Press Release – Fiona Green
Disability advocate Fiona Green has consistently spoken about the importance of challenging assumptions and giving disabled people a voice.
16 August 2026
A growing call for change is being made across Aotearoa New Zealand: people suspected of having dementia | mate wareware must receive the right assessment, the right diagnosis and the right care — not assumptions based on age, presentation or a single cognitive screening test.
“I lost my Dad last year to a misdiagnosis of dementia and many questions around his diagnosis and care remain unanswered when put to Whangarei Hospital staff and Social Workers. Nevertheless families are calling for dementia-competent care if they do indeed have Denentia, accurate diagnosis and respect for the rights and choices of older people, “says Fiona Green Tai Tokerau Disability Activist.
A suspicion of dementia is not a diagnosis.
Being 65, 75, 85 or 95 is not a dementia diagnosis.
And a person who presents to an Emergency Department with confusion, memory difficulties, communication difficulties or behavioural changes should not automatically be treated as though they have dementia.
The distinction matters because Alzheimer’s/Dementia is an umbrella term for symptoms caused by different diseases affecting the brain, and there are many possible causes of cognitive change. Health New Zealand notes that dementia is more common after 65, but it can also affect people much younger.
Subject competency must become a standard of care
The call is for genuine dementia subject competency across the health and medical workforce — not simply awareness that dementia exists.
Clinicians need to understand the difference between:
– a suspicion of dementia;
– cognitive impairment;
– delirium or an acute change in cognition;
– other medical, neurological, psychological or medication-related causes of cognitive symptoms;
– normal ageing; and
– a properly established diagnosis of a particular condition causing dementia.
The recently refreshed Dementia Mate Wareware Action Plan 2026–2031 makes timely and accurate diagnosis one of its five national priorities. It also identifies workforce support, training, resources and accredited learning pathways as essential components of improving dementia care.
That should be a wake-up call.
The question is not whether a health professional has heard of dementia.
The question is whether they have the knowledge and competency to recognise what else might be happening, understand the limits of a screening tool, pursue an appropriate diagnostic pathway and communicate respectfully with the person concerned.
A cognitive screening test is not a dementia diagnosis
Cognitive screening has a place in healthcare when clinically indicated. Aotearoa New Zealand has a recommended cognitive-impairment screening tool, the Mini-ACE, and national guidance exists for professionals involved in cognitive assessment.
But screening is not synonymous with diagnosis.
A brief cognitive test undertaken during an Emergency Department admission should not be allowed to become a shortcut to labelling somebody with dementia.
Emergency Departments exist to assess and treat acute health problems. A person may be frightened, in pain, exhausted, acutely unwell, affected by medication, experiencing delirium, struggling to communicate, or functioning very differently from their usual baseline.
Context matters. Baseline matters. The person’s voice matters. Collateral information matters. Clinical judgement matters.
Most importantly, a screening score must not become a substitute for a proper diagnostic process.
Do not confuse age with disease
We need to challenge age-based assumptions in healthcare.
The fact that someone is older does not mean that every change in behaviour, communication, memory or decision-making is dementia.
The current Dementia Mate Wareware Action Plan itself describes mate wareware as a health condition “and not a normal part of ageing.”
Older people deserve the same diagnostic curiosity, respect and clinical rigour as everyone else.
And do not take away a person’s choices simply because dementia has been suspected
There is another equally important issue: Enduring Powers of Attorney (EPOAs).
Families and professionals should not treat an EPOA as permission to automatically take over a person’s life.
In New Zealand, a personal care and welfare EPOA is intended to operate when the person is unable to make or communicate relevant decisions. The Government states that activation requires assessment by a suitably qualified medical practitioner who determines that the person lacks the mental capacity to make decisions about their personal care and welfare.
The law also establishes a presumption of competence. People are presumed to have capacity unless the contrary is shown, and capacity is considered in relation to the particular decision.
That means a diagnosis — or even a suspicion of dementia — should not automatically erase a person’s autonomy.
Where a person has capacity to make a decision, let them make it.
Support them.
Explain things.
Give them time.
Make reasonable communication adjustments.
Listen to them.
Do not speak over them simply because they are older or because somebody has written “possible dementia” in a clinical record.
As disability advocate Fiona Green has said
Disability advocate Fiona Green has consistently spoken about the importance of challenging assumptions and giving disabled people a voice.
In publicly available advocacy material, Green writes:
«“The world is full of ableists. Stand up for your loved one or you will lose everything.”»
In another public statement concerning disability and social policy, Green called for “more flexibility and individualised support”, arguing that rigid systems can fail to account for people’s unique circumstances.
Those principles are highly relevant to dementia care.
A person is not a diagnosis.
A person is not a cognitive-test score.
A person is not their age.
And a person does not lose their right to dignity, communication, participation and choice because somebody suspects they may have dementia.
The Action Plan tells us what needs to change
The Dementia Mate Wareware Action Plan 2026–2031 identifies five priorities:
1. promoting brain health;
2. timely and accurate diagnosis and comprehensive management;
3. improved community support;
4. supporting formal and informal workforces; and
5. effective governance.
The workforce priority is particularly important.
If New Zealand is serious about providing the right care for the right diagnosis, then dementia competency cannot be an optional extra.
It must extend across primary care, hospitals, Emergency Departments, aged residential care, disability services, allied health, mental health services and community services.
The call to action
Ms Green is calling for:
1. Dementia subject competency across the health and disability system.
Health professionals should have access to meaningful education and competency development in dementia | mate wareware, differential diagnosis, delirium, communication, capacity and person-directed care.
2. Accurate diagnosis rather than assumption.
A suspicion should remain a suspicion until an appropriate diagnostic process establishes what is actually happening.
3. Appropriate use of cognitive screening.
Cognitive screening should be used when clinically appropriate and interpreted in context. It should not be treated as a stand-alone dementia diagnosis.
4. Respect for the person’s own voice.
Health professionals should communicate directly with the person, make communication accessible and presume capacity unless there is evidence to the contrary.
5. No automatic loss of autonomy because of age or a dementia label.
Being 65+ is not a diagnosis. A suspected diagnosis is not proof of incapacity.
6. EPOA decisions must respect the law and the person’s remaining capacity.
An EPOA should not become a mechanism for unnecessarily removing choice, control or participation from the person it is intended to support. New Zealand law requires attorneys to encourage the donor to develop and exercise their capacity and to act on their own behalf to the greatest extent possible.
Right care. Right diagnosis. Right person.
The goal is not to prevent people from receiving dementia assessments.
The goal is to ensure that people receive the right assessment for the right clinical circumstances — and that a diagnosis is made carefully, accurately and respectfully.
Aotearoa New Zealand has already produced the roadmap.
Now we need to turn that roadmap into everyday practice.
Because behind every assessment is a person.
Behind every diagnosis is a family or whānau.
And behind every decision is someone’s life.
A suspicion of dementia is not a diagnosis.
Age is not a diagnosis.
A cognitive screening score is not a person.
Capacity should be assessed, not assumed away.
And every person deserves the opportunity to be heard, understood, supported and — wherever they have capacity — to choose.
Content Sourced from scoop.co.nz
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