Daniella Kanareck - the Prince of Wales Hospital

Daniella Kanareck - The Prince of Wales Hospital

Ms Kerrie Westcott
Director
Legislation Section Transition Branch Ageing and Aged Care Division
MDP 550
GPO Box 9848
CANBERRA ACT 2601

Dear Ms Westcott

Comments on Amendments to Aged Care Act 1997

Generally Aged Care legislation and policies lack specific reference to older people who have a mental illness (excluding dementias). Therefore it is positive to note that the proposed changes to the Aged Care Act 1997 and related legislation recognises the need to “support veterans with an accepted mental health condition.” However there is a dire need to extend this support to all older people who have a mental illness.

Older people who have a mental illness are an expanding vulnerable sector of the aged population whose ability to access appropriate Aged Care Services through the Living Longer Living Better aged care reform package needs to be safeguarded.

This sector’s vulnerability is exacerbated by

• Having to seek services from a number of primary health care, Aged Care and Mental Health Services, resulting in fragmentation and a lack of coordination, failing to address their holistic needs.
• For people over 65 years of age, mental illness per se does not meet the eligibility criteria for access to existing Aged Care Community Services. These services in accordance with the Aged Care Act, base their eligibility criteria upon age-related physical frail care needs and/or dementia; targeting assistance with personal care, domestic assistance and health care support.
• Mental health recovery goals are not specified in Aged Care Services’ care planning.
• Mental Health programs often have an age cut off of 65 years.
• Older people with a mental illness have the dual stigmata associated with both age and mental illness. Lack of information and understanding about age related comorbidities and mental illness result in it being all too easy for Aged Care and Mental Health Services to reject the older person with a mental illness.

Aged Care Services require the skills to manage older people with a non-acute mental illness and equally importantly, to be able to identify consumers who require mental health interventions. It is important for Aged Care legislation and policies to recognise the risks of this vulnerable group and address the difficulty they have in accessing appropriate community services. Failure to do so tragically results in exacerbation of mental health symptoms, increased medical health problems, greater risk of homelessness and higher hospitals and Residential Aged Care Facilities admission rates. Elements that would assist older people with a metal illness to remain independent in the community include

• Services that accommodate the episodic nature of mental illness, with a flexible treatment approach, in terms of level of care, hours, staff rostering, intervention strategies and funding.
• Greater emphasis on recovery goals such as socialisation and engagement in the community, as older people with mental illness are often isolated due to symptoms of their mental illness, the associated stigma and poor interpersonal skills
• A transitional component for stabilising older patients in the community post discharge from psychiatric inpatient units.
• Regular and/or daily supervision and management of medication, especially when treatment commences.
• Assistance with the coordination of service providers, such as Department of Housing, Primary Health Care, Mental Health Services and the Public Guardian.
• Establishing and maintaining partnerships between all stakeholders to reduce the rate of rehospitalisation, placement in residential care or homelessness.
• Greater understanding of cultural perceptions of mental illness.
• Support for the carers of older people with a mental illness, regardless of age of the carer.
• Support for carers through specialised mental health respite hours, at home or in residential care.
• On going mental health education and training of new and existing Aged Care Community Service providers to assist in the identification and management of symptoms, behaviours and risk factors associated with mental illness.

Without Aged Care legislation and policies recognising the needs of older people who have a mental illness, they will remain a marginalized and vulnerable sector that fall in the cracks between different services.

Yours sincerely

Daniella Kanareck
Social Worker