Consultation: Specialist Dementia Care Units

In 2016, the Australian Government announced it would establish Specialist Dementia Care Units (SDCUs) to support people who experience very severe behavioural and psychological symptoms of dementia (BPSD).

Many of you who read this blog will know, I don’t believe in BPSD, and in fact, feel strongly against this term, and the very negative labels it provides. Many others are also questioning it now, and there is emerging evidence it causes more harm than good. But that has been written about before, and at this point, is irrelevant to this consultation, so I won’t focus on it.

The Australian Government has committed to establish at least one Specialist Dementia Care Units in each of the 31 Primary Health Network regions. Specialist Dementia Care Units are intended to complement similar existing and planned state and territory government investments in services for people with very severe behavioural and psychological symptoms of dementia (BPSD).

For now, I actually believe we currently need these units, only because BPSD is so entrenched, and the lack of quality care in responding to the needs of people with dementia is what has caused this need.

Dementia Alliance International will probably submit a response, so if you want to provide us with any feedback for that, please send it to info@infodai.org by 15 January, 2018. See below a brief outline of why they are being set up, and the questions to consider.

Individual submissions to the consultation paper are also invited through the Department’s website by 21st January 2017.

You can download the consultation paper from their website Specialist Dementia Care Units consultation paper November 2017

SPECIALIST DEMENTIA CARE UNITS

Why are SDCU’s being set up:

SDCUs are being established to:

  • provide care for people with very severe BPSD who are unable to be effectively cared for by mainstream aged care services due to the risk of harm they present to themselves or others
  • deliver care within a dedicated 8–12 bed unit with a residential aged care setting
  • offer transitional support that focuses on reducing or stabilising symptoms, with the aim of enabling the person to transition to a less intensive care setting
  • operate as the ‘third level’ of Australian Government programs to assist people with dementia, complementing the existing Dementia Behaviour Management Advisory Service and Severe Behaviour Response Teams
  • enhance the existing health and aged care service systems for people with very severe BPSD, including complementing state and territory government funded services and supports for people with BPSD.

The questions:

The consultation is aiming to address the following issues (please read attached consultation paper for more context to these questions).

Q1) Are there are other system reforms that would impact on, or be impacted by, the establishment of Australian Government-funded SDCUs?

Q2) What other risks and issues need to be considered in introducing SDCUs into the existing service systems for people with very severe (tier 6) BPSD?

Q3) Are there alternatives to the establishment of SDCUs that would better address the current system issues, which should be considered by Government?

Q4) Do you consider 1,450 to be a reasonable estimate of the national demand for SDCU-like beds for people with very severe BPSD? If not what other factors and/or methodologies should be considered?

Q5) Are the proposed SDCU service principles appropriate? If not, how should they be amended?

Q6) Are the above benefits what SDCUs should be aiming to deliver? If not, why?

Q7) What are the pros and cons of the SBRT performing the SDCU assessment service role? What other body (or bodies) might appropriately carry out this role?

Q8) Might the requirement for evidence of a primary dementia diagnosis (as described above) impact on timely access to SDCU services for some people with BPSD?

Q9) Are the proposed assessment arrangements appropriate? If not, why not?

Q10) What other factors should the SDCU assessment service consider in deciding whether to recommend a person for a SDCU placement?

Q11) Is an 8–12 bed unit (within a larger residential aged care facility) the appropriate care setting for SDCUs? Are there circumstances in which larger or smaller units would be more appropriate?

Q12) Should there be a maximum limit on the duration of an individual’s residence within a SDCU? If not, why not? If so, how long?

Q13) What is a reasonable period for transitional support from a SDCU to the new accommodation provider?

Q14) Might existing security of tenure arrangements pose a significant issue for the ‘transitional’ operation of SDCUs? If so, how?

Q15) What strategies could be used to facilitate SDCU ‘throughput’ within existing security of tenure provisions?

Q16) What mechanisms should be used to support partnerships between SDCUs and acute services?

Q17) Should there be any additional requirements for SDCU providers caring for people from Aboriginal and Torres Strait Islander, CALD or other diverse backgrounds?

Q18) Would it be feasible to establish SDCUs in rural and remote locations? How can SDCUs (or alternative initiatives) best support people with very severe BPSD living in rural and remote areas?

Q19) What specific costs would contribute to the ‘top up’ amount?

Q20) To what extent might these costs vary across SDCUs, for example in response to geographic location or local mix of people with BPSD?

Q21) Which ‘top up’ funding option do you prefer? Why?

Q22) Are there other funding mechanisms that should be considered?

Q23) Is block funding, occupancy-based funding or a combination of both most appropriate for SDCUs? Why?

Q24) Are the proposed uses of ‘top up’ funding appropriate or should there be other costs included or excluded?

Q25) With no specific capital funding for SDCUs proposed – is there a minimum funding period to justify an operator investing to establish a SDCU?

Q26) Do the proposed provider funding arrangements pose any financial sustainability risks?

Q27) Should any special resident fees and payments arrangements apply to people receiving care in a SDCU?

Q28) Are the proposed provider selection criteria appropriate? Do you consider some selection criteria mandatory?

Q29) Which factors should be prioritised in determining the regional rollout schedule and why?

Q30) What factors should be considered in evaluating the SDCU program?

9 thoughts on “Consultation: Specialist Dementia Care Units

  1. Having worked with people living with dementia for 30 years I would like to share a more suitable solution.
    This notion is a disgraceful step backwards into the archaic realms of the past, where people living with dementia were misunderstood, mismanaged and locked up for no evident reason but the inadequacies of those caring for them.
    The definition of insanity is “doing the same thing over and over and expecting a different result” – Einstein.
    I question and challenge why anyone can even suggest how locking vulnerable people up in a prison and treating them as inferior would result in an environment where they would thrive. In my mind this would be the very trigger to the behavioural expression we so incessantly complain about. How dare we treat human beings this way. What ever happened to compassion, empathy and humanity?
    I have worked against this paradigm for my entire career and my life’s work has proven without a doubt that behavioural expression is a result of our own cognitive inadequacies and assumptions.
    We must acknowledge that our negative attitudes are usually the impetus to creating and triggering the very behavioural expression we then use to label and judge people living with dementia.
    Not only does this affect our perception of dementia and how we treat people, but affects how a person living with dementia perceives themselves.
    As always, I do my best as a cognitively aware person, within my limited ability, to view life through the eyes of those inspirational people who live with dementia.
    I have written numerous articles to expose these subjective attitudes toward people living with dementia to shake up those who continue to foster these disrespectful mindsets.
    Time to be accountable for our own behaviour.
    Im in Kate – please sign me up for this.
    L.xx

  2. this is the catch 22 situation isn’t it> we need them but don’t want them, there needs to be high quality considerations for all with chronic changing and challenging health needs. I’ll download the paper and give it my opinions. they may or may not be useful.

  3. I hear your anger and frustration and am sad for you. As a carer I feel lost trying to figure out why anyone would doubt you – life is tough and continuing to fight and be articulate in your efforts to advance understanding, rights and support for all in similar situations is an extraordinary battle. I was hoping to meet you and hear you speak when you came to Kiama recently. Unfortunately it didn’t happen. I use you to try and see the world through the eyes of people dealing with the diagnosis. Of course those views and visions are different to a carers – I just want to be there for my husband and advocate for him without ‘disempowering’ him!

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