Brodaty calls for care units in dementia response
Leading Australian expert on dementia welcomes the new specialist mobile teams to help care for residents with severe behavioural and psychological symptoms of dementia but says they need to be backed up by a national network of specialist care units.
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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Henry once again has shown why he is the expert in Dementia care. Interestingly this was the model used in Wagga Wagga that lost funding due to statewide decision making on funding.
Brodaty is on the money and in agreement with my views which must make him right!
What is it about dangling large sums of money in front of people that makes them go all weak at the knees and loose their critical faculties. Let’s think about this proposal.
There are about 345000 people in Australia living with dementia – lets call that 350000 as it makes the sums easier to do. According to Brodaty et al (2003) and the seven tiered model of service delivery, somewhere around 1 per cent of people have BPSD that is severe or extreme.
So, according to a best guess, we are talking about 3,500 people.
This new proposal is to direct about $11 million funding per year, according to reports I have read, to this group of 3,500 people, yet in addition, according to Brodaty (above) ” special care facilities were the next component required to provide a comprehensive service that catered for residents with very severe BPSD” thus one can imagine the fiscal blowout.
I think this is bad policy and poor direction of the health dollar.
Completely agree!!!
It will be interesting to see how this new service works operationally. More resources to respond to severe behaviours is positive, however there is always unintended consequences to initiatives like these. The over subscription to the severe behaviour supplement did not match the forecasts. The same may be true for the new Severe Behaviour Response Team as we don’t really know the prevalence of “Severe behaviour”.
I am in full agreement with what these two men have said.
What is the point of just throwing money out there if the bottom line is that Dementia Specific Units are under staffed, by staff that do not have the skills to put into place Person Centred Care. How long have we been talking about the benefits of Person Centred Care and it still isn’t happening even though organisations say their oganisation focuses on Person Centred Care.
The government needs to put more money into appropriate training of staff to up skill them, but organisations need to be accountable and openly show how the training money is spent, and how many of their staff have the skills to manage a resident or client in the community that displays behaviours due to an unmet need. Care staff need to be paid accordingly if they have done extra training and are dementia champions.
Sue O’Brien, I think, hits the proverbial nail on the head. Let us ask ourselves, what problems confront aged care? Poor staff training, lack of dementia and mental health literacy, high rates of delirium (often going unrecognised by care staff due to the former), over use of antipsychotics, task oriented culture, even problems with nutrition and hydration not to mention often untreated/unrecognised pain.
The focus on this new whizz bang initiative is directed toward very few consumers. Why can’t we actually set about to fix up the industry rather than tinker at the edges with a “sexy” new initiative? I think the answer to that is that we really do not want to spend the money. For us, in Australia, in the 21st century, it is not a priority.
Is it better to have blended care, so all individuals can see ageing in progress. Also if facilities have such it would be nice to call them Memory Support Units or something less clinical. Plus if residents are altogether it makes a lighter and broader work load for staff – if homes are designed well using the latest assistive technologies.
Victoria’s public psycho geriatric units that did do this are now being sold off though. Operating costs unviable with current funding, such a loss to the community….