Specialised staff training and coordinated care models are not clinical add-ons. They are strategic financial and operational investments that Australian hospitals can no longer afford to postpone.
A recent US white paper published in the Global Journal of Medical Research presents a peer-reviewed analysis of the economic case for dementia-competent hospitals.
It shows that people living with dementia generate substantially higher healthcare costs through longer stays, higher rates of preventable complications and delayed discharges. Evidence-based staff training and comprehensive care models reverse those pressures, delivering measurable returns through reduced utilisation, better patient experience and lower staff burnout.
The same dynamics are already firmly established in Australia, and they are intensifying as the population ages.
The scale of the challenge in Australian hospitals
In 2023–24 there were approximately 27,800 hospitalisations due to dementia. The average length of stay was 15 days, nearly six times the overall hospital average of 2.7 days, accounting for roughly 420,000 bed days.
Public hospital admitted-patient care attributable to dementia cost almost $953 million in 2022–23, the largest single component of the $1.5 billion in direct health-care spending linked to the condition. For common principal diagnoses, average costs per hospitalisation were up to 2.2 times higher when dementia was present.
These figures capture only part of the picture. Professor James Vickers, Distinguished Professor Emeritus and recently retired former Director of the Wicking Dementia Research and Education Centre, notes that around half of older people admitted to hospital in Australia have some form of cognitive impairment or dementia. Many have not received a diagnosis before arrival.
“Hospitals were essentially switching over to another form of aged care,” Vickers explains, “because most of the people coming through the hospitals, and most of the people who are inpatients, are going to be older patients. A lot of people who come and then need to stay in hospital will have some degree of cognitive impairment, and often it is the case that they may not have had a diagnosis outside the hospital system.”
When cognitive impairment is revealed or acknowledged during an admission for surgery or an acute episode, the pathway frequently becomes complicated. People who are not well supported at home often arrive in crisis.
Once in hospital, the recognition that they may not be able to return home safely triggers complex discharge planning. Finding appropriate community support or a residential place takes time. The result is prolonged stays that contribute directly to bed-block.
Only 37 per cent of dementia hospitalisations end with discharge home, compared with 92 per cent of all hospitalisations. This is not merely a clinical issue; it is an operational and financial one that affects every hospital’s capacity and budget.
International evidence and Australian relevance
The US analysis highlights programs that shift care from reactive, high-cost interventions to proactive management. The Care Ecosystem model delivered mean savings of $475.80 per member per month by reducing emergency, outpatient and professional visits.
The Eskenazi Health Aging Brain Care program produced net annual savings of $980 to $2,856 per patient against a program cost of approximately $618, primarily by lowering symptom burden and avoiding hospitalisations and emergency presentations. Hospitals with excellent patient experience ratings achieve higher net margins, and trained staff report less burnout, reducing costly turnover.
Vickers sees clear parallels for Australia. “Investing in that sort of training in Australia, you would hope, like the US, it would lead to fewer complications and shorter stays and better outcomes,” he says.
He identifies two foundational elements: ensuring staff across the hospital have dementia knowledge and training so they can identify and respond to issues that arise, and investing in care coordination so that a person’s trajectory through the hospital is managed in their best interests and leads to a better outcome on discharge.
“One of the worst places somebody with dementia can end up being in is an emergency department,” Vickers observes. “Are there ways that we can, if there is an emergency or an acute need, bring them in in a different way so that we are not adding to the complexity? Appropriate pathways for people with dementia through the hospital system is another important element.”
Why progress has been uneven
Australia’s federated system creates distinctive barriers. Hospitals are largely the responsibility of the states and territories, while residential and community aged care are primarily Commonwealth-funded. “Often there’s a view by the state jurisdictions that dementia is a part of aged care and therefore a Commonwealth responsibility,” Vickers explains. “
Conversely, the Commonwealth would say that they give funds to the states to run the hospitals, which of course should include the best care for older patients as well. Sometimes these things get caught in the middle.”
There is currently no national mandate requiring hospitals to maintain dementia-competent workforces. Individual jurisdictions have developed good local practice, but consistency is lacking. Undergraduate curricula for doctors, nurses and allied health professionals have not always kept pace with the demographic shift.
“A lot of these medical degrees, the curriculum is a bit outdated and doesn’t really represent that older people are becoming a much greater proportion of people requiring care,” Vickers notes. “When they’re into their 80s, a good proportion of those will have cognitive impairment. We need to be preparing our graduates much better to do their roles properly.”
The Wicking Centre has trained hundreds of thousands of Australians through its free education programs.
Vickers acknowledges that systematic evaluation of the impact on hospital care is still limited, but the centre is adapting its massive open online courses into versions tailored for medical, nursing and allied health students, with the goal of offering them free to programs across the country. The challenge remains convincing curriculum leaders that this content is essential.
Practical models already working in Australia
Australia does not need to start from a blank page. The Dementia Care in Hospitals Program, originating at Ballarat Health Services, combines cognitive screening of older patients, a bedside Cognitive Impairment Identifier, education for clinical and non-clinical staff, and active carer engagement.
Elements of the program have been implemented nationally, and evaluations have shown improved staff confidence, comfort and job satisfaction, along with reductions in hospital-acquired complications in some settings.
Dementia Support Australia’s Hospital to Aged Care Dementia Support Program is helping older people living with dementia who are at risk of delayed discharge to transition successfully into residential aged care or home support. Early results indicate high placement success rates and low rates of return to hospital.
Vickers highlights the value of early engagement with these specialist resources. “Engagement with dementia specialists as early as possible would be a really good idea. Some sort of engagement with Dementia Support Australia. Many hospitals probably now do take advantage of that.”
What hospital leaders can do now
Asked what single change he would urge every Australian hospital CEO to prioritise, Vickers points first to specialist engagement and staff capability.
Frontline staff, particularly nurses, but also allied health professionals and doctors, should be supported to undertake education and training they may not have received in their original qualifications.
He offers a pragmatic view of coverage: “Not everybody in a health setting needs to be a specialist in dementia care, but it would be good if one of them was. If you had a suite of nurses on a night shift, if one of them had the additional education and training, maybe that would be sufficient.”
Environmental and process changes can also make a substantial difference without major capital expenditure. Screening for cognitive impairment during triage, creating quieter alternative pathways, and reducing visual and auditory clutter help lower distress for patients and stress for staff.
Vickers recalls a personal experience in a well-regarded emergency department where an older woman with likely dementia called out throughout the night in confusion. The situation escalated to a nurse calling across the department for her to be quiet, an outcome that training and a calmer environment could have prevented.
Technology such as monitoring systems has a supporting role in detecting complications early, including falls, pressure injuries and infections. “People with dementia, when they come into the hospitals, they’re at a much higher risk of complications,” Vickers notes.
“Monitoring for those complications can not only be good for that person’s health, but also will reduce the amount of time that they might need to spend in the hospital.” The largest gains, however, still come from culture, staff training and smoother coordination between state hospital systems and Commonwealth-funded aged care.
Breaking the cycle
The pressures are interconnected. Changes to residential aged care funding, including the removal of the dementia supplement, have reduced incentives for providers to accept people with complex or advanced dementia.
When suitable places are unavailable, hospitals become the default. “It’s all part of a pretty vicious cycle,” Vickers observes. “If people with the most severe dementia aren’t finding places in residential aged care, what’s the next step? It’s hospitals.”
Addressing the hospital experience of people living with dementia has received less attention than broader aged care reform. Vickers argues that better alignment between Commonwealth and state responsibilities would deliver benefits on both sides, including relief for the bed-block that currently constrains hospital capacity.
A clear strategic choice
The evidence from both the United States and Australia points in the same direction. People living with dementia will continue to form a large and growing share of the hospital population. Continuing with inconsistent approaches imposes avoidable costs in longer stays, complications, delayed discharges and workforce strain.
Investing in standardised staff training, early specialist engagement, care coordination and practical pathway redesign generates returns through improved efficiency, better outcomes and stronger organisational resilience.
For hospital executives the question is no longer whether to invest in dementia-competent care. It is how quickly and how systematically they will implement it. The models, the data and the expert guidance already exist. The remaining task is to turn them into consistent practice across the Australian hospital system.
