Hope for the hardest cases of all

A small trial project has demonstrated successful transitional care for homeless older people struggling with substance abuse and alcohol-related brain injury, leading to extremely challenging behaviours.

Above: CEO of Wintringham, Bryan Lippman.

By Stephen Easton

A trial of intensive individualised support has shown to be a clinically effective and cost-effective way of improving the lives of older homeless people with alcohol-related brain injury (ARBI) who exhibit challenging behaviours.

The Wicking Project put seven people with substance abuse problems and related brain injuries though a transitional program, based around intensive personalised support delivered in a four-bedroom house owned by specialist aged care provider, Wintringham.

The group participated in a program of recreational activities, behaviour modification and individualised rationing of alcohol and tobacco, with a ratio of 1.5 carers to four residents. The outcomes for the experimental group were compared with a ‘control group’ of seven others with similar issues who remained living in the community.

The project demonstrated a statistically significant reduction in anxiety, depression and alcohol consumption among the participants, according to its final report, authored by Wintringham’s research manager, Dr Alice Rota-Bartelink.

Dr Rota-Bartelink also reports a saving to taxpayers of around $30 a day, compared with the cost to the government of people living in the community “who frequently access crisis and emergency services in the pursuit of having their needs met”.

Managing challenging behaviours is nothing new for Wintringham, which has taken in older people who have experienced homelessness, including some “for whom all other avenues of care have failed”, for over 20 years.

But it is difficult to help every person, according to the organisation’s CEO, Bryan Lippman. There are some individuals whose violent and aggressive behaviours are so severe that even Wintringham has, like other service providers, struggled to provide care for them in its aged care facilities.

This group of people “tend to be shuffled between homeless service providers, housing support services, emergency services, correctional services and mental health services, all of which cannot provide appropriate long-term residential care solutions”, according to the research report.

“I always felt we had the skill to look after these people, but we just lacked the funding,” Mr Lippman said. “The everyday funding that Wintringham receives from [the Department of Health and Ageing] doesn’t cover the kind of support these people need.”

The JO & JR Wicking Trust provided the necessary funding of about $1 million for the project, which Mr Lippman said had been “quite a stunning success”.

“The trial demonstrated we actually didn’t need another program for people who are a danger to themselves and other people around them,” he said. 

“What we needed was just this intensive support over about six months because brain injury is not a disease, it’s an injury; it doesn’t get worse.

“We found that with intensive support and care over six months people can actually transfer back into our normal aged care service – maybe not a mainstream one, but within Wintringham that is certainly possible.”

“[…] It’s been wonderful to see people transition back into our normal service. One man, when the [former] Prime Minister came, he entertained Mr Rudd. They yakked and laughed; he’s still a wild and woolly man, but months earlier he was a danger to everybody.”

Mr Lippman said he believed the small trial had “enormous implications for the rest of aged care”, in clearly demonstrating that people with alcohol-related brain injuries could be rehabilitated if their substance abuse was controlled.

“This type of study demonstrates they can and should be cared for in a totally different way to people with other forms of dementia.”

Dr Rota-Bartelink’s report includes not only data and analysis but also short stories on each of the seven participants, which give a human face to the project’s successes, as well as the more unfortunate and tragic cases where participants could not complete the program.

The Wicking Project will soon move onto its second stage, which will see people with ARBI go straight into a new aged care facility Wintringham is building in Dandenong, in south-east Melbourne. 

“There is going to be half a dozen people with alcohol-related brain injury and they’re getting the Wicking treatment in-situ, in the building itself,” Mr Lippman said.

“It’s only just started but it’s already looking pretty positive, and if this works, you could almost have roving teams and that can go into a facility like this and help them so they could stay at the facility.”

Copies of the final report from stage one the Wicking Project, Older people with complex behaviours: a psychosocial model of care, can be requested from Wintringham by email: admin@wintringham.org.au

Tags: homeless, homelessness, wintringham,

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