Governments will either need to come up with new untested ideas, or adopt interventions of less certain effectiveness, if they intend to rely on supporting carers of people with dementia to prevent or delay entry into residential aged care.
The Productivity Commission today released its latest ‘what works’ paper on the topic. However, the answer appears to be: probably nothing, with an asterisk.
The aim of reducing the reliance on residential aged care is a priority for governments as it meets the community’s preference for ‘age in place’ and the costs of residential aged care consume more than 70% of government aged care budgets. Currently, more than half of those in permanent residential care in Australia have dementia.
Dementia is estimated to cost Australia more than $15 billion each year, and as its population ages, projections from the National Centre For Social And Economic Modelling show the prevalence of dementia will increase from an estimated 436,366 now to the 589,807 by 2028 and 1,076,129 by 2058.
Carers allow people with dementia to stay at home longer, but that role is demanding and interventions may help support carers and reduce the risk that the person they care for will residential aged care.
Interventions examined in 44 research trials were all found to have faults, were ineffective when implemented elsewhere, or were solely effective in a context substantially different from Australia that the Productivity Commission did not consider them appropriate to implementation at this stage.
The interventions trialled by governments around the world included:
- case management — involves identifying the needs of the person with dementia and their carer, and planning and co-ordinating the care required, including the purchasing of services
- education and skills building — involves building carers’ knowledge about dementia and available resources, and helping them to develop skills to address identified problems, such as managing difficult behaviours
- counselling — involves emotion-orientated or education-based counselling, including individual, family and group therapy
- respite care — involves temporary care services (day or overnight) provided to the person with dementia to provide a break for the carer.
The commission pointedly does not recommend that dementia-related funding for carer services, resources and research be reduced, as existing research has gaps, particularly on respite services, and as members of the community with their own health risks, carers do have specific support needs irrespective of the benefit to person they care for.
Read the full report at the Productivity Commission website.