Targeted services for people with acute dementia symptoms

The Senate report into 'Care and management of younger and older Australians living with dementia and behavioural and psychiatric symptoms of dementia (BPSD)' draws heavily on submissions from HammondCare, alongside other aged care and dementia organisations.

HammondCare, which provides dementia specific care, training and support across NSW, submitted a written report to Senate alongside the testimony of two expert witnesses, General Manager of Residential Care, Angela Raguz, and Director of HammondCare's Dementia Centre, A/Prof Colm Cunningham.

Below is a summary of our submission, an encouraging case study, a link to the full HammondCare submission and a link to the Senate report.

HammondCare has called on the Federal Government to better target funding to prevent some people with severe behavioural and psychological symptoms of dementia (BPSD) from 'bouncing around' the aged and health care systems.

"There is a strong need for targeted services offering care and support to people with very severe BPSD that fill the gap between Commonwealth-subsidised residential aged care and acute aged care psychiatry units in state hospitals," says HammondCare's submission to the Senate Standing Committee on Community Affairs which is inquiring into 'Care and management of younger and older Australians living with dementia and behavioural and psychiatric symptoms of dementia'.

Of equal concern was the lack of targeted funding to support care options for younger people with dementia and BPSD.

The submission describes the two main care options available - residential care in nursing homes and acute care in hospital aged care psychiatry units and highlights that a new option, as modeled in HammondCare's Special Care Program at Hammondville is required.

While acute care in hospital aged care psychiatry units does offer "helpful and effective short-term interventions for people with very severe BPSD", these units are not designed to provide long-term accommodation options (although they often do) and will seek to help their patients transition back into nursing homes.

However "most conventional aged care facilities are often unable to accommodate people with acute BPSD. In our experience, they end up ‘bouncing around’ the system, unable to find a suitable care setting," the report says.

"These people experience distress and upheaval as they are subjected to inconsistencies in approach and uncoordinated variations in medication. This can lead to significant negative side effects including increased stress and trauma to the people with BPSD and their families. As well as posing high risks and increasing distress the constant transfers are also costly and extremely inefficient."

Encouraging case study from HammondCare's SCP:Mr A is the classic example of a person with very severe BPSD who ‘bounced around’ the system. Over the course of 12 months, he was transferred between three hospitals and two nursing homes – where he was transferred eight different times. Mr A was not physically aggressive but he exhibited particularly difficult and persistent BPSD. He would constantly shout and make extremely disruptive noises, snatch objects out of other residents’ hands and continuously take food from other residents’ plates during meal times. The nursing homes could not cope with this behaviour and in desperation they transferred him to the hospital aged care psychiatry unit. After being transferred for the eighth time, Mr A was admitted to HammondCare’s Special Care Program (SCP). He had been prescribed a several different medications, including two antidepressants, an anti-psychotic, an anti-anxiety agent and morphine. Despite this he was still displaying difficult behaviours including damaging furniture and making extremely disruptive, loud noises. The staff in the SCP spent time getting to know Mr A, focusing on him as an individual rather than his behaviours. Over the following six months, the support team gradually took Mr A off most of the medications, which were producing little benefit, and began trialling new medications and nonpharmacological strategies in their place. As a result, Mr A became much calmer and although he still exhibited some difficult behaviours, he was much more manageable than when he entered the SCP.

There's a better way for acute BPSD

In contrast, HammondCare's Special Care Program - which includes a dedicated Special Care Unit cottage within a larger dementia care campus and a Supported Internal Relocation Program - has had excellent results in reducing acute BPSD and assisting residents to transition into HammondCare's standard dementia-specific residential care.

This program is an initiative of HammondCare's with the support of NSW Health and also features links with HammondCare's Braeside Hospital aged care psychiatry unit. In 2011-12, a total of 19 people stayed in the SCU, seven of whom successfully completed the program and were relocated to mainstream dementia-specific residential care. The average length of stay for the overall program is 335 days.

New models need for younger people with dementia

HammondCare has pioneered residential care for young people with BPSD both in the Special Care Program described above, and more particularly, in a younger onset dementia specific cottage in another dementia care campus. This experience has shown that a 15 place cottage is not suitable for younger people with BPSD and a smaller, group-living model is being explored.

Learning from these experiences has led HammondCare to advocate for "dedicated policy at the Commonwealth level which reflects the distinctiveness of services for younger people with dementia and provides for targeted subsidies. Services for younger people with dementia should remain separate from aged care services while maintaining close links that promote communication and knowledge sharing."

HammondCare's official recommendations to the Senate Committee are:

Recommendation 1: That the Commonwealth Government allocate funding for targeted residential services providing dedicated care and support to people with very severe BPSD, based on the key components outlined in this document.

Recommendation 2: That the Commonwealth develop policy and targeted subsidies for dedicated, small-scale residential services providing care and support for younger people with dementia. This model must recognise the need for smaller household clusters for younger people with BPSD.