Reinstate dementia supplement or fail duty of care

Dementia is the single greatest cause of disability in older Australians aged 65 years or older and is the third leading cause of disability burden overall.

According to Alzheimer’s Australia, three in 10 people over the age of 85 years and almost one in 10 people over 65 have dementia. There are 332,000 Australians living with dementia. In less than 10 years, this number is expected to increase by one third to 400,000 people.

In merely looking at the numbers, it is surprising and extremely distressing that that the federal government made the decision to scrap the Dementia and Severe Behaviours Supplement, effective from 31 July.

With the budget cut, the government has stopped paying the $16 per day supplement to providers to support the extra care and support needed for people who are living with dementia. No replacement scheme or other responsible course of action has so far been proposed despite significant representation from aged care peak bodies.

The budget cut is a result of an oversubscription of the $52 million budget that the federal government had allocated for a four year period. In less than 12 months of operation, the supplement had already consumed the entire budget due to the fact that the supplement was being claimed for 15% of all residents instead of the 1% that was the initial target estimate. This exposed a seriously flawed system and a poorly thought out and administered supplement program.

The question is: 'Why are people who are living with dementia made to pay the price for the government’s poor handling of the supplement?'

The supplement was implemented as part of the ‘Living Longer Living Better’ aged care reforms and became operational in August 2013. The aim was to provide additional funding necessary to adequately support residents with severe behavioural and psychological symptoms associated with dementia and mental illness. “We welcomed the implementation of the supplement and recognised the importance of utilising the funding to directly benefit residents, families and staff,” Ms Horsnell says.

As a result of the new funding, SCCV created a new role of behaviour management specialist with the appointment of a registered nurse with mental health qualifications and considerable experience working in the area of psychogeriatric specialty.

“We also developed a new model to ensure positive outcomes for residents who are living with dementia, including the provision of appropriate treatment and management of depression and anxiety, and the development of an appropriate care plan to reduce verbal and/or physical abuse in residents and the rostering of additional staff to provide extra support.”

SCCV supports 530 residents across eight homes. In these homes, there are seven specialised areas to support residents who are living with dementia, each supporting 10 to 16 residents. “Our new home, which is under construction in Dandenong, will also have two specialist areas of 15 places each. All these were planned and implemented as a result of the Dementia and Severe Behaviours Supplement.

“The cessation of the supplement was made without consultation with the aged care sector and is a huge blow to the provision of essential services to the most vulnerable people – those living with severe and debilitating symptoms of dementia. What we are experiencing is a situation where staff have been employed, services are in operation, but where the funding we relied on to pay for this additional service has now been axed without warning. It impacts us financially, and also causes unnecessary angst and distress among residents, families and staff dealing with residents who are living with severe dementia.

“Incidents of aggression or severe behaviours from residents are not unusual occurrences within the residential homes. Without the funding, we face the risk of not being able to allow people who are living with dementia and severe behaviours to become residents as the risk to other residents and staff, without the additional supports, is too great,” Ms Horsnell continues.

“As an aged care organisation, we have urged the government to consider reinstating the Dementia and Severe Behaviours Supplement and introduce clear guidelines and a formal process for validation from those providers who claim it. We also propose that the supplement be made available only to providers who are operating specialised areas for residents who are living with dementia and severe behaviours.”

In recent years, there has been a spike in the number of male residents with younger onset of dementia and severe behaviours requiring entry to aged care homes. These residents are mobile and are also strong physically, compared to the staff in aged care who are predominantly female and over 50 years of age. Unless the supplement is reinstated, SCCV and other organisations will potentially not be able to meet their duty of care obligations under the Occupational, Health and Safey Act to provide a safe environment for residents and staff alike.

Southern Cross Care (Vic) is a not for profit community based organisation that provides in home and residential services to more than 5,300 older people in metropolitan Melbourne and regional Victoria.