By David L. Stokes, Manager, Professional Issues

Budget initiatives released last month have given a new perspective and importance to aged care. The emphasis on this occasion has been on institutional and nursing home care, but some of the funding measures adopted could have important implications for psychologists. This has to be seen in the context of a considerable emphasis in recent years on chronic health conditions, many of which primarily affect the aged – namely, diabetes, asthma, heart disease, cancer and obesity. This focus has put extra funds into primary care and acute care settings. Even the new budget initiative for extending such services to include Allied Health (read to mean psychologists) is to be managed under the Enhanced Primary Care Initiative – a program to specifically assist the chronically ill, most of who are among the aged population.

I had the opportunity to be present on budget night at the Department of Health and Ageing’s pre-budget speech presentation of the health budget. The Minister for Aged Care, the Honourable Julie Bishop, was clearly very proud of their investment into this area, and with the Government's comprehensive response to the Hogan review of residential aged care. Despite the media focus shifting to tax relief and family issues, the aged care initiatives are very significant.

The Howard Government commissioned the respected economist, Professor Warren Hogan, to undertake a major inquiry into the future of residential aged care. His report, The Review of Pricing Arrangements in Residential Aged Care, set some considerable challenges and demands on Government in both short and long-term policy areas. Minister Bishop clearly felt her Government and Department had gone a long way to meeting those recommendations. The major inclusions were: increased aged care places over the next three years; additional payments to aged care providers to allow them to improve wages for staff; increased capital funding for construction and refurbishment; additional transition care places (to allow for supported recovery following hospitalisation); and investment in access to culturally appropriate settings and for special services for ATSIC groups.

Money into training and Aged Care Assessment Teams (ACATs)

What was of particular interest was the “preparedness” of the Government to invest in assistance and assessment programs and the training and education of aged care workers and nurses. Some of the extra provisions were:

  • over $100 million over the next four years to expand education and training places for aged care workers and nurses;
  • nearly $50 million in additional funding over four years for aged care assessment teams;
  • additional supplements for dementia and palliative care residents.

As I sat there, a number of questions recurred to me: Where was the funding for the training of other health professionals? Was the role of psychology identified in the ACATs? Is there any clear understanding of the contribution that psychologists can make to the management of difficult behaviour, mood disorders and family issues?

The APS and aged care

For some time now, a number of our members involved in aged care or research into ageing have been collaborating on a Position Statement regarding psychologists in aged care facilities. They have shared their ideas with the APS Psychology and Aging Interest Group who have endorsed and embellished these positions. The result has been a four-page document that identifies: the services that psychology can offer within the aged care context; the limited role that psychology currently performs within aged care; the current evidence supporting the effectiveness of psychological interventions; and the need for an aged care focus in some training courses.

This document follows some of the recommendations that were made in the APS Position Paper on Psychology and Ageing issued in 2002.

Some of the major points made in the new document regarding the role of psychology in aged care facilities are as follows:

  • properly trained psychologists can deliver evidence-based treatments for anxiety and depressive disorders that not only have proven effectiveness and are longer lasting than drug therapies, but are also cost–effective;
  • appropriately trained psychologists can objectively assess cognitive and behavioural functions in the elderly which can assist with both diagnosis and focussed drug interventions;
  • many psychologists are being trained for specialised work with older people through special tertiary programs; and
  • there is considerable evidence suggesting that psychological interventions with behaviour problems in older people in residential care has substantial cost savings through:
  • a tenfold reduction in hospitalisation;
  • a threefold reduction in drug side effects;
  • a halving of the number of visits by general practitioners; and
  • a quartering of the number of visits by geriatrics psychiatrists.

The paper goes on to discuss the limited role that psychologists play in aged care, despite having so many skills and contributions to make. It also expresses some interest in the concept of developing specialist postgraduate programs to specifically train our clinicians for work with older people. It then highlights the development of roles for psychologists in the United States in aged care and hints at some possible directions for Australian psychologists. It concludes by reviewing the evidence for the significance and relevance of psychological interventions and procedures in gaining the best services for our aging unwell.

How to further this issue

The Australian Psychological Society would like to add this Brief, and the major health issue that it represents, to its list of issues regularly represented to Federal politicians. We have recently presented (in connection with MedicarePlus) a range of papers regarding evidence-based practice, the contribution of psychologists to areas of chronic disease, and have reiterated our constant message on the benefits of psychological interventions in the area of mental health and, most particularly, for the prevalent disorders of depression and anxiety. Much of this overlaps with the concepts reiterated above regarding aged care services. It would be good to have some specific strategies and recommendations that we could put before the Minister for Aged Care and her advisers.

We would like to challenge our members who are currently working in aged care, and those with considerable experience in areas of assessment of treatment, to offer their suggestions regarding strategies and initiatives of potential benefit. We would also like to receive communication of a supportive nature to give us some sense of the unanimity of opinion that may exist among our members. Please feel free to comment either directly with the author at the APS National Office, d.stokes@psychsociety.com.au, with any members of the group that collaborated over this document, or with any of the Psychology and Aging Interest Group Office Bearers. Their names are tabled below.

Members of the collaborative group

Name Email
A/Prof Stephen Bowden s.bowden@psych.unimelb.edu.au
Ian Johnston ijohnston@svh.org.au
Deborah Koder deborahpsych@aol.com
Dr Nancy Pachana npachana@psy.uq.edu.au
Dr Miriam Tisher miriamtisher@almafamilytherapy.com
Dr Yvonne Wells y.wells@latrobe.edu.au
Hugh Woolford woolford@ecn.net.au

 

Psychology and Ageing Interest Group Office Bearers

Name Position
Dr Nancy Pachana National Convenor and Convenor, Qld
A/Prof Ed Helmes National Chair Ex Officio
Deidre McLaughlin National Treasurer and Secretary, Qld
Michael McMahon Convenor, NSW
Mike Tyrrell Section Representative, NT
Paul Kemp Convenor, SA
Jan Harry Secretary/Treasurer, SA
Dr Clive Skilbeck Section Representative, TAS
Dr Yvonne Wells Convenor, VIC
Deborah Gardner Convenor, WA
Dr Kaarin Anstey Convenor, ACT