ACAT Assessment and Specialist Dementia Care Program

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ACAT Assessment

The Australian Government Department of Health has in recent times received a number of enquiries from providers of aged care about when an Aged Care Assessment Team (ACAT) assessment is required. The department states that “A subsidy cannot be paid to an approved provider for providing care to a person, unless the person is approved under the Aged Care Act 1997 (the Act) as a care recipient.

An ACAT assessment is required if a person is seeking access to aged care services that are funded under the Act, such as:

  • Residential Care
  • Flexible Care in the form of Transition Care or Short-Term Restorative Care
  • Residential Respite Care
  • a Home Care Package. “

 

New Initiative Rollout 2019

One of the Department of Health’s new initiatives – the Specialist Dementia Care Program (SDCP) is beginning to roll out.

This program will provide care for people exhibiting very severe behavioural and psychological symptoms of dementia (BPSD), who are unable to be appropriately cared for by mainstream aged care services.

The SDCP will offer specialised, transitional residential support, focussing on reducing or stabilising symptoms over time. I have, at times, been in the position of finding suitable accommodation for people exhibiting behaviour that cannot be managed in the aged care residential service in which they reside. It is a difficult situation and, as an Aged Care Support Consultant, I applaud the introduction of specialist services to accommodate people in this position.

The department has advertised a targeted grant opportunity for a prototype SDCP service, with the next round of 14 SDCP grant opportunities to be advertised early this year. This first phase of specialist dementia care units is expected to be operational in early 2020 with a full rollout in 2022-23. It is expected that there will be at least one specialist dementia care unit (within a broader residential aged care service) operating in each of the 31 Primary Health Networks.

One of the objectives of the SDCP is to generate evidence on best practice care for people exhibiting very severe behavioural and psychological symptoms of dementia that can be adapted for use in mainstream settings to benefit all people with dementia.

Source: Australian Government Department of Health website.

 

The Ins and Outs of Dementia

 

Interesting face

Dementia in Australia has some worrying statistics, such as it being the leading cause of death among Australian women and the third most common cause of death among men, it is estimated to cost Australia more than $15 billion this year and by 2025 the total cost of dementia is predicted to increase to more than $18.7 billion.

The brain controls everything we do and generates instructions to our body, as well as facilitating our complex behaviours, such as personality and cognition (our ability to think, understand and do things). When a person has dementia, neurons in various parts of their brain stop communicating properly, disconnect, and gradually die.

Dementia is caused by progressive neurodegenerative diseases, with the disease starting in one part of the brain and spreading to other parts, affecting more and more functions in the body. Dementia is caused by different diseases and depending on the cause different parts of the brain will be affected, resulting in differing symptoms depending on the part of the brain being affected. Memory loss is often associated with dementia and it is one of the most common symptoms and usually the first symptom people notice. When neurons in the part of the brain called the hippocampus degenerate and die memory loss is experienced.

Dementia is not caused by old age but ageing is a high risk factor for the condition. When the frontal cortex of the brain is affected by dementia behaviours will change and often socially unacceptable behaviour is exhibited.

These symptoms often mean that people with dementia will require care in an aged care facility where they will be safe. The care of residents with dementia has often been challenging but new ways of caring are being developed to enable those residents to have a better quality of life. Construction has just begun on Korongee, a new concept dementia village in Glenorchy, Tasmania. The design of Korongee is based on a typical Tasmanian cul-de-sac, and is intended to encourage people living with dementia to continue to take part in normal, everyday activities. Households with eight bedrooms set in the village and a café, supermarket, beauty salon and gardens will all create a delightful, safe living space.

When I have clients living with dementia who need to find  suitable aged care accommodation I search for facilities that have  innovative programs to care for their needs and I would love to see a village like Korongee built in Melbourne.

 

 

Delicious Introduction To Brain Food vs Dementia

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I recently attended a networking lunch hosted by Home Instead Brighton held at The Crescent in Brighton with guest speaker author Ngaire Hobbins. I found Ngaire’s presentation very informative as it highlighted the role of food for the older person living at home or in residential care. We were treated to a lovely tasting lunch with recipes from her book ‘Better Brain Food: eat to cheat dementia and cognitive decline.’  The Chef at The Crescent prepared the dishes from Michelle Crawford’s delightful recipes used in the book.

Ngaire Hobbins, APD, BSc., Dip. Nutrition and Diet, is a dietitian and researcher with a special passion for geriatric nutrition. She is committed to ensuring that the frail elderly have the very best food possible available to them. Most people – be they frail or fighting fit – are unaware that public health messages which are ideal for younger adults can instead be unhelpful, even harmful, for those entering their senior years.  In the science section of the book Ngaire offers insight on the importance of the gut-brain axis and looks at the pros and cons of the latest ‘superfoods’ and diet trends. She also advises what food should be eaten in each decade as a person ages to boost brain health.

‘Better Brain Food’is an important read, especially for anyone involved in aged care residential support as it discusses the science of nutrition and cognitive health and provides seventy tasty recipes based on this science, making it easy to follow Ngaire’s advice. Having visited many aged care facilities in my time as a Placement Consultant I know how important food is to the residents. For their ongoing health and well-being they should be served delicious meals that are nutritious and boost their brain health. This book will be an invaluable resource to this end.

New Aged Care Facility in Box Hill

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Bluecross opened its newest aged care residence in Box Hill on October 22nd amongst much fanfare and a family open day with radio broadcasts, Mike Brady, games and a sausage sizzle. I had a quieter intro to this facility, being an Aged Care Placement Consultant I was invited before the opening for a preview.

The residence boasts a host of world-class facilities, including several lounges, dining and sitting rooms, activity areas, consultation and treatment rooms,

a library, hairdressing salon, private dining room, as well as a gymnasium and cinema .

I was impressed to learn they have a memory support environment for people living with dementia. With more people developing this condition as the population ages I am often called upon to find a suitable environment for my clients living with dementia.

The residence is designed with an emphasis on a homelike environment for residents, despite its state-of-the-art facilities according to Interim Chief Executive Officer Robert Putamorsi.

Bluecross Box Hill-suite

The different functional spaces like a number of smaller sitting rooms and dining areas make it more homely and a private dining room is available for residents who want to share a family meal with their relatives. The bedroom suites are generous and feature kitchenettes.

Comprising a basement and three levels, stage 1 boasts 173 rooms and another 43 rooms will be added in the stage 2 development in 2019. $64million was spent on the residence as it becomes part of the stable of 33 aged care facilities owned and managed by Blue Cross across Victoria. With a growing demand for high quality aged care homes in Victoria I welcome this new addition as I source suitable aged care residential places for my clients.

 

The Gap For Older People With Behavioural Problems

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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.

The Leisure Seeker Film Opens Up a Moral Discussion on Dementia

It was good to read Phillipa Byer’s review of the film The Leisure Seeker on 12th July in the Sydney Morning Herald. She pulled no punches about her opinion of the ending and its message. The story is about a retired teacher who has dementia and his wife who has cancer. They embark on a journey in their motor home. Spoiler alert – the finale involves the wife giving her husband a drink that brings about his demise then she commits suicide. The husband had earlier said to his wife that when the time came for him to go to one of “those places” (meaning an aged care residential facility) she should equip him with a rifle and remind him how to use it (on himself).

Phillipa was furious at this ending and I can understand her emotion. I am an Aged Care Placement Consultant and help elderly people find suitable accommodation, this includes people living with dementia and I take a keen interest in aged care facilities that support those with dementia. Philippa volunteers at a dementia specific residential facility, has a relative with dementia and is a research associate at the Australian Catholic University’s Plunkett Centre for Ethics and is currently working on a dementia project.

She states “The belief that residential aged care facilities are so bad that killing or suicide are reasonable preferences is apathetic and alarming.”  She points out that there are surely alternative moral imperatives, such as advocating for more funding as a minimum. She also has issue with the wife administering the death juice but not informing the husband that’s what it is. Surely, he has the right to decide in that moment. She is concerned, that as people with dementia live amongst us, we can’t loosen the moral bonds of honesty with them just because it may be uncomfortable or difficult. A new village being developed in 2019 in Hobart reflects the philosophy that, after a full life making their own decisions, people with dementia can have a valid opinion on their day to day life. Koongee Village allows people with dementia to live, roam free and have all the facilities they need in a safe setting.

The butterfly model being introduced to many aged care facilities in Australia is a new culture of care for people living with dementia and focuses on emotional intelligence. People live in smaller homes, are not treated as patients and are involved in daily activities in the home and garden and also learn new skills. There are good news stories about people living with dementia and, as an Aged Care Placement Specialist, I’m pleased to share them.

Read Phillipa’s Review.