A greater proportion of people with dementia are choosing to continue living in their own homes. Over the years, AccessCare has become an early onset dementia specialist, known in the sector for being experienced in complex care and dementia care.

We support a range of different people. People who live alone with no carer, people who have no formal diagnosis of dementia, people who have other issues such as sensory loss, family conflict or complex medical issues.  We undertake regular training and have dedicated Aged Care Advisers who are experts in the area with both professional experience and personal family experiences with dementia. 

We have developed a dementia model of care and person centred assessment to support our clients.  Our Aged Care Advisers take a ‘whole of person’ approach to care-planning which promotes autonomy, independence, participation and dignity in the care planning process.   


AccessCare's Dementia Care Model

All aspects of our service delivery recognise the particular needs of clients with dementia and their carers.

Information giving

  • Addresses informed decision-making and consent.  Information needs to be in a format which is understood, may need to be repeated on several occasions and would normally be given to a client in the presence of a carer or advocate of their choice.  This key person should be involved at all subsequent stages of care provision.
  • Ensures that Rights and Responsibilities (including the Complaints Policy) are understood.


  • Considers what aspects of care a person with dementia may be able to decide – for example choice of activities, but not major life decisions.  If there is an Enduring Power of Attorney, this is documented.  If a major decision is required to be made referral to VCAT for an Administration or Guardianship Order may need to be considered.
  • Recognises the possibility of conflict between the wishes of the client and carer and balances a client’s right to autonomy and “dignity of risk” with the needs of a carer providing support.
  • Recognises the need to work closely with carers and families, for example to ensure the safety of clients at home or to develop Advanced Care Directives in the case of deteriorating health and future planning.

Understanding the situation

Uses a range of methods to gather information, bearing in mind that a person may present with varying degrees of memory problems, communication difficulties, confusion, depression, apathy or withdrawal.  People may be at increased risk in terms of the physical environment (heating/cooling, appliances) diet, hygiene, falls, medication management and self-neglect.  

  • Provides capacity for a registered nurse to role to assess where there are clinical requirements linked to physical health issues.
  • Focuses on person-centered practice, recognising the uniqueness of the client, their personal history and personality, previous occupation and lifestyle, religious or philosophical beliefs and attitude to risk-taking. 
  • Recognises the importance of early intervention, from the point where mild cognitive impairment or queries about early dementia are first noted.  
  • Pays particular attention to psychological symptoms and behaviour and their triggers, and the impact of these on carers.  
  • Considers particular strategies for clients who do not have an identified carer.  
  • Looks closely at the carer relationship (where one exists), the history of that relationship, the client’s preferred level of carer involvement, carer stress indicators and areas of conflict or potential conflict.  The nature of this relationship changes over time.  

Care planning

  • Is based on the Active Service Model and on moving beyond goals of maintenance to increasing quality of life and independence. It recognises clients’ rights to choose, based on their own preferences and routines.
  • Builds in roles for family, informal networks and volunteers.  These roles are opportunities to enhance relationships and promote communication with others, to increase safety and to reduce social isolation and dependency. 
  • Pays particular attention to medication management and aids and equipment.  
  • Provides extra services for carers of people with dementia (eg support, respite, counselling) and ongoing support for carers.  
  • Conveys to contracted service providers that the quality of interaction is important, not just completion of a task.

Monitoring and review

  • The frequent fluctuations, changing needs and progressive nature of dementia requires the capacity to respond flexibly with more frequent home visits and reviews, particularly if the person with dementia has limited or no informal support network.
  • Acknowledges the care management time and resources required to do this.  


  • Seeks regular feedback from paid carers on the basis of their part in the “Support Team”.
  • Acknowledges the importance of relationships and effective communication with preferred providers in order to work together for feedback and review..
  • ‘Preferred provider’ arrangement is in place to better meet the need for continuity of carers who are appropriately trained and supported and  have an ongoing supportive relationship with AccessCare's Aged Care Advisers, whilst preserving a range of options to maximise client choice and matching for specific factors (eg cultural needs).
  • Within this arrangement, there is consideration of preferred providers for dementia care also.

Service coordination

  • Includes GP engagement and relationships with other providers including Allied Health, Aged Psychiatry and respite providers.
  • Recognises the overlap between boundaries of various program areas and the need to provide continuity for clients with dementia between these “systems” eg hospital, public housing and Supported Residential Services.
  • Commitment to keeping up to date with developments in the field of dementia care and networking with other agencies.  

Feedback and consultation

  • Contributes to overall service development in the community.
  • Seeks input from clients and carers about satisfaction in relation to existing services and ideas for further development – through a range of options including an annual survey.

Training and professional development

Partnerships with other organisations

  • Provides information and advice, secondary consultation for Aged Care Advisers and resource materials.
  • Allows collaboration on research, including closer links with hospitals.
  • Contributes to community capacity-building.  
  • Allows for an effective informal working relationship with Alzheimers and Dementia Australia to enhance the skills of the community including AccessCare’s preferred providers.

Resources and information

Our Aged Care Advisers are provided with a range of resources and information inicluding resource kits, activity guides, memory therapy and other materials. 

Best practice dementia care

The development of the Dementia Model allows AccessCare to have a cohesive, focussed approach to dementia and to deliver best practice care for people with dementia and support for their carers. 

Need help?

Call our friendly consultants to discuss your individual needs on 1300 819 200. 

Dementia care | Aged Care | Melbourne

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