Most specialist care residents return to mainstream services

A study has found that the majority of residents with very severe BPSD in specialised care return to mainstream aged care services in about 12 months.

Most aged care residents with very severe dementia-related behaviours are able to transition back to mainstream services after a year in specialist dementia care, a 10-year review of a HammondCare service shows.

The research paper describes environmental design, governance, clinical processes, characteristics and outcomes of 80 aged care residents with very severe and persistent Behavioural and Psychological Symptoms of Dementia (BPSD) at HammondCare Linden in south-west Sydney between November 2007 and December 2018.

Under a state partnership, the home offers a similar set up to the Commonwealth Government’s Specialist Dementia Care Program (SDCP), which was announced in 2016 to provide interim care for up to 12 months for residents who are unable to be cared for in mainstream aged care due to the severity of their BPSD.

To date, 10 of the 35 planned 8-12 bed SDCP units across Australia’s 31 Primary Health Networks are operational, with the remaining expected to be up and running by 2022-23.

The study found that the average length of stay at Linden was slightly over 12 months and that all residents except one could transition back to a mainstream aged care service after this time.

The findings highlight that these type of specialist care units can effectively support people living with very severe and persistent BPSD, said study co-author Thomas Morris, who is senior service manager of research and analytics at HammondCare.

Thomas Morris

“We know that the model works and we know that it can support these residents to transition them back into mainstream care,” Dr Morris told Australian Ageing Agenda.

The Linden specialist dementia home includes an eight-place domestic-style residential cottage and an eight-place transition program.

The cottages provide a small, low stimulus, homely and enabling environment that includes clear visual access to promote wayfinding for residents and ease of monitoring by staff.

They include a domestic-style kitchen and safe garden accessible at all hours, individual rooms with ensuites and two care workers per eight residents on duty at all times.

The study found a significant reduction in antipsychotics during a resident’s stay, with 85 per cent of residents prescribed a regular antipsychotic at admission compared to 62 per cent at discharge.

It also identified a reduction in as needed antipsychotics, regular anxiolytics and as needed anxiolytics and paracetamol from admission to discharge but not significantly, the report said.

Dr Morris said it was “really important” to transition residents with very severe BPSD back into mainstream aged care.

“These aren’t the final endpoints for a person’s care or trajectory in life. It’s about providing them with gold standard support and understanding, so things such as their behaviours can be understood and acknowledged in a welcoming environment,” Dr Morris said.

“Medications can be assessed for suitability and titrated if necessary, and then re-incorporated into mainstream solutions,” he said.

The study shows that small cottage models of care with higher staff-to-resident ratios are effective, Dr Morris said.

“Previously, these behaviours were very difficult to support in mainstream residential aged care settings… And this is a solution that really benefits them and improves their quality of life.”

The paper was published in the Australasian Journal on Ageing in May.

Access the study.

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Tags: dementia, hammondcare, research, sdcp, specialist-dementia-care-program, thomas morris,

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