Chapter 5

Dementia Supplement

5.1        This proposed supplement is to cover the “... additional costs involved in caring for people with dementia and other mental health issues.”

5.2        The Coalition is concerned at the lack of sufficient definition to determine the level of cognitive impairment how it will be valued and/or costed and the lack of clarity about who will make such a determination.

5.3        It is accepted that complex behaviours add to the load of staff within residential aged care.  But it is also an emerging issue for care services delivered to residents who remain in their own homes and it needs to be evaluated and considered in that setting as well. 

5.4        The Coalition believes that further clarification and expansion of the definition is required.

5.5        The Coalition believes that the name should reflect those targeted older Australians that may be eligible for the supplement.  The Act indicates that the supplement is in recognition of the additional costs involved in caring for people with dementia and other mental health issues.

5.6        Evidence from Dr Roderick McKay from the Royal Australian and New Zealand College of Psychiatrists states that:

The idea is that the funding for residential aged care should be sufficient to provide the mental health care. There are two things explicitly wrong with that. Firstly, mental-health care requires time and we know that the funding does not allow that time. Secondly, it needs skilled staff; nor does it provide for that. The third thing is that it is exacerbated even further by the fact that people with mental-health needs are not there is a list of people with special needs and those with mental-health conditions are not listed. There are many ways it has gone backwards. The recognition of people with mental health conditions as a special needs group I believe is within the scope of this. I think that would be a very good starting place in at least recognising those needs, because then those needs actually will be evaluated as to whether they are being met. Hopefully some of them will therefore be better met and, if they are not being met, there will be a driver for better planning for these things. If you look at the analysis of the aged-care funding instrument data, in very rough terms what it shows is that coming into residential care about 50 per cent of people have dementia and 50 per cent of people have mental illness, with a 50 per cent overlap between those groups. So it is not actually that one is a bigger problem than the other. They are equivalent sized problems but we are only planning for one. I can answer that directly. On the psychogeriatric assessment scales, as I understand, the cognitive assessment scale is being considered for use for assessing eligibility for cognitive impairment in terms of access to the dementia supplement in the community. So there is no measurement of behaviour or mental health in terms of eligibility for that supplement in the community.[1]

5.7        Dr Lucy Morris from Aged and Community Services Association, Western Australia has the following concerns around the impacts of the new arrangements and that the need for the supplement to appropriately cover all the complex behaviour aspects:

There is the issue around the dementia supplement. The fact that we are taking cuts to level 2 and level 4 under the new arrangements is going to impact. We are losing money out of that provision to pay for the dementia supplement. There is the fact that the dementia supplement does not cover the issues of complex behaviour care, and it is inappropriately named. We have issues around who will be able to diagnose and whether GPs actually want to diagnose people with dementia. That means that you are going to have issues around exclusion et cetera.[2]

5.8        In addition, the proposed delegated legislation deals with the dementia, veterans and workforce supplements in the one instrument.  Given the concerns raised about definition and proper reflection of behavioural problems, the three supplements should be dealt with in separate instruments.

Recommendations

That the mechanisms for determining the Dementia Supplement are made transparent and that the name more accurately reflects the broader aspects of the issues that impact on the eligibility.

That any delegated legislation relating to the dementia, veterans and workforce supplements are separate and not combined in delegations in any way.

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