0. Update on the NSW Dementia Services Framework 2010 – 2015
Anne Cumming
NSW Dementia Policy Team
Wendy Noller
Ageing Disability and Home Care
Collaborations and Innovations Symposium

1. Overview Background & policy context The Framework
Draft Implementation Plan
Principles – “I” statements
Progress so far
Key Projects

2. Dementia prevalence in NSW by LHD by Year
Rapid increase in the number of people with dementia due to an ageing population
Issues confirmed in development of the framework:
The main burden falls on family carers
Lack of early detection and treatment denies opportunities for improving the quality of life
Those who do access services, the services are overstretched now and are inequitably distributed
Access to diagnosis and appropriate services is a significant issue for younger people
Current hospital experience leads to poor outcomes

3. Policy context Commonwealth Dementia Planning
National Action Plan on Dementia Care
The Dementia Initiative – 2005
Living Longer Living Better
National Dementia Planning
National Framework for Action on Dementia
Dementia as the 9th National Health Priority
NSW Dementia Planning
NSW Action Plan on Dementia
Future Directions
NSW Dementia Action Plan
NSW Dementia Services Framework 2010 – 2015

4. NSW Dementia Services Framework
Launched September 2010 in Dementia Awareness Week
Joint publication NSW Health and ADHC
s/gl/2011/pdf/GL2011_004.pdf

5. Draft implementation plan
Approved and jointly signed by NSW Minister for Health and NSW Minister for Ageing and Disability Services
Launch by Hon Andrew Constance, MP at public seminar on World Alzheimer’s Day 21 September 2011

6. Version 1 WHAT WILL WE DO? WHO WILL DO IT? WHAT WILL WE REPORT ON?
Provide clinical support, education and leadership
Local Health Districts
Access to dementia expertise in hospitals
Implement Confused Hospitalised Older Person Study (CHOPS)
Agency for Clinical Innovation, Aged Health Network
Evaluation completed and findings promoted
Improve dementia detection, care and intervention
Adverse events monitored and reduced
Implement the National Delirium Guidelines and Pathway
Delirium pathways in place and monitored
Increase dementia access to hospital substitution programs
Dementia patients access to hospital substitution programs
Expand carer consultation and support strategies
Carer consultation and support strategies in place
Identify and respond to current design constraints in hospitals
Department of Health
Outcomes of project reported, environmental audits conducted
Strengthen evidence and support the development of behavioural units
Evidence collected, site appraisals undertaken

7. Summary of changes – version 2
LHD reporting reduced
Essential actions listed and sequenced
Importance of parallel initiatives emphasised
Changed format
Additional content
Principles
Governance structure added
Self assessment checklist
State-wide projects table
Essentials
Local governance structure
Dementia Service Networks
Local dementia action plans
Dementia initiatives with Medical Locals
5. Referral and care pathways
6. Integrated dementia care models
7. Routine cognitive screening over 70 years in hospitals
8. Collaboration between specialist health and mental health services
Parallel Eg
Carers Recognition Act
Falls policy
Framework for specialist health services for older people
Connecting Care
Hospital in the Home

8. Setting the direction for dementia care in NSW
My community contributes to my quality of life
I am valued, respected and treated with dignity
I am supported to maintain my quality of life, based on what I consider to be important and meaningful to me
My family carer/s are valued, supported and consulted. They are recognised as experts and as partners in care
When I need to go to hospital my cognitive difficulties are recognised and I receive the care and treatment I need
I was given a timely diagnosis and follow up information and support for me and my carer
We know a professional whom we can trust, who knows us well who we can contact when required to resolve issues and provide advice
The professionals I interact with have the right skills, knowledge and attitude and are valued for their expertise in dementia care
I am free from pain and receive best possible end of life care
My end of life wishes are discussed and followed

9. Proposed essential actions for LHDs
Local governance structure
Dementia Service Networks
Local dementia action plans
Dementia initiatives with Medical Locals
5. Referral and care pathways
6. Integrated dementia care models
7. Routine cognitive screening over 70 years in hospitals
8. Collaboration between specialist health and mental health services

10. Steps Timeline 2010 2011 2012 Governance (2009) Framework consultation
Steps
Timeline
2010
2011
2012
Governance (2009)
Framework consultation
Draft for comment
Framework release
Issued as Guideline
Plan drafted
Plan revised
 Plan submitted
Final plan released
Policy Directive ?
Implementation

11. Implementation How? National reforms Parallel initiatives Who?
Investment
Planning
Redesign
Policy
Pilots
Who?
Ministry of Health and ADHC
4 Pillars
Local Health Districts and ADHC regions
Local Dementia Networks
Partners and contracted projects
Critical to the implementation process is the recognition that service activity is being implemented at various levels.
These include:
State Govt Departments - NSW Department of Health and Ageing Disability and Home Care (ADHC)
NSW Statewide Policy Teams – Dementia Policy Team , Older People Mental Health and Statewide Centre for Palliative Care
Local Health Districts (from July 2011) and ADHC regions
Partners and contracted projects - partners include the four pillars – ACI CEC, CETI
Local Dementia Networks
In some cases this has translated to the Framework being used at local service provision levels to reflect on service provision and practices, identifying opportunities for improvement- much like a self assessment/quality improvement tool.
For example the Inner West Dementia Advisory Service located in Sydney has taken sections from the service pathway to the local dementia network meetings with question and discussion time among stakeholders to consider opportunities for service improvement.
Also the Southern Dementia Network is drafting a Dementia Action Plan that is structured under the Service Pathway areas of the NSW Dementia Services Framework.

14. A life shared ….
TOP 5

15. Ageing, Disability and Home Care
Home and Community Care (HACC) Program transition
1 July 2012 – NSW Community Care Supports Program for people aged 65/50
Dementia remains a target group of ADHC’s Community Care Supports Program – under review in 2012/13
Approximately 54,000 (was 280,000) people access community supports each year
Since 1 July 2012, the Commonwealth has assumed full funding and operational responsibility for aged care services, including the HACC program.
This means that ADHC is now solely responsible for administering basic community care services for people aged under 65, and 50 for Aboriginal and Torres Strait Islander people.
ADHC is currently in the process of approving new program arrangements, including program guidelines to support its community care program. As per the National Partnership Agreement in which both levels of government agreed to not substantially altering service delivery in the HACC program until 30 June 2015, the changes to the ADHC program guidelines is more about reflecting the new younger cohort.
This means that dementia will remain as one of the five target groups for the ADHC community care program. And ADHC’s policy and program development in dementia will focus on services for younger people with dementia which as you know, is targeting dementia which occurs in people before 65 years.
In saying that, although NSW does not retain a service delivery role for older people, it maintains an interest in this group. The Office for Ageing hold policy responsibility for this group of people.
It’s estimated that approximately 54,000 younger people access community care supports in NSW. Based on the latest research from the Australian Institute of Health and Welfare – it could be estimated that there are approx 8000 people in NSW with younger onset dementia.

16. Dementia 2011/2012 – ADHC funded 65 new dementia projects across NSW
$3.4 million in growth funding
$1.4 million in non-recurrent funds
Announcement of Younger Onset Dementia Person Centred Packages – 3 year pilot ($1m recurrent)
In 2011/12 through the Home and Community Care Program, Ageing, Disability and Home Care funded 65 new dementia projects across NSW.
$3.4 million in growth funding (18.6% of total growth in 2011/12) was allocated to dementia related direct service delivery.
In addition, $1.4 million in non-recurrent funds were allocated to support projects relating to the priorities and recommendations from the NSW Dementia Services Framework
In April this year, ADHC in conjunction with Alzheimer’s Australia held a Younger Onset Dementia forum in Sydney. 140 people attended from across NSW. At the forum, the Minister announced ADHC’s commitment of $1 million in recurrent funding for a new younger onset dementia program. The program will operate as a 3 year pilot that will provide flexible person centred packages for people with younger onset dementia.

17. ADHC Dementia projects under DSF
Younger Onset Packages and evaluation
Person centred packages
Guidelines finalised
Considering funding options
YOD mapping and information / advisory service
Ella Centre
YOD research
Completed and about to be launched
It’s difficult at this stage to predict was the sector will look like and where younger onset dementia will sit long term with the current reforms for aged care and disability services
Until more information becomes available ….?
ADHC will continue to support the sector in adjusting to the changes as a result of the HACC transition
…? Inclusion of this slide?

18. ADHC DSF projects continued
Increase of funding to Dementia Awareness Week
Meets goals of awareness and community engagement
Hospital Dementia Services Project
AANSW and University of Canberra
Studies people in hospital’s experience of community care services, impact on carer
Transport and Dementia Research Project
AANSW – looks at community transport, personal transport, public transport

19. ADHC DSF projects continued
Dementia and Disability Education Program
66 workshops over three years
Intellectual and physical disabilities targeted
Carer Coaching Program
Carer education workers / train-the-trainer model
Assist carers working with people or families with dementia
CALD Dementia Link Worker (now recurrent)

20. ADHC DSF projects continued
Aboriginal Dementia Advisory Service expansion (Hunter)
Koori Dementia Care Project
5 communities across NSW
State-wide Aboriginal project
2 year project
Develop strategic plan / link into existing strategies
ADHC currently supports people with younger onset dementia through existing community care supports to help them continue to live at home.
There are already some services that are specifically for people with younger onset dementia in NSW and people also access general community care services such as those offered through the HACC program.
However, there are a number of issues that have informed the need to trial a new service model for people with younger onset dementia. Including: people with younger onset dementia do not always find it easy to access appropriate services in the community to meet their needs, and
Contemporary approaches to designing services emphasises giving people greater control over the supports they receive, through person centred planning.
We’re still developing the program and are conducting extensive consultation to ensure the program aligns with ADHC broader policy and program direction for individualised funding and self-direct support models.
ADHC has engaged Alz Aust NSW to assist in the implementation of the program by conducted the program’s evaluation and also provide support to providers that deliver the packages.

21. ADHC DSF projects continued
Dementia Services Evaluation Grants Program
Administered by DCRC
Funding grants for 11 projects
Build evidence base through formal evaluation
Upskill workers
Dementia Workforce Competencies Scoping Project
For managers and health practitioners in HACC and health setting
Support workforce recruitment, skills development and enhance career opportunities
ADHC currently supports people with younger onset dementia through existing community care supports to help them continue to live at home.
There are already some services that are specifically for people with younger onset dementia in NSW and people also access general community care services such as those offered through the HACC program.
However, there are a number of issues that have informed the need to trial a new service model for people with younger onset dementia. Including: people with younger onset dementia do not always find it easy to access appropriate services in the community to meet their needs, and
Contemporary approaches to designing services emphasises giving people greater control over the supports they receive, through person centred planning.
We’re still developing the program and are conducting extensive consultation to ensure the program aligns with ADHC broader policy and program direction for individualised funding and self-direct support models.
ADHC has engaged Alz Aust NSW to assist in the implementation of the program by conducted the program’s evaluation and also provide support to providers that deliver the packages.

22. Dementia Services Evaluation Grant Program

24. In conclusion...
Implementation of the NSW Dementia Services Framework is underway at state and local levels.
The implementation plan will provide further momentum, direction and guidance for LHDs and ADHC regions with an emphasis on partnerships, collaboration and co-ordination.
The work in NSW will build on a national agenda for improving the quality of dementia care.
Nepean - implementation would be coordinated by working party under Chronic and complex Committee

25. Thank you