One of Australia’s leading experts on dementia has welcomed the new specialist mobile teams to help aged care facilities care for residents with severe behavioural and psychological symptoms of dementia (BPSD) but says they need to be backed up by a national network of specialist care units.
Assistant Minister for Social Services Mitch Fifield announced last Wednesday that multidisciplinary Severe Behaviour Response Teams would provide advice to residential aged care facilities to assist caring for residents with severe BPSD under a new Federal Government initiative to replace the short-lived dementia supplement.
Professor Henry Brodaty, who is co-director of the Centre for Healthy Brain Ageing at the UNSW, said the response teams would address severe BPSD, or tier five of the seven-tiered triangular model of services, which he proposed with Professor Brian Draper and Associate Professor Lee-Fay Low in 2003 for managing behaviours.
However, he said special care facilities were the next component required to provide a comprehensive service that catered for residents with very severe BPSD, or tier six on the model.
“It is now timely to plan for a national approach to help those residents who are even more severely disturbed and who may be at risk to themselves or to others,” Professor Brodaty told Australian Ageing Agenda.
Residents who cannot be managed in mainstream facilities can be accommodated in the special care facilities, sometimes called psychogeriatric or aged-care neurobehavioural units, for a defined period of time until behaviours abated before returning to mainstream care, he said.
“Such facilities, which require secure grounds, more and better trained staff than mainstream nursing homes, and support from multidisciplinary specialist mental health services for older people, have been shown to reduce problematic behaviours and increase socialisation,” he said.
Models of these special care units exist and are usually developed in partnership with commonwealth and state funding, he said.
Similar calls from providers
Professor Brodaty’s comments on the need for the specialised units echo those of HammondCare CEO Dr Stephen Judd who also called for the introduction more broadly of special care units, such as those units run by Southern Cross Care in Perth and Linden Cottage at Hammondville.
Catholic Health Australia CEO Suzanne Greenwood similarly said specialist high dependency units were needed to provide a more comprehensive response to addressing severe BPSD.
Mrs Greenwood said this suggestion was included in CHA’s 2015-16 pre-budget submission as part of a three-pronged approach, which also included expert advice response teams and funding directed to services that demonstrated capability in managing severe behaviours.
Challenges and short-comings of response teams
While Professor Brodaty welcomed the response teams he said organising them across six states and two territories to provide comprehensive coverage with around $11 million of funding per year would create a logistical challenge.
Coordinating teams with the current Dementia Behaviour Management Advisory Services (DBMAS) would further present a structural challenge, he said.
Adding much stronger criticism, clinical psychologist and dementia educator Bernie McCarthy said he was disappointed the initiative was for teams to provide advice, which the DBMAS already provided enough of, rather than resources.
“All the advice in the world will not resolve the issues staff face when severely disturbed situations arise,” Mr McCarthy told AAA.
“They need better training in person-centred approaches to relating, communicating and problem solving, and they need leadership trained in leading dementia care settings in a person-centred manner so that issues like pain and emotional distress due to inappropriate or ineffective interactions from staff can be addressed.”
He said until there was a person-centred focus that flowed into care decisions with detailed knowledge of the individual there would continue to be excessive levels of behavioural disturbance and short-term fixes like this.
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