Annual Report - Outcome 4 – Aged Care and Population Ageing

Table of contents

Part 3: Management Arrangements

Part 4: Accountability Reporting

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Outcome Summary

Outcome 4 aims to ensure that older Australians receive a choice of high quality, accessible, and affordable aged care; and carers get the support they need to look after frail older people living at home. Outcome 4 also aims to encourage older people to remain active members of the community. The Department worked to achieve this outcome by managing initiatives under the programs outlined below.

Programs Administered Under Outcome 4 (Program Objectives in 2008–09)

Program 4.1 – Aged Care Assessment

Evaluate the care needs of frail older people and establish their eligibility for residential aged care and community care services.

Program 4.2 – Aged Care Workforce

Increase the aged care workforce.
Provide training opportunities for existing staff.
Create better career paths for all aged care workers.

Program 4.3 – Ageing Information and Support

Keep the community and service providers informed of government services.
Support the Aged Care Complaints Investigation Scheme, the Community Visitors Scheme and the National Aged Care Advocacy Program.

Program 4.4 – Community Care

Assist government and non-government organisations to help the frail, aged and people with a disability to live independently in their own homes, and to support carers.

Program 4.5 – Culturally Appropriate Aged Care

Provide culturally appropriate care for members of Aboriginal and Torres Strait Islander communities, particularly in rural and remote locations.
Support access to culturally appropriate aged care for people from culturally and linguistically diverse backgrounds.

Program 4.6 – Dementia

Fund dementia research, dementia care services and early intervention opportunities.

Program 4.7 – Flexible Aged Care

Support the provision of flexible care outside the usual residential and community care settings.
Address the needs of care recipients in alternative and innovative ways.

Program 4.8 – Residential Care

Support residential aged care services for older Australians whose care needs are such that they can no longer remain in their own homes.

This chapter reports on the major activities undertaken by the Department during the year, addressing each of the key strategic directions and performance indicators published in the Outcome 4 chapters of the 2008–09 Health and Ageing Portfolio Budget Statements and 2008–09 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

The Ageing and Aged Care Division and the Office of Aged Care Quality and Compliance were responsible for Outcome 4 in 2008–09. The Department’s State and Territory Offices and the Aged Care Standards and Accreditation Agency Ltd, which produces its own annual report, also contributed to the achievement of this outcome.
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Major Achievements for the Outcome:

Improved access to aged care in regions where there was a high need for more aged care by making available $150 million in zero real interest loans for 1,348 residential aged care places and 107 community care places (see Providing Equitable Access to Affordable and Culturally Appropriate Aged Care);
Implemented fairer and simpler fee arrangements for residential aged care, treating pensioners and self-funded retirees the same (see Providing Equitable Access to Affordable and Culturally Appropriate Aged Care);
Supported the delivery of care services in remote and Aboriginal and Torres Strait Islander communities by creating more than 500 permanent part-time jobs for Aboriginal and/or Torres Strait Islander people in rural and remote aged care services across Australia (see Providing Equitable Access to Affordable and Culturally Appropriate Aged Care); and
Invested significantly in training in vocational education, nursing qualifications, and post graduate scholarships including for more than 9,500 vocational training places, more than 960 of which were for enrolled nurses and a further 724 undergraduate and postgraduate places (see Ensuring the Aged Care Sector Delivers High Quality Care).

Challenges for the Outcome:

Attracting a sufficient number of high quality applications for residential care places (see Improving the Efficiency and Sustainability of the Aged Care Sector);
A lower than expected number of nurses returning to the aged care workforce under the Bringing Nurses Back into the Workforce Program (see Ensuring the Aged Care Sector Delivers High Quality Care); and
Increased complexity and number of complaints received through the Aged Care Complaints Investigation Scheme (see Ensuring the Aged Care Sector Delivers High Quality Care).

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Key Strategic Directions for 2008–09 – Major Activities

Providing Equitable Access to Affordable and Culturally Appropriate Aged Care

Australia’s aged care system aims to ensure that older people receive support and quality care when they need it. This can be through residential aged care, which assists people who can no longer live at home for reasons such as illness and disability; or community care.

In 2008–09, the Department improved people’s access to affordable and culturally appropriate aged care, by helping aged care providers to deliver services in areas of high need by making available loans at zero real interest rates. Activities also included implementing new income-tested fees and accommodation payments; and supporting care in Indigenous communities.

Review of Aged Care Planning Ratios

Reviewing aged care planning ratios to determine the number of available aged care places enables planning arrangements to take better account of demographic shifts and changing patterns of aged care service usage by older Australians. In 2008–09, a planned examination of the aged care planning ratio was deferred due to the extent of review and reform work in the aged care sector over the last year. While this did not take place, the Department contributed to the Senate Inquiry into Residential and Community Aged Care in Australia, which considered the current planning ratio; providing written submissions and evidence at public hearings. The Department will commence work on this review in 2009–10.

Loans at Zero Real Interest Rates

A major achievement for the Department in 2008–09 was the implementation of the first round of zero real interest loans to residential aged care providers. Through this initiative, the Department aims to improve the affordability of capital works in high need regions by providing low cost finance to encourage care providers to make places available sooner than would otherwise be the case. Related activities involved designing an administrative framework for managing the loans, and bringing in expertise to ensure compliance with banking industry standards. The Department also modified its in-house financial system to support the loans product and implemented the use of direct debit for loan repayments.

The Department assessed the first round of loan applications in September 2008, which resulted in offers of loans for 1,348 residential aged care places around the country. The Department will seek applications for a second round of loans next financial year, in conjunction with the 2009–10 Aged Care Approvals Round.

Figure 2.3.4.1: Summary of Zero Real Interest Loans Stage One Offers

Source: Department of Health and Ageing
* Includes Community Aged Care Packages, Extended Aged Care at Home and Extended Aged Care at Home Dementia packages.
The information in this table reflects the expected result from the 2008 Loans Round, based on the offers made by the Department. The final allocations will depend on applicants’ compliance with the terms and conditions of their individual loan agreement. Once the loan agreement has been executed by the Department, the zero real interest loan and places are formally allocated.

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Income-tested Care Fees and Accommodation Payments

Another major achievement was the implementation of changes to make the income test for residents fairer and simpler. Previously, self-funded retirees paid higher income-tested fees because most of their income was counted under the income test. These changes ensure that pensioners and self-funded retirees are now treated in the same way, irrespective of whether they are on a pension or private income.

These changes did not affect people in residential care prior to 20 March 2008. Government assistance was available for self-funded retirees who entered care after this date and could not meet their aged care accommodation costs.

The Department implemented a communication campaign, which included a kit with information sheets and a brochure for the aged care industry and residents; and a short-term specific website that provided users with a question and answer facility.

In addition, the Department implemented changes that resulted in members of same-sex couples being treated in the same way as opposite-sex couples in income and asset tests for entry to permanent residential aged care. As of 1 July 2009, members of same-sex couples are taken to have 50 per cent of the total value of the couple’s income and assets when determining aged care fees and charges.

Support for Care Providers in Aboriginal and Torres Strait Islander Communities

The Department supported the provision of aged care services to older Aboriginal and Torres Strait Islander people which enabled them to remain in their community and close to family. In 2008–09, the Department managed a number of initiatives to support aged care providers to provide Aboriginal and Torres Strait Islander communities with culturally appropriate aged care services.

The Department commissioned the development of an independent quality framework to set standards for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program. The quality framework will include culturally appropriate standards for health and personal care, safety and the physical environment, and effective management and governance.

The Department initiated the development of new Flexible Aged Care Services in Mutitjulu and East Arnhem Land in the Northern Territory; and funded the construction of aged care staff accommodation at the Docker River aged care service in the Northern Territory to help attract and retain staff. In addition, the Department offered short-term financial support to aged care providers providing aged care for Aboriginal and Torres Strait Islander people which experienced difficulties in delivering aged care services.

A major achievement was the creation of more than 500 permanent part-time jobs for Aboriginal and/or Torres Strait Islander people in rural and remote aged care services across Australia, through changes to Community Development Employment Projects processes. These positions are in services funded under the Home and Community Care program, the National Aboriginal and Torres Strait Islander Flexible Aged Care Program and under the Act which provide care to older or disabled Aboriginal and Torres Strait Islander people.

Funding for the above activities was sourced from Programs 4.4 – Community Care, 4.5 – Culturally Appropriate Aged Care and 4.8 – Residential Aged Care.
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Improving the Efficiency and Sustainability of the Aged Care Sector

There are currently over 2.0 million Australians aged 70 years and over, which accounts for nearly 10 per cent of the population. This number will double in the next 20 years. As the number goes up, the need to support older people in quality aged care accommodation will increase. A priority in 2008–09 was to support structures and processes that improve the efficiency and sustainability of the aged care sector. The Department worked to achieve this by efficiently managing the Aged Care Approvals Round, and monitoring the compliance of providers holding accommodation bonds. The Department also focused on implementing arrangements set out in the Home and Community Care Review Agreement, and streamlining care for older Australians.

Improving the Efficiency of the Aged Care Approvals Round

During 2008–09, the Auditor-General reviewed the Department’s management of the planning and allocation of aged care places in accordance with the Aged Care Act 1997. The Auditor-General concluded that the process is mature and the Department has an appropriate approach to its planning, implementation and reporting against government targets.

At the same time, it was suggested that the Department consider how to apply the Government’s national aged care planning ratio across states and territories to better take account of state demographic differences. The Government has announced an inquiry into aged care to be undertaken by the Productivity Commission. The Department believes it is prudent to await the outcomes of that inquiry before implementing any changes to the way in which it applies the current target ratios for levels of aged care provision. (For further discussion relating to this audit, please refer to the 3.5 External Liaison and Scrutiny chapter.)

In addition, the Department took on board the results of a Probity Review of the Aged Care Approvals Round. Commissioned by the Department in 2006 and completed this year, the review concluded that the processes in place for managing probity related issues were sound, however there was scope for improving the efficiency and transparency of decision making. The Department subsequently worked to implement recommendations from the review, which included establishing a working group with the aged care industry, through the Ageing Consultative Committee, to look at milestones for bringing newly allocated places on-line.

A challenge this year was the low number of applications for residential care places. Economic uncertainty created a level of caution in the marketplace, and as such, Western Australia, Tasmania and the two territories were under-subscribed. In addition, not all of the residential places available in New South Wales, Victoria and Queensland were allocated due to a lack of competitive applications. The Department addressed these shortfalls by allocating additional community care places in the form of Community Aged Care, Extended Aged Care at Home, and Extended Aged Care at Home Dementia packages. This addresses consumer preferences to be cared for at home and strong interest from aged care providers in expanding community care.
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Compliance Monitoring of Providers Holding Accommodation Bonds

The Department is responsible for monitoring the prudential compliance of approved providers holding accommodation bonds, and taking action against providers that breach their responsibilities. In 2008–09, the Department revoked Vitality Care Commissioning Pty Ltd’s approval to provide aged care following its failure to refund accommodation bonds paid by residents of the Bridgewater Aged Care Facility in Victoria, which financially collapsed on 23 May 2008. Refunds of accommodation bonds totalling approximately $8.4 million were paid to these residents through the Accommodation Bond Guarantee Scheme. The Department is currently attempting to recover this amount from the company.

The Department issued a Notice of Non-Compliance to another approved provider for failing to submit an Annual Prudential Compliance Statement. It also issued a number of approved providers with warning letters for failure to comply with their legislative obligations such as not refunding accommodation bonds within statutory timeframes.

Home and Community Care Review Agreement

The Home and Community Care Review Agreements were signed by the Australian, State and Territory Governments in May 2007, to improve long-term planning and streamline administration of the Home and Community Care Program. The agreements detail the program’s funding and management arrangements and include one off bonus pool funding which is available to those states and territories that work collaboratively towards the timely introduction of common arrangements. They also provide for a three-year planning cycle (known as Triennial Plans) to allow greater certainty to communities and service providers, and to improve timeliness when allocating funds to service providers.

The Department worked with the State and Territory Governments in 2008–09 to develop funding packages and annual supplements to the 2008–09 to 2010–11 Triennial Plans. Agreement was also made on five key performance indicators, which will provide robust and meaningful outcome measures for the Home and Community Care Program. This will help make data more consistent between the states and territories, and improve evaluation and planning within the program.
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Streamlined Care for Older Australians

In October 2008, the Council of Australian Governments agreed to reform the roles and responsibilities of the Australian, State and Territory Governments in the delivery of community and residential care services for the aged and people with disabilities, and community care for people with a mental illness.

The Department participated in a Senior Officials Working Group, made up of Australian, State and Territory Government representatives, to develop a reform package for consideration by the Council of Australian Governments. The principal objective of the reforms is to improve client services in aged care and disability services, by enabling the creation of integrated and coordinated care systems that are easier for clients to access and navigate, and that respond more flexibly to clients’ changing care needs. Work on developing these reforms will continue in 2009–10.

The Department also progressed work to streamline community care programs and simplify clients and carers’ access to services, to assist older people to live independently in their own homes for as long as possible. During the year, the Department supported nine Access Point Demonstration Projects in seven states and territories which provided clients and carers with information about community care services. They also provided advice on eligibility for services, conducting a broad assessment of a person’s needs and facilitating referrals to community care service providers, specialists or comprehensive assessors.

The Demonstration Projects were evaluated over a period of at least 12 months at national, state and local levels to refine and improve their operations. The Department will consider longer term options for Access Points and Commonwealth Respite and Carelink Centres and a wider roll-out of Access Points.

Funding for the above activities was sourced from Programs 4.4 – Community Care and 4.8 – Residential Care.

Ensuring Appropriate Care to Meet the Needs and Preferences of Frail Older People

Community and residential aged care services need to respond to the requirements and preferences of frail older people. This year, the Department managed initiatives that helped older people to return home from hospital. It also continued implementation of the Aged Care Funding Instrument to allocate subsidies in residential aged care; and funded community care grants to expand services.

Transition Care Places

Transition care provides tailored services for older people leaving hospital, who want to return home rather than go to an aged care facility. This care may include a range of low intensity therapy services (such as physiotherapy) and nursing support and/or personal care services.

In 2008–09, the Department allocated 470 new transition care places, including 70 places that were brought forward from future allocations at the request of the states and territories. Places were allocated to each state and territory based on the population aged 70 years and over, and Aboriginal and Torres Strait Islander people aged 50 and over. The states and territories will make the 470 places operational during 2009–10.

The Department also worked with state and territory health departments to make the 228 transition care places allocated in 2007–08 operational during 2008–09. This brought the number of operational transition care places nationally to 2,228.
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Aged Care Funding Instrument

The Aged Care Funding Instrument was introduced on 20 March 2008 to determine the level of care payments for residents in aged care homes, ensuring that they benefit from payments that are aligned with their care needs. In implementing this initiative in 2008–09, the Department consulted with an Industry Reference Group on the role of the instrument. The Department also supported residential care providers by answering queries via a dedicated e-mail account, and providing access to an independent business advisory service for approved providers requiring assistance with changing business needs. As at 30 June 2009, more than 80 providers had sought advice through this service.

The Department visited 1,068 aged care homes to ensure facilities receive the correct level of funding under the Aged Care Funding Instrument. This followed the implementation of a 2008–09 Budget initiative that completed 5,000 additional reviews of funding claims made under the former Resident Classification Scale.

In addition, the Department started work on developing a new definition for ‘high care’, after it found that the proportion of residents appraised as eligible for high care upon entry had increased from 62 per cent to 71 per cent since the introduction of the Aged Care Funding Instrument. The Department will work with the aged care sector in 2009–10 to finalise the new definition, to come into effect on 1 January 2010. This will ensure that people are correctly appraised as requiring high care and the approved providers will not have to provide high care when it is not required. The Department is working with the Aged Care Funding Instrument Industry Reference Group and Medicare Australia to ensure a seamless transition to the new arrangements.

The Department will also review the outcomes of the Aged Care Funding Instrument, consulting with community representatives and commissioning independent data analyses. The Department expects that the review will begin in September 2009 and last some six months, with draft findings to be discussed with the Industry Reference Group and the Minister for Ageing’s Ageing Consultative Committee, among others, prior to finalisation.

Community Care Infrastructure Projects

In 2008–09, the Department expanded its establishment grants program to allow providers of Extended Aged Care at Home, Extended Aged Care at Home Dementia, and Community Aged Care packages to apply for funding for infrastructure projects. These grants are targeted at service providers without established infrastructure; those providing care in remote or isolated communities where there are limited resources; or services with only small numbers of packages available.

This year the Department provided grants to 20 service providers, to improve access to tailored home care services for community care clients in areas identified as having special needs and/or limited accessible services. Through these establishment grants, the Department aims to assist community care clients to access the care they require without the need to move away from their homes or communities.

Funding for the above activities was sourced from Programs 4.4 – Community Care, 4.7 – Flexible Aged Care and 4.8 – Residential Care.
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Ensuring the Aged Care Sector Delivers High Quality Care

In response to the need for older Australians to receive high quality care in both residential and community settings, the Department continued to build the aged care workforce capacity, and to strengthen quality assurance processes. The Department investigates issues of concern in relation to the delivery of care and services and takes action, including the imposition of sanctions, where failures occur. The process by which homes are accredited to provide care to residents and the care standards they are required to meet are being reviewed in consultation with the aged care sector in an effort that began in 2008–09 and will continue in the next financial year.

Workforce Capacity Building

According to the results of the 2007 National Aged Care Workforce Census and Study, a typical aged care worker is female, aged around 50, with at least 12 years of schooling and some relevant post school qualification. While aged care workers are mostly content with their jobs, turnover is an issue, particularly when Australia’s population is ageing.

In 2008–09, the Department worked to improve career paths for aged care workers, by investing in training from vocational education through to nursing qualifications and postgraduate scholarships. This major achievement saw the funding of more than 9,500 vocational training places (more than 960 of which were for enrolled nurses), and 724 undergraduate and postgraduate places. As a result, an unqualified personal care worker will be able to progress through the vocational education system onto undergraduate nursing studies and postgraduate study. The Department ensures that a number of these training places are targeted at providing training to workers in financially less viable facilities in rural and remote Australia.

The Department also supported the return of nurses to the workforce, through the Bringing Nurses Back into the Workforce Program, providing cash bonuses of up to $6,000. While there were 519 enquiries relating to the program, uptake of the initiative was lower than anticipated, with only 71 nurses returning to work and being assessed as eligible to receive the cash bonuses. The Department moved to address this low participation rate by developing a targeted promotional campaign to advertise the program nationally. (Further discussion relating to the Bringing Nurses Back into the Workforce Program can be found in the Outcome 12 Health Workforce Capacity chapter.)
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Residential Aged Care Accreditation and Monitoring

Accreditation forms an integral part in the Department’s approach to quality in residential aged care. It involves an independent team of assessors evaluating the achievements of an aged care home against a pre-determined set of standards, the Aged Care Accreditation Standards. In 2008–09, the Department commenced reviewing the accreditation process for residential aged care, releasing a discussion paper for public consultation in May 2009. The opportunity to provide submissions formally closed on 17 July 2009; and the Department will consider stakeholder feedback in 2009–10 when it develops options for improving the accreditation process and the Accreditation Standards. The Department also established a technical reference group to provide advice on the review of accreditation standards, and on the further development of quality indicators for future piloting in residential aged care.

Through the Aged Care Complaints Investigation Scheme (free call 1800 550 552), the Department has the ability to investigate concerns raised by anyone about the health, safety and/or wellbeing of people receiving aged care. This year, the scheme received 12,573 contacts and investigated 7,962 cases (the remaining contacts were either addressed through the provision of information or were out of scope of the scheme). The Department conducted 3,151 site visits and identified 1,093 breaches. Of these, 181 Notices of Required Action were issued. The Department also issued 163 Notices of Non-Compliance and imposed 30 sanctions.

A challenge for the Department was dealing with a greater number of complex cases reported, resulting from an increased awareness of the scheme and more people raising their concerns. In response, the Department developed clinical protocols for registered nurses working in the Aged Care Complaints Investigation Scheme to ensure that concerns about clinical care in aged care homes are identified and acted upon consistently and appropriately. This year 113 Departmental nursing officers received training in use of the protocol.

Key Facts for 2008–09: Protecting Residents in Aged Care

Approved providers and other parties affected by decisions under the Aged Care Complaints Investigation Scheme have a right to seek an examination of those decisions by the Aged Care Commissioner. During 2008–09, the Commissioner reviewed 125 examinable decisions and provided her recommendations to the Department. The Department reconsidered 120 of these cases as well as an additional five examinable decisions that were completed by the Commissioner in 2007–08. In all but nine instances the Department agreed with the Commissioner’s recommendation and partially agreed with the Commissioner’s recommendations in a further three instances.
In 2008–09, the Government expanded the requirement for aged care staff who have supervised and unsupervised access to people receiving care, to undergo a police check to assess their suitability for employment in aged care.
From 1 January 2009, aged care homes have been required to notify the Department, within 24 hours, when residents go missing without explanation, and the police have been contacted. The Department received 367 notifications of missing residents between 1 January 2009 and 30 June 2009.

Strengthened Quality Assurance Processes

The Department aims to strengthen quality assurance processes for the residential and community aged care sectors through the identification and promotion of evidence-based practice, and improved information for consumers. As part of this effort, the Department funded eight projects in 2008–09 through the Encouraging Best Practice in Residential Aged Care program to form consortia to: improve evidence-based clinical care for residents; provide additional skills for clinical care staff; and promote a sustainable best practice care culture in Australian Government-funded aged care homes. These projects focus on four clinical areas including behaviour management, palliative care, wound management and infection control. Work is also being undertaken to streamline quality assurance standards and processes across community care services.

The Department also undertook significant development work during the year to enable the publishing of additional compliance information on the www.agedcareaustralia.gov.au website. In doing so, the Department consulted with the Ageing Consultative Committee and invited submissions on the proposal.

Funding for the above activities was sourced from Programs 4.2 – Aged Care Workforce, 4.4 – Community Care, and 4.8 – Residential Care.
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Active, Independent Lives for Older Australians in the Community

Support for the Ambassador for Ageing

Improving understanding of positive ageing is a key goal in achieving effective preventative health strategies and outcomes for older people in the community. In 2008–09, the Department supported the Ambassador for Ageing to promote positive and active ageing through a range of activities across Australia including: media interviews in metropolitan, regional and rural community settings; health promotion events; community events; and conferences. The Ambassador for Ageing attended a total 75 events during the year.

The Department also supported the launch of a series of posters and brochures, focusing on: staying physically active; eating well; keeping in touch with family, friends and community; and avoiding falls at home. The posters feature the Ambassador for Ageing and provide reminders of simple things older people can do to help lead a healthier life and remain active and engaged with the wider community. More than 4,300 sets of posters and brochures were distributed through seniors’ groups and community organisations. A further 24,000 were provided to interested people through Centrelink offices across Australia. The Department will continue to support the Ambassador for Ageing to promote positive and active ageing messages in 2009–10.

Consultation and Cooperation with the States and Territories

In 2008–09, the Department contributed to Australian, State and Territory Government collaboration on ageing issues, by supporting the Minister for Ageing to work with her state and territory counterparts through the Ministerial Conference on Ageing, and its advisory council the Ministerial Advisory Council on Ageing.

The Ministerial Conference met in November 2008 and considered a range of issues including: developing social measures to reduce social inclusion among older people; creating more seamless care for the aged and people with a disability; improving care for people in nursing homes with complex psycho-geriatric conditions; and building better age-appropriate housing.

The Department worked in partnership with State and Territory Governments to develop a more consistent approach across all community care programs, including the Home and Community Care Program, to achieve a more integrated, streamlined and efficient system. This provides greater consistency and simplicity for people who rely on the system, as well as for service providers and program managers. In addition, the Department commenced negotiations with State and Territory Governments on a new funding structure for the Aged Care Assessment Program under new federal-state financial arrangements announced by the Council of Australian Governments in March 2008.

Funding for the above activities was sourced from Programs 4.1 – Aged Care Assessment and 4.8 – Residential Care.
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Performance Information for Outcome 4 Administered Programs

Program 4.1 – Aged Care Assessment
Indicator:	Support for frail older Australians to be assessed for Australian Government subsidised care.
Reference Point/Target:	85% of the highest priority older Australians are assessed within 48 hours of referral.
Result: Indicator substantially met.
In 2007–08, 83.2% of the highest priority older people were assessed within 48 hours of referral. This target was met by all states and territories except for Queensland (79.0 %) and South Australia (70.2%). Changes to the Aged Care Act 1997 will reduce the overall number of re-assessments required by Aged Care Assessment Teams and consequently it is expected that response times for Priority Category 1 clients will improve.

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Figure 2.3.4.2: Percentage of Priority Category 1 Clients Assessed within 48 Hours of Referral

Source: Aged Care Assessment Program National Data Repository: Minimum Data Set Annual Report 2007–2008.

Program 4.2 – Aged Care Workforce
Indicator:	Improve the skills of aged care workers to deliver high quality care.
Reference Point/Target:	6,000 vocational education and training places offered by June 2009.
Result: Indicator exceeded.
In 2008–09, the Department entered into arrangements to deliver over 9,500 certificate-level training places across its Better Skills for Better Care, Community Aged Care Workforce Development and Support for Aged Care Training programs. These programs aim to increase the skills of aged care workers in eligible residential and community aged care services, including those in rural and remote Australia that face additional workforce challenges. The places awarded included more than 960 training places for enrolled nurse qualifications, including 127 for smaller, financially less viable services in rural and remote Australia.
Indicator:	Increasing the nursing workforce in residential aged care.
Reference Point/Target:	Between 300 and 400 nurses returning to residential aged care by June 2009.
Result: Indicator not met.
Seventy-one nurses returned to work in residential aged care and were assessed as being eligible to receive cash bonuses under the Bringing Nurses Back to the Workforce program.

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Program 4.3 – Ageing Information and Support
Indicator:	Provision of information and support to enable older Australians to lead independent, active and healthy lives. Measured through: rates of access to information published by the Department on ageing issues and the role of older Australians in the community; level of consumer access to information published by the Department on aged care options; and level of access to continence advice and support.
Reference Point/Target:	An average of at least 95,000 calls to the Aged Care Information Line. An average of at least 10,000 Home Finder searches and 1,500 Community Care searches per month to the aged care consumer website. Approximately 18,000 calls to the National Continence Helpline in 2008–09.¹
Note: This performance indicator was amended in the 2008–09 Health and Ageing Portfolio Additional Estimates Statements, where ‘in 2007–08’ was deleted from the end of the Reference Point or Target ‘a) An average of at least 95,000 calls to the Aged Care Information Line ~~in 2007–08~~’.
Result: Indicator exceeded.
The number of calls to the Aged Care Information Line for 2008–09 was 102,624. The average number of Home Finder searches per month was 23,970 and the average number of Community Care searches per month was 1,900. Over 22,200 calls to the National Continence Helpline were received in 2008–09.

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Program 4.4 – Community Care
Indicator:	Increased number of: services provided through the Home and Community Care Program; and carers provided with respite assistance through the National Respite for Carers Program, as measured for the latest year in which data is available (ie 2007–08).
Reference Point/Target:	More than 2.076 million instances of Home and Community Care services in 2007–08. More than 84,000 carers to receive respite assistance through respite services and Commonwealth Respite and Carelink Centres funded under the National Respite for Carers Program in 2007–08.
Note: This performance indicator was amended in the 2008–09 Health and Ageing Portfolio Additional Estimates Statements, to refer to ‘2.076 million instances’, not ‘2.043 million instances’, to reflect updated information.
Result: Indicator met.
There were 2.158 million instances of Home and Community Care services provided in 2008–09 In 2008–09, 119,591 carers were provided with respite assistance through the National Respite for Carers Program.
Indicator:	Quality community care services achieved. Measured by the percentage of services that provide evidence of quality improvement processes and systems.
Reference Point/Target:	30 services provide evidence of effective quality improvement processes and systems in their reports to the Department and during site visits under the Quality Reporting Program.
Note: This performance indicator was amended in the 2008–09 Health and Ageing Portfolio Additional Estimates Statements, to refer to ‘30 services’, not ‘97% of services’, to reflect updated information.
Result: Indicator substantially met.
Services are assessed once in a three year cycle. In 2008–09, 286 services participated in the Quality Reporting Program. Twenty per cent of services participated in quality reporting and 95% of these services received an outcome rating consistent with effective quality improvement processes and systems.
Indicator:	Provision of operational community care places.
Reference Point/Target:	Progress towards meeting the target of 25 community care places per 1,000 persons aged 70 years and over by June 2011.
Result: Indicator substantially met.
As at 30 June 2009, there were 23.1 operational community care places per 1,000 persons aged 70 years and over.

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Program 4.5 – Culturally Appropriate Aged Care
Indicator:	Support for culturally appropriate aged care for people from culturally and linguistically diverse and/or Aboriginal and Torres Strait Islander backgrounds.
Reference Point/Target:	Over 70 projects and services funded nationally with many cultural and language groups provided for.
Result: Indicator exceeded.
The Department funded 75 projects nationally to provide culturally and linguistically diverse communities with increased access to aged care services and information. Examples of projects included the provision of language-specific resources on aged care options and advice to service providers on the cultural, religious and dietary needs of particular communities.

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Program 4.6 – Dementia
Indicator:	Implementation and evaluation of a comprehensive range of measures to support those with dementia and their carers, including research, early intervention programs, improved care initiatives and training for aged care workers, carers and other relevant professionals.
Reference Point/Target:	The initiative as a whole will be evaluated by 30 June 2009. Within that evaluation, all individual components will also be the subject of either an in-depth evaluation (seven components) or a project review (ten components).
Result: Indicator met.
An independent evaluation of the Dementia Initiative was completed by 30 June 2009, and included an in-depth evaluation of the seven major components and a project review of ten components. The draft final report has been provided to the Department.

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Program 4.7 – Flexible Aged Care
Indicator:	Increased number of transition care and multipurpose service places provided through the Flexible Care Program.
Reference Point/Target:	An additional 200 transition care places are allocated in 2008–09. There will be more than 2,492 multipurpose service places operational in 2008–09.
Result: Indicator exceeded.
A total of 470 new transition care places were allocated on 26 March 2009, including 70 places that were brought forward from future allocations at the request of states and territories. The Department allocated more than 171 Multi-purpose Service places in 2008–09, 84 of which have been made operational by the State and Territory Governments. The total number of Multi-purpose Service places operational in 2008–09 was 3,076.

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Program 4.8 – Residential Care
Indicator:	Provision of operational residential aged care places.
Reference Point/Target:	Achieving the national provision ratio of 88 residential aged care places per 1,000 persons aged 70 years and over.
Result: Indicator substantially met.
As at 30 June 2009, there were 86.9 operational residential aged care places per 1,000 persons aged 70 years and over, that is, 98.8% of the target. The operational ratio is subject to a range of influences including changes in population, the level of uptake of places and the time it takes providers to bring new places on line. While the release of places takes these factors into consideration in any given year the result can vary from the target.
Indicator:	Increased proportion of residential care places that become operational within two years of being allocated.
Reference Point/Target:	21% of residential care places allocated in the 2005 Aged Care Approvals Round became operational within two years of being allocated.
Result: Indicator met.
A total 21.6% of residential aged care places allocated in the 2006 Aged Care Approvals Round became operational within two years of being allocated.
Indicator:	Quality residential aged care and services achieved through the Aged Care Standards and Accreditation Agency’s accreditation and monitoring of Australian Government-funded aged care homes. Measured by the percentage of services compliant with the 44 outcomes under the Accreditation Standards.
Reference Point/Target:	At least 97% of services are compliant in 2008–09.
Result: Indicator substantially met.
In 2008–09, the Aged Care Standards and Accreditation Agency Ltd conducted 1,622 accreditation site audits, 104 review audits, and 5,869 support contacts. Three hundred and three homes were identified as having some non-compliance at some point throughout the year. As at 30 June 2009, 2,794 homes were accredited. Of these homes, 91.6% (2,560) had been awarded three years accreditation. As at 30 June 2009, only 2.4% (68) were identified as having some non-compliance.

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Performance Information for Outcome 4 Departmental Outputs

Output Group 1 – Policy Advice
Indicator:	Quality, relevant and timely advice for Australian Government decision-making, measured by ministerial satisfaction.
Reference Point/Target:	Ministerial satisfaction.
Result: Indicator met.
Ministers were satisfied with the quality, relevance and timeliness of advice provided for Australian Government decision-making.
Indicator:	Production of relevant and timely evidence-based policy research.
Reference Point/Target:	Relevant evidence-based policy research produced in a timely manner.
Result: Indicator met.
In 2008–09, the Department contracted three dementia collaborative research centres to conduct research projects on assessment and better care; prevention, early intervention and risk reduction; carers, consumers and social research. Two additional projects were funded under round two of the Dementia Research Grants Program bringing the total grants funded under this round to 17 at a cost of $10.9 million. Round two projects are expected to finish by mid–2012.

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Output Group 2 – Program Management
Indicator:	Administered budget predictions are met and actual expenses vary less than 0.5% from budgeted expenses measured by comparison of actual expenses against budget.
Reference Point/Target:	0.5% variance from budgeted expenses.
Result: Indicator met.
The actual Administered expenses for Outcome 4 were 0.48% greater than budgeted expenses.
Indicator:	Stakeholders participate in program development through avenues such as surveys, conferences, meetings, and submissions on departmental discussion papers.
Reference Point/Target:	Stakeholders participate in program development.
Result: Indicator met.
Stakeholders participated in program development through: advisory and management committees for dementia, incontinence and other initiatives; and discussion with representatives of residential aged care consumers, workers and providers on the introduction and ongoing implementation of the Aged Care Funding Instrument, including through the Aged Care Funding Instrument Reference Group.

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Outcome 4 – Financial Resources Summary

	(A) Budget Estimate 2008–09 $’000	(B) Actual 2008–09 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2009–10 $’000
Program 4.1: Aged Care Assessment
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	3,324	2,222	(1,102)	1,143
Annual Appropriation Bill 2 (Other Services)	41,628	41,630	2	-
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	4,355	4,464	109	4,023
Revenues from other sources	60	106	46	63
Subtotal for Program 4.1	49,367	48,422	(945)	5,229
Program 4.2: Aged Care Workforce
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	52,933	53,376	443	55,940
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	5,638	5,780	142	5,208
Revenues from other sources	77	137	60	82
Subtotal for Program 4.2	58,648	59,293	645	61,230
Program 4.3: Ageing Information and Support
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	36,051	34,854	(1,197)	38,622
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	55,007	56,406	1,399	50,816
Revenues from other sources	752	1,341	589	793
Subtotal for Program 4.3	91,810	92,601	791	90,231
Program 4.4: Community Care
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	293,166	289,866	(3,300)	324,829
Annual Appropriation Bill 2 (Other Services)	634,421	635,762	1,341	-
Special appropriations
Aged Care Act 1997 - Community Care Subsidies	468,289	479,718	11,429	511,679
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	41,320	42,369	1,049	38,172
Revenues from other sources	565	1,007	442	595
Subtotal for Program 4.4	1,437,761	1,448,722	10,961	875,275
Program 4.5: Culturally Appropriate Aged Care
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	29,280	29,291	11	29,918
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	3,329	3,414	85	3,075
Revenues from other sources	45	81	36	48
Subtotal for Program 4.5	32,654	32,786	132	33,041
Program 4.6: Dementia
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	30,949	31,420	471	30,784
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	3,788	3,884	96	3,499
Revenues from other sources	51	92	41	55
Subtotal for Program 4.6	34,788	35,396	608	34,338
Program 4.7: Flexible Aged Care
Administered Items
Special appropriations
Aged Care Act 1997 - Flexible Care Subsidies	405,474	431,090	25,616	484,443
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services	5,165	5,298	133	4,772
Revenues from other source	71	126	55	74
Subtotal for Program 4.7	410,710	436,514	25,804	489,289
Program 4.8: Residential Care
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	54,497	64,411	9,914	84,669
Special appropriations
Aged Care Act 1997 - Residential Care Subsidies	5,524,686	5,514,327	(10,359)	6,043,641
Aged Care (Bond Security) Act 2006	9,000	16,579	7,579	-
Unfunded Expenses	8,358	3,739	(4,619)	41,319
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	69,312	68,690	(622)	64,031
Revenues from other sources	947	1,633	686	999
Subtotal for Program 4.8	5,666,800	5,669,379	2,579	6,234,659
Total Resources for Outcome 4	7,782,538	7,823,113	40,575	7,823,292
Outcome 4 Resources by Departmental Output Group
Department of Health and Ageing
Output Group 1: Policy Advice	34,698	35,490	792	32,219
Output Group 2: Program Management	155,783	159,338	3,555	144,085
Total Departmental Resources	190,481	194,828	4,347	176,304
Average Staffing Level (Number)	1,126	1,126	-	1,079

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1 Funding for the National Continence Helpline in 2008–09 was provided under Program 4.4 not Program 4.3, as identified in the 2008–09 Health and Ageing Portfolio Budget Statements and 2008–09 Health and Ageing Portfolio Additional Estimates Statements.

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