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ACAP 2010. Extended Aged Care at Home Dementia - How do ACATs assess for EACHD, and what are EACHD clients like? Dr Colleen Doyle National Ageing Research Institute www.nari.unimelb.edu.au. N clients receiving EACHD packages per month. Source: Department of Health and Ageing, SPARC data.

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acap 2010
ACAP 2010

Extended Aged Care at Home Dementia -

How do ACATs assess for EACHD,

and what are EACHD clients like?

Dr Colleen Doyle

National Ageing Research Institute

www.nari.unimelb.edu.au

n clients receiving eachd packages per month
N clients receiving EACHD packages per month

Source: Department of Health and Ageing, SPARC data

population 70 people with dementia pwd allocated care packages
Population 70+ , People with dementia (PWD) & allocated care packages

Source: Report on the Operation of the Aged Care Act 1997; 1 July 2006 to 30 June 2007;

Aged care approval round results 2005/06, 06/07, 07/08.

ABS Population by Age and Sex, Australian States and Territories, 30 June 2007, Table 7

Estimated resident population, by age and sex, preliminary – 30 June 2007

dementia initiative national evaluation 2006 2009
Dementia Initiative National Evaluation 2006-2009
  • Australian Department of Health and Ageing, Dementia Policy & Programs Section, tender
  • LAMA consortium: La Trobe University (Australian Institute of Primary Care, Lincoln Centre for Research on Ageing), Access Economics, University of Melbourne (Centre for Health Policy Programs & Economics), Applied Aged Care Solutions
  • Colleen Doyle, Vanessa White, Cecily Hunter, David Dunt, Susan Day, Rosemary McKenzie, Pauline Van Dort, Lynne Pezzullo, Katie Yates, Richard Rosewarne, Janet Opie
national evaluation dementia initiative 2006 2009
National Evaluation Dementia Initiative 2006-2009

OVERVIEWS

  • Dementia Policy in Australia
  • Dementia Dynamic Economic Model Manual
  • Dementia Dynamic Economic Model
  • Economic Evaluation of the Dementia Initiative
  • Overview and Summary of Main Findings

IN DEPTH EVALUATIONS

  • Dementia Collaborative Research Centres
  • Dementia Behaviour Management Advisory Services
  • Dementia Training Study Centres for Health Professionals
  • National Dementia Support Program
  • Extended Aged Care at Home Dementia
  • Dementia Care Essentials
  • Dementia Caring Pilot

PROJECT REVIEWS

  • National Dementia Research Workshop
  • Dementia Research Mapping
  • Primary Care Project
  • Dementia Resource Guide
  • National Dementia Communications Strategy
  • Dementia Research Grants
  • Dementia Community Support and Dementia Service Development Grants
  • Community Worker Training
  • Dementia Training Resources for People with Special Needs
  • Stock take of Dementia Curricula and Training
national evaluation eachd
National evaluation EACHD

Approved by La Trobe University Human Research Ethics Committee

Prospective study of clients using EACHD oct 07 to oct 08

Secondary data analysis

Service provider perspectives (processes)

Client and carer information (outputs)

key performance indicators
Key performance indicators
  • Appropriateness - Is EACHD what people want and need?
  • Effectiveness - Does EACHD make a difference?
  • Efficiency - Is EACHD worth it?
  • Quality - Is EACHD any good?
  • Accessibility - Can people access EACHD?
  • Impact on collaboration - Do services work together or work with consumers?
  • Sustainability - Does EACHD make a longer term difference?
  • Outcomes - What is the end result?
slide8

How clients with possible dementia are assessed

for BPSD and cognitive functioning

by ACATs (N = 59)

Source: LAMA ACAT Survey, 2009

slide10

Percentage of people approved for packaged care with activity limitations and mean dependency scores

Source: ACCR NDR MDS 06-07

slide11

Percentage of people approved for packages receiving types of government assistance at assessment.

Source: ACCR NDR MDS 2006-07

Note: Shading = re-assessments

distribution of dem qol client s general quality of life n 69
Distribution of DEM-QOL client’s general quality of life (n=69)

25

24 (34.3%)

21 (30.0%)

20

20 (28.6%)

n clients

15

10

5

4 (5.7%)

0

V good

Good

Fair

Poor

most common bpsd n 349
Most common BPSD (n=349)

Required prompting to undertake activities of daily living (73.6%)

Asked repetitive sentences or questions (62.4%)

Was uncooperative or unwilling to participate (50.7%)

Was restless or fidgety, always moving around (49.1%)

Was up at night (48.3%)

slide21

Community services

N

% use at COMMENCE-MENT

Change

Domestic assistance

257

73.9

27.9

Personal care

255

73.3

32.6

Formal linen service

48

13.8

8.2

Meal preparation/Other food services

143

41.1

25.8

Delivered meals

56

16.1

1.6

Transport

126

36.2

20.0

slide22

Community services

N

% use at COMMENCEMENT

Change from before EACHD

Day centre respite care

92

26.4

4.6

Residential care respite

43

12.3

4.3

In home respite care

181

32.0

7.2

slide23

Community services

N

% use at COMMENCEMENT

Change

Social support

196

56.3

34.2

Counselling/support, information and advocacy

122

35.1

32.2

On-call access

186

53.4

43.7

Behaviour management

87

25.1

20.7

Neuropsychology

7

2.0

1.1

slide24

Community services

N

% use at COMMENCEMENT

Change

Podiatry

145

41.7

22.5

Medication management

112

32.2

14.8

Home nursing care

85

24.4

11.1

Continence management

133

38.1

24.8

Skin care management

84

24.4

17.6

Advice on home safety/security

57

16.4

11.4

slide25

Community services

N

% use at COMMENCEMENT

Change

Home maintenance

36

10.3

5.3

Occupational therapy

54

15.5

10.8

Home modification

21

6.0

1.3

Physiotherapy

22

6.3

1.9

Communication assistance

14

1.0

2.5

Speech therapy

6

1.7

0.2

Diversional or recreational therapy

54

15.5

14.0

Dietetics

1

0.3

0

supports psychotropic medication
59% taking anti-depressants, anti-psychotics or anti-dementia drugs

32% taking no psychotropic medications

Of 95 clients taking psychotropics

19% anti-psychotics

8% anti-anxiety

7% hypnotics

23% anti-depressants

Supports: Psychotropic medication
outcomes
Outcomes

Relief from caring and assistance with personal care important goals for EACHD clients and their carers

Goals achieved in majority of cases

Increased frailty over period of use of EACHD

Average length of stay six months, 1/5 clients died; 2/3 discharged to residential care