As the aged care sector grapples with the increasing complexity of resident needs, the call for a paradigm shift in dementia care grows louder. Gone are the days when aged care primarily supported low-dependency residents. Today, facilities are effectively managing subacute, palliative, and dementia-intensive populations — often with limited staffing, underwhelming funding, and outdated training models.
Evidence-Based Dementia Rehabilitation: Not Just Ideal, But Essential
Rehabilitation in dementia care is no longer a radical idea — it’s an evidence-backed imperative. Cognitive and functional rehabilitation programs, such as the GREAT model and various community-based reablement programs, have demonstrated significant improvements in daily functioning, independence, and quality of life. According to research published in The Gerontologist, reablement and goal-oriented interventions reduce symptoms of dementia and delay transitions to higher levels of care.
Key outcomes include:
- Increased engagement in daily living
- Reduced behavioural symptoms
- Improved confidence and autonomy
- Delayed entry into residential care
Yet despite these proven benefits, rehabilitation services remain underutilised, especially in residential aged care, where operational pressures and systemic barriers dominate.
Behaviour Support Practitioners: A Missing Pillar in Aged Care
Behavioural and psychological symptoms of dementia (BPSD) affect up to 90% of residents with dementia, often leading to distress, carer burnout, falls, and avoidable restrictive practices. The NDIS has long recognised the value of Positive Behaviour Support (PBS) practitioners — but aged care lags far behind.
Introducing Behaviour Support Practitioners in aged care settings could:
- Provide trauma-informed, person-centred behaviour assessments
- Reduce restrictive practices through tailored, proactive strategies
- Lower incidents and distress, improving staff morale
- Support families and teams in understanding behavioural triggers
The aged care reforms highlight a shift to care that is “with me, not to me” — a philosophy that aligns perfectly with behaviour-informed, rehabilitative approaches. However, without adequate funding and staffing support, this vision risks being rhetoric rather than reality.
Systemic Constraints: Funding, Fatigue, and Workforce Capacity
Residential aged care today is under immense strain. The demographic profile of new residents reflects more complex, higher-acuity needs, often requiring subacute-level care. Despite this, the Australian National Aged Care Classification (AN-ACC) funding model struggles to keep pace with the true cost of delivering intensive personal care and dementia-responsive services.
Workforce challenges compound the issue:
- Chronic staff shortages make it difficult to recruit and retain skilled and empathetic workers.
- Fatigue and burnout are prevalent due to increased care minutes per resident without proportional increases in staffing.
- Training gaps in Registered Training Organisations (RTOs) leave personal care workers underprepared to meet the evolving needs of residents living with dementia.
Delivering rehabilitative, relationship-centred care isn’t just a staffing issue — it’s an operational systems challenge. Meeting the expectations of the Aged Care Quality Standards and reforms requires:
- Redesigning workflows to integrate rehabilitation and behavioural support
- Investing in multidisciplinary teams and allied health input
- Funding staff development and modernising RTO curricula
- Embedding evaluation and quality improvement mechanisms
The Path Forward: Brave Choices for Better Outcomes
Dementia rehabilitation is not a luxury for the few — it’s a necessity for the many. We know what works. We know that proactive, person-centred care improves lives and outcomes. But we also know that to deliver it at scale, the system must be structurally reimagined.
What’s needed now:
- Mandated inclusion of Behaviour Support Practitioners in aged care funding models and regulatory frameworks.
- Expanded access to community and residential rehabilitation programs, with tailored support for those living with dementia.
- Comprehensive training reform to ensure that personal carers are equipped to support complex care and behaviour.
- Sustainable workforce planning, including incentives and supports to retain skilled, compassionate staff.
The reforms set the right intent. The challenge now is courage — to move from intent to action, from pilot to policy, and from reactive to proactive care. Let’s be brave enough to build an aged care system where those living with dementia are not only cared for, but supported to thrive.
