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Response teams to address severe dementia behaviours

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.

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

John Kelly

CEO of mission-based provider peak Aged and Community Services Australia, John Kelly, 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

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

Ian Yates

Chief executive of Council on the Ageing (COTA) Australia Ian Yates 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.

Carol Bennett

Carol Bennett

Alzheimer’s Australia said it supported 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.

Stephen Judd

Stephen Judd

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.

Lin Hatfield-Dodds

Lin Hatfield-Dodds

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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6 Responses to Response teams to address severe dementia behaviours

  1. Concerned February 4, 2015 at 1:31 pm #

    Would like to have more details. I am unsure how this will work when you are 3 hours from a major city and an episode takes place at 3 am on a Sunday morning and apart from taking some direct action to address the situation what will the “flying team” do.

    Is this not a reintroduction of the old “Dementia Support service” that many State Health Departments ran in the past? with moderate success.

    While this may address some of the medium and long term issues what do we do when we require staff, in the short term, to deal with behavior issues, which is what the original supplement was designed to do?

  2. Gregory Millard February 4, 2015 at 2:39 pm #

    At this stage, all that’s been presented is a concept. It really requires a more detailed summary of strategy and execution. How will this new approach help a facility with a high proportion of advanced dementia clients? It’s hard to see how a robust program that will draw on what is already in place (DBMAS) is going to be cost efficient and produce better long term results.

  3. 28 years in aged care February 4, 2015 at 2:40 pm #

    Maybe we can put this into the “intergenerational theft basket referred to by the PM several times in his address to the National Press gallery the other day

  4. Sandy Bartlett February 4, 2015 at 9:38 pm #

    The key to addressing behaviors of concern, whether it be in an Aged Care setting or in the Community – is to have staff, who are trained extensively in strategic interventions. Staff who regularly work with the client(s), not a team who are contacted outside the workplace. Training of staff during their initial certificate course and ongoing training by the facility or organisation.
    I have 20 years experience working in Aged Care Facilities and Community Care – now as a Trainer and Assessor in Aged Care and Disability, I am endeavoring to ensure that my students have a very clear understanding of their role with clients with behaviors of concern. Teaching them from my experiences and the latest strategies and interventions.
    Why must the Government waste millions of dollars, forming teams of people! Educate those who are already working with the clients and give funding to educators and RTO’s
    Stop complicating the Industry.

  5. Eden in OZ & NZ February 5, 2015 at 2:26 pm #

    Our organisation , Eden in Australia & New Zealand welcomes new initiatives to better support people living with dementia. However we feel this proposed service is missing the key issue of why many behaviors present in people with dementia in the first place. For many people with dementia, the behavior we may label as BPSD, is a way of the person communicating their unmet needs. The need to feel connected, to have meaning and purpose, to have a sense of identity and to feel joy. Is it surprising that when people do not have this in their life they communicate their ill-being through behavior? Research clearly shows that a care environment that is physically enabling, socially supportive and that meets human needs can have a dramatic effect on the presentation of behaviors of unmet need in people living with dementia. Sadly this proposal does little to be proactive in addressing these issues and give care providers the dementia specialist education, leadership training and support and culture change resources they need to undertake this transformational work. Responding to behavior after the event with a medical model approach will not resolve the underlying causes for the person or the care environment. We urge the Government in its review of dementia funding to take a comprehensive approach to supporting the needs of people living with dementia through improving dementia design, providing free dementia specialist training and to promote culture change to implement a person centered approach.

  6. Bonzodog March 2, 2015 at 2:41 pm #

    “For many people with dementia, the behavior we may label as BPSD, is a way of the person communicating their unmet needs. The need to feel connected, to have meaning and purpose, to have a sense of identity and to feel joy. Is it surprising that when people do not have this in their life they communicate their ill-being through behavior? ”

    Whoever you are – you have summed up dementia care in a few words.

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