Along with cognitive decline, dementia is characterised by changes in emotional control, social behaviour and physical performance. Individuals living with dementia often require assistance with their activities of daily living as dementia progresses. Requirements for higher levels of care result in more individuals with dementia living in residential aged care facilities (RACFs); up to 52% of all individuals living in RACFs have a diagnosis of dementia.
Physiotherapists are key members of the multidisciplinary team that provide the necessary services to individuals living with dementia in RACFs. Physiotherapists can help individuals improve or maintain physical and functional ability, and assist with chronic pain management. They provide exercise, education, equipment and manual techniques. However, access to physiotherapists and other allied health professionals (AHPs) in RACFs is restricted by limited funding and availability of AHPs.
As the population ages, the demand on health care services will continue to rise. The ways in which health and social care services are funded and delivered to older individuals need to be addressed to meet future demands. In Australia, residential aged care funding comes from two main sources: government subsidies and contributions by the individuals living in RACFs. The Australian Government determines funding allocations to RACFs using the Aged Care Funding Instrument (ACFI).
This paper contributes to the debate regarding the funding and provision of services for individuals living with dementia in RACFs from the perspective of a physiotherapist who is a researcher in gerontological studies and has nine years’ experience of working clinically with older individuals. It specifically considers the role of physiotherapists and the provision of exercise for individuals living with dementia in Australian RACFs, and how the ACFI influences this. Discrepancies are highlighted between best practice evidence, current clinical practice and funding.