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Tuesday, 23 August 1994
Page: 114

(Question No. 1305)

Senator Lees asked the Minister representing the Minister for Human Services and Health, upon notice, on 7 April 1994:

  (1) What costings were done by the Government to reach the conclusion that there need to be 30 residents for a nursing home to be viable.

  (2) What specific staffing needs were included in these costings and did they include maintenance staff, cleaners and administrative staff or only nursing staff.

  (3) What other needs were costed and what were the costs for these needs.

  (4) What specific needs of residents were included in the costings and were the additional needs of patients who suffer from dementia included in the costings.

  (5) Have costings been done on the extra burden dementia sufferers in hostels place on the viability of the hostel.

  (6) Has the Government investigated the cost of housing dementia sufferers in a hostel (if they are mobile and physically fit).

  (7) Has the Government investigated the possibility of another level of funding to hostels that are catering for dementia sufferers who do not require nursing home care.

  (8) What additional support does the Government believe residents of hostels need if these residents are suffering from dementia.

  (9) Does the Government believe all dementia sufferers are better catered for in a nursing home than in a hostel.

Senator Crowley —The Minister for Human Services and Health has provided the following answer to the honourable senator's question:

  (1)—(4) The Government has not concluded that homes with fewer than 30 beds will not be viable. It has, however, been of the view that homes with fewer than 20 beds are in fact inherently not viable and has provided assistance accordingly. The Small Homes Initiative provided additional recurrent assistance and also capital assistance to voluntary and private sector homes to enable them to restructure their operations.

  It is generally accepted that very small homes are less economical to operate. For example, there must always be at least two staff on duty to allow a resident to be lifted, so a very small home may have the same nursing staff cost as a larger home.

  While the Government has not done any costings specifically for this purpose, there is consensus in the industry that very small homes are not viable. Accordingly, people considering entering the industry may have been provided with advice to this effect, depending on the implications for viability of the particular nursing home design or structure contemplated.

  (5) and (6) Assessment by Aged Care Assessment Teams of frail aged people needing care ensures that people requiring care receive it in the most appropriate setting available. In practice, this means that most people with dementia who are active and otherwise healthy, but who require residential care, are in hostels.

  Hostels are funded to provide care services to residents with a range of care needs including those arising from dementia. The scale of subsidies varies in recognition of the differing costs of caring for residents with different care needs.

  The Government recently sponsored Aged Care Australia to conduct a survey of hostel financial performance which showed that a number of factors, including the proportion of residents with dementia, affect hostel financial performance.

  Hostels with more than half the residents with dementia or other cognitive or behavioural impairments (22 per cent of hostels) had higher costs per head than hostels with fewer such residents. Nonetheless, most such hostels achieved a place day surplus.

  The survey also showed that hostels with a high proportion of residents with dementia received higher levels of Government subsidy as well as higher levels of contributions from residents to help them meet their costs. The proportion of income from Government subsidies was higher than for other hostels.

  Hostels which were dementia specific or which had separate dementia units (16 per cent of hostels) were more costly to run than integrated hostel facilities.

  Separate dementia facilities provide one model of care for residents with dementia. Available studies have not shown that separate dementia facilities provide better outcomes for hostel residents with dementia.

  (7) The implication behind the question appears to be that people with dementia who do not require nursing home care, require a level of hostel funding different from that currently provided.

  The levels of personal care subsidy payable in respect of hostel residents since 1992 are Personal Care Low, Personal Care Intermediate and Personal Care High. Assignment into one or other category is done by assessment of relative need for care, as determined by the Personal Care Assessment Instrument.

  Each category of personal care attracts a different level of subsidy. The great majority of people in Personal Care High and Personal Care Intermediate categories are people with special needs arising from cognitive or behavioural disorders, such as dementia.

  The Government believes that this three category system allocates funding, in an equitable manner, against the relative care needs of hostel residents. The Government does not believe that dividing existing funding allocations into four categories would be in the interests of hostel residents or organisations providing hostel care.

  (8) Dementia will tend to affect the degree to which assistance is required in one or more areas of care need, rather than result in needs radically different from those of other aged people needing hostel support.

  Funding provided to hostels for provision of care services is based on relative care needs, as assessed by the Personal Care Assessment Instrument. This instrument provides for a comprehensive consideration of the care needs of all aged people needing hostel care, whether or not they have dementia.

  However, it is recognised that there is a subset of people with dementia who also have very disruptive behaviours, whom hostels and nursing homes find difficult to support.

  For this reason, the Psychogeriatric Units established following the 1994-95 Budget will have access to funds with which they can supplement hostels and nursing homes caring for a resident with dementia and disruptive behaviours while care needs are being established.

  (9) The Government does not believe all dementia sufferers are better catered for in a nursing home than in a hostel. The need for hostel or nursing home care is determined by careful multi-disciplinary assessment, generally through an Aged Care Assessment Team, and consideration of the wishes of the person and their relatives.

  Following the 1994-95 Budget decision, the department has been asked to accelerate research into the care needs of people with dementia and disruptive behaviours, using the best academic and applied expertise that is available. The issue of appropriateness of different care models to different individual needs is central to this research.