Senate debates

Wednesday, 26 March 2014


Community Affairs References Committee; Report

6:40 pm

Photo of Rachel SiewertRachel Siewert (WA, Australian Greens) Share this | | Hansard source

Pursuant to order, I present the report of the Community Affairs References Committee on the care and management of younger and older Australians living with dementia and behavioural and psychiatric symptoms of dementia, commonly known as BPSD, together with the Hansardrecord of proceedings and documents presented to the committee.

Ordered that the report be printed.

by leave—I move:

That the Senate take note of the report.

This committee inquiry was particularly important. I would like to acknowledge the fact that Senator Lin Thorp made the initial referral. I would like to take the opportunity to thank all the submitters and witnesses who gave so much of their time and expertise and also the secretariat, who, once again, did a sterling job for us.

We made 18 recommendations. These recommendations are very important, if we are going to take seriously the issue of dementia in this country. Almost 1.5 million Australians are currently affected by dementia, if you include patients, family, friends and carers. Dementia in fact covers a wide range of symptoms, including impairment of brain function, language, memory, perception, personality and cognitive skills. The type and severity of symptoms varies extensively.

In particular, the committee looked at issues around behavioural and psychiatric symptoms or so-called complex behavioural issues around dementia. These can be caused by unmet need, physical or mental distress, illness, reactions to medication and other factors in a patient's environment. This is important and I will come back to those issues in a moment. This issue will become increasingly prevalent as our population ages, and we have heard much on that. So we need to be taking this issue seriously, as well as our recommendations. This is one of our most pressing health concerns and, if left unchecked, it will increasingly become a large problem for our community, residential care, aged care and community care. We need to get this right.

As a starting point, the committee has recommended that the Commonwealth create a new Medicare item number that allows longer consultations with patients, family members and carers to help them provide a more accurate dementia diagnosis. We heard that was a significant problem. Increasingly, more and more people will suffer from BPSD and will in fact be cared for in the community. Almost 70 per cent of people with dementia are already cared for in the community. We as a nation are not prepared to handle the increasing prevalence of dementia. We need to understand the issues around dementia so that we can better provide care and support for people who have it. This will require a change in our attitude to addressing dementia and the need to put care of the person first.

We have heard a number of significant concerns about the current treatment of people with dementia. But we have also heard of cases where there are very supportive and positive approaches to supporting people with dementia, that in fact address the perceived issues around dementia, in particular the area around complex behavioural needs. We were also given a much more detailed understanding of why some of these so-called violent behaviours happen. That is mainly due to issues such as prolonged or incorrect medication; people being in environments that do not suit their needs; and people then being restrained. This is an issue that caused some significant concern to the committee.

The committee was provided with evidence that seems to confirm that there is a significant overuse of psychotic medication for those in aged care and in community care, for the control of BPSD. The committee believes that this overuse must not be allowed to continue. We are concerned about the reliance on restraints to manage dementia and complex behaviours. We hold the view that this is an unacceptable model of care. We also heard evidence about physical restraints, and about people being locked into facilities. We have made a number of recommendations about the need to look at the issue of restraints, both through medication, and physical restraints. Importantly, we saw some really good examples of how you can change people's environments. We need to recognise that people's perceptions and cognitive skills are affected, and we need to understand what is motivating the behaviours. If you look at those motivations and understand them; if you provide significant and much better training to staff; and if staff and carers understand why people are behaving the way they are, you in fact mitigate the use of restraints.

We went to Yarriambiack Lodge in Warracknabeal in Victoria and saw there, I would say, first-rate care. That care had significantly reduced the use of medications to almost nothing. They did not lock doors. They did not even have a nursing station; staff interacted with the patients, and it was much more like a family environment. They had just established beautiful gardens. In other words, we can do this. There is no need for the heavy reliance on restraints or the overuse of both medication and physical restraints. We need to get our act together in this country—to better support people with dementia, to understand what is causing these so-called complex behaviours, and to change our perceptions. We have made 18 recommendations around training, around better designed facilities, and around tracking and monitoring the use of medications in particular. I am conscious of the time, so I will curtail my contribution now to enable the deputy chair to also make a contribution.

6:48 pm

Photo of Sue BoyceSue Boyce (Queensland, Liberal Party) Share this | | Hansard source

Mr Acting Deputy President, I feel sometimes a little bit like a broken record in this place when I say that so many situations remind me of the problems that were experienced in the disability sector so many years ago.

Thank you to Senator Lin Thorp for suggesting that we undertake this inquiry. While enjoyable is not a word one can use about it, it has certainly been very educative. I would hope that, through our work, there will be a big improvement for people with dementia and for the people who look after them, whether that be in the community, in their homes, or in institutions such as residential aged-care facilities. I guess that is my starting point. We do still have many of our aged people living in what look like 19th-century institutions—very large places; and often the funding that we provide actually encourages large buildings with lots of people congregating. This is not in any way useful to people with dementia. They need quiet, and they need spaces that they can understand. One person gave evidence that putting someone with dementia into some of these facilities was like putting someone in a wheelchair at the bottom of a set of stairs and saying, 'off you go, you sort it out yourself'.

There is much work that needs to be done in this area. As Senator Siewert said, we have made 18 recommendations. Many of them are around how community care could be better improved. The services that are now available in the community for people with dementia, particularly for those with behavioural and psychiatric symptoms, are not good. They do not meet the needs of the individuals themselves or of their families. Often they are required to go on a two-week respite break, whether they want it or not.

There is much work to do here. I seek leave to continue my remarks later.

Leave granted; debate adjourned.