ACAP 2010

1. 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

2. N clients receiving EACHD packages per month Source: Department of Health and Ageing, SPARC data

3. 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

4. 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

5. 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

6. 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)

7. 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?

8. How clients with possible dementia are assessed for BPSD and cognitive functioning by ACATs (N = 59) Source: LAMA ACAT Survey, 2009

10. Percentage of people approved for packaged care with activity limitations and mean dependency scores Source: ACCR NDR MDS 06-07

11. Percentage of people approved for packages receiving types of government assistance at assessment. Source: ACCR NDR MDS 2006-07 Note: Shading = re-assessments

12. EACHD clients ~ prospective study

17. 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

18. 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%)

20. Number of clients accessing specialist dementia support

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. Mean Barthel Index scores at each time point

28. Mean Cohen Mansfield Agitation Inventory Scores at each time point

29. Destination of clients discharged from EACHD

30. Carer ratings

31. Case manager ratings

32. 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