Submission on The Dementia & Veterans Supplements In Aged Care Consultation Draft May 2013
1. About FECCA FECCA is the national peak body representing and advocating for culturally and linguistically diverse communities. Our role is to advise, advocate, and promote issues on behalf of our constituency to government, business and the broader community. FECCA promotes Australian multiculturalism, community harmony, social justice, community participation and the rejection of discrimination so as to build a productive, culturally rich Australian society. FECCA s policies are designed around the concepts of empowerment and inclusion, and are formulated with the common good of all Australians in mind. 2. Executive Summary FECCA thanks the Department s preparation of the Consultation Paper that seeks the delivery of new dementia and veterans supplements in Home Care Packages, Residential Care and other programs that apply from 1 July 2013. FECCA commends the Consultation Paper for its cohesive and clear presentation of the new supplements. FECCA welcomes the opportunity to comment on the Paper where culturally and linguistically diverse (CALD) ageing and aged persons comprise a substantial and growing percentage of the ageing Australian population. FECCA believes that where relevant, their needs must be articulated in informing the final guidelines and subordinate legislation. The following comments are guided by our awareness of the many barriers that may preclude the appropriate provision of the new supplements for CALD ageing or aged Australians. Our comments are offered to improve the ability of older people from CALD backgrounds to equitable access to appropriate aged care. 3. The Demementia and Veterans Supplements in Home Care Packages In terms of rights to information and access to services, FECCA recommends that the final Guidelines reflect the needs of CALD ageing or aged Australians, to ensure theyare eligible for all levels of the new supplements. 3.1 The Dementia Supplement in Home Care To address equity in terms of barriers for CALD persons who may have dementia (and who could be younger onset, as well as ageing or aged), FECCA asks that the appropriate assessment of cognitive impairment is undertaken. We recommend the Rowland Universal Dementia Assessment Scale (RUDAS) which is a short cognitive screening tool, for assessment of dementia, the RUDAS is designed to enable the easy translation of the items into other languages and to minimise cultural bias. Interviews last about 10 minutes. Use of an interpreter is important. Page 2 of 5
3.1.1. Transition arramgements for Extended Aged Care at Home Dementia (EACHD) It is unclear what variation in the Program if any is required or is in place for CALD care recipients (younger onset dementia, chronic and severe mental conditions, ageing or aged) who have not started to receive EACHD at the commencement of the new supplement. 3.2.6 The Veterans Supplement in Home Care FECCA supports the range of programs that support veterans, war widows and widowers as a Special Needs Group. 4. The Dementia and Veterans Supplements in Non-Mainstream Programs FECCA commends the supplementation of community-based services delivered under the Multi-Purpose Service Program (MPS), the National Aboriginal and Torres Strait Islander Flexible Aged Care Program, the Innovative Care Program and Transition Care Program. 4.1 Multi-Purpose Services Program FECCA agrees that the Multi-Purpose Services Program (MPS) Program is important for small rural and remote communities. The Dementia and Veterans Supplements funding built into the program will support CALD persons with younger onset dementia, or ageing and aged CALD people. FECCA recomments that appropriate assessment conducted should use the services of an interpreter. 4.2. National Aboriginal and Torres Strait Islander Flexible Care Program FECCA agrees that the supplement funding be distributed across the home care places, that it be flexible, culturally appropriate, and meet the needs of older Aboriginal and Torres Strait Islander people. 4.3 Transition Care Program In integrating the Dementia and Veterans Supplements in Aged Care, FECCA suggests that when CALD older persons receive therapy such as physiotherapy, occupational therapy, and nursing and personal support, that these are undertaken in culturally appropriate ways. FECCA agrees that the additional funding for Transition Care providers will not impose new assessment requirements and for the funding to be equally distributed across all Transition Care places. Innovative Care Program FECCA defers to the recommendation of the working group in setting the value of the supplements that attract Level 2 or Level 4 Home Care Package. Page 3 of 5
5. The Dementia and Veterans Supplements in Residential Aged Care FECCA asks if the working group considered CALD persons with high care needs who are likely to be moved around because of their complex care needs? In addition to their demands on resources, are their cultural needs also assessed? This is particularly relevant to people who have newly arrived who have suffered trauma. Those care costs must include more skilled staff, including bilingual, bicultural and cultural-competency trained staff. 5.1 The Dementia Supplement in Residential Care FECCA defers to the working group, but asks in addition that in defining eligibity for the dementia supplement in residential aged care, that cultural background is considered, and recommends that interpreter services are provided for assessments assessments are undertaken in a culturally aware and sensitive manner CALD people (who may be younger, older or elderly) have access to legal representation on their behalf. FECCA is interested in how the application will be devised. 5.1.1. A Relevant Medical Diagnosis FECCA defers to the criteria as set in Attachment B. 5.1.2. Assessment of Severe Behaviours and Psychological Symptoms With regard to assessment tools for measuring cognitive decline or the severity of depression, FECCA asks if the CALD cultural competency measures are factored in, and if it is appropriate to have an interpreter and/or legal representative and other support such as a case manager present? 5.1.3 Meeting Resident Care Needs FECCA defers to the Department s recommendation in regards to funding the provider based on demonstrated capacity and according to requirements determined by the Aged Care Standards and Accreditation Agency. 5. 1.4. Annual Review of Eligibility for the Dementia Supplement FECCA waits for advice when the criteria to determine eligibility for the supplement will be developed in consultation with care providers and clinicians before the first 12 month review is required in 2014. Page 4 of 5
5.1.5.An ACFI Reappraisal as a result of the Supplement To eliminate inconsistencies and changes in circumstances, FECCA agrees with the voluntary ACFI reappraisal. 6. Evaluation of the Supplements FECCA awaits advice from the Department when the evaluation will assess effectiveness and appropriateness of the assessment tools, effectiveness of the supplements in improving care outcomes in residential care, home care and other relevant aged care programs, and how well the assessment tools are being applied, ease of use, and appropriateness of the thresholds used to determine eligibility. Page 5 of 5