Objective: The project concerns development of models for optimal care and accommodation for older Australians with severe and persistent behavioral disturbance in long term care in New South Wales. The presentation is designed to review literature and opinion on current management, and to stimulate international exchange of ideas.
Design: The project includes a comprehensive review of the international literature, focused group discussions with expert panels, and site visits to centers recognized as providing innovative care.
Materials and Methods: Long term psychogeriatric hospital wards are some of the last vestiges of the large, old psychiatric institutions in New South Wales. The unwritten mandate of these wards has been to take very difficult people, previously considered "unplaceable". Current policy direction is to devolve these wards into mainstream nursing home care. Some authors have characterized today's nursing homes as small psychiatric hospitals. However, concerns have been raised that nursing home residents with complex psychiatric, physical, social and emotional needs are cared for primarily by low paid, minimally trained staff.
Choice of model of service delivery is problematic when faced with diversity of social, demographic and geographic variables across the state, and innovation can be challenging when faced with regulatory and funding arrangements that are based in a history of a medical model of long term care.
A comprehensive review of the literature was conducted. While the diversity of literature reflects the complexity of the origins and effects of behavioral disturbance, a systematic overview is difficult. The nomenclature is inconsistent; the frequently episodic and fluctuating nature of behavioral disturbance preclude it from existing nosology; settings and subjects differ on a multitude of variables; and the quality of evidence is questioned. The conceptual basis of investigation or management of behavior varies along a continuum from internal neurochemical events to the perceptions of others who experience the behavior. There is a plethora of literature of advice on management; but evaluated studies of comprehensive programs for severe behavior are few. Conclusions can be difficult to draw from fragmentary and sometimes conflicting results.
Results: Focused group discussions conducted with experts, service providers and family caregivers provide insight into management and service delivery issues. Questions examined include: Is devolving psychogeriatric long term care to the residential care sector further marginalizing older people with behavioral disturbance, or is it affording opportunities for better, more humane care? What support do nursing homes need to provide optimal care of severely behaviorally disturbed people? Is the nursing home, even with special services, the best option? How do we provide both good care for residents and a safe, fulfilling work environment for staff?
Conclusion: In the 21st century the globally aging population will continue to place pressure on nursing homes to accept increasingly cognitively impaired and behaviorally disturbed residents. These issues require urgent debate to develop solutions.
Back to S007 Quality of Life in Dementia: Is It Measurable and Is It Possible?
Back to The Eleventh International Congress