Poor training and compliance of the Dementia and Severe Behaviours Supplement led to its abuse by some aged care providers, clinical psychologist and dementia educator Bernie McCarthy has told Australian Ageing Agenda.
He said some aged care facilities were claiming the supplement for up to 60 per cent of residents, despite the initiative targeting the small group of residents with the most severe symptoms.
He said while aged care staff did not deliberately submit false claims, poor knowledge and training in the use of the Neuropsychiatric Inventory – Nursing Home (NPI-NH) assessment tool contributed to the blow-out in the $16 per day supplement.
He said misapplication of the tool led to “false positive” applications being made.
“Claims were being made for people who were not eligible for the supplement. Some providers had as much as 60 per cent of their resident group on the supplement and this was a clear abuse of the supplement,” he said.
“There was very poor preparation by the department for the nursing staff conducting the assessments and that meant that many of them were not clear about how to interpret the ratings, particularly the rating of the severity of behaviour where a fair degree of subjectivity is involved. The influence of personal judgement on the decisions that are made should be limited by effective training.”
He said if the department had introduced a compliance regime to test the validity of the claims being made, claiming could have been more tightly controlled. He said it was unusual for a funding program not to include a higher degree of departmental oversight.
The Department of Social Services told AAA it was the former administration’s decision not to include a validation process and it declined to comment if it had advised the former government to include one in the original design.
The CEO of HammondCare Stephen Judd also told AAA the absence of a validation process was a key flaw in the design of the supplement.
Eligibility estimates
Mr McCarthy agreed with industry peak bodies that the department had “grossly underestimated” the number of residents that would have attracted the supplement (the department estimated around one per cent of aged care residents would be eligible). But he said the 15 per cent of residents that ended up claiming the supplement was higher than the prevalence of these extreme symptoms within the aged care population.
He said a more accurate figure would be approximately 5-10 per cent of residents. “That will vary across resident populations. It might be as high as 20-25 per cent in some aged care facilities but overall the population of people with severe symptoms of dementia in aged care would be around 5-10 per cent.”
A spokesperson for the department said eligibility for the supplement required assessment by professionals trained in the use of the assessment tools. The spokesperson said as part of the initial communication on the supplement, the department made available to providers an instructional DVD on the NPI-NH scoring requirements.
However, Mr McCarthy said the department’s resource was not a training tool and did not attempt to train assessors on how to interpret assessment scores using clinical studies.
Acting Deputy Secretary of the Department of Social Services Carolyn Smith told a senate estimates hearing on 5 June there appeared to be multiple reasons for the oversubscription including problems with the original design of the supplement and the lack of a sufficient compliance regime in place.
Supplement redesign
If allowed to continue in a revised form, Mr McCarthy said there was no doubt the supplement could make a difference to care outcomes for people with severe symptoms of dementia.
“My experience was yes it was starting to make a difference to some residents particularly if it was used to improve staff training and skills, the physical environment or to improve staffing levels. Those three things, that’s what makes the difference and where that was the case, we saw improved outcomes.”
During early consultation on the development of the supplement in 2013, Alzheimer’s Australia and the Royal Australian & New Zealand College of Psychiatrists (RANZCP) called for additional eligibility requirements to be placed on providers receiving the supplementary funding, such as employing a behaviour program coordinator, regularly reviewing the use of medication and conducting an environmental audit.
However, aged care industry peak bodies strongly opposed the linking of funding to minimum expectations and these areas were included in the final eligibility guidelines as considerations only. Both LASA and ACSA argued that the existing accreditation system was sufficient to demonstrate the capacity of providers to deliver appropriate care for residents with severe BPSD. The peaks also expressed concern that some regions might also be deprived of services if no local provider elected to be a specialist dementia care provider.
LASA CEO Patrick Reid said he did not support the supplement being delivered as block funding for specialist dementia care providers because dementia care was a mainstream not a niche issue in aged care.
Related AAA coverage:
Peak body calls for redirection of research funds to dementia care
Fall out from cancelled dementia supplement
Minister cuts $110 million dementia supplement
