The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has called for more specialised aged care beds for people with severe behavioural disorders, often associated with dementia.
Often they are admitted to an acute mental health unit in a hospital while they wait – sometimes up to a year – for an aged care bed.
A WA case involving an older man with dementia whose murder charge was dismissed prompted RANZCP’s call.
Associate Professor Stephen Macfarlane, chair of RANZCP’s Faculty of Psychiatry of Old Age and head of clinical services at HammondCare’s Dementia Centre told AAA that many more severe behavioural disorders (SBD) beds were needed in residential aged care.
He said there were only 16 such beds in WA, which is one for every 21,600 aged over 65, compared with 521 beds, or one per 1,770 seniors, in Victoria.
“These SBD beds are always full, and by placing those with dementia in psychiatric beds while waiting, keeps out people with acute mental health needs,” Associate Professor Stephen Macfarlane said.
“Victoria provides SBD beds funding on top of the Commonwealth funding, enabling some residents to be cared for in an appropriate facility and environment with a better staff model and access to visiting specialists.”
“This could be a model for other states,” he said.
AAA spoke to the wife of a man with Lewy body dementia, who spent 10 months in a mental health hospital waiting for an aged care bed after police took him there following hallucinations, paranoia, and aggression while in respite care.
“The aged care system as a whole wouldn’t take him even though most of their residents would have some form of dementia. Surely all the staff should be trained in care for those with all sorts of dementia no matter how challenging?” she said.
Dementia care provider HammondCare has developed a service devoted to residents with SBD at its facility in Hammondville.
In its submission to the Carnell review into national aged care quality regulatory processes, HammondCare said there were significant differences in the care needs of older people with an ongoing mental illness and people with very severe and persistent challenging behaviours who have a primary diagnosis of dementia.
“Their disease trajectories and types of support required are not the same,” it said.
In response to the RANZCP’s call for more SBD beds, the Minister for Aged Care Ken Wyatt said treating older people with mental health challenges and maintaining good mental health during aged care was a high priority.
He told AAA there were a wide range of options ranging from new technologies to lifestyle interventions he was considering for consultation.
Meanwhile, the sector is still waiting for the national network of specialist dementia units to care for people with very severe behavioural and psychological symptoms of dementia (BPSD).
The government’s December 2016 Mid-Year Economic Fiscal Outlook confirmed its June 2016 $7.5 million election commitment to establish Specialist Dementia Care Units in the 31 Primary Health Networks.
Planning is underway for the units, which will provide more intensive support than a mainstream aged care service can provide, but there is no word yet on when they will be established.
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The issue is that Aged Care staff and nurses are not well trained to deal with this specialised behaviour. Unless you have been in the industry for a period of time, most are ill equipped to deal with current dementia residents let alone those who are highly aggressive. Need to also think of the people that co reside with a highly aggressive resident. Where does the safety of staff, residents and family sit in this plan?
Need more specialised trained people to help people through no fault of their own live with this disease. Good luck finding them with the minimal wage structure that Aged Care staff are on, where shelf packers at supermarkets are on a higher hourly rate and where qualified nurses receive $10 or more per hour less than hospital nurses.
As a qualified diversional therapist I have worked with a variety of residents needs including a variety of dementia behaviours, aggression and mental illness, a lot of the time it is lack of experience and time that care staff have to spend with residents. If there are qualified, educated and experienced staff who have the time to approach residents properly and not be in a rush to look after their personal cares and that’s there are appropaoriately trained diversional therapy staff as a team it is very possible to have a great routine , happening with a variety of leisure experiences and knowledge of what may trigger certain behaviours…. in saying that there definitely needs to be more allocated beds and units to assist in the management of residents that require that time and extra care… I hope these units are well planned and consultated with all disciplines, nursing, psychiatric, diversional therapist art and music therapists, occupational and physiotherapists…