Mailbox Response

The question was submitted Tuesday, 2 October 2007

Subject: ACAT assessments.

How long does it normally take to complete an ACAT assessment on an inpatient or is this a case of "how long is a piece of string"? My 85 year old mother was admitted to a dementia unit at the end of May with Non Vascular mild dementia. On the day she was admitted I gave the registrar as much medical history as I could including the fact that she had been treated for a chronic UTI months earlier. My sister and I assumed it would have been one of the first infections that they would have checked for but it took two weeks for the staff to discover she had a chronic UTI. Once this was treated her hallucinations stopped. She was then put on Acertips at our request. Anti-psychotics followed and the latest is anti-depressants. I understand that they need to sort out her meds but surely she is paranoid because strange women keep coming into her room and taking things and depressed because her life as she knew it has ceased to exist. Yes she is paranoid and depressed but these symptoms got worse after being admitted. I love my mother and I want what is best for her but I am begining to think that having her admitted was the worst thing we could have done to her. Concerned Daughter.

Answer from DementiaNet

Your mother’s circumstances are not uncommon. When a person with dementia becomes acutely unwell, hospital admission is often the only appropriate course of action. Unfortunately many elderly demented patients do not do well in hospital because of the change in environment and unfamiliar people who are attending them. But the outcome probably would not have been any better if hospital admission had not occurred. When a person with dementia has behavioural disturbance, it may take many months for the best medication regimen to be determined by the doctors. Eventually the problem resolves and the discharge plan can be considered. When a demented person has altered behaviour it is often impossible to send them home or elsewhere. It is certainly very frustrating to have Mum in hospital for so long and her circumstances highlight how difficult it is to manage a person with dementia.

The ACAT process is quite separate from the medical care process. Often, the same health professionals carry out the two processes. But the ACAT process is an assessment of a person’s care needs. So the ACAT will determine whether a person is eligible to receive Commonwealth government care at home (community care package) or in a residential care facility (hostel or nursing home). The assessment for these services cannot occur until a person is medically stable, so your Mother has not been eligible for the ACAT to see her given that she has been medically unwell. Once she is stable ie the infections resolved and behaviour settled, then the ACAT can determine if she is able to go home with care or whether she needs to go to residential care. Mum will need to agree with this process if she is mentally able to do so. Otherwise family members will be able to facilitate the process with the assessor.

The answer was published on DementiaNet Wednesday, 3 October 2007