We need a model of health and aged care services that adequately supports Australians with dementia

To the Editor: Low and colleagues1 highlight the long‐standing issue that the provision of residential aged care in Australia remains grossly inadequate. This is particularly egregious given that these deficits and remedial actions have been known for decades from numerous inquiries commissioned by successive federal governments and reiterated by the Royal Commission.

This vacuum is being filled by initiatives undertaken by the Victorian Government in public sector residential aged care services to develop better ways to conceptualise aged care. We acknowledge there is no single ideal model2 for the provision of residential aged care, as there is such wide variation in residential aged care services profiles (eg, number and type of residents, geographic location, physical environment, staffing). However, our recently proposed conceptual model for the provision of residential aged care3 includes many of the necessary aspects recommended by the NHMRC National Institute for Dementia Research Special Interest Group in Rehabilitation and Dementia.

Our conceptual model takes as its purpose the provision of person‐centred care to older people with complex health issues, especially those living with dementia. It consists of five domains relevant to the experience of older people living in residential aged care: health care, social inclusion, individual rights, personal care and reablement, and dementia management. The model also supports the dignity of risk and quality of life beyond clinical care to enable older people to thrive. The development of our model involved several stages using a similar approach to model development described in 20104 which comprised:

• initial conceptualisation and development based on a review of the literature to document and map the key domains of residents’ needs in aged care;
• brainstorming using the expertise and experience of the research team to refine and categorise the domains and subdomains;
• extensive consultation with key stakeholders (n = 382) to test the model for feasibility and acceptability (field testing) for the sector; and
• testing against a range of theoretical organisational failure scenarios (validity checks against coroners’ cases).

The model has been presented to the Royal Commission into Aged Care Quality and Safety and published in a peer‐reviewed journal.3

Uptake of this model would allow the Commonwealth government, which finances and regulates this sector, and individual service providers to have a common understanding of aged care. This is an important step towards improving aged care services.