Dementia care in aged residential facilities

Dementia is a mental health condition that falls within the scope of Aged Persons’ Mental Health Services (APMHS). Mental health services have a vital role to play in the care of older people whose mental health condition exceeds the capacity of other stakeholders – family carers, general practitioners, residential care providers and dementia care agencies.

APMHS are expected to maintain a high level of expertise in the assessment, care and treatment of people with dementia and to engage with aged residential care providers and other dementia support agencies in a way that promotes the timely, coordinated and expert care and treatment of vulnerable older people.

The Chief Psychiatrist is concerned that APMHS vary in their responses to requests for help from residential providers regarding residents whose dementia is complicated by behavioural and psychological symptoms. The following advice is intended to promote consistent practice and good working relationships with residential providers and other agencies.

Commonwealth-funded dementia services

The Commonwealth-funded Dementia Behaviour and Management Advisory Service (DBMAS) provides assessment and care to people with mild to moderate behavioural and psychological symptoms of dementia. The Severe Behaviour Response Team (SBRT) provides assessment and care to people with severe symptoms of dementia who reside in Commonwealth-subsidised residential facilities. SBRT resources are relatively limited.

Aged Persons’ Mental Health Services

It is reasonable for APMHS to pass referrals of residents with mild to moderate behavioural and psychological symptoms of dementia to DBMAS. Before doing so, the service must enquire about the nature and frequency of a resident’s symptoms to ensure that the referral to DBMAS is appropriate.

Residents whose very severe behavioural or psychological symptoms of dementia present serious and immediate risk to themselves or other persons should be accepted by APMHS.

Where the level of risk is serious but not immediate, the APMHS should accept the referral, conduct an assessment and provide advice about management of the symptom. If it is decided that SBRT is better placed to provide ongoing care, the APMHS may refer the person to SBRT and provide a handover once the referral has been accepted. There must be clear communication to the residential provider about the status of the referral.

When a person with dementia is discharged from a mental health inpatient unit, the APMHS remains responsible for mental health treatment. If ongoing care by DBMAS or SBRT is warranted, the APMHS should make a referral and remain engaged until the referral has been accepted.

Questions regarding the level of symptom severity and risk that warrant referral to SBRT are best dealt with through discussion with the agency.