Senate debates

Tuesday, 5 December 2017

Committees

Government Response to Report

4:28 pm

Photo of James McGrathJames McGrath (Queensland, Liberal National Party, Assistant Minister to the Prime Minister) Share this | Hansard source

I present five government responses to committee reports as listed on today's Order of Business. In accordance with the usual practice, I seek leave to incorporate the documents in Hansard.

Leave granted.

The documents read as follows—

Australian Government response to the Senate Community Affairs References Committee report:

Care and management of younger and older Australians living with dementia and behavioural and psychiatric symptoms of dementia (BPSD)

Foreword

In 2017, there are an estimated 365,100 people in Australia living with dementia. This is expected to increase to almost 900,000 by 2050.

The Senate Community Affairs References Committee report Care and management of younger and older Australians living with dementia and behavioural and psychiatric symptoms of dementia (BPSD) provides 18 recommendations on a range of issues affecting people living with dementia in Australia. Since the report was tabled, the Australian Government has taken action through a wide range of initiatives and reforms targeting dementia.

These actions are outlined in this response and underpinned by the National Framework for Action on Dementia 2015-2019 (NFAD). The NFAD was endorsed by the Council of Australian Governments Health Council on 7 August 2015. It outlines Australian, state and territory government priorities across primary, acute and aged care to reduce the risk of dementia and improve the quality of life for people living with dementia and their support networks.

On 29 May 2017, Australia supported the adoption of the World Health Organisation Global Action Plan on the Public Health Response to Dementia 2017-2025 (GAP). The goal of the GAP is to improve the lives of people living with dementia, their carers and families, while decreasing the impact of dementia on them as well as on communities and countries. The GAP includes seven distinct action areas and outlines measurable targets for achievement.

The WHO Global Dementia Observatory provides the monitoring mechanism to track implementation and progress of the GAP and will be a valuable resource for knowledge translation and exchange. Australia is proud to be among the first countries supporting and sharing our data and resources on this platform.

The Australian Government is committed to the provision of quality services for people living with dementia, their families and carers, as well as research into the prevention, diagnosis, treatment and cure of dementia. In the 2014-15 Budget $200 million over five years was allocated to boost Australia' s dementia research capacity and deliver best practice support for people with dementia across the health system. Key priorities of projects funded under this commitment are improving care and interventions for the behavioural and psychological symptoms of dementia and maximising the independence of people living with dementia. Research funding includes a strong knowledge translation component to translate research findings into practice within dementia policy and programs.

Phase one of the re-design of national dementia support programs and services was announced by the Government on 25 January 2016. The co-designed reforms are based on the advice of stakeholders and experts received through the Ministerial Dementia Forums of 2014 and 2015 and KPMG' s nationwide consultation and analysis of dementia programs commissioned by the Government in 2015. Outcomes of the redesign address many of the report' s recommendations.

Importantly, the redesign included the engagement of a single national provider to deliver nationally consistent accredited dementia training and education to the aged care workforce and health care professionals across Australia. Accredited training in best practice care of people with behavioural and psychiatric symptoms of dementia is available free to eligible health professionals and care workers.

Other key elements of service redesign include the establishment of the Severe Behaviour Response Teams (SBRT) and engagement of a single national provider to deliver the Dementia Behaviour Management Advisory Service (DBMAS) across all states and territories. The national DBMAS supports staff and carers in community, residential, acute and primary care settings with information, advice, assessment and short term case management interventions. Family carers, health professionals and aged care providers have access to 24 hour advice and support to improve the quality of life of the person living with dementia. The SBRT supports Commonwealth funded approved residential aged care providers requiring assistance with addressing the needs of people with severe and very severe BPSD.

A mobile workforce of multidisciplinary clinicians also provides locally delivered person-centred interventions, capacity building and resources for carers and organisations to improve skills in the care of people living with dementia in the longer term.

The Ministerial Dementia Forum held in December 2016 focused on redesigning dementia consumer supports to ensure national consistency and regional and remote coverage. The Government is now working with stakeholders on phase two of the redesign of national dementia support programs to develop an improved suite of dementia consumer supports for people living with dementia and their carers across the life-cycle of the disease.

The Government has also supported additional research and service improvement projects at a cost of more than $30 million through three rounds of the Aged Care Service Improvement and Healthy Ageing Grant Fund between 2012 and 2017. Projects address a range of priorities identified through the NFAD including improving dementia diagnosis and care in hospitals and primary care settings, delivering sensory experience interventions, reducing the use of antipsychotic medications in aged care facilities and development of tools and resources to manage and reduce behavioural and psychological symptoms of dementia (BPSD).

In June 2016, the Government committed to establishing Specialist Dementia Care Units (SDCUs) across Australia to support residents with very severe BPSD.

In addition, the Australian Government has provided funding over three years from June 2016 to Dementia Australia (formerly Alzheimer' s Australia) to establish the Dementia Friendly Communities initiative, which is designed to help ordinary Australians better understand dementia. This educative, community awareness raising program aims to give people a greater understanding of dementia and the small things that can be done to make a real difference to people living with the condition. A national dementia-friendly community resource hub will also be developed, to enable communities to network, learn from other initiatives and provide the latest evidence and information on best practice approaches to increasing community awareness and support for people living with dementia.

Aged Care Reforms

The Australian Government is implementing significant reforms to the delivery of aged care services for older people and their carers to ensure that Australia has the best possible system, which is sustainable and affordable. The reforms are consistent with the long term policy direction recommended by the Productivity Commission in its 2011 inquiry into Care for Older Australians.

A number of review processes have also recently been conducted that investigated how aged care services are delivered and the protections for vulnerable older Australians.

On 1 May 2017, the Government announced an independent Review of National Aged Care Quality Regulatory Processes (the Review). The Review was led by Ms Kate Carnell (AO), in conjunction with Professor Ron Paterson (ONZM), and examined Commonwealth aged care accreditation, monitoring, review, investigation, complaints and compliance processes. On 25 October 2017, the Minister for Ageing, the Hon Ken Wyatt AM, MP released the Review report. The Government is considering the Review recommendations.

On 15 June 2017, the Australian Law Reform Commission released its report into elder abuse, recommending tighter regulation and safeguards in relation to the use of restrictive practices in residential aged care. The Review panel considered these recommendations.

The Government recognises that care for older people living with dementia is an integral part of the aged care system.

The Australian Government is committed to the provision of quality services for all older Australians, including for people living with dementia, their families and carers, as well as research into dementia prevention and cure.

Responses to the recommendations have been developed collaboratively by the Department of Health, the Department of Social Services, the Australian Commission on Safety and Quality in Health Care and the National Health and Medical Research Council.

Recommendation 1

The Committee recommends that the Commonwealth create a new Medicare item number that encourages General Practitioners, registered psychologists or other relevant accredited professionals, to undertake longer consultations with a patient and at least one family member or carer where the patient has presented with indications of dementia (para 2.42).

Noted

The Australian Government notes this recommendation.

The second priority area for action under the National Framework for Action on Dementia 2015-2019 (NFAD) is "The need for timely diagnosis". Under this priority, the Government has committed to the following outcome: Australians will have access to skilled and knowledgeable health professionals who can support and provide an accurate and timely diagnosis of dementia.

The Government recognises the important role that can be played by primary care providers in the identification, assessment and management of dementia.

The Government' s view is that rather than creating a new Medicare Benefits Schedule (MBS) item, it would be more appropriate to consider whether current items are effective through the Medicare Benefits Schedule Review and Primary Health Care Advisory Group, and also to improve doctors' awareness of existing MBS items that allow for cognitive screening and care planning.

Whilst there are no specific items for dementia diagnosis and intervention under the Medicare Benefits Schedule (MBS) arrangements, a wide range of existing items may be used for these purposes. These include:

            On 22 April 2015, the Government, announced an MBS Review Taskforce. The Taskforce is undertaking a program of work to review all MBS items to ensure they are contemporary, reflect current clinical practice and allow for the provision of health services that improve health outcomes. Further, it will identify services that are considered unsafe or ineffective.

            It is anticipated that the Mental Health Services Clinical Committee will be established to review psychiatry, GP mental health and psychology MBS items.

            The Government also established the Primary Health Care Advisory Group, led by Dr Steve Hambleton, former Australian Medical Association President. The Advisory Group investigated options to provide: better care for people with complex and chronic illness; innovative care and funding models; better recognition and treatment of mental health conditions; and greater connection between primary health care and hospital care. Following an extensive national consultation process and review of the evidence, the Advisory Group provided a final report to Government in December 2015.

            In response to that report, as announced on 31 March 2016, the Government is providing funding for stage one of the establishment of Health Care Homes in ten Primary Health Networks (PHNs) regions across Australia from 2016-17 through 2019-20. Under this model, eligible patients with chronic and complex health conditions will voluntarily enrol with a participating medical practice known as their Health Care Home. This practice will provide a patient with a ' home base' for the ongoing coordination, management and support of their conditions. The model moves away from current fee-for-service payments for these eligible patients except for routine health issues not related to their chronic illness.

            Recommendation 2

            The Committee recommends that the Commonwealth consider increasing funding for the Younger Onset Dementia Key Worker Program in order to provide support to all people living with dementia. The increased funding should also ensure that accurate data is collected for evaluation purposes (para 3.39).

            Not Supported

            The Australian Government does not support this recommendation.

            Priority four of the NFAD is "Accessing ongoing care and support".

            The Younger Onset Dementia Key Worker Program (YODKWP) is transitioning to the National Disability Insurance Scheme (NDIS). Transitioning to the NDIS will provide the opportunity for Dementia Australia to receive significantly more funding whilst providing services to eligible people with younger onset dementia.

            The Government' s priority is to ensure that the NDIS is structured to provide support to those who need it. The NDIS is designed to provide people with disability, their families and carers greater choice and control over the course of their lives, including the flexibility to make decisions about which disability services and supports they use. Evidence suggests that when people with disability are given greater choice and control over their services they achieve better life outcomes.

            Access rates for the YODKWP have not been high and performance statistics do not support expansion of the program. An evaluation of this program is currently underway and although initial reports suggest that the program has resulted in some good outcomes so far, it would be inappropriate to expand the program based on preliminary findings without the analysis of longer term, more meaningful data.

            The Cognitive Decline Partnership Centre funded by the National Health and Medical Research Council (NHMRC) and industry groups recently conducted an evaluation of current models of key workers for people living with dementia in Australia, including a systematic review of the evidence in Australia and internationally. The key findings from the evaluation supported the role of dementia support workers and identified a need to further explore ways to increase access to the role within consumer directed care. Trialling and aligning the model with Primary Health Networks was also recommended. Key findings are relevant to future policy development.

            Recommendation 3

            The Committee recommends that each State and Territory develop dementia training facilities similar to the Perc Walkley Dementia Learning Centre in Victoria (para 3.40).

            Noted

            The Australian Government notes this recommendation.

            Priority four of the NFAD is "Accessing ongoing care and support". The related action to which the Government has committed is: Support system wide, organisational and workforce awareness of BPSD together with evidence-based prevention and management strategies, including the provision of dementia friendly environments.

            The Government recognises the role that the physical environment and design of the care setting plays on providing high quality care to people living with dementia. Noting environmental design as an emerging priority, the Government is committed to providing flexible funding for a range of different approaches. The Government also notes that the aged care industry and the community share a role in ensuring environments are dementia friendly.

            In 2013-14 the jointly funded Commonwealth-Victorian Home and Community Care program provided one-off funding to Dementia Australia Victoria towards establishment of the Perc Walkley Dementia Learning Centre in Victoria. The Perc Walkley Dementia Learning Centre is a dementia learning facility which showcases dementia friendly design. The goal of the Centre is to provide education on how workplaces, homes and public spaces can become dementia friendly. The Centre creates a multi-sensory simulation using light, sound, colour and visual content to create a virtual reality experience at the Centre, which enables aged care and health care workers to be taken into the world of people living with dementia.

            The Australian Government funds the Dementia Training Program (DTP) to provide dementia-specific training to aged care, health care and other community providers and their staff in order to improve the care and wellbeing of people living with dementia. The DTP offers an environmental design workshop and consultancy for aged and healthcare services. A consultancy and resources specifically for the design, construction and maintenance of aged care facilities for Aboriginal and Torres Strait Islander peoples is also available. The program provides service managers and their design consultants with the knowledge, resources and tools required to understand the effects of the built environment on the person living with dementia and modify the environment to promote well-being while reducing confusion and depression. The information is provided through education and on-site consultation and is available in each state and territory.

            The Government acknowledges the ongoing work of non-government organisations in improving environmental design. For example, Dementia Australia Victoria and HammondCare have both been involved in development of virtual reality dementia training technology which enables anyone to experience planned physical spaces from the perspective of someone living with dementia. The technology assists care staff, designers and builders to understand sensory challenges for a person living with dementia and design environments that are much more welcoming and less confronting.

            The Government-funded DBMAS provider notes that environmental factors contribute to over 70 per cent of referred cases. To inform practice, the DBMAS provider can use portable virtual reality technology to educate staff about how sensory challenges contribute to behavioural and psychological symptoms of dementia.

            The Government currently funds Dementia Australia New South Wales for a trial of a dementia-specific experiential learning program in hospitals. The program uses a train-the-trainer model to engage hospital staff in simulation exercises to see how life might be experienced by their patients with dementia. The program is an opportunity for staff to reflect on the effect their work practices can have on the behaviour of those they are caring for.

            Recommendation 4

            The Committee recommends that the Commonwealth encourage relevant professional organisations, such as the Royal Australian College of General Practitioners, to ensure that patients diagnosed with dementia and their carers are informed by health professionals of the dementia supports available and how to access them (para 3.53).

            Supported In-Principle

            The Australian Government supports this recommendation in principle.

            Two priority areas for action under the NFAD is "the need for timely diagnosis" and "accessing care and support post diagnosis".

            The Australian Government has delivered multiple initiatives to increase awareness for patients, carers and General Practitioners about the pathways into support and care.

            The NHMRC Cognitive Decline Partnership Centre (the Centre) has developed Clinical Practice Guidelines and Principles of Care for People with Dementia (the Guidelines) in consultation with an expert multi-disciplinary Guideline Adaptation Committee convened by the Centre. The Guidelines provide recommendations for the diagnosis and management of dementia and are intended for use by staff working with people living with dementia in the health and aged care sectors. The Guidelines also inform GPs about the key entry points for support services for the person with dementia, including Dementia Australia, My Aged Care, Carers Australia and the Aged Care Assessment Teams.

            The Centre has also published Diagnosis, treatment and care for people with dementia: A consumer companion guide to the Clinical Practice Guidelines and Principles of Care for People with Dementia. This consumer version of the Clinical Practice Guidelines includes accessible information about the latest evidence on dementia as well as information about the full range of dementia services and support. It is available from: www.sydney.edu.au/medicine/cdpc/resources/dementia-guidelines.php. The guidelines and the consumer companion have both been promoted to GPs via the Primary Health Networks.

            GPs also have access to the HealthPathways program which is a web-based information portal supporting primary care clinicians to plan patient care through the primary, community and acute health care systems. This is designed to be used at the point of care, primarily for General Practitioners but is also available to Hospital Specialists, Nurses, Allied Health and other Health Professionals.

            Other activities undertaken by the Department of Health may also assist dementia patients and their carers to be aware of the supports available to them. This includes the establishment of Primary Health Networks (PHNs) which aim to improve the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improve coordination of care to ensure patients receive the right care in the right place at the right time.

            PHNs have undertaken their baseline needs assessments and prepared their 2016-18 Activity Work Plans which have informed their commissioning decisions from 2016-17. While there are no activities specifically devoted to dementia in PHNs' first Activity Work Plans (submitted in May 2016), a number of them give consideration to dementia within broader activities that are focused on aged care including falls prevention, medication management, advanced care planning, palliative and end of life care, and promotion of healthy ageing.

            Another important initiative was the launch of My Aged Care in 2013 and its expansion in 2015 to become a true gateway for consumers to have their needs assessed and where appropriate, be referred to government funded aged care services. My Aged Care now includes a central client record to facilitate the collection and sharing of information, holistic needs assessment through a national standardised assessment form, online referral management and web based portals for clients, assessors and service providers.

            Prior to the establishment of My Aged Care, there was no central pathway for older people to access information and services. The transition to My Aged Care was a significant shift in how information, assessment and referral to access aged care services took place.

            The My Aged Care Regional Assessment Service (RAS) conducts face-to-face home support assessments for clients seeking entry-level support at home, provided under the Commonwealth Home Support Program (CHSP). The Aged Care Assessment Teams (ACATs) conduct face-to-face comprehensive assessments to determine a client' s eligibility for care types under the Aged Care Act 1997, including home care packages, residential care, residential respite care, Transition Care and Short Term Restorative Care.

            In June 2017, the Government launched a national awareness campaign promoting the My Aged Care website and national 1800 phone line. The advertising campaign will run in newspapers, magazines, radio, digital and social media. Other public relations activities will also be undertaken, including materials being available in 4,820 GP surgeries across the country.

            In addition, carers are able to access further support through the Carer Gateway at https://www.carergateway.gov.au.

            Resources are also available to encourage clinicians in hospital settings to provide information on support and referrals for care. In 2014, the Australian Commission on Safety and Quality in Health Care (the Commission) released resources titled A better way to care: safe and high quality care for patients with cognitive impairment (dementia and delirium) in hospitals. This publication emphasises the importance of a comprehensive assessment that includes assessing and addressing the support needs for carers.

            The booklet Dementia and Your Legal Rights created by Dementia Australia, contains practical information for people living with dementia, and their families and carers, for when the person with dementia no longer has the mental capacity to make decisions that affect them. This resource could assist GPs to support people living with dementia and their family and carers.

            Recommendation 5

            The Committee recommends that the Commonwealth facilitate and potentially fund the establishment of dementia-specific respite facilities, including in regional and remote areas (para 3.95).

            Noted

            The Australian Government notes this recommendation.

            Priority four of the NFAD is "Accessing ongoing care and support". The related action to which the Government has committed is:

            Provide people with dementia and their carers and families access to appropriate and responsive respite services.

            Given its prevalence amongst older people, the Government considers the provision of appropriate care and support of people with dementia, their families and carers to be core business for all providers of aged care (including respite care). To support this, the Government provides a broad range of training and resources in dementia care for the aged care sector, as outlined in other recommendations in this document.

            The Government acknowledges the unique respite needs of people living with dementia and their carers, as well as the additional challenges faced by those living in regional and remote areas. Consequently, the Government currently funds a range of programs and initiatives that provide respite support for carers of people living with dementia.

            The CHSP provides a range of planned respite services for older people including flexible respite such as in-home respite and host family respite; cottage respite; and centre-based respite. Respite services provided through the CHSP are complemented by other respite services including emergency respite, which can be accessed through the Commonwealth Respite and Carelink Centres (CRCCs), and residential respite (short term stays in aged care homes).

            In response to the growing need for planned respite services for frail older clients, the 2016 CHSP Growth Funding Round targeted planned respite services as a priority area across a number of Aged Care Planning Regions for identified client groups. Through this funding round, an additional $115 million has been made available to deliver additional aged care services, including an increased number of planned respite services.

            Residential respite is provided across Australia. In 2015-16, of the 2,669 aged care homes that claimed Australian Government residential care subsidies, 2,438 (91 per cent) claimed for delivering residential respite care. This includes 944 (91 per cent) of the 1,042 aged care homes located in regional, remote or very remote areas of Australia.

            The Australian Government funds 54 CRCCs nationally to assist carers, including those living in rural and remote locations. CRCCs provide a link to carer support services and assist carers with options to access short-term and emergency respite. Where appropriate, a Centre can help with putting in place regular respite for a carer to reduce the need for unplanned and emergency respite. CRCCs also provide information about carer support services in their local area.

            As noted in response to Recommendation 4, My Aged Care is the primary entry point to Australia' s aged care system. My Aged Care provides information about ageing and aged care, and also assesses people' s needs, as well as locating and accessing suitable services, including respite care.

            The Department of Social Services (DSS) administers a range of services and programs to specifically support carers. DSS is currently developing and implementing a new Integrated Plan for Carer Support Services which seeks to recognise, support and sustain the vital work of unpaid carers. The first stage of the plan is the implementation of the Carer Gateway, which supports carers to locate and access carer support services. The Carer Gateway can be accessed at https://www.carergateway.gov.au.

            The Department of Health is working collaboratively with the DSS to ensure that the support needs of clients and their carers are can considered holistically and in recognition of the importance of supporting the ongoing care relationship.

            Recommendation 6

            The Committee recommends that the Commonwealth, in consultation with industry, develop guidelines regarding dementia-specific respite facilities that can effectively manage BPSD (para 3.96).

            Noted

            The Australian Government notes this recommendation.

            Priority four of the NFAD is "accessing ongoing care and support". The related action to which the Government has committed is:

            Provide people with dementia and their carers and families access to appropriate and responsive respite services.

            The Government acknowledges that transitioning from home to respite and back again can be very difficult for a person living with dementia.

            As noted in the Foreword, the national DBMAS supports staff and carers in community and residential care services (including respite care), as well as acute and primary care settings. DBMAS provides information, advice, assessment and short term case management interventions to improve the quality of life of the person living with dementia. SBRTs support Commonwealth funded approved residential aged care (including respite care) providers requiring assistance with addressing the needs of people with severe and very severe BPSD.

            These services can be provided to support the transition of a person living with dementia to and from respite care. Through both programs, a mobile workforce of multidisciplinary clinicians provides locally delivered person-centred interventions, capacity building and resources for carers and organisations to improve skills in the care of people living with dementia in the longer term.

            As previously noted, the Australian Government also funds 54 CRCCs nationally to assist carers, including those living in rural and remote locations. CRCCs provide a link to carer support services and assist carers with options to access short-term and emergency respite. Where appropriate, a Centre can help with putting in place regular respite for a carer to reduce the need for unplanned and emergency respite. CRCCs

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