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
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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
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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