The Gap For Older People With Behavioural Problems

Arcare lauriston

This week I was asked to assist two sisters to find accommodation for their 67 year old mother, Doreen.  It was one of the most heart wrenching experiences I have had as an Aged Care Placement Consultant for some time. Doreen had recently been diagnosed with dementia, although the sisters were aware she had been in gradual cognitive decline for some time.

One of the daughters, Rosie, and her 3 year old had moved from Queensland 5 months ago to live with her mother and be her carer.  When I went for the initial visit I found that Rosie and her child had been sleeping in the car in the driveway for the past 2 weeks because Doreen had been screaming at them, banging doors and talking to imaginary people every night.

Doreen was not eating or sleeping and was wandering. Rosie was getting calls from local shopkeepers worried about her mother, but she was unable to stop the behaviour and could no longer cope. So the daughters spoke with Doreen’s neurologists and it was decided to initially admit Doreen to a private hospital for a medication review.

I took Rosie and her sister Kate to visit 4 aged care homes that had dementia care.  They chose a home which they felt was the best fit; flexible and in a great location for friends and family to visit.  The plan was to admit Doreen there once her medication had been sorted at the hospital.

Just as they breathed a sigh of relief they got a call from the hospital saying they could not accommodate Doreen’s behavioural needs and suggested that she be admitted to a psycho geriatric hospital.  Despite frantic calls the sisters found there were no beds available for their mother in a pyscho geriatric hospital and Doreen’s condition was worsening.

There has always been a large gap in our system for older people living with dementia and exhibiting difficult behaviours or psychosis. Aged care homes are fearful of danger to current clients and there are very few psycho geriatric hospitals, leaving very few options for an ever increasing number of people suffering this way.

Having heard the desperation in Rosie’s voice when I called to check in on Doreen I decided there might be one more avenue I could try. Drawing on my many years of experience as an Aged Care Placement Consultant and my knowledge of the aged care system, I contacted the aged care facility they had selected and explained to the manager that the hospital medication review was not going to happen and the daughters’ current circumstances.  I asked her to consider admitting Doreen to the facility in the dementia support section and, if she became unmanageable, transfer her to an appropriate hospital.  This type of transfer is easier to arrange by a manager of an aged care facility than for family.

The great news is that management did not dismiss this out of hand and agreed to Doreen moving into the facility immediately.

New Concept For Dementia Aged Care Residence

Artist’s impression Korongee Village

The Netherlands are leaders in innovation in aged care and the dementia village, De Hogeweyk, based there is to be the model for a new residential facility being constructed in Hobart.  The Korongee dementia village in Glenorchy, Hobart will be designed to recreate real-life experiences for people with dementia. The fifteen six-bedroom homes will be set within a small town featuring streets, a supermarket, cinema, café and gardens, with residents wandering freely within a safe and supported environment.

The residents of De Hoeweyk dementia village live longer, eat better and take less medication and it is hoped the same health benefits will be seen in residents at this new Australian facility. The environment within the houses will be more relaxed, with casually-dressed health professionals and residents free to wake up and move about in their own time, free of institutional routines. Residents will live alongside people of like backgrounds, experiences, interests and skills.

A New Zealand aged care provider is also looking at developing a village based on the Hogeweyk design.  They have engaged Aged care specialists Ansell Strategic to undertake a feasibility study for the development of a dementia village in Invercargill. Funding systems and staff-to-resident ratios are among key challenges with the Netherlands model using two carers per resident.  “New Zealand has a similar mixed aged care funding model to Australia, where residents and the government both contribute to the cost of care, said Rosie O’Dowd, assistant analyst “Comparatively, the Netherlands operates under a more tax-financed system, allowing for residential aged care models to be developed based on optimal community modelling rather than a focus on efficiency, scale or aesthetics.”

Korongee village is a partnership between not-for-profit aged care provider Glenview, industry superannuation fund HESTA, social financing organisation Social Ventures Australia (SVA) and the Commonwealth Government. Only many levels, this is the way of the future in Aged Care provision.

As an Aged Care Placement Consultant I await, with great optimism, the opening of this new concept in dementia care in 2019.