Hard data on dementia in nursing homes

A report from the AIHW has crunched the numbers from the Aged Care Funding Instrument’s first full year of operation, focusing on dementia.

By Stephen Easton

New figures from the Australian Institute of Health and Welfare (AIHW) back up previous estimates that most Australians who live in nursing homes have dementia.

The report, Dementia among aged care residents: first information from the Aged Care Funding Instrument, found that 53 per cent of people who were the subject of an Aged Care Funding Instrument (ACFI) assessment in 2008/09 had a confirmed medical diagnosis of dementia.

Of those with a dementia diagnosis, 87 per cent were assessed as having high care needs, compared with 68 per cent of other residents without a diagnosis.

While the figures only confirm what many have suspected for quite some time, finding the actual number of people with a diagnosis of dementia living in residential aged care would not have been possible prior to the introduction of the ACFI system in 2008.

The CEO of Alzheimer’s Australia, Glenn Rees, said the figure confirms dementia as core business in aged care, and that the ACFI system had helped redress the lack of recognition for the scale of the epidemic.

“We have known for a long time that dementia is an enormous issue and that it is both under-recognised and underfunded in aged care,” he said. “The introduction of the Aged Care Funding Instrument recognises at long last the extra costs of providing dementia care.”

The ACFI assessments were mined for the detailed information they contain on all people who entered aged care during 2008/09 (and didn’t leave before the assessment was completed), and any whose previous Resident Classification Scale (RCS) had reached its 12-month expiry date.

The needs of people with dementia were found to be higher in two of the three domains used in ACFI assessments to determine the level of Commonwealth support required by each aged care resident.

Almost half of the group with dementia had high care needs in terms of the activities of daily living (ADLs), compared with about 27 per cent of residents without the diagnosis, while nearly 60 per cent presented high-level challenging behaviours, compared with 20 per cent of the rest.

In terms of complex healthcare, there was no significant difference found between those who had been diagnosed and those who had not, but on average, people with dementia needed $6500 more per year to take care of them.

Aged Care Association CEO, Rod Young, said Australia’s response to the dementia epidemic had been inadequate thus far, due to “a very centralised planning system imposing a one size fits all response to a variety of care and clinical needs”.

“The [AIHW report] clearly demonstrates the need for flexibility to be the cornerstone of future care systems,” Mr Young said. “When you compare Australia with comparable systems in other countries, the other systems are responding more rapidly to a changing client population and particular service need.”

The new data adds further weight to estimates already accepted by many in the industry. Alzheimer’s Australia President, Ita Buttrose, put the figure at 60 per cent of the nursing home population in February this year, and according to Chris Hatherly from the organisation’s research division, the real figure is likely to be even higher.

Brent Diverty from the AIHW, who worked on the report, said the larger estimations often included the approximate number suspected to have undiagnosed dementia, which could add significantly to the total.

“Our measures [only] used a confirmed medical diagnosis of dementia,” he said. “There is a threshold where you pass over to a diagnosis but there are people who, in the lead up to that diagnosis, might have all the signs and symptoms.”

“What’s unique about our study is this is the full [nursing home] population, so this is a very robust number.

“This information can be helpful to providers and other stakeholders to describe what the level of dementia is in aged care, and what some of the unique care needs are of those residents. But we’re retrospectively looking at the situation, and my sense is this wouldn’t come as a surprise to most providers.”

Tags: aged-care, ageing, ageing-agenda, aihw, alzheimers-australia, australian-institute-of-health-and-welfare, brent-diverty, dementia, dementia-among-aged-care-residents-first-information-from-the, glenn-rees, nursing-home, residential-aged-care, rod-young,

3 thoughts on “Hard data on dementia in nursing homes

  1. I think you could have a lot of figures wrong doctors don’t always diagnose dementia and a good percentage of people are in nursing homes under false pretenses with mostly medication related problems and Aged Care Providers fudging the numbers to get more funding unless you sit down at every single Aged Care Facility and study medications provided and also doctors diagnosis you will find that a good percentage of these people can stay at home and be cared for with a change of medication. Quite a lot of residents also aquire dementia in Aged Care Facilities because they are understaffed because the providers aren’t making enough money

  2. I agree that caution must be given to statistics provided by those with a vested interest. The one thing that people with dementia can’t do is speak for themselves because they are deemed as lacking mental capacity – whether or not they do – and they are chemically restrained if they resist.

    This smells too much of nursing homes trying to get their hands on the resources of ARIPs (asset rich income poor).

  3. I find the above comments are idealistic. Aged care in the home is only one stage on the road of dementia because it is progressive (our current medical knowledge and capacity to treat is not able to prevent this). Lacking mental capacity is real but the government is keen, if anything, to keep people at home for cost reasons. My mother is in high care with vascular dementia because of her inability to cope with toileting, memory loss, need for supervision and nursing and following a diagnosis in hospital of dementia. If anything, the rate of disability from dementia is definitely under-reported. Her struggles had been going on for some time (I lived with her and observed but did not comprehend the cause) before arriving in hospital after yet another bad fall. The attitude to how to care for the individual should improve but the facts of increasing rates of dementia are real. There are also many relatives just as ignorant and seemingly stupid as I was about the health signs, who are puzzled by changes physical and mental but everyone simply carries on until the old collapse in a heap. This could easily happen to me too, within the next twenty or so years! No-one in my family responded effectively.

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