Evaluation of a mental health service reform program, the Pathways to Community Living Initiative, for people with severe mental illness and complex needs.

OBJECTIVE: The Pathways to Community Living Initiative (PCLI) aims to reform mental health care for people with severe and persistent mental illness (SPMI) and complex needs. This study reports independent evaluation findings on transitions from hospital and practice change in mental health services. METHODS: Data for this mixed-methods evaluation were obtained from administrative collections and semi-structured interviews with PCLI program managers, teams and executive leads; aged care managers; and leaders in inpatient, community and older people's mental health services. RESULTS: Between July 2015 and December 2020, 674 participants (67% of those eligible for the PCLI) were transitioned from hospital to community. Of those transitioned, 21 required subsequent long-stay admissions. The PCLI introduced resources, clearly defined processes, and state-wide networks to guide changes in practice which are becoming embedded in the operations and governance of mental health services across New South Wales. CONCLUSIONS: Severe and persistent mental illness and complex needs can be managed in community settings with highly individualised planning and care, supported by specialised clinical teams in partnership with mental health, aged care and disability services. Evaluation findings highlight the importance of continued investment in rehabilitation psychiatry.

The Australian National Aged Care Classification (AN-ACC): a new casemix classification for residential aged care.

OBJECTIVE: To develop a casemix classification to underpin a new funding model for residential aged care in Australia. DESIGN, SETTING: Cross-sectional study of resident characteristics in thirty non-government residential aged care facilities in Melbourne, the Hunter region of New South Wales, and northern Queensland, March 2018 - June 2018. PARTICIPANTS: 1877 aged care residents and 1600 residential aged care staff. MAIN OUTCOME MEASURES: The Australian National Aged Care Classification (AN-ACC), a casemix classification for residential aged care based on the attributes of aged care residents that best predict their need for care: frailty, mobility, motor function, cognition, behaviour, and technical nursing needs. RESULTS: The AN-ACC comprises 13 aged care resident classes reflecting differences in resource use. Apart from the class that included palliative care patients, the primary branches were defined by the capacity for mobility; further classification is based on physical capacity, cognitive function, mental health problems, and behaviour. The statistical performance of the AN-ACC was good, as measured by the reduction in variation statistic (RIV; 0.52) and class-specific coefficients of variation. The statistical performance and clinical acceptability of AN-ACC compare favourably with overseas casemix models, and it is better than the current Australian aged care funding model, the Aged Care Funding Instrument (64 classes; RIV, 0.20). CONCLUSIONS: The care burden associated with frailty, mobility, function, cognition, behaviour and technical nursing needs drives residential aged care resource use. The AN-ACC is sufficiently robust for estimating the funding and staffing requirements of residential aged care facilities in Australia.

Support for people with dementia experiencing severe responsive behaviours: Unpacking the disconnect between policy and practice.

OBJECTIVE: The Severe Behaviour Response Team (SBRT) program, which was established in 2015 to support aged care residents with dementia experiencing very severe and extreme responsive behaviours received far fewer referrals than projected during its first year. This article describes the outcomes of a brief survey to identify potential barriers to referrals and identify opportunities to improve the uptake of the service. METHODS: A pragmatic, quasi-experimental study was conducted involving clinical leads working in a representative sample of care homes that had not used the SBRT. The study was part of the formative evaluation activities of an ongoing program evaluation. RESULTS: Of the 53 clinical leads that participated in the survey, one-third had not heard of the SBRT prior to being contacted. The remaining two-thirds (n = 36) had not used the service due to the availability of existing resources and concerns regarding responsiveness of, and access to, the new service. CONCLUSIONS: Three themes emerged from the study relating to awareness of the service, responsiveness and the interface between local aged care and health services. Referrals increased following interventions to address the first two themes; however, they continue to remain well below the number projected. This indicates a fundamental disconnection between the policy design process and the day-to-day experience of residential aged care. The study highlights the importance of aged care clinical leads being engaged in dementia policy and program development processes to support improved targeting of resources.

Rapid response teams to support dementia care in Australian aged care homes: Review of the evidence.

OBJECTIVES: To identify attributes of rapid response services designed to support people with very severe and extreme responsive behaviours, otherwise known as behavioural and psychological symptoms of dementia, in aged care homes. METHODS: A rapid evidence assessment was conducted to inform the evaluation of the Severe Behaviour Response Team (SBRT) service, including a targeted search of peer-reviewed academic literature and an Internet-based search of government, service provider, peak body and university websites. RESULTS: A number of localised rapid response services targeting people with similar clinical profiles were identified, but none operated on the scale of the SBRT. Five operational attributes in common were as follows: clearly defined parameters and processes; provision of clinical expertise and knowledge translation activities; person-centred philosophy; relationship-oriented approach to stakeholders; and generalisable and sustainable outcomes. CONCLUSIONS: The five attributes provided a useful framework to guide the evaluation of the SBRT and clarify opportunities for continued service development.

Younger Onset Dementia.

This literature review focused on the experience, care, and service requirements of people with younger onset dementia. Systematic searches of 10 relevant bibliographic databases and a rigorous examination of the literature from nonacademic sources were undertaken. Searches identified 304 articles assessed for relevance and level of evidence, of which 74% were academic literature. The review identified the need for (1) more timely and accurate diagnosis and increased support immediately following diagnosis; (2) more individually tailored services addressing life cycle issues; (3) examination of the service needs of those living alone; (4) more systematic evaluation of services and programs; (5) further examination of service utilization, costs of illness, and cost effectiveness; and (6) current Australian clinical surveys to estimate prevalence, incidence, and survival rates. Although previous research has identified important service issues, there is a need for further studies with stronger research designs and consideration of the control of potentially confounding factors.