Integrated assessment and management of dementia in the community – the Newcastle model John Ward, Hunter New England LHD Sept, 2014,

The Newcastle Model A shared-care arrangement involving –General practitioner –Community geriatrician –Community Dementia Nurse –Community care providers –Dementia Advisory Service –SMHSOP –Alzheimer Australia –Younger Onset Dementia Program –Community Options

33 Why is a model like Newcastle’s required There is a lot of dementia in the community and there will be a lot more in the future

Why is a model like Newcastle’s required Adequate assessment is much more than a medical diagnosis –other comorbidities, function, mobility, living situation, behaviour, future planning, carer health Assessment requires two health professionals if self-esteem and family cohesion is to be maintained Management is much more than cholinesterase inhibitors –information/education, carer support, behaviour management, future planning, respite, end-of-life care The assessment and management of dementia requires a shared care approach involving GP, medical specialist and specialist RN or case manager –every PWD with difficult behaviour or carer stress requires case management –case management keeps people out of residential care

Role of Community Dementia Nurse –home visit to assess function, mobility, psychosocial supports –assess behaviours –assess carer competency, stress –assists the geriatrician in the clinic –further cognitive testing – Adas-Cog, RUDAS, ACE-R –determine required supports housework, meals, personal care, respite (in-home, day centre) –provide information, education written material, Living with Memory Loss, Alzheimers support groups –future planning POA, Guardianship, ACCR for residential respite, placement, services

Greater Newcastle Dementia Service 6 Community Dementia Services, embedded in ACAT 7 Community Dementia Nurses – one per 50,000-70,000 pop. –within ACAT 6 Community Geriatricians – one (P/T) per 50,000-70,000 pop. 7 weekly clinics – Toronto, Morisset, Eastlakes, Wallsend, Hunter St, Raymond Tce, Nelson Bay Supported by Neuropsycholgist, Psychogeriatricians, Neuropsychiatrists, Dementia Advisory Service, Alzheimer Australia, Younger Onset Dementia Program

Geriatrician clinic history from patient with family in clinic room –don’t ask questions of family that would embarrass ask family to step outside for examination CDN interviews family in nearby room geriatrician joins CDN and family family returns to clinic room for summary CDN visits family at home in next few weeks –leaves contact details

Weekly case conferences Before clinic Attended by: –ACAT –CDNs –geriatrican –COPS Case Manager –SMHSOP Community Nurse –Package and HACC service providers –Social worker from large ACF

Advantages of Newcastle model No more than 90 minutes for initial assessment Minimises erosion of self while ensuring full disclosure Not coming to a “Memory Clinic” Assessment plus case management Embedded in ACAT Acceptable to GPs High community penetration (62% c.f. 26% for CDAMS) Cost-effective –Geriatrician covered by Medicare –CDN - $100,000 pa

What I believe It is unacceptable not to have an effective service for the assessment and management of dementia which, I believe, requires a geographical responsibility.. The assessment and management of dementia in the community requires an integrated approach, involving a wide range of service providers.. The essential basis for this integrated approach is the Community Dementia Service comprising a Community Dementia Nurse and a geriatrician.

What I fear Increasing fragmentation of community aged care Increasing privatisation of Geriatric Medicine Loss of geographical responsibility for dementia Removal of the coordinating role of HNE LHD

What I hope for Government to accept responsibility for funding assessment and management of dementia Community Dementia Nurses in all areas of NSW (? Australia) Role of ACAT to be expanded to comprehensive aged care service to include case management

What are we doing about it Lobbying governments Lobbying Alzheimer Australia Meeting in Newcastle, March, 2015, to establish Network for the Assessment and Case Management of Dementia in the Community

Summary The prevalence of dementia will increase three- fold by 2050 and we need a cost-effective model for assessment and management. Coordination and integration is essential, not fragmentation Some variant of the Newcastle model may be the most cost-effective. We need one CDN per 5000 people over age 70 –140 for NSW –$14,000,000 annually for NSW