5.3 Plan to use services

Types of Services

There are four groups of services that people with dementia use:

1. Medical services. These include GPs, and public or private medical specialists and their teams.
2. Allied health services. These include psychologists, occupational therapists, physiotherapists, speech pathologists, dietitians, and exercise physiologists. These might be private services – you might be able to get a subsidy for them under a Chronic Disease Management Plan (through your GP) or from your private insurance. They might be provided by your state health service usually for free. They might be provided as part of an aged care service to which you usually pay a contribution to the cost. See 3.11 Speech and occupational therapy for how different allied health professionals can help you manage symptoms of dementia.
3. Home and community services. Usually these services help you at home or when out and about. These services can help with home modifications, home cleaning and gardening, showering, meals, transport, support and information groups, and other jobs around and outside the home. Home and community services are provided through the Federal government’s Aged Care services, the Department of Veteran’s Affairs (DVA) services, and the National Disability Insurance Scheme.
4. Dementia information and support services. Dementia Australia, the largest provider nationally, runs the dementia helpline, dementia post-diagnosis counselling services, dementia support groups and other services for people with dementia and carers. You might have to travel or wait for in-person groups as coverage of these varies. Dementia advisors are employed by both aged care and health services around Australia and provide dementia information and support (you can also read 2.3 Support to adjust to diagnosis). Dementia Support Australia is a national, free 24/7 telephone service (1800 699 799) to provide support for people with dementia where changed behaviours are impacting their lives or the lives of their carer.

Service systems and getting services

There are five main ‘systems’ through which you can obtain therapies and services:

• General practice and primary care
• State health care
• Federally funded aged care services for people over the age of 65 years
• National Disability Insurance Scheme
• Services provided by not-for-profit organisations and councils

You’ll usually use more than one of these systems, and confusingly there is overlap in the services that they provide. The systems don’t always link to each other, and professionals within the different systems sometimes don’t understand the other systems very well.

General practice and primary care

Your GP will provide day-to-day medical management for your health and make referrals for subsidised therapies with the practice nurse and/or allied health professionals as part of a Chronic Disease Management Plan or Mental Health Plan.

Your GP also helps with conversations about driving, and accessing taxi subsidies, and making a referral for aged care assessment. GP services are subsidised by Medicare; many GPs bulk bill so you don’t pay a contribution to visit the GP.

Also see the page 2.10 Tell other health professionals  on being assertive with your doctor and other health professionals.

State health care

Your state hospital or community health centre medical specialist (e.g. geriatrician, neurologist, old age psychiatrist) and their team will provide specialist dementia assessment and management.

Teams vary in terms of the types of services and supports they provide for people with dementia. Some may have a dementia nurse specialist, a dementia advisor, or allied health professionals who can provide information and support, run support groups, and provide therapy at the health service or in your home. These services are usually free or require a small contribution. Others offer minimal additional services.

After an emergency visit to hospital, you might be given a short-term course (i.e. 6 to 12 weeks) of allied health and home services as part of your discharge from hospital. Hospital to home services are meant to provide rehabilitation and services until you can manage yourself at home, or until you receive ongoing home care services.

Private medical specialists may refer you to private allied health professionals, or state health services at the hospital or community health centre.

Federally funded aged care

For people over the age of 65 years old, the Federal government funds a range of aged care services for people living in the community which are provided by many different providers throughout the states and territories.

The Commonwealth Home Support Program (CHSP) includes community transport, meals-on-wheels, community nursing, home modifications, and social programs. People might use one or more of these services, often delivered by different providers. For example, Wei-Wa might get meals from the Multicultural Meals-on-Wheels services and use the Dandenong Community Transport Service.

Home Care Packages provide a bundle of services which are case managed and delivered by the one provider. Your case manager will interview you to understand your preferences and needs, consult with you to write a service care plan, and coordinate the different people who come to help you. Home Care Packages provide a set amount of funding based on your level of need, and you can choose to spend those funds in a way that supports you to live well at home. For instance, Christine’s Home Care Package case manager might organise to have care worker Noleen come and take her shopping on Tuesday afternoons, a physiotherapist Sam to come on Wed mornings, and Noleen takes her to appointments on Thursdays.

To get services through My Aged Care:

• You’ll need to register on the My Aged Care website. My Aged Care is the government gateway to getting aged care services. The website can be confusing, you can also telephone a free helpline 1800 200 422.
• As you move through the process of requesting services, there are different and sometimes long forms to fill out. Get help with these forms if you need it.
• Depending on the type of service that you’re applying for, you might need to provide a large amount of financial information around your income and assets as this information is used to determine what your financial contribution to the service will be.

Assessment for aged care services:

There are two assessment services:

• Regional Assessment Services (RAS) conduct assessments for people with fewer needs.
• Aged Care Assessment Teams (ACATs) conduct assessments for people with greater needs.

You might need to wait a few months to get an assessment. The assessor will usually come to visit you in your home, and often talk to your family or supporters. The assessor might make suggestions about the types of services which might help you.

Approval for aged care services

You’ll receive a letter once you’re approved for a type of service. If you’re approved for a Home Care Package, your letter will give you some information about how long you might wait for your service. Many people have been waiting for over a year to get their full Home Care Package.

You’ll need to find the right service provider for you. My Aged Care has a postcode service finder which helps you see the providers in your area. Ask friends for recommendations. Speak to a few providers about their services (ask about their staff training about dementia). This might help you find a service that’s best for you.

For more information you can visit The Conversation website including:

• This article which explains more about home care services in Australia; and
• This article which gives tips on choosing a home care provider.

National Disability Insurance Scheme (NDIS)

People who were diagnosed with dementia before the age of 65 years, and register for the National Disability Insurance Scheme (NDIS) before the age of 65 years old, may be eligible for support. Dementia is considered a disability as part of this scheme. See Dementia Australia for more information including how to apply.

The NDIS does not provide services directly. It provides funds to cover the cost of services and/or supports that are assessed as necessary to enable the person with younger onset dementia live daily life, achieve their life goals and aspirations, and connect with their community.

To access NDIS support, there are a few steps to complete:

• Step 1: There is a process to determine if you are eligible to receive NDIS support – check this short, online eligibility questionnaire.
• Step 2: Once eligibility is determined, there is an Access Request Form or phone 1800 800 110 to have the form posted to you. Forms can be provided in other languages. A representative can be appointed to provide assistance on your behalf. There are other documents that need to be provided with the Access Request Form including a confirmation of diagnosis by your doctor, a form to be completed by your doctor, proof of residency and age, and letters from other health professionals such as an occupational therapist, physiotherapist or psychologist to support your application.
• Step 3: Following submission of the Access Request Form and other documents, NDIS will advise by letter if your application has been successful.
• Step 4: NDIS will then contact you to arrange a planning meeting to talk about what services are required and funding that can be made available. You (and your representative or carer) will choose a provider to deliver the services. If you require support with the co-ordination of your services, a support co-ordinator can be appointed.

Terri was diagnosed with dementia at age 56. She had to leave a satisfying senior management role in her company and found retirement lonely and isolating. Eventually Terri found a role as a dementia advocate which helped her come to terms with the disease. Her NDIS support enabled her to have transport to meetings and conferences and provided her with a support person to help write presentations and manage her diary. From feeling useless and depressed, Terri found she had a purpose in life.

Services provided by not-for-profit organisations and councils

Local councils and not-for-profit organisations often provide services which might help with your life plan. These might include seniors’ classes on exercise or computers, social groups including bus trips, council clean-up services, and help accessing aged care services. Contact your local council or search the internet for the service you’re after in your suburb.