Dementia supplement replacements under review

By Linda Belardi and Darragh O’Keeffe

A capped grants scheme, specialised care units or boosting the resources of the Dementia Behaviour Management Advisory Service (DBMAS) were among the key proposals discussed at the recent Ministerial Dementia Forum to replace the axed dementia supplement.

Australian Ageing Agenda understands that while a number of options were debated, the meeting of almost 70 industry and expert stakeholders in Melbourne on 11 September did not result in a decision on a replacement.

A report for Assistant Minister for Social Services Mitch Fifield is currently being prepared by KPMG based on the day’s discussions, which AAA understands is due to be handed to government by the end of the month.

It is expected the report will draw together views expressed at the forum on current dementia care, gaps in service provision and the priorities both short and longer term that would enhance access to quality dementia care for those with behavioural and psychological symptoms of dementia (BPSD).

Ahead of the meeting, the National Aged Care Alliance’s Dementia Supplement Working Group, consisting of representatives of consumers, providers and unions, prepared a progress report for members noting that a grants scheme should be the preferred option for discussion.

The 13-member working group suggested that a capped grants program was a pragmatic short term approach that could be developed within the government’s proposed budget and would directly target people with severe behaviours.

As AAA has previously reported, the proposed grants program would be eligible to providers who could show they had a critical mass of residents with severe BPSD and met specific eligibility criteria such as having a dementia coordinator, pathways to specialist care and regular reviews of medication use.

However, the NACA working group recognised that there would be inequitable access to care across Australia under this option and the program would need to be designed in a way that was not administratively burdensome.

Alternative proposals

Other options canvassed at the minister’s forum last week included partnerships between mental health and residential care, redirecting the dementia supplement money to fund a small number of specialised care units to provide short-term, high-level care for residents requiring specialised support or to improve access to external services such as the DBMAS.

However, it was acknowledged that uptake of DBMAS is variable across the country and the service was broad in scope and not targeted towards those with very severe BPSD.

Several attendees described the forum as a constructive day with wide-ranging collaborative discussions on short and long term priorities to improve dementia care in the industry.

After the forum, Patrick Reid, CEO of Leading Age Services Australia, told AAA that he hoped that a replacement scheme and longer term strategies would build the capacity and capability of the industry as a whole.

While he said LASA was not significantly opposed to a grants scheme, he said the peak body held some reservations about its limited scope. “We don’t necessarily believe that it is the right option. It is just one of the options that are on the table,” he said.

“We need to look for outcomes and processes that help build the capability and the capacity of the whole industry, not just those who specialise in dementia.”

Mr Reid said LASA would also be examining the lessons learned from the original dementia supplement to create a “resource pool” for providers to share improvements in practice for the care of people with dementia.

CEO of Alzheimer’s Australia Glenn Rees agreed the forum had been a valuable opportunity to share views. He told AAA he continued to favour a targeted grants program to improve access to care for people with severe symptoms of dementia, as was the policy intention of the original supplement. He said there was enough known about the elements that constitute a good model of dementia care to set criteria for the scheme.

Adjunct Professor John Kelly, CEO Aged & Community Services Australia, said while a consensus on a replacement scheme was not reached at the meeting, there was a positive commitment to spend the limited funds on the small cohort of people with the most severe behaviours.

He said there was there was also agreement on the need for a broader government strategy to fund the care of those with dementia and other severe behaviours that did not increase red tape for the sector.

Ian Yates, chief executive of Council on the Ageing (COTA) said there was recognition at the forum of the complexity of this area of care and the need for improvements in both the industry and the broader community.

“The degree to which we have dementia friendly communities, for example, affects the capacity of people to remain living at home in the community with dementia,” he told AAA.

Mr Yates said there also needed to be clear and enforceable guidelines for the sector on creating supportive environments for people with dementia. “We know that it is possible for certain kinds of environments to actually make behaviours worse and we should not be financially rewarding that.”

Assistant Minister for Social Services Mitch Fifield told attendees the forum was “not a talkfest” and he would use the advice provided to develop a replacement scheme targeting the small group of people with severe behaviours. Longer term strategies to improve best practice dementia care  in the sector would also be considered by government.

Senator Fifield also announced that the Ministerial Dementia Forum would be an annual event.