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Minister cuts $110m dementia supplement

 

The Federal Government’s decision to axe the Dementia and Severe Behaviours Supplement following a ten-fold blow out in expenditure has drawn sharp criticism from industry and consumer lobbies.

Assistant Minister for Social Services Mitch Fifield announced on Thursday the government would stop paying the $16 per day supplement to providers from 31 July. Mr Fifield said there was no other responsible course of action in the circumstances and he did not commit to a replacement scheme.

Aged and Community Services Australia CEO John Kelly said the supplement’s scrapping was a knee-jerk reaction that would jeopardise services.

Alzheimer’s Australia CEO Glenn Rees told AAA on Thursday that people with dementia were being made to pay the price for the poor handling of the supplement.

The Department of Social Services revealed to a senate estimates committee hearing on 5 June the supplement had already consumed its four-year allocated budget of $52 million in less than 12 months of operation.

Acting deputy secretary of DSS Carolyn Smith told senate estimates the supplement was expected to target 1 per cent of all residents but 15 per cent ended up claiming it.

ACSA criticised the lack of consultation from the government prior to the minister’s decision and said services were now at risk following the withdrawal of funding.

“It is convenient to flick an issue past the Aged Care Sector Committee and say there has been consultation, when there has been no real attempt to forge a clear path where people will be supported properly, despite the blow-out being apparent for some time,” said Adj Prof Kelly.

“A number of aged care providers were in receipt of this funding and it allowed those who had a cluster of residents eligible for the dementia supplement to recruit specialist dementia staff who could provide the best of care for these residents.”

Mr Rees said he was also disappointed the government had taken so long to respond to the oversubscription.

He said there was no sign that the original objectives that were set out in the aged care reforms were going to be implemented.

Shadow Minister for Ageing Shayne Neumann said the minister’s department knew about the oversubscription since late last year and had “every opportunity to act” before it had reached this level of expenditure.

‘Had to happen’

Taking a different view, HammondCare’s CEO Dr Stephen Judd told AAA he was unsurprised by the supplement’s termination.

He said the supplement, which was introduced in August 2013, had been poorly designed and implemented.

“Its cessation had to happen,” he said. “There is still a place to have a supplement but it has to be focused and targeted to that small group with severe behaviours requiring specialist dementia care.”

Dr Judd said there was no validation of the supplement and no requirement on providers to demonstrate what actions they were taking to deliver the specialist care required by their residents.

Have your say: Was the dementia and severe behaviours supplement flawed? Comment below.

An earlier version of this article incorrectly stated that the assessment tool was not validated. This has been corrected.

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12 Responses to Minister cuts $110m dementia supplement

  1. Wendy Ritchie June 27, 2014 at 11:01 am #

    This is a terrible development. I have worked in a specialist behavioral team for the past 5 years on the Central Coast and the Aged Care facilities I visit are barely coping with challenging behaviors now, and the numbers of people with dementia are expected to soar in the coming 20 years. The government should be giving more money to assist with managing these people, not taking it away. Ultimately this will cost more, as aged care facilities will send residents with challenging behaviour into the emergency departments.

  2. Patrick Reid June 27, 2014 at 12:10 pm #

    Read LASA’s statement ‘Government abandons funding for most vulnerable: residents with severe Dementia’ here

    http://www.lasa.asn.au/category/news-and-media/media-releases/

  3. Louise June 27, 2014 at 1:13 pm #

    I would like the government to explain exactly how they could choose to cancel this supplement without having plans for what they will replace it with.
    Just before the report that revealed the number of people who had proved eligible for the supplement, the Senate estimates committee had released a report into the use of psychotropics and restraint in residential care. This report made a raft of
    recommendations regarding the reduction of use of psychotropics and restraint and the improvement in the well being of people living with dementia.
    Then in the next breath the supplement which goes some way to helping providers provide non pharmacological interventions for working with challenging behaviours is taken away!!!!
    I do hope this story reaches the mainstream media and the government is severely embarrassed by their action. To me is displays a callous disregard for the wellbeing of some of the most vulnerable people in our society. Ageism sadly is alive and well.

  4. Louise June 27, 2014 at 1:21 pm #

    Prior to the government revealing the apparent “oversubscription” to the dementia supplement there was a senates estimate committee report released into reducing the use of psychotropic medications and restraint in residential care. The recommendations within went some way to providing a framework for improving the life of people living with dementia in residential care.
    In the very next breath the government cancels the supplement without so much as explaining what they plan to do now.
    This is a cynical exercise in ignoring the well being of some of society’s most vulnerable people.
    I do hope that a major media player makes the link between the two and exposes the governments blatantly ageist exercise and embarrasses them into providing an alternative and fair replacement.

  5. Bernie McCarthy June 27, 2014 at 1:38 pm #

    The Supplement was poorly implemented and poorly used by the industry. The primary problem with the implementation was the scope for abuse by providers and staff conducting the assessments, often not deliberately trying to misuse the tool but simply not having the skills or knowledge about psychological assessment to use the tool validly or reliably. So many residents who were not eligible for the supplement were declared eligible by “false positive” decisions to submit an application for the supplement. Some providers had as much as 60% of their resident group on the supplement and this is an abuse of the supplement that has successfully.

    There was no clarity about compliance or validation by the Department, allowing poor use of the tool to continue.

    If there is some form of supplement in the future, either separate to or integrated into the ACFI Behaviour section, it should be accompanies by better education for the nurses who are expected to conduct the assessments and better guidance for the approved providers so that the tools are used validly and reliably.

  6. Tony Schumacher Jones June 27, 2014 at 1:45 pm #

    This is the most pertinent comment:

    “A number of aged care providers were in receipt of this funding and it allowed those who had a cluster of residents eligible for the dementia supplement to recruit specialist dementia staff who could provide the best of care for these residents.”

    A large proportion of people diagnosed with dementia will display behaviours that tend toward the moderate to severe end of what we might call ‘the challenging behaviours spectrum’. These are the most difficult behaviours that so challenge carers, cause distress to families and, most importantly, significantly reduce the quality of life of the person with dementia.

    The point has been made before that it is not all about money. Society is not a business. It is about people and about people’s lives. Not only will this mean that specialised staff will not be employed to care for those people with dementia who have challenging behaviours, but it will also mean that the carers who do care for them, who do not have the skills required, will be more likely to leave the industry (there is only so many instances of physical abuse you can take after all), take days off sick due to stress or provide care that is not appropriate to the needs of the person.

    But at least we might be able to balance the books.

  7. Garry Wescombe June 27, 2014 at 4:15 pm #

    Once again a good idea wasted due to pathetic public policy and bureaucracy by firstly the Labour Government and then through lack of proper management the Coalition. Is there anything the Labour Party get right when you hand them the public purse. Those saying that they may not be able to properly care for their at risk residents I simply ask, what were you doing before this supplement came along? I dont see anything in it that would “guarantee” you would have been then able to provide the level of care that was required, its just a bit more to spread across the spectrum of your total service provision and the administrative work required to get there and retain currency in your claim is horrendous. Therefore I would say that on the basis of the statistic put forward by the Minister, what else could the current Government do but stop this blatant waste of taxpayers money, including yours and mine. I do agree that it should have been stopped last year by the current government and not got to this outrageous situation, who is looking after the governments budget, reviewing the ongoing cost/income ratio just as we as providers are being told to do all the time lest we become insolvent, I mean where is the management of this policy, I certainly know where I am and what is expected of me by my Board and so a little consistency wouldn’t be out of place. I guess another question would be, what bright spark came up with a figure of 2,000 eligible persons across the whole of Australia warranting a claim. My local scenario tells me there is at least 20% of the permanent resident number who exhibit and are being cared for with severe behavioural dementure. So across Australia you have to be pretty dumb to think that 2000 is going to come anywhere near the figure required. OR was the government of the day just playing games to get us all excited knowing that sooner or later the incoming government would be forced to put a stop to it. I cant wait for all the screams by the Labour party heavy weights calling Abbott and Fifield and Co all manner of poor managers and cheats and liars etc. Meanwhile this industry pays and another black hole turns up right after most of us have set our budgets with some difficulty for 2014/2015. You just have to laugh or you will cry. This is pretty much the reason why I wont consider packages in our area because I have no confidence at all that something just like this will eventuate and the existing services are doing just fine.

  8. Ian Yates, CE COTA Australia June 27, 2014 at 5:23 pm #

    COTA Australia agrees with Stephen Judd that termination of the supplement was inevitable. Many providers were receiving very substantial extra funds without validation and with no guarantee of better outcomes for people with severe dementia symptoms. Providers already got a 2.4% funding boost in the Federal Budget without any obligation to improve consumer outcomes.

    COTA joins with Alzheimer’s Australia in welcoming the Minister’s commitment to work with consumers and service providers to support people with severe Behavioural and Psychological Symptoms of Dementia (BPSD). We look forward to taking part in these consultations.

    We also agree with AA that it is vital that a new scheme is implemented as soon as possible to deliver the original objective of ensuring scarce resources within residential aged care funding benefit those with the greatest needs, and that it is critical that the Government ensure that funding is linked to better care and support for people with severe BPSD, including monitoring the use of restraint and antipsychotic medications.

  9. Russell Egan June 30, 2014 at 6:16 pm #

    The dementia supplement is a fraction of the slashed payroll tax supplement but, as per usual, since the NFPs are not affected by the payroll tax supplement changes it goes with a whimper. This will exacerbate the contradictory taxation treatment of aged care providers.

    Whereas payroll tax supplement goes to the core of privately owned operators revenue, the dementia supplement was a new payment linked to the number of residents with extreme needs. To me it always seemed unsustainable when it was premised on applying to only 1% of residents.

    This is policy on the run by a government simply trying to plugs budget gaps with easy fixes.

  10. Ray Glickman June 30, 2014 at 6:41 pm #

    With great respect to both Stephen Judd and Ian Yates, I disagree with their sentiments that cessation of the supplement ‘had to happen’ and ‘was inevitable’. (Also, in passing, I disagree with Ian’s suggestion that the 2.4% return of the workforce supplement money was a ‘funding boost’). I understand where they are coming from in relation to sustainability and targeting, however, surely the manner of the axeing can’t be accepted? The Minister had signalled consultation with the sector about this issue.This didn’t happen in any meaningful sense. Also, once again, substantial cuts to revenue were imposed by government when providers had already struck their budgets for the forthcoming year. I can accept that a process needed to be entered into to address the issues Stephen and Ian have raised, but I do not accept the manner of this decision-making. Furthermore, I know that this subsidy was being put to good effect for the people that really matter – our residents living with dementia.

  11. Mark McBriarty July 1, 2014 at 3:34 pm #

    This may sound a little naive – but surely residents who are high care with severe behavioral issues would benefit from contributing 95% of their pension towards their own care- rather than the current 85%- this 10% equates to the behavioral supplement that has been withdrawn – 5% for incidentals would cover a high care client whose day to day needs are provided by the facility.

  12. Jason July 2, 2014 at 1:41 pm #

    It is dissapointing to see a potentially useful funding increase be so poorly managed. Hopefully it will be repalced with something that supports good quality person centred dementia care, can be used to create enabling environments and train staff and is based on meeting wellbeing of people living with dementia rather than an antiquated notion of behaviour management. Whilst recognising increased needs of people with dementia we should not be financially rewarding poor care that increases illbeing and subsequent behaviour. We need to flip it around to support good care that increases wellbeing so we don’t see these so called “BPSD’s”

    This is a great opportunity for the Govt to show some leadership in the promotion of person centred care and move away from the old paradigm of behaviour management.

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