but it called for pain management education for care staff and more specialised care units.

HammondCare CEO Dr Stephen Judd, who participated in the Ministerial Dementia Forum last year, said the DBMAS in some states found that more than half so-called severe and challenging behaviours were related to unrecognised pain rather than the underlying dementia.

Environmental triggers such as noise intrusion were also a leading factor, he said. Dr Judd said the government’s review of dementia programs should include education for nurses and carers in identifying and treating pain experienced by people with dementia.

“A longer term response also needs to include the introduction more broadly of special care units for people with severe behavioural and psychological symptoms of dementia, such as units run by Southern Cross Care in Perth and our Linden Cottage at Hammondville,” Dr Judd said.

National Director of UnitingCare Australia Lin Hatfield Dodds said the government had clearly understood the concerns raised at the dementia forum and that it was right to trial a new initiative to improve care capacity.

“It is a positive step forward both for the people who need specialised care and for the services doing their best to provide that care with limited resources,” said Ms Dodds, who was speaking on behalf of UnitingCare’s provider agencies.

She also welcomed the comprehensive review of existing dementia programs.

Clinical psychologist and dementia educator Bernie McCarthy asked how the new response teams would differ to the work of DBMAS.

“I can’t see how this will provide residential aged care facilities with anything different to what is currently available,” Mr McCarthy told Australian Ageing Agenda.

“The DBMAS are supposed to have the experts so where are we going to find people to staff these teams?”

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