Innovative dementia program helps nearly 700 hospital patients transition to aged care

A pioneering initiative to support older patients living with dementia at risk of delayed discharge in select public hospitals is achieving a very high success rate transitioning the patients safely to aged care.

The Hospital to Aged Care Dementia Support Program (HACDSP) has relocated 667 hospital patients deemed at risk of delayed discharge due to dementia to move into suitable aged care services in its first 14 months of operation. Another 244 patients are either being assessed or waiting for transition.

HACDSP, provided by Dementia Support Australia (DSA), is resulting in only 3 per cent of those involved being returned to hospital due to the placement failing, primarily due to Behavioural and Psychological Symptoms of Dementia (BPSD). DSA, funded by the Australian government, is led by HammondCare.

There are 148 people receiving active support in aged care to assist their transition. The figures cover the period January 16, 2025, to March 31, 2026.

HACDSP operates in 11 jurisdictions nationally to help inpatients living with dementia optimise their wellbeing during their hospital stay, transition out of hospital to an aged care setting and then provides three months of post-discharge follow-up.

HammondCare CEO Andrew Thorburn said the results confirm HACDSP’s positive contribution to the national challenge of delayed discharge from hospitals.

He welcomed Minister for Aged Care and Disability Mark Butler’s Federal Budget commitment to expand HACDSP, part of a $200 million announcement to support people living with dementia that also includes 20 additional Specialist Dementia Care Program Units.

“This program is improving the quality of life of vulnerable people living with dementia who would otherwise become caught up in what is often described as bed block,” Mr Thorburn said. “Hospitals do the best job they can to care for people living with complex dementia, but they are not the appropriate care setting long-term for people with these health circumstances.”

HACDSP is delivered by 75 staff, including Dementia Consultants, Dementia Support Coaches and Family Liaison Officers, that operate within the hospital environment. 

HammondCare Executive General Manager Advisory Care & Partnerships Mark Peacock, thanked the Local Health Districts and hospitals participating in the program for their readiness to work closely with on-site HACDSP team members.

One patient supported to placement, 78-year-old David Osborn - who lives with Primary Progressive Aphasia - successfully transitioned to an aged care home in the Melbourne suburb of Camberwell after more than a month in Box Hill Hospital. At his new home, Mr Osborn is settled and active in gardening and maintenance tasks and even takes part in Friday afternoon dancing activities with wife Judy.

Daughter Sarah Osborn said finding an aged care place for her dad had been troublesome due to aggressive behaviours and an incident where he left the hospital unaccompanied for five hours, triggering a search.

“The HACDSP team improved his hospital experience, even providing a robotic dog for comfort,” Ms Osborn said. “I cannot speak more highly of the support provided by DSA for my dad.”

Since inception, there have been 1108 referrals. Patients not placed typically transitioned to other hospitals not part of the program, were found clinically ineligible, withdrew due to consent issues or passed away. Patients referred to HACDSP spend, on average, about 92 days from hospital admission to placement.

HACDSP Locations include John Hunter, Belmont, Maitland and Calvary Mater Hospitals in NSW; all Adelaide public hospitals in SA; Hervey Bay, Maryborough and Bundaberg Hospitals in Queensland; Canberra and North Canberra Hospitals; Maroondah, Box Hill, Sunshine, Williamstown and Bendigo Hospitals in Victoria; Bentley, Osborne Park and Rockingham Hospitals in WA; and all public hospitals in Hobart, Launceston and the North West in Tasmania.

HACDSP is also assisting with capacity building for hospital and aged care staff to assist them transition patients living with dementia into aged care.

Click here for more information about HACDSP.