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Outcome 4 Aged Care and Population Ageing

Access to quality and affordable aged care and carer support services for older people, including through subsidies and grants, industry assistance, training and regulation of the aged care sector.

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Outcome Summary

Outcome 4 aims to ensure that older people receive a choice of high quality, accessible and affordable care and that carers get the support they need to look after frail older people living at home. The Australian Government also aims to encourage older people to live active and independent lives. The department worked to achieve this outcome by managing initiatives under the programs outlined below.

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the key strategic directions and performance indicators published in the Outcome 4 chapters of the 2009-10 Health and Ageing Portfolio Budget Statements and 2009-10 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 2009-10. 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.

Programs Administered under Outcome 4 and 2009-10 Objectives

Program 4.1: Aged Care Assessment

Provide assessment services to meet the needs of all frail older people to establish their eligibility for residential aged care and community care services.

Program 4.2: Aged Care Workforce

Improve the skills of aged care workers and create better career paths.

Program 4.3: Ageing Information and Support

Keep older people, service providers and the wider community informed of Government services.
Support programs to enhance the quality of life of older Australians.

Program 4.4: Community Care

Ensure that older Australians receive a choice of high quality, accessible and affordable care, and carers get the support they need to look after frail older people living at home.

Program 4.5: Culturally Appropriate Aged Care

Provide and support access to aged care services for older people from culturally and linguistically diverse communities.
Provide and support access to aged care services for older people from Aboriginal and Torres Strait Islander communities wishing to remain in their communities.

Program 4.6: Dementia

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

Program 4.7: Flexible Aged Care

Enable the provision of flexible aged 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 provision of residential care to older people whose care needs are such that they can no longer remain in their homes.

Major Achievements

In December 2009, the Better Oral Health in Residential Aged Care training initiative commenced. The initiative is designed to strengthen dental and oral care in aged care facilities. By the end of June 2010, more than 300 train-the-trainer workshops were held, with 4,000 registered nurses and trainers receiving training. More than 2,000 aged care facilities attended the training, which is expected to be completed by December 2010.
Supported an independent review of the Aged Care Complaints Investigation Scheme to identify options for improvement. The recommendations of the review and subsequent funding will see changes to the scheme which will improve the experience of its clients, including aged care recipients.
Implemented the Continence Aids Payment Scheme, replacing the Continence Aids Assistance Scheme. This involved transitioning 75,000 existing clients to the new scheme and holding information sessions across Australia. The department’s National Continence Helpline fielded close to 19,000 calls regarding the new scheme.
On 1 October 2009, the department implemented a new Charter of Rights and Responsibilities for Community Care and drafted a package of information for community care recipients. The charter affirms the right of every person to freedom and respect and the right to be treated fairly by others.
Redefined the meaning of ‘high care’ under the Aged Care Funding Instrument. The change removed the requirement for residential aged care services to provide a higher level of nursing care than necessary, resulting in decreased costs to aged care services.

Challenges

Attracting a sufficient number of high quality applications from potential aged care providers to offer residential care places, including multi-purpose places in rural and remote communities. This limited the ability of the department and the aged care industry to meet the increasing demand for aged care places.
Increased complexity and range of complaints received through the Aged Care Complaints Investigation Scheme.
Ensuring that there is a sufficient stock of aged care residential facilities to meet increasing demands from an ageing community and a reconsideration of financial risk by lenders as a result of the global financial credit crisis.
Increasing demand from consumers to have a greater say in the types of services and care that they receive, in a setting of their choice.
Ensuring that there is an adequate and appropriately skilled workforce employed to deliver high quality care to older people.

Program 4.1: Aged Care Assessment

Program 4.1 aims to provide assessment services to meet the needs of all frail older people, to establish their eligibility for residential aged care and community care services.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

provide equitable access for frail older people to assessments that determine eligibility for the subsidised aged care services that meet their care needs.

Major Activities

Equitable Access to Assessments of the Care Needs of Frail Older People

During 2009-10, the department worked with states and territories to endorse the Aged Care Assessment Program National Training Strategy. This overarching training strategy is designed to promote best practice and national consistency in key practices and core processes for all Aged Care Assessment Team members.

The department revised and updated the Aged Care Assessment Program National Orientation Training Resources in 2009-10 to support both face to face and online delivery of this resource. Resources were revised following extensive consultation with Aged Care Assessment Teams from all jurisdictions. As a result, this national training resource now aligns with the established Aged Care Assessment Program National Delegation Training Resources.

Through a collaborative effort with state and territory governments, the department continued to negotiate the Aged Care Assessment Program Implementation Plan, which will be a schedule to the National Partnership Agreement on Health Services. The implementation plan will provide incentives to state and territory governments to meet benchmarks measuring improvements in the timeliness, consistency and quality of Aged Care Assessment Team assessments against key performance indicators.
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Performance Information for Outcome 4

Program 4.1: Deliverables

Qualitative Deliverable

Qualitative Deliverable:	Regular stakeholder participation in program development through avenues such as surveys, conferences, meetings, and submissions on departmental discussion papers measured by the extent to which the department works with the Aged Care Assessment Program (ACAP) Officials (the peak Australian, state and territory government level committee that oversees the operation of the program), and the department’s hosting of the 2010 Aged Care Assessment Program National Conference.
Result: Deliverable met.
In 2009-10, the department worked collaboratively with Aged Care Assessment Program Officials to develop policy and program improvements with a focus on improving the timeliness, consistency and quality of assessments conducted by Aged Care Assessment Teams. The department also hosted the National Aged Care Assessment Program Conference at the Melbourne Convention and Exhibition Centre on 20-21 May 2010. The conference provided approximately 600 representatives from across Australia with an opportunity to share their expertise, explore new ideas and review best practice. The theme of the conference was: Respect, Recognition and Responsibilities, with guest speakers including the Hon Justine Elliot MP, Minister for Ageing; Dr Anna Howe, Consultant Gerontologist; Merle Mitchell, Community Advocate; and many others. Presentations from the conference are available online.¹

¹ Accessible at www.health.gov.au/acats.

Quantitative Deliverables

Equitable Access to Assessments of the Care Needs of Frail Older People
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-23.3%
Result: Deliverable not met.
The National ACAP conference in May 2010 was conducted for a significantly lower cost than originally estimated.
Quantitative Deliverable:	Percentage of all complete assessments which were performed by the Aged Care Assessment Teams on clients in the target population.
2009-10 Target:	85%	2009-10 Actual:	92.3%
Result: Deliverable met.
In 2009-10, projected figures based on the 1 July to 31 December 2009 data indicate that 92.3 per cent of all complete assessments undertaken by Aged Care Assessment Teams were for the target population. South Australia had the highest proportion of assessments from the target population with 93.6 per cent, while the Northern Territory the lowest with 87.7 per cent. All states and territories are projected to meet the 2009-10 target of 85 per cent. The data was for the period 1 July 2009 to 31 December 2009. Final data for 2009-10 will be available in the ACAP MDS Annual Report 2009-2010 in March 2011 and will be published on the department’s website www.health.gov.au/acats
Quantitative Deliverable:	Percentage of Aged Care Assessment Team delegates who have successfully completed the knowledge assessment component of the delegation training.
2009-10 Target:	100%	2009-10 Actual:	80.4%
Result: Deliverable substantially met.
In April 2009, the department introduced a new national training resource for Aged Care Assessment Team delegates using a range of training formats, including an online learning management system. Take-up of this training by delegates has been gradually increasing since April 2009. In 2009-10, 80.4 per cent of delegates successfully completed the knowledge assessment component of the delegation training. The department will require that states and territories ensure all Aged Care Assessment Team delegates complete this training in 2010-11.

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Program 4.1: Key Performance Indicators

Qualitative Key Performance Indicator

Qualitative Indicator:	All states and territories have improved timeliness of assessments of older people in community, residential, and hospital settings. This will be measured using the data collated at the National Data Repository on the Aged Care Assessment Program Minimum Data Set. Each state and territory government is required to provide data on each Aged Care Assessment Team in accordance with the requirements set out in the National Partnership Agreement and relevant department guidelines on the Aged Care Assessment Program Minimum Data Set. Based on the information from the Minimum Data Set, baseline targets for Aged Care Assessment Teams will be established in 2009-10.
Result: Indicator met.
All states and territories provide data on each Aged Care Assessment Team. Baseline targets for the performance of each Aged Care Assessment Team are established using the Aged Care Assessment Program Minimum Data Set. The requirement for timely assessments of older people in all settings (community, residential and hospital) will be measured in line with the key performance indicators in the Aged Care Assessment Program Implementation Plan.

Quantitative Key Performance Indicator

Equitable Access to Assessments of the Care Needs of Frail Older People
Quantitative Indicator:	Percentage of older people in the target population prioritised as being at the highest level of need for assessment seen within 48 hours of referral.
2009-10 Target:	85%	2009-10 Actual:	Data not available until December 2010
Result: Cannot be reported.
In 2008-09, 80.9 per cent of the highest priority older people were assessed within 48 hours of referral. The target of 85 per cent was only met by New South Wales (86.0 per cent), Victoria (90.5 per cent), the Northern Territory (86.4 per cent) and the Australian Capital Territory (95.7 per cent). The target was not met by South Australia (68.0 per cent), Tasmania (75.7 per cent) and Queensland (84.3 per cent). The data was extracted on 17 June 2010 from the Ageing and Aged Care Data Warehouse and is for the period of 2008-09. Data will be revised when 2009-10 data is available in December 2010 and may alter the information in the graph.

Program 4.2: Aged Care Workforce

Program 4.2 aims to support the delivery of high quality aged care by a skilled aged care workforce, and to improve the skills and create better career paths for aged care workers.

Key Strategic Direction for 2009-10

The department’s strategy to achieve these aims was to:

improve the quality of aged care by improving the skills of the workforce.

Major Activities

Improving Quality of Care by Improving the Skills of the Workforce

A skilled aged care workforce is critical to ensuring quality aged care for all Australians. In 2009-10, the department funded more than 9,000 vocational training places, including 947 Enrolled Nursing places, and nearly 700 aged care nursing scholarships. The department targeted a number of these training places to workers in financially less viable facilities in rural and remote Australia.

In 2009-10, the department funded projects 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 subsidised aged care homes. Five projects, focusing on the clinical areas of pain management, nutrition and hydration, falls management, ‘as required’ medicines and oral health, were completed in December 2009. Eight projects, focusing on the four clinical areas of behaviour management, palliative care, wound management and infection control, continued throughout 2010.

The department also commenced the national roll-out of the Better Oral Health in Residential Care training for staff in residential aged care facilities, multi-purpose services and Aboriginal and Torres Strait Islander flexible care services. More than 4,000 nursing staff and nominated trainers were trained using a train-the-trainer model so they can, in turn, train care workers in daily oral hygiene for residents of aged care facilities.

In response to the report to the Minister for Ageing on Residential Care and People with Psychogeriatric Disorders, the department established the Psychogeriatric Care Expert Reference Group. This group is made up of old age psychiatrists, a geriatrician, a general practitioner, service providers and expert nursing staff. The department supported the group to provide advice on appropriate service models and delivery for people with severe psychogeriatric disorders to the Australian Ministerial Conference on Ageing.
image of older australians

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Performance Information for Outcome 4

Program 4.2: Deliverables

Qualitative Deliverable

Qualitative Deliverable:	Regular stakeholder participation in program development, through surveys, conferences, meetings, and submissions on departmental discussion papers. This will be measured by the extent to which the department works with the Aged Care Workforce Committee as the primary stakeholder forum for aged care workforce and training policy discussions. The Aged Care Workforce Committee advises the Australian Government on aged care workforce challenges, issues and trends.
Result: Deliverable met.
In 2009-10, the Aged Care Workforce Committee formally met three times and provided feedback and advice out of session. The department provided regular updates to the Aged Care Workforce Committee on workforce programs. The Aged Care Workforce Committee facilitates partnerships and discussion between the aged care sector and the workforce education and training industry. In 2009-10, the committee provided advice to identify national workforce goals and took part in discussions regarding workforce training models, including future directions.

Quantitative Deliverables

Improving Quality of Care by Improving the Skills of the Workforce
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-4.9%
Result: Deliverable not met.
In 2009-10, the department had an underspend for this deliverable due largely to the lower than expected take-up of the Bringing Nurses Back to the Workforce program.
Quantitative Deliverable:	Number of training places funded for aged care workers.
2009-10 Target:	8,200	2009-10 Actual:	9,028
Result: Deliverable met.
In 2009–10, the department entered into arrangements with registered training organisations to deliver more than 9,000 training places across its aged care workforce programs through regular competitive funding rounds. 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.
Quantitative Deliverable:	Number of scholarships funded for aged care nurses.
2009-10 Target:	445	2009-10 Actual:	716
Result: Deliverable met.
In 2009-10, the department, through the Royal College of Nursing Australia, delivered 716 aged care nursing scholarships. The scholarships were awarded for undergraduate and postgraduate studies to support the aged care sector to attract and retain nurses and to improve the clinical skills of aged care nurses. These scholarships were targeted at workers with an interest, aptitude and employment history in aged care, to maximise retention in the sector.

Program 4.2: Key Performance Indicators

Qualitative Key Performance Indicator

Qualitative Indicator:	The quality of each project under the Encouraging Best Practice in Residential Aged Care program will be evaluated through an ongoing national evaluation framework.
Result: Indicator substantially met.
A national evaluation is underway and is considering all Round 1 and Round 2 projects as well as the effectiveness of the program overall. Evaluation progress reports have been received throughout 2009-10, and a final report will be received following the completion of Round 2 projects in November 2010.

Quantitative Key Performance Indicators

Improving Quality of Care by Improving the Skills of the Workforce
Quantitative Indicator:	Improve the skills of aged care workers to deliver high quality care. Measured by the percentage of aged care worker training places taken up.
2009-10 Target:	100%	2009-10 Actual:	100% + additional places
Result: Indicator met.
In 2009–10, the department entered into arrangements with registered training organisations to deliver more than 9,000 training places across its Aged Care Workforce programs. This was higher than anticipated. The places awarded included 4,037 short course training places, 4,044 accredited Certificate training places, and 947 enrolled nurse and medication management training places.
Quantitative Indicator:	Improve the skills of aged care nurses. Measured by the percentage of scholarships taken up.
2009-10 Target:	100%	2009-10 Actual:	100% + additional scholarships
Result: Indicator met.
During 2009-10, the department offered 716 aged care nursing scholarships, comprising 354 undergraduate and 362 postgraduate scholarships. More scholarships were offered than anticipated, and provided aged care workers with the opportunity to become registered nurses or to further develop their clinical skills to deliver quality care.
Quantitative Indicator:	Number of nurses returning to the aged care workforce.
2009-10 Target:	300	2009-10 Actual:	83
Result: Indicator not met.
In 2009-10, 83 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. The take-up of this initiative was slower than anticipated and therefore, in 2010-11 funds from this program were redirected as part of a restructure of aged care workforce programs. This will support broader nursing initiatives to encourage nurses to work in aged care.

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Program 4.3: Ageing Information and Support

Program 4.3 aims to fund a range of information products to keep older people, service providers and the wider community informed of the Government’s services; and to support programs to enhance the quality of life for older Australians.

Key Strategic Directions for 2009-10

The department’s strategies to achieve these aims were to:

provide essential information services and assist with a national campaign for advising service providers on best practice arrangements in community care;
maintain high quality care by investigating complaints about Australian Government subsidised aged care services and ensuring service providers rectify problems where they are not meeting their responsibilities, including supporting advocacy services;
help reduce social isolation by providing community visitors; and
provide information and support services to assist care recipients and their carers.

Major Activities

Information Services for Consumers and Industry

The Aged Care Australia website² and the Aged Care Information Line² both provide free and easily accessible information to assist older people to make informed decisions about Australian Government aged and community care services. This includes information on quality and standards, the Aged Care Funding Instrument and also information resources for industry.

In 2009-10, the department improved access to quality information about aged care services to help consumers, providers and other interested parties make decisions about aged care, and so that service providers could find funding and industry information.

In addition, the department commenced publishing additional information on its website and the Aged Care Australia website about compliance action taken against aged care services and/or the approved providers identified as not meeting their responsibilities under the Aged Care Act 1997. This information aims to assist older Australians and their families in making more informed choices about aged care services.

During the year, the department released on its website de-identified financial performance data provided to the department by residential aged care providers for 2007-08.³ The release of this data is consistent with the department’s approach to transparency in reporting on the financial performance of residential aged care providers and its aim to help identify areas where providers can improve their financial performance. The data enables individual providers to compare their financial performance with similar organisations and contains information on revenues, costs, facility size and location across the industry.

Consistent with this approach to transparency, a list of residential aged care services showing their location and other information has been placed on the department’s website. This is designed to assist potential residents and their families to identify a service that will best suit their needs.

Maintaining Quality by Taking Action on Consumer Feedback

The department aims to improve the quality of care for older people in care by investigating and acting on concerns raised about care or services and by providing advocacy assistance.

The department continued to fund organisations in each state and territory under the National Aged Care Advocacy Program. These organisations provide independent advocacy services to recipients or potential recipients of Government subsidised aged care services. In addition to advocacy, these organisations provide clients with information and raise awareness through their participation and involvement in education sessions targeted at both the aged care industry and consumers. Regular surveys of service recipients were conducted by funded organisations to gauge satisfaction levels. In 2010-11, the department will review the National Aged Care Advocacy Program to ensure it meets the challenging needs of clients and to develop options to provide greater flexibility for funding the program.

An independent review of the Aged Care Complaints Investigation Scheme was undertaken in 2009-10 to identify options for improvement, taking into account the views and experiences of clients, including aged care recipients, their families, and approved providers. The recommendations of the review will see changes to the scheme to improve the experience of its clients, including aged care recipients. From July 2010, the department will start to develop and implement improvements including: more timely responses to complaints through early risk assessment and resolution; greater access to clinical expertise; improved processes, procedures and training for the scheme; a broader range of options to resolve complaints; an enhanced communications strategy for the scheme; and better access to seek an independent review of the scheme’s decisions and processes.

In 2009-10, the scheme received 13,166 contacts and investigated 8,055 cases (the remaining contacts were either addressed though the provision of information or were out of scope of the scheme). The department conducted 3,197 site visits and identified 931 breaches. Of these, 236 Notices of Required Action were issued and the remainder were either remedied immediately or referred to another agency. The department also issued 134 Notices of Non-Compliance and imposed seven sanctions.

Approved providers and other parties affected by decisions under the scheme have a right to seek external examination of those decisions by the Aged Care Commissioner. In 2009-10, the Commissioner reviewed 114 examinable decisions and provided recommendations to the department. The department reconsidered 105 of these as well as an additional five that were completed by the Commissioner in 2008-09. The department fully accepted all of the Commissioner’s recommendations in all but one instance. In a further four instances the department partially accepted the Commissioner’s recommendations. Parties can also request the Commissioner to examine the handling and investigation of a complaint by the scheme. In 2009-10, the department received 10 complaints about process from the Commissioner. The department responded to all 10 complaints about process as well as an additional six that were completed by the Commissioner in 2008-09.

Reducing Social Isolation

The department makes a significant contribution to enabling and supporting the opportunities that older people need to be socially included through its administration of the provisions of the Aged Care Act 1997, the Aged Care Principles 1997, and arrangements for programs funded outside the Act. Ageing and aged care programs and services are designed so that access to care is on the basis of need; services support personal interests and continuing participation; and there are particular protections for groups at risk of exclusion, including helping to ensure that their voices are heard.

Through the Assistance with Care and Housing for the Aged program, the department helped 3,842 frail older people living in insecure housing to access secure accommodation and appropriate support services in order to live, participate and feel included in the community of their choice. Of these, 946 were from culturally diverse backgrounds, 338 were Aboriginal and Torres Strait Islander people and there were more men (1,960) than women (1,882).

The department provided advice and support to the International Federation on Ageing’s 10th Global Conference on Ageing and associated Senior Officials’ Meeting in Melbourne on 3-6 May 2010, which were attended by more than 1,000 international and Australian delegates. The department used these opportunities to promote the Australian Government’s Social Inclusion Agenda, the framework for building A Stronger, Fairer Australia, and ways in which ageing and aged care policies, legislation and programs are supporting the social inclusion of older Australians.

Throughout 2009-10, the department continued its commitment to the Community Visitors Scheme. The scheme provides one-on-one volunteer visitors to residents of Government-subsidised aged care homes who have been identified as being socially or culturally isolated, and whose quality of life would be improved by friendship and companionship. The department funded, monitored and supported 157 community-based organisations to recruit, train, and match volunteers to visit residents and help them maintain links to the community. In 2010-11, the department will continue to work with the organisations to develop flexible strategies to meet the needs of their clients and address the challenges presented by the potential shortfall of volunteers and the changing nature of the volunteer workforce.

Information and Support for Care Recipients and Carers

The department in 2009-10 supported 54 Commonwealth Respite and Carelink Centres through the National Respite for Carers Program. Centres provided information on a wide range of community, aged care and support services available locally or across Australia to older people, people with a disability, and those who provide care and services. Centres also helped carers to take a break from their caring role, and purchased short-term and emergency respite for carers based on assessed need. The availability of respite in emergency situations helped carers access a range of care options at short notice. The department continued to work towards aligning the work of centres with other complementary community aged care entry points by promoting consistent practice in the areas of assessment, access, common standards and quality reporting across the sector.

The department continued to support the Dementia Education and Training for Carers Program throughout 2009-10. The program delivered 40 education and training programs and provided accurate and relevant information to the general public and those living with dementia to help them manage their dementia and access services. These programs are being implemented by 36 of the 54 Commonwealth Respite and Carelink Centres.

2 Available at www.agedcareaustralia.gov.au and 1800 500 853, or 1800 555 677 (TTY).

3 Available at www.health.gov.au/internet/main/publishing.nsf/Content/ageing-resid-care-fin-data.htm.

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Performance Information for Outcome 4

Program 4.3: Deliverables

Qualitative Deliverables

Information Services for Consumers and Industry
Qualitative Deliverable:	Regular stakeholder participation in program development, through avenues such as surveys, conferences, stakeholder consultation forums, and submissions on departmental discussion papers.
Result: Deliverable met.
In 2009-10, there were two meetings of the Ageing Consultative Committee and two meetings of the Aged Care Funding Instrument Industry Reference Group. The department undertook a comprehensive review of the Aged Care Funding Instrument, and considered 98 formal submissions from industry. The department will report the results of the review to Government in early 2010-11. An independent review of the Aged Care Complaints Investigation Scheme was conducted in 2009-10. The reviewers consulted with aged care recipients, their families and carers, the aged care industry, the Ageing Consultative Committee, and other stakeholders on ways to improve the scheme. A total of 119 submissions were received in response to the review. Further consultation will occur during 2010-11 and these consultations will inform the implementation of enhancements to the scheme.
Qualitative Deliverable:	Development of a web-based source of information for consumers on the quality of aged care homes in 2009-10.
Result: Deliverable met.
To help consumers assess the quality of homes, the department updated the website each week to show compliance action taken against aged care homes and/or providers of those services.
Maintaining Quality by Taking Action on Consumer Feedback
Qualitative Deliverable:	Timely investigation of concerns raised about the care or services provided in Australian Government subsidised aged care homes indicated by factors such as consumer satisfaction with the Aged Care Complaints Investigation Scheme.
Result: Deliverable substantially met.
In 2009-10, the department investigated 8,055 complaints and distributed approximately 16,000 satisfaction surveys to complainants, aged care homes and/or the providers of those services. Feedback showed 76.1 per cent of complainants were either highly satisfied or satisfied that staff of the scheme responded to their complaint in a timely manner, although the independent review identified that high case loads contributed to a lack of timeliness in some investigations.

Quantitative Deliverables

Information Services for Consumers and Industry
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-0.6%
Result: Deliverable substantially met.
Minor underspend is a result of small variations in demand and cost.
Quantitative Deliverable:	Number of calls made to the Aged Care Information Line.
2009-10 Target:	104,500	2009-10 Actual:	103,341
Result: Deliverable met.
The March 2008 residential fee changes and the introduction of the Aged Care Funding Instrument resulted in an average rise in queries of about four per cent over the two previous financial years. The variance of one per cent in 2009-10 is a natural decrease, as information on fees continues to reach ageing and aged care consumers, care providers and health professionals.
Quantitative Deliverable:	Average number of searches per month on the Aged Care Australia website in the Home Finder section.
2009-10 Target:	12,500	2009-10 Actual:	21,519
Result: Deliverable met.
In 2009-10, the continuing trend of a 90 per cent or greater increase in Home Finder searches indicates that online resources are becoming more accessible and better known. Website addresses and information line telephone numbers are now prominent in contact information, driving a move to greater choice in information channels. The Aged Care Home Finder is an online search facility that enables people to look for Australian Government-funded aged care homes that meet their particular needs.
Quantitative Deliverable:	Average number of searches per month on the Aged Care Australia website in the Community Care section.
2009-10 Target:	1,600	2009-10 Actual:	3,220
Result: Deliverable met.
The significant number of searches each month for 2009-10 reflects the increased use of this online resource to assist consumers in making informed decisions.
Information and Support for Care Recipients and Carers
Quantitative Deliverable:	Number of Commonwealth Respite and Carelink Centres client episodes (current funding arrangements end in 2010-11).
2009-10 Target:	200,000	2009-10 Actual:	209,028
Result: Deliverable met.
This number represents the number of times that carers were assisted by a Commonwealth Respite and Carelink Centre. It includes telephone calls, emails, facsimiles and visits to a centre. A carer may have been helped more than once in this period.
Quantitative Deliverable:	Number of searches on the Commonwealth Respite and Carelink Centre website.
2009-10 Target:	246,000	2009-10 Actual:	155,700
Result: Deliverable not met.
The target of 246,000 was based on incorrect data. Searches on the Commonwealth Respite and Carelink Centre website in 2007-08 were 201,810, and in 2008-09 were 209,301. Fluctuations in numbers accessing the website can occur for a number of reasons, including the level of promotional activity undertaken by the centres. The department does not direct the range and level of promotional activity that centres undertake from year to year. The overall level of information provided to carers in 2009-10 has been maintained through the items distributed under the Carer Information Support Program which increased from 276,000 in 2008-09 to 374,695 in 2009-10.

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Program 4.3: Key Performance Indicators

Qualitative Key Performance Indicator

Qualitative Indicator:	Program effectiveness is determined through consultation with key stakeholders, including consumers and industry.
Result: Indicator met.
The Ageing Consultative Committee and the Aged Care Funding Instrument Industry Reference Group both met according to committee governance arrangements. The Aged Care Funding Instrument Technical Working Group (a sub-committee of the Aged Care Funding Instrument Industry Reference Group) met more regularly to discuss technical issues arising from the review and was instrumental in advising the department on technical issues related to care and the care needs of residents in Residential Aged Care Facilities.

Quantitative Key Performance Indicators

Maintaining Quality by Taking Action on Consumer Feedback
Quantitative Indicator:	Percentage of people contacting the Aged Care Complaints Investigation Scheme who are satisfied with the effectiveness of the investigation process.
2009-10 Target:	75%	2009-10 Actual:	79.2%
Result: Indicator met.
In 2009-10, the department investigated 8,055 complaints and distributed approximately 16,000 satisfaction surveys to complainants, aged care homes and/or the providers of those services. Feedback showed that 79.2 per cent of consumers who completed the survey were either highly satisfied or satisfied overall with the way the scheme handled their complaint. However, the independent review identified options to improve the scheme which are being considered.
Quantitative Indicator:	Percentage of client feedback expressing satisfaction with the services delivered under the National Aged Care Advocacy Program.
2009-10 Target:	80%	2009-10 Actual:	94.8%
Result: Indicator met.
During 2009-10, National Aged Care Advocacy Program organisations achieved a range of between 71 per cent and 100 per cent satisfaction for the Advocacy Assistance Surveys and between 73 per cent and 100 per cent for the Education Session Surveys.

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Program 4.4: Community Care

Program 4.4 aims to ensure that older Australians receive a choice of high quality, accessible and affordable care, and carers get the support they need to look after frail older people living at home.

Key Strategic Directions for 2009-10

The department’s strategies to achieve these aims were to:

streamline and improve access to care and respite services for clients and their carers, and to ensure that care options meet the needs of individuals;
provide alternatives to residential care to help people remain at home and in the community;
support carers through the National Respite for Carers Program;
help the homeless and disadvantaged to access services;
assist older people to lead independent, active and healthy lives; and
improve the quality of care for older Indigenous Australians.

Major Activities

Improvements for Access to Care

The department continued to work in partnership with state and territory governments during 2009-10 to promote consistency across community care (particularly in the Home and Community Care program), agreeing to progress common arrangements in the areas of assessment, access, and common standards and quality reporting. Ten Access Points across seven states and territories were operational, and the National Evaluation of Access Points Demonstration Projects – Final Report was completed, and will inform the establishment of ‘one-stop shops’ in 2010-11. Access Points provided consumers and carers with an identifiable point of entry into community care services, and promoted consistent assessment of needs and eligibility for services.

The department remains committed to developing assessment tools so that assessment outcomes for individuals (care recipients and carers) are consistent and equitable. In 2009-10, the department trialled the Australian Community Care Needs Assessment Revised in access points across Victoria, Tasmania and Queensland. Also, a carer assessment tool, the Carer’s Eligibility and Needs Assessment – Revised, is being developed, and the department is preparing for a national trial of this tool in 2010-11. Outcomes of the Access Points Demonstration Projects and assessment tool trials will be considered in line with the implementation of the National Health and Hospital Network reforms.

Care for People in the Community

Australia has an ageing population and many older, frail Australians now prefer to remain living independently at home rather than moving prematurely into permanent residential care. Community care gives older, frail Australians this choice, by offering them support in their own homes and communities. The Home and Community Care Program delivers affordable and accessible care to help meet the individual needs of older people, people with a disability and their carers.

In 2009-10, the department continued to work with state and territory governments to implement program initiatives agreed by the states and territories and included in the Home and Community Care Review Agreement which was signed in 2007. This included work on additional performance indicators to improve accountability and efficiency in the way the program is delivered to clients in the community. The new indicators will also assist in monitoring the efficiency of state and territory programs.

During the year, the department also published the first consolidated annual report on the performance of the Home and Community Care Program since the program’s inception in 1985. The Home and Community Care Annual Report included state and territory government information on seven key performance indicators and represents a significant milestone to improving national program accountability. To complement the Annual Report, the department prepared and published the Home and Community Care Minimum Data Set online⁴, which presents a statistical picture of the program nationally.

Strengthening Quality Assurance Processes

The department developed common standards for community care in conjunction with state and territories, which were then endorsed by the Minister for Ageing and the majority of state and territory ministers. The department also developed accompanying guidance documentation.

On 1 October 2009, the department implemented a new Charter of Rights and Responsibilities for Community Care and drafted a package of information for community care recipients. The charter affirms the right of every person to freedom and respect and the right to be treated fairly by others.

The department continued to work in partnership with state and territory governments to develop and implement a more consistent approach to quality monitoring across all community care programs and achieve a more integrated, streamlined and efficient system.

Respite and Carers

In October 2009, the Government responded to the House of Representatives Standing Committee on Family, Community, Housing and Youth’s Who Cares? Report on the inquiry into better support for carers tabled in May 2009.

Central to the response was a commitment to lead the development of a National Carer Recognition Framework, comprising the carer recognition legislation and a national carer strategy. The department is co-leading this work on the development of the strategy with the Department of Families, Housing, Community Services and Indigenous Affairs, in consultation with other Commonwealth agencies and relevant Ministerial Councils.

The Carer Recognition Bill 2010 was tabled in Parliament by the Hon Jenny Macklin MP Minister for Families, Housing, Community Services and Indigenous Affairs, in March 2010. If enacted, this legislation will represent a significant step forward in recognising the role and contribution of hundreds of thousands of carers across the country. It establishes a broad definition of the term carer, and includes a Statement for Australia’s Carers, which sets out ten principles on how carers should be treated and considered by Australian Government agencies and funded providers. It includes the fundamental principle that all carers should have the same rights, choices and opportunities as other Australians.

The National Carer Strategy will shape the short to long-term reform agenda for carers across the health, disability, community care, mental health and aged care systems. This will ensure that support services and policy directions for carers are coordinated, responsive and targeted throughout the course of the caring role. Consultation with carers, key stakeholders and state and territory governments will inform the development of the strategy. It is expected that the strategy will be delivered by April 2011.

Throughout the year, the 54 Commonwealth Respite and Carelink Centres provided information and support to carers in their caring role. Centres provide carers with access to emergency and short-term respite options which allow them to take a break. This assistance contributes to the maintenance of caring relationships through the provision of services such as personal care, meal preparation or shopping, assistance with transport and household tasks. In 2009-10, information was provided on more than 209,000 occasions to carers, service providers, health care professionals and the community on services in their local area that support carers and the people they care for.

In 2009-10, the National Respite for Carers Program provided support for carers of frail older Australians and people with disabilities. Carers are supported in their caring role with respite, information and other support, enabling care recipients to remain living in the community for as long as possible. In 2009-10, more than 147,387 carers received assistance, including respite care delivered in the community or in their homes, information and guidance to assist them in their caring role, and counselling from qualified counsellors.

The Day Therapy Centre (DTC) program provides therapy services to both frail older people living in the community, and to residents of Commonwealth funded residential aged care facilities which aim to optimise their independence to allow them to remain in the community or in low level residential care, for as long as possible. There are currently 139 funding agreements in place with DTC service providers.

Clients receive a wide range of services such as physiotherapy, occupational therapy, speech therapy and podiatry services which aim to optimise their independence to allow them to remain in the community or in low level residential care for as long as possible.

The most recent data on clients receiving DTC program services is for 2008-09, when 160,026 clients received DTC support. The department provided $36.035 million in funding in 2009-10.

Help for the Homeless or Disadvantaged in the Community

The Assistance with Care and Housing for the Aged program provides assistance to frail older people living on low incomes who are renting, living in insecure accommodation or on the streets. This initiative improves support for vulnerable older Australians with complex needs, often relating to mental illness, cognitive impairment and alcohol and substance abuse. Support is provided through a case worker who facilitates access to more permanent housing as well as other community support and care services such as culturally appropriate health or aged care.

During 2009-10, the department supported 42 Assistance with Care and Housing for the Aged services. The program assisted 3,842 people to secure or maintain housing and care, and the average cost of providing services was $1,329.80 per client. There was a trend for more male clients (1,960) than female clients (1,882). There were also 946 clients from culturally and linguistically diverse backgrounds and 338 clients of Aboriginal or Torres Strait Islander background.

Targeted Initiatives to Maintain Independent, Active and Healthy Lives

The department aims to help older Australians to lead independent, active and healthy lives and to remain in their own homes and in the community.

In 2009-10, the department worked through the Ambassador for Ageing Program, the National Eye Health Initiative, the National Continence Management strategy and the Continence Aids Assistance Scheme, to promote preventative health messages and services.

Support for the Ambassador for Ageing

During the year, the department supported the Ambassador for Ageing, Ms Noeline Brown, to promote positive and active ageing, highlighting the importance of lifelong learning, and mature-age workforce options and volunteering. The Ambassador for Ageing attended more than 50 events across Australia during the year, including media interviews, with many events located in regional and rural communities. A highlight of the year’s activities included the Ambassador’s meeting with Ms Ruth Marks, Older People’s Commissioner for Wales, when Ms Marks visited Australia. In 2010-11, the department will continue to support the Ambassador for Ageing to promote positive and active ageing messages.
Image of older woman with doctor

National Eye Health Initiative

The department, through the National Eye Health Initiative, aims to promote eye health and prevent avoidable blindness and vision loss in Australia. In 2009-10, the department supported a range of initiatives to promote eye health. Initiatives included eye health promotion activities, professional development activities such as clinical practice guidelines, and the completion of a series of national reports providing an overview of eye health in Australia by the Australian Institute of Health and Welfare. In addition, a project to assist older Australians to enjoy cinema was completed. This project was undertaken in partnership with the Independent Cinemas Association of Australia and Media Access Australia. Sites were selected in rural, regional and metropolitan areas, and resulted in 12 independent cinemas around Australia being equipped with technology to enable people with hearing and vision impairment to enjoy the movies. The department will continue to promote eye health and prevent avoidable blindness and vision loss activities in 2010-11.

Implementation of the Continence Aids Payment Scheme

The Continence Aids Payment Scheme replaced the Continence Aids Assistance Scheme from 1 July 2010. In 2009-10, about 75,000 existing clients were invited to move to the new scheme. Similar to its predecessor, the Continence Aids Payment Scheme is designed to assist people with permanent and severe incontinence. Where clients under the Continence Aids Assistance Scheme received a delivery of products, the Continence Aids Payment Scheme is a direct payment to clients, allowing them to purchase from a continence product supplier of their choice.

In 2009-10, implementation work included legislative amendments, a close working relationship with Medicare Australia to establish an automated client payment system and the roll-out of 78 information sessions in 32 locations across Australia. The department’s policy phone line assisted clients, health professionals and industry with questions about the new scheme and fielded close to 19,000 calls over the year. These activities have assisted people with continence issues to lead healthy and active lives, encouraging greater social inclusion and community participation.

Indigenous Community Care Workforce Development

In 2009-10, the department increased the number of ongoing jobs for Indigenous Australians in community aged care across all states and territories. The department funded more than 700 permanent part-time positions in services delivering Home and Community Care, Australian Government-funded community aged care programs, and in the majority of services funded under the National Aboriginal and Torres Strait Islander Flexible Aged Care program.

The department provided nationally accredited aged care training to more than 300 Aboriginal and Torres Strait Islander workers in more than 40 communities in the Northern Territory, as well as in four Cape York communities. The department also supported several training initiatives for the Aboriginal and Torres Strait Islander aged care workforce nationally. These activities contributed to an increased and better skilled Aboriginal and Torres Strait Islander community aged care workforce, and supported the provision of quality and culturally appropriate services to Aboriginal and Torres Strait Islander clients.

4 Available at www.health.gov.au/internet/main/publishing.nsf/Content/hacc-mds.htm.

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Performance Information for Outcome 4

Program 4.4: Deliverables

Qualitative Deliverables

Qualitative Deliverable:	Timely production of evidence-based policy research: A range of improvement and reform work will be funded through the various community care programs and will be informed by research where required. Approaches to this work will include consumer research, literature reviews, evaluation of field trials and demonstration projects.
Result: Deliverable met.
During 2009-10, the department evaluated a trial involving the establishment of access points which are designed to provide consumers with a range of aged care information from the one place. The results are still being assessed. During the year, the department held discussions, primarily with providers of community care, with a view to developing a trial of an electronic platform to support improved assessments of care eligibility.
Qualitative Deliverable:	Regular stakeholder participation in program development will continue through avenues such as surveys, conferences, meetings, and submissions on departmental discussion papers. In addition Community Care Program initiatives are reviewed and improved as required. Where such work is underway, the department consults with a range of stakeholders through formal and informal mechanisms, which include cross-Government committees, other committees, working groups, consumer research activities, census processes and trials.
Result: Deliverable met.
The department held biannual meetings with state and territory representatives to discuss a range of community care issues including program management and the collection of data. The outcomes of these meetings were taken into consideration when planning the delivery of aged care services to particular states and territories as well as special needs groups identified under the Aged Care Act 1997.

Quantitative Deliverables

Care for People in the Community
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-0.8%
Result: Deliverable substantially met.
The variation can be attributed to some projects with state and territory governments being put on hold while the Council of Australian Governments considered the roles and responsibilities of the Australian Government and state and territory governments in the delivery of community care programs in April 2010.
Quantitative Deliverable:	Estimated number of Community Aged Care Packages allocated.
2009-10 Target:	43,128	2009-10 Actual:	42,728
Result: Deliverable substantially met.
As at 30 June 2010, there were 42,728 Community Aged Care Packages allocated nationally.
Quantitative Deliverable:	Number of Home and Community Care Services provided to eligible⁵ clients in the community.
2009-10 Target:	2.076 million	2009-10 Actual:	2.146 million
Result: Deliverable met.
Home and Community Care services are provided by state and territory governments with funding shared between the states and territories, and the Australian Government.
Respite and Carers
Quantitative Deliverable:	Number of respite services provided to eligible clients in the community.
2009-10 Target:	84,000	2009-10 Actual:	143,387
Result: Deliverable met.
In 2009-10, some 143,387 carers were provided with assistance through the National Respite for Carers Program. This figure includes 37,076 carers assisted with respite through respite services; 100,273 carers assisted to receive respite through Commonwealth Respite and Carelink Centres and 6,038 carers who received counselling services. This is an increase of 12 per cent from 2008-09. Respite services funded under the National Respite for Carers Program provided approximately 5,120,588 hours of respite in 2009-10. This was delivered through over 650 respite services in a variety of settings, including day respite in community settings, in the home and in respite cottages.
Targeted Initiatives to Maintain Independent, Active and Healthy Lives
Quantitative Deliverable:	Provision of information and support through the National Continence Helpline. Measured by the number of calls received.
2009-10 Target:	20,000	2009-10 Actual:	25,754
Result: Deliverable met.
This deliverable was exceeded due to the introduction of the new Continence Aids Payment Scheme and a significant increase in the level of support offered to the public through the National Continence Helpline. It is notable that not only did the volume of calls increase for the helpline, the range of advice and assistance required was expanded to better communicate and educate the public on the new scheme. Helpline data showed: the administration of 25,754 calls, comprising 7,172 from Carers, 9,463 from consumers, 8,744 from health professionals (375 were from an unknown origin); in total, there were 1,028,379 resources ordered through the National Continence Helpline, including 769,558 National Continence Management Strategy resources, 200,634 Continence Foundation of Australia resources, 32,096 non-English resources and 26,091 Indigenous specific resources; and a Customer Satisfaction Survey of 651 callers, resulting in an overall satisfaction rating of 8.5 or above (with 1 indicating extremely unsatisfied and 10 indicating extremely satisfied). The increased number of calls also coincided with a strengthening of internal information technology and phone systems. The upgrade of the National Continence Helpline has enabled the introduction of an Interactive Voice Response system which ensures callers are directed to the right person who can assist with their enquiry. It also improved clients access to online service directory information. The support for clients has been enhanced by the establishment of remote access to the system which has enabled employment of Continence Nurse Advisors nationally.
Indigenous Community Care Workforce Development
Quantitative Deliverable:	Total number of paid positions for Indigenous workers in community care.
2009-10 Target:	≥600	2009-10 Actual:	>700
Result: Deliverable met.
The department funded more than 700 permanent part-time positions in community aged care services nationally. Funding for these positions includes award wages and access to superannuation and leave entitlements. The department developed and implemented training initiatives and other workforce supports to improve the retention of Aboriginal and Torres Strait Islander workers in these positions.

5 Eligibility for services is outlined in the National Program Guidelines for the Home and Community Care Program 2007.

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Program 4.4: Key Performance Indicators

Quantitative Key Performance Indicators

Care for People in the Community
Quantitative Indicator:	Increase in the number of eligible care recipients provided with Community Aged Care Packages, as measured by the percentage increase to the previous financial year’s allocations.
2009-10 Target:	8.2%	2009-10 Actual:	0.1%
Result: Indicator not met.
The 2009-10 Aged Care Approvals Round was still being assessed at 30 June 2010; therefore it has not been possible to take Community Aged Care Package growth stemming from this process into account in the number allocated in 2009-10. In 2009-10, there were an additional 34 Community Aged Care Packages allocated nationally. This represents a 0.1 per cent increase from 2008-09.
Targeted Initiatives to Maintain Independent, Active and Healthy Lives
Quantitative Indicator:	Increase in the number of calls received through the National Continence Managed Helpline, as measured by the percentage increase on 18,000 calls to the helpline.
2009-10 Target:	5%	2009-10 Actual:	15.7%
Result: Indicator met.
This indicator was exceeded due to the introduction of the new Continence Aids Payment Scheme and a significant increase in the level of support offered to the public through the National Continence Helpline.

Program 4.5: Culturally Appropriate Aged Care

Program 4.5 aims to provide and support access to aged care services for older people from culturally and linguistically diverse communities and Aboriginal and Torres Strait Islander communities.

Key Strategic Direction for 2009-10

The department’s strategy to achieve these aims was to:

provide culturally appropriate aged care services to culturally and linguistically diverse communities, and older Indigenous Australians wishing to remain in their communities.

Major Activities

Culturally Appropriate Aged Care

People from culturally and linguistically diverse backgrounds are recognised as a special needs group as they can face particular difficulties understanding aged care information and services, and receiving care appropriate to their needs.

During the year, the department funded two programs designed to address this need. The Community Partners Program funds projects to provide culturally and linguistically diverse communities with increased access to aged care services and information. An example of a project is the provision of language-specific resources on aged care options. The Partners in Culturally Appropriate Care program funds one organisation in each state and territory to equip aged care providers with the necessary skills to deliver appropriate care to older people from culturally and linguistically diverse backgrounds, for example providing advice to service providers on the cultural, religious and dietary needs of particular communities. Both these programs will continue in 2010-11.

Culturally Appropriate Aged Care Services for Aboriginal and Torres Strait Islander People

Older people from Aboriginal and Torres Strait Islander communities have been identified as a special needs group under the Aged Care Act 1997. Social, cultural and linguistic differences can contribute to differences in health status, aged care, support needs and the health outcomes for people from special needs groups. The provision of aged care services delivering culturally responsive aged care close to Aboriginal and Torres Strait Islander communities allows people to age in a supported way, close to family and in familiar surroundings.

Through the Indigenous aged care plan, the department is developing an independent quality framework to set standards for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program. The framework will include standards for health and personal care, safety and physical environment, culturally appropriate lifestyle and effective management.

During August and September 2009, community consultations took place, enabling the communities to meet and share their views. Following these meetings, a Consultation Package outlining the draft Quality Framework was developed. The Consultation Package is ready for distribution to the communities for comment. Education sessions and pilot testing of the Quality Framework will commence in early 2010-11.

The department continued to manage funding under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program to support 29 flexible aged care services in Indigenous communities across the country. Major activities during the year included the commencement of development of two additional flexible aged care services in Mutitjulu and East Arnhem Land in the Northern Territory. It is expected that these two services will be completed during 2010-11.
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Performance Information for Outcome 4

Program 4.5: Deliverables

Qualitative Deliverables

Culturally Appropriate Aged Care Services for Aboriginal and Torres Strait Islander People
Qualitative Deliverable:	Regular stakeholder participation in program development, through such avenues as surveys, conferences, meetings, and submissions on departmental discussion papers.
Result: Deliverable met.
In 2009-10, the organisations funded under the Partners in Culturally Appropriate Care program continued to be regularly engaged through teleconferences and an annual face-to-face meeting to assist in managing challenges and opportunities in assisting approved providers to provide culturally appropriate care. Work on improving support to provide culturally appropriate care will continue in 2010-11 through this network.
Qualitative Deliverable:	The timely allocation and expenditure of funding provided to aged care providers delivering care under the Flexible Aged Care program.
Result: Deliverable met.
The department provided funding of more than $23 million to 29 services funded through the National Aboriginal and Torres Strait Islander Flexible Aged Care Program. This program provides flexible, culturally appropriate aged care services to older Aboriginal and Torres Strait Islander Australians, close to their homes and community.
Qualitative Deliverable:	The timely implementation of the Peer and Professional Support program aimed at providing Indigenous aged care service providers with access to professional advice on care management, governance and financial management and support to aged care staff.
Result: Deliverable substantially met.
The department commenced implementation of the support program by running an open tender process to select a panel of suitably qualified organisations to provide professional support services. The panel of support organisations will be appointed in 2010-11 to enable aged care service providers in remote areas, and those providing care to Aboriginal and Torres Strait Islander Australians to access advice on care management, governance and financial management, and locum support.
Qualitative Deliverable:	The introduction of an independent quality framework which will set standards for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program.
Result: Deliverable substantially met.
Through the Indigenous aged care plan, the department is developing an independent quality framework to set standards for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program. The framework will include standards for health and personal care, safety and physical environment, culturally appropriate lifestyle and effective management and governance. During 2009, community consultations took place enabling the communities to meet and share their views. Following these meetings, a Consultation Package outlining the draft Quality Framework was developed for further comment from the communities before commencing a pilot program.

Quantitative Deliverables

Culturally Appropriate Aged Care
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-1.8%
Result: Deliverable not met.
A minor underspend as projects were delayed due to bad weather and lack of access to tradespeople.
Quantitative Deliverable:	Number of nationally funded projects and services catering for many language groups.
2009-10 Target:	>70	2009-10 Actual:	75
Result: Deliverable met.
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 include the provision of language specific resources and acting as a conduit between service providers and the community.
Culturally Appropriate Aged Care Services for Aboriginal and Torres Strait Islander People
Quantitative Deliverable:	Number of flexible places available for Aboriginal and Torres Strait Islander people.
2009-10 Target:	700	2009-10 Actual:	653
Result: Deliverable substantially met.
In 2009-10, more than 650 flexible places for Aboriginal and Torres Strait Islander people were funded; 30 new places have been allocated, and are expected to be operational in late 2011-12.
Quantitative Deliverable:	Number of projects undertaken to provide culturally appropriate aged care services to older Indigenous Australians.
2009-10 Target:	10	2009-10 Actual:	65
Result: Deliverable met.
During 2009-10, the department provided funding for over 65 projects to support culturally appropriate aged care services to older Indigenous Australians. The initial target was based on a small number of larger grants being provided instead of a larger number of grants allocated for smaller projects. These projects resulted in a greater number of services receiving grants to improve the quality of aged care services in the form of essential equipment and minor building upgrades.

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Program 4.5: Key Performance Indicators

Qualitative Key Performance Indicator

Culturally Appropriate Aged Care
Qualitative Indicator:	People from culturally and linguistically diverse communities have increased access to aged care services and information through targeted projects. This will be measured against the nature and extent of information currently available.
Result: Indicator met.
The number and nature of funded projects is dependent on the number and quality of applications received by the department. As a result of a competitive funding round held in 2009, the department funded 75 projects in 2009-10, compared to 77 in 2008-09. In 2009-10, 30 language groups were represented, compared to 27 in 2008-09. The overall result was increased access to aged care services and information for the community.

Quantitative Key Performance Indicator

Culturally Appropriate Aged Care
Quantitative Indicator:	Proportion of aged care recipients from culturally and linguistically diverse communities accessing culturally appropriate residential care and community based care.
2009-10 Target:	≥95%	2009-10 Actual:	N/A
Result: Cannot be reported.
Data for this performance indicator is currently not available. Although the department collects information about clients from culturally and linguistically diverse communities, no appropriate measure or proxy measure was able to be identified for this indicator. The department will continue to develop such a measure in 2010-11.

Program 4.6: Dementia

Program 4.6 aims to improve the lives of people with dementia and their carers by implementing research, training for aged care workers, behaviour management advice and support, and information and education for people with dementia, their carers and families.

Key Strategic Directions for 2009-10

The department’s strategies to achieve this aim were to:

support dementia research;
promote dementia studies and pathways;
provide behaviour management support for aged and community care workers and family carers; and
help people with dementia, their carers and families through information and education.

Major Activities

Dementia Research

Access Economics has estimated that about 250,000⁶ people in Australia currently have dementia. The Australian Institute of Health and Welfare has predicted that since dementia prevalence is strongly age-related, the number of cases of dementia will increase to around 592,000 by 2030 as the population grows and ages.⁷ The department is taking a two-pronged approach to supporting research into dementia through three Dementia Collaborative Research Centres and the Dementia Research Grants program, which is managed and administered by the National Health and Medical Research Council on behalf of the department. In 2009-10, the three Dementia Collaborative Research Centres had around 115 dementia research projects that had either been completed or were underway.

During 2009-10, in collaboration with the National Health and Medical Research Council, the department continued to monitor progress on funded research projects. A challenge was the development and implementation of a new Memorandum of Understanding for new grant projects to be awarded in late 2010 for commencement in early 2011.

University Studies and Dementia Training

With Australia’s ageing population and the projected increase in incidence of dementia, it is important that the dementia care workforce is equipped and capable of providing quality dementia care. Investing in professional development, curriculum and education resource development and delivery is central to achieving this.

In 2009-10, the department worked with Dementia Training Study Centres across Australia to promote dementia studies in both graduate and undergraduate programs and provide tertiary career pathways in dementia studies. The department also established a fifth Dementia Training Study Centre and is developing options for the national coordination of the Dementia Training Study Centres.

During the year, the department reviewed and updated the Dementia Resource Guide, an online catalogue of dementia resources developed to assist dementia care providers in gaining access to current best practice.

The department also provided $4.866 million under the Dementia Care Essentials Training Program to deliver accredited dementia training to residential and community aged care workers across Australia. The training covers vital aspects of good dementia care including care planning, communication and managing challenging behaviours which enables workers to enhance their knowledge and skills and improve the quality of care they provide. Funding under the program will continue through to 2012.

Dementia Behaviour Management Support

The department provides support for aged and community care workers and family carers through the Dementia Behaviour Management Advisory Services in each state and territory. In 2009-10, these activities included clinical interventions to help aged care staff and carers improve their care of people with dementia where the behaviours of the person with dementia affected their care.

Evaluation of the program was positive but noted the potential to improve data collection. In collaboration with the Australian Institute of Health and Welfare, the department is executing strategies to improve data collection to inform the future of the program.

Dementia Education and Information

Throughout 2009-10, the department worked with Alzheimer’s Australia to support people with dementia, their families and carers through the National Dementia Support Program. This program provides counselling and referrals, information, education and training, awareness raising and early intervention programs. Under this program, the department also supported the National Dementia Helpline⁸ which received more than 34,000 calls during the year.⁹ More than 80,000 calls have been received since the start of the program in April 2007. This is 19 per cent more than the estimated target for this period. In 2009-10, the department provided additional funding to Alzheimer’s Australia to improve service delivery and assist with increasing demand.

Under the Dementia Community Support Grants Program, 82 projects were offered funding during round three. These small community projects (up to $50,000 in funding each) are designed to support awareness raising activities in local communities and assist innovative local services to provide support for people with dementia, their families and carers. Difficulties during this period were related to the significant number of applications and interest in the program and in supporting small organisations to commence their projects.

The department also continued to disseminate and promote existing resources whilst developing additional resources under the Dementia Communications Strategy.

6 Access Economics (August 2009), Keeping Dementia Front of Mind: Incidence and Prevalence 2009-2050, Access Economics, Canberra, p13.

7 Australian Institute of Health and Welfare (2007) Dementia in Australia: National Data Analysis and Development, Australian Institute of Health and Welfare, Canberra.

8 Telephone 1800 100 500.

9 Number of calls received for six months were extrapolated for the 2009-10 period. It is expected that the target of 28,000 will be exceeded by 6,584 calls with a total of 34,584 calls for the year.

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Performance Information for Outcome 4

Program 4.6: Deliverables

Qualitative Deliverables

University Studies and Dementia Training
Qualitative Deliverable:	Regular stakeholder participation in program development, through avenues such as surveys, conferences, meetings, and submissions on departmental discussion papers.
Result: Deliverable met.
In 2009-10, the department was represented at the quarterly meetings of the Dementia Collaborative Research Centres Coordinating Committee, meetings of its Advisory Committee and each centre’s Steering Committee meetings. The department also attended the annual National Dementia Research Forum. Through these processes, the department contributed to setting the centres’ research priorities and work plans, assessed and commented on their research proposals, and commented on the centres’ draft reports, journal articles, conference presentations, publications, guidelines, tools and other project outcomes. The department also worked closely with the National Health and Medical Research Council to implement and manage the Dementia Research Grants program. This involved ongoing monitoring of the eight grant projects which commenced in 2007 and the 17 grant projects which commenced in 2009.
Qualitative Deliverable:	Access to training and career pathways for health professionals and aged care workers. Measured by information received in progress reports required as funding agreement deliverables.
Result: Deliverable met.
Dementia Training Study Centres continue to provide education and training opportunities to dementia care providers including allied, medical, and nursing practitioners through the provision of scholarships, work based placements, guest lectures, professional development and curriculum development activities. Major difficulties for this project include: implementing dementia specific content into tertiary curricula, meeting the needs of the diverse and varied dementia care sector – from undergraduate students to specialist medical practitioners; and meeting the needs of stakeholders in regional, rural and remote areas. To mitigate these risks, the department is developing a proposal for a national coordination model and focusing on activities that will strengthen the uptake of these programs into clinical practice.
Dementia Behaviour Management Support
Qualitative Deliverable:	Access to clinical advice for aged and community care workers, and carers of people with dementia, where the behaviour of the person with dementia is impacting on their care. Measured by information received in progress reports required as funding agreement deliverables.
Result: Deliverable met.
In 2009-10, the department worked closely with all eight Dementia Behaviour Management Advisory Service providers to ensure timely delivery of biannual progress reports and funding agreement deliverables. Target groups accessing the program increased, with the 24 hour a day telephone support service receiving a total of 15,007 calls from 1 April 2008 until 30 June 2010. Most of the reports were received on time. The current providers now have well established infrastructure, staffing and processes in place to meet the requirements of the program. The direct engagement of current providers until 2013 will ensure continuity and stability in the program and reduce potential disruption of services to clients. As part of negotiations with these organisations, the department will review the models of service delivery, data collection and the operation of the program in each jurisdiction to ensure local needs are effectively addressed.
Dementia Education and Information
Qualitative Deliverable:	Access to information, counselling and support for people with dementia, their carers and families. Measured by information received in progress reports required as funding agreement deliverables.
Result: Deliverable met.
The department funds 36 of the 54 Commonwealth Respite and Carelink Centres to provide 40 education and training programs to carers of people living with dementia. Carers of people living with dementia are provided with, or linked to, a wide range of skill enhancement activities to assist them to care for the person with dementia. In addition, Alzheimer’s Australia is funded to provide information, counselling and support for people with dementia, their carers and families. Organisations are required to provide regular progress reports on activities. Alzheimer’s Australia provides statistical data in biannual reports on its information, counselling and support services.

Quantitative Deliverables

Dementia Research
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-6.8%
Result: Deliverable not met.
Delays in finalising the national evaluation of the Dementia Initiative led to delays in implementing changes to the education and training program. There was also an underspend in the Dementia Behaviour Management Advisory Service.
Quantitative Deliverable:	Number of research projects undertaken.
2009-10 Target:	85	2009-10 Actual:	128
Result: Deliverable met.
Dementia Collaborative Research Centres had 115 projects underway at the end of 2009-10, of which 104 were research oriented. In addition, the National Health and Medical Research Council managed 25 research projects through the Dementia Research Grants Program. The program is focused on the practical application of evidence-based research in the areas of early intervention, risk reduction, assessment and treatment, care and service, and epidemiology and population health.
Dementia Training
Quantitative Deliverable:	Number of training places available to aged care workers.
2009-10 Target:	4,800	2009-10 Actual:	5,425
Result: Deliverable met.
In 2009-10, the department entered into arrangements with registered training organisations to provide accredited dementia training to 4,800 residential and community aged care workers, however training was able to be delivered to 5,425 workers.
Dementia Behaviour Management Support
Quantitative Deliverable:	Number of Behaviour Management Advisory Services funded.
2009-10 Target:	8	2009-10 Actual:	8
Result: Deliverable met.
Under existing arrangements, the department funded eight organisations, established in each state and territory, with the following models: Model A: Non-Government Auspice – Central Service: this model was implemented in the Australian Capital Territory, Western Australia, South Australia and Queensland. In each jurisdiction the relevant agency is Alzheimer’s Australia with the services being delivered from the capital city of each jurisdiction. Model B: Non-Government Auspice – Central service with Out-Posted Staff: this model was implemented in the Northern Territory where the auspice is Frontier Services and in Victoria where the auspice is St Vincent’s Hospital. Model C: Government Auspice – Central Service with Out-Posted Staff: This model was implemented in New South Wales and Tasmania. The auspice in each jurisdiction was the state health department and the Dementia Behaviour Management Advisory Services have been located within the Older Persons Mental Health Units. Both models have staff located within these units in regional areas.

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Program 4.6: Key Performance Indicators

Qualitative Key Performance Indicator

Qualitative Indicator:	An independent evaluation of the Dementia Initiative is due to report by 30 June 2009 and includes an evaluation of dementia projects both individually and as a whole. It also provides ongoing evaluation advice to organisations funded to undertake the individual projects.
Result: Indicator met.
The department received the final report of the independent evaluation of the Dementia Initiative in November 2009. The report identified that the Dementia Initiative has made a substantial contribution to support people living with dementia and their carers and that the early successes of the initiative could be built on and consolidated through lessons learning in the initiative. In 2009-10, the National Evaluation of the Dementia Initiative was completed. In line with the report findings, the department extended the scope of the Dementia Care Essentials training program to include training for both dementia specific units under the Certificate III and Certificate IV in Aged Care.

Quantitative Key Performance Indicators

Dementia Research
Quantitative Indicator:	Percentage of research projects undertaken collaboratively.
2009-10 Target:	90%	2009-10 Actual:	100%
Result: Indicator met.
All Dementia Collaborative Research Centres and Dementia Research Grant projects involve collaboration between researchers and with external entities such as service providers, academic institutions, consumers, government agencies and non-government organisations. In 2009-10, existing collaborations with Australian and overseas researchers in the dementia field were strengthened and opportunities for new collaborations were explored.
Dementia Training
Quantitative Indicator:	Improving the skills of aged care workers – measured by the percentage of training places taken up.
2009-10 Target:	100%	2009-10 Actual:	100% plus additional places offered
Result: Indicator met.
In 2009-10, participation in the program was higher than anticipated due to a larger number of aged care workers requesting training than originally planned. As a result, 625 additional training places were offered in addition to the 4,800 places planned for 2009-10.
Dementia Education and Information
Quantitative Indicator:	Number of calls to the National Dementia Helpline.
2009-10 Target:	28,000	2009-10 Actual:	34,584 (estimated)
Result: Indicator met.
Data has not been received for the full period. This is expected by 30 September 2010. However the department, through the National Dementia Helpline, addressed a total of 17,292 calls for the period 1 July 2009 to 31 December 2009. This is 24 per cent above the target of 14,000 for the same period. The growth in demand for calls to the National Dementia Helpline will continue and represents a significant challenge in terms of ongoing capacity. Additional funding was provided in 2009-10 to assist in meeting growth in demand.

Program 4.7: Flexible Aged Care

Program 4.7 aims to enable the provision of flexible aged care outside the usual residential and community care settings, and to address the needs of care recipients in alternative and innovative ways.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve these aims were to:

ensure older people have access to flexible care that meets their needs and preferences; and
enable older people with complex care needs to remain in their home, should they want to, through community care packages.

Major Activities

Flexible Care to Meet the Needs and Preferences of Older People

Community and residential care services need to have the flexibility to respond to the preferences and needs of older frail people. In 2009-10, the department worked with states and territories, and other interested parties, to deliver a range of initiatives to respond to those needs.

The Transition Care program is a joint initiative between the Australian Government and the state and territory governments. It helps older people leaving hospital to complete their recovery and to optimise their functional capacity, while assisting them and their carers (including their family) to make long-term care arrangements, if necessary. In many cases, this resulted in people returning to their own homes rather than entering residential care prematurely. The care provided includes low intensity therapy, nursing support and personal care. Throughout 2009-10, the department also managed a range of community care packages designed to enable older people with complex care needs to remain in their own homes for as long as possible. These programs included the Extended Aged Care at Home and the Extended Aged Care at Home Dementia community care packages. Services funded through these packaged care programs include clinical assistance, personal assistance, meal preparation, continence management, assistance to access leisure activities and home safety.

In addition, the department implemented a new program that enables the allocation of time-limited, flexible aged care places to states and territories under the Innovative Pool arrangements under the Aged Care Act 1997. These allocations provide funding to states and territories to care for older people who have been assessed as requiring aged care, but who cannot be released from hospital because they cannot access appropriate aged care services outside the hospital setting.

The department also works with states and territories to establish Multipurpose Services in areas of need for small rural and remote communities. Multipurpose Services are integrated health and aged care services that provide a range of flexible services that meet the needs of these smaller communities. While Multipurpose Services are funded by the states and territories, the department manages a program of grants to fund existing flexible aged care places, in addition to creating and allocating additional flexible care places where a need is identified.

Community Care Packages for People with Complex Needs

The department made 1,109 additional Extended Aged Care at Home places operational during 2009-10, delivering individually planned and coordinated care services for older people with high care needs so they can remain living in their own homes and communities.

In 2009-10, the department also provided an additional 547 Extended Aged Care at Home Dementia packages which provide targeted assistance for people with dementia to assist with behavioural and psychological symptoms associated with their dementia that impact their ability to live independently in the community.

Through the 2009-10 Aged Care Approvals Round, the department made available 1,541 Extended Aged Care at Home places and 955 Extended Aged Care at Home Dementia packages to be allocated in 2010-11. In particular, for this Aged Care Approvals Round, the target level for the provision of high level community care has been increased from four to five places, with the target level for high level residential care in 2011 to be 43 places per 1,000.

During the year, the department allocated 14 Multipurpose Service places, all of which have been made operational by the state and territory governments and which have increased the overall availability of aged care in rural and remote communities in 2009-10.

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, nursing support and personal care services. In 2009-10, the department allocated 651 new transition care places, including 51 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 70 years and older, and Aboriginal and Torres Strait Islander people 50 years and over. The states and territories will make the 651 places operational during 2010-11.

The department also worked with state and territory health departments to make the 470 transition care places allocated in 2008-09 operational during 2009-10. This brought the number of operational transition care places nationally to 2,698.
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Performance Information for Outcome 4

Program 4.7 Deliverables

Qualitative Deliverables

Flexible Care to Meet the Needs and Preferences of Older People
Qualitative Deliverable:	Regular stakeholder participation in program development through formal and informal mechanisms, which include cross-Government and other committees, evaluations and reviews, working groups, consumer research, census processes and trials.
Result: Deliverable met.
In 2009-10, the department consulted broadly across the health and ageing sectors on the Dementia Initiative, including the evaluation of the Dementia Initiative. The department has regular meetings with stakeholders, including the Minister’s Dementia Advisory Group, annual workshops with providers under the specific elements of the initiative, and ongoing dialogue with the state and territory governments to inform progress in relation to the National Framework for Action on Dementia.
Qualitative Deliverable:	The department reviews Flexible Aged Care Program initiatives to improve their quality and determine their effectiveness in meeting the needs of older people experiencing symptoms of dementia, and its results will be available in the 2009-10 financial year.
Result: Deliverable met.
The department received the final report of the independent evaluation of the Dementia Initiative in November 2009. The report identified that the Dementia Initiative has made a substantial contribution to support people living with dementia and their carers and that the early successes of the initiative could be built on and consolidated through lessons learned in the initiative.
Community Care Packages for People with Complex Needs
Qualitative Deliverable:	An independent evaluation of the Dementia Initiative is due to report by 30 June 2009 and includes an evaluation of all dementia projects both individually and as a whole, and also provides ongoing evaluation advice to organisations funded to undertake the individual projects. This evaluation includes the Extended Aged Care at Home Dementia program.
Result: Deliverable met.
The department received the final report of the independent evaluation of the Dementia Initiative in November 2009. The report identified that the Dementia Initiative has made a substantial contribution to support people living with dementia and their carers and that the early successes of the initiative could be built on and consolidated through lessons learned in the initiative.

Quantitative Deliverables

Flexible Care to Meet the Needs and Preferences of Older Australians
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	0.6%
Result: Deliverable substantially met.
A payment for July 2010 was processed in June 2010 and has subsequently resulted in an increase for the 2009-10 financial year.
Quantitative Deliverable:	Number of operational flexible aged care places in Multipurpose Services.
2009-10 Target:	2,817	2009-10 Actual:	3,120
Result: Deliverable met.
In 2009-10, the Multipurpose Service Program increased the availability of aged care in rural and remote communities. The department allocated 14 Multipurpose Service places which were made operational by the state and territory governments.
Quantitative Deliverable:	Allocation of additional transition care places.
2009-10 Target:	470	2009-10 Actual:	470
Result: Deliverable met.
In 2009-10, the department worked with state and territory health departments to make the 470 new transition care places operational. This brought the total number of operational transition care places nationally to 2,698 (2,000 existing and 698 additional transition care places).
Community Care Packages for People with Complex Needs
Quantitative Deliverable:	Estimated numbers of Extended Aged Care at Home places.
2009-10 Target:	5,117	2009-10 Actual:	5,584
Result: Deliverable met.
More Extended Aged Care at Home places were allocated in the 2008-09 Aged Care Approvals Round than originally planned. These packages will help support older Australians to remain at home by providing practical and clinical care in the community.
Quantitative Deliverable:	Estimated numbers of Extended Aged Care at Home Dementia places.
2009-10 Target:	2,438	2009-10 Actual:	2,583
Result: Deliverable met.
More Extended Aged Care at Home Dementia places were allocated in the 2008-09 Aged Care Approvals Round than originally planned. These packages will help support older Australians to remain at home by providing practical and clinical care in the community.

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Program 4.7: Key Performance Indicators

Qualitative Key Performance Indicators

Flexible Care to Meet the Needs and Preferences of Older Australians
Qualitative Indicator:	The target percentage of people whose functional capacity improves during a transition care episode is 60 per cent. This will be measured by Transition Care service providers who will assess clients using the Modified Barthel Index at the start and finish of the Transition Care episode. The variance between the start and finish scores is the measurement of functional improvement.
Result: Indicator met.
In 2009-10, 60 per cent of people who received transition care gained functional improvement, as assessed using the Modified Barthel Index, which includes assessment of activities of daily living such as personal hygiene, feeding and independent movement, on discharge from the Transition Care Program, compared with their functional capacity score on entry to the Transition Care Program.
Qualitative Indicator:	The target percentage of people who return home after their transition care episode with or without community care support is 45 per cent. This will be measured by Transition Care service providers who complete a Medicare Australia claim form citing the client’s ‘discharge destination’.
Result: Indicator met.
In 2009-10, 50 per cent of people who received transition care returned home either with or without community care support, rather than needing residential aged care services. Community care support includes Home and Community Care services, Community Aged Care Packages, Extended Aged Care at Home or Extended Aged Care at Home Dementia packages.

Quantitative Key Performance Indicator

Flexible Care to Meet the Needs and Preferences of Older Australians
Quantitative Indicator:	More clients accessing increasing numbers of operational transition care places.
2009-10 Target:	≤2,698	2009-10 Actual:	2,698
Result: Indicator met.
An additional 470 transition care places were made operational in 2009-10, bringing the total number of operational places to 2,698.

Program 4.8: Residential Care

Program 4.8 aims to provide residential care to older people whose care needs are such that they can no longer remain in their homes.

Key Strategic Directions for 2009-10

The department’s strategies to achieve this aim were to:

ensure the availability of high quality, resident-centred care, by promoting equitable access to residential aged care;
help older Indigenous Australians to access residential services through the provision of building infrastructure and capital works; and
work towards financial security for residents to support their choice of an aged care home and improve the quality of aged care services through compliance with minimum standards and encouraging continuous quality improvement.

Major Activities

Equitable Access

The department continued to implement the Zero Real Interest Loans Initiative in 2009-10. Round two of the initiative, conducted as part of the 2009-10 Aged Care Approvals Round, made available a minimum of $150 million in loans and 1,250 residential places to aged care providers to build in locations where they may not have previously been prepared to invest. Round two focussed on culturally and linguistically diverse and Indigenous areas of undersupply, and in areas of extreme undersupply, consideration was given to a combination of zero real interest loans and capital grants.

Aged Care for Older Indigenous Australians

The department funded aged care services for older Aboriginal and Torres Strait Islander people so they can remain in their community and close to family. The department commenced implementation of a support program to provide remote and Indigenous aged care services with access to a range of professional expertise for capacity building and training purposes.

In 2009-10, the department supported aged care providers to provide Aboriginal and Torres Strait Islander communities with culturally appropriate aged care through the provision of support for building infrastructure and capital works. The department progressed staff accommodation to assist in engaging and retaining staff in the: Tjilpi Pampa Ngura Flexible Aged Care Service, Pukatja, South Australia; Umoona Aged Care Aboriginal Corporation Flexible Aged Care Service, Coober Pedy, South Australia; and Sandy Boyd Flexible Aged Care Service, Palm Island, Queensland.

Residential Support and Accreditation

Accreditation is an integral component of the department’s approach to quality in residential aged care. In 2009-10, the department analysed 147 submissions received in response to a public discussion paper on the review of the accreditation process. The department, along with the Ageing Consultative Committee, analysed 24 options for enhancing the accreditation process in the short-term, aimed at increasing consumer engagement in the accreditation process and reducing regulatory burden on industry. Further consultation with the aged care industry, consumers, and other stakeholders will occur during 2010-11 and will inform the implementation of improvements to the accreditation process resulting from the review.

The department, in collaboration with a Technical Reference Group and the Aged Care Standards and Accreditation Agency, drafted a revised set of aged care accreditation standards. The draft standards are currently with the Ageing Consultative Committee for comment prior to final review. Once initial consultations are completed, the draft standards will be trialled in a selected number of residential aged care services during 2010-11.

The department is responsible for monitoring the prudential compliance of approved providers holding accommodation bonds, and taking action against providers that are in breach of their responsibilities. In 2009-10, the department revoked Kendalle Pty Ltd’s approval to provide aged care following its failure to refund accommodation bonds paid by residents of Gracedale Manor in Victoria, which financially collapsed on 23 May 2008. Refunds of accommodation bonds totalling approximately $9.8 million were paid to these residents through the Accommodation Bond Guarantee Scheme. The department is currently attempting to recover this amount from these companies and is undertaking investigations of the failures to identify any breaches of approved provider obligations. A further $5.6 million has been paid from the Accommodation Bond Guarantee Scheme as a result of action against Drysdale Aged Care Hostel Pty Ltd and Hirange Management Pty Ltd.

During 2009-10, the Australian National Audit Office completed the audit on the Protection of Residential Aged Care Accommodation Bonds. The department accepted the seven recommendations made in the report and is well progressed in their implementation.

The department visited 2,139 aged care homes – 77 per cent of all homes – to review funding classifications for residents to ensure that residents are appropriately funded according to their care needs. The department reviewed 23,394 funding classifications for residents in 2009-10, downgrading the classification in 16 per cent of cases and upgrading the classifications in six per cent of cases.
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Performance Information for Outcome 4

Program 4.8: Deliverables

Qualitative Deliverables

Aged Care for Older Indigenous Australians
Qualitative Deliverable:	Regular stakeholder participation in program development, through avenues such as surveys, conferences, meetings, and submissions on departmental discussion papers.
Result: Deliverable met.
In 2009-10, there were two meetings of the Ageing Consultative Committee and two meetings of the Aged Care Funding Instrument Industry Reference Group.
Qualitative Deliverable:	The timely allocation and expenditure of capital funding provided to eligible aged care providers delivering care to older Aboriginal and Torres Strait Islander people.
Result: Deliverable met.
In 2009-10, the department supported aged care providers to provide Aboriginal and Torres Strait Islander communities with culturally appropriate aged care through the provision of support for building infrastructure and capital works. The department progressed staff accommodation to assist in engaging and retaining staff in three flexible aged care services in the Northern Territory, South Australia and Queensland, together with two other services in Victoria and Western Australia and two in Queensland. Capital maintenance and upgrade work was also initiated in all 11 Flexible Aged Care Services in the Northern Territory.

Quantitative Deliverables

Equitable Access
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	2.2%
Result: Deliverable not met.
The actual average cost per operational aged care place was higher than originally estimated. The department aimed for broad sector coverage and a high volume of reviews to support the sector’s understanding of the new funding instrument.
Quantitative Deliverable:	Number of residential aged care places made available in the annual Aged Care Approvals Round.
2009-10 Target:	9,182	2009-10 Actual:	8,140
Result: Deliverable substantially met.
The places made available in the 2009-10 Aged Care Approvals Round will ensure that the overall target ratio of 113 aged care places per 1,000 people aged 70 or over will be achieved in 2011, and that the balance of 48 high care and 65 low care is also achieved in 2011. This will be done through allowing greater flexibility in the balance between community and residential places. For the 2009-10 Aged Care Approvals Round, the target level for the provision of high level community care provision increased from four to five places, with the target level for high level residential care in 2011 to be 43 (rather than 44) places per 1,000.
Quantitative Deliverable:	Total value of zero real interest loans provided to aged care providers to build in locations where they may not have previously been prepared to invest (funding ends in 2009-10).
2009-10 Target:	$150m	2009-10 Actual:	Aged Care Approvals Round ongoing at 30 June 2010
Result: Deliverable not met.
The second round of the Zero Real Interest Loans program was advertised as part of the 2009-10 Aged Care Approvals Round. Aged care providers were able to apply for a minimum of $150 million in loans to build or expand residential aged care services in areas of high need. As at 30 June 2010, the round was still being assessed.
Quantitative Deliverable:	Number of residential aged care places offered with zero real interest loans (funding ends in 2009-10).
2009-10 Target:	1,250	2009-10 Actual:	Aged Care Approvals Round ongoing at 30 June 2010
Result: Deliverable substantially met.
The second round of the Zero Real Interest Loans program was advertised as part of the 2009-10 Aged Care Approvals Round. Aged care providers were able to apply for a minimum of 1,250 places to build or expand residential aged care services in areas of high need. As at 30 June 2010, the round was still being assessed.
Aged Care for Older Indigenous Australians
Quantitative Deliverable:	Number of projects undertaken to provide culturally appropriate aged care services to older Indigenous Australians.
2009-10 Target:	5	2009-10 Actual:	13
Result: Deliverable met.
In 2009-10, the department undertook 13 projects to help deliver culturally appropriate aged care services to older Indigenous Australians. Activities supported under the Remote and Indigenous Service Support Program included assistance for aged care providers to access professional services, including: registered nurses; implementation of care assessment tools; the development of an Indigenous Aged Care Design Guide; and projects to facilitate recruitment and retention in remote areas through improvements to staff accommodation.
Residential Support and Accreditation
Quantitative Deliverable:	Number of unannounced visits per aged care home per year conducted by the Aged Care Standards and Accreditation Agency.
2009-10 Target:	≥1	2009-10 Actual:	1.29
Result: Deliverable met.
In 2009-10, the Aged Care Standards and Accreditation Agency conducted 3,570 unannounced site visits to homes which equates to 1.29 visits per home. The agency conducts unannounced visits to homes to ensure homes are meeting the Accreditation Standards at all times.

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Program 4.8: Key Performance Indicators

Qualitative Key Performance Indicators

Aged Care for Older Indigenous Australians
Qualitative Indicator:	The timely allocation of funds to support eligible services to undertake essential capital works to upgrade or expand.
Result: Indicator met.
In 2009-10, the department facilitated the timely allocation of funds to support eligible services to undertake essential capital works to upgrade or expand. The department progressed essential capital works maintenance and priority upgrades in 11 Flexible Aged Care Services in the Northern Territory. A range of projects were also progressed in eligible services throughout Australia, including upgrades and rebuilds to kitchens and improved provisions for fire safety and occupational health and safety.
Residential Support and Accreditation
Qualitative Indicator:	Enhancements to the accreditation process are developed in consultation with key stakeholders, including consumers of residential aged care services and the aged care industry. This will be measured by reporting on the consultation process undertaken by the department in reviewing the accreditation process.
Result: Indicator met.
The department published a discussion paper on the review of the accreditation process on its website in May 2009 and advertised a call for submissions in the national media. A total of 147 submissions were received from a range of stakeholders, including the aged care industry, consumers and health professionals. Following the analysis of these submissions, the department consulted with members of the Ageing Consultative Committee and held a teleconference with peak consumer groups. Further consultations will occur during 2010-11 and these consultations will inform the implementation of enhancements to the accreditation process arising from the review.

Quantitative Key Performance Indicators

Equitable Access
Quantitative Indicator:	Provision of operational residential aged care places. Measured by the number of residential aged care places per 1,000 people aged 70 years or over.
2009-10 Target:	≤88	2009-10 Actual:	86.8
Result: Indicator substantially met.
As at 30 June 2010, there were 86.8 operational aged care places per 1,000 persons aged 70 and over. That is 98.6 per cent 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 that it takes 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. Over each of the last four years, the target operational ratio for residential places has been substantially met, with only slight variation: June 2007: 86.8 (98.6 per cent of target) June 2008: 87.3 (99.2 per cent of target) June 2009: 86.9 (98.8 per cent of target) June 2010: 86.8 (98.6 per cent of target)
Quantitative Indicator:	Increase in the proportion of residential aged care places that become operational within two years of being allocated. Measured by the percentage of places allocated in the Aged Care Approvals Round.
2009-10 Target:	> 21%	2009-10 Actual:	24%
Result: Indicator met.
Twenty four per cent of residential aged care places allocated in the 2007 Aged Care Approvals Round became operational within two years of allocation.
Aged Care for Older Indigenous Australians
Quantitative Indicator:	Improved capacity, buildings and equipment in remote Indigenous aged care services. Measured by the amount of grants allocated to eligible aged care services.
2009-10 Target:	$2.7 million	2009-10 Actual:	$2.7 million
Result: Indicator met.
In 2009-10, the department worked to improve the capacity, buildings and equipment in remote Indigenous aged care services. The department provided 24 grants in remote and Indigenous aged care services across Australia. The funded projects included essential capital works maintenance and priority upgrades in the 11 Flexible Aged Care Services in the Northern Territory. A range of other projects were also progressed in eligible services throughout Australia, including upgrades and rebuilds to kitchens, improved provisions for fire safety and occupational health and safety, the provision of replacement equipment and installation of fire protection devices to increase the safety of traditional open fire usage.

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Outcome 4 – Financial Resources Summary

	(A) Budget Estimate 2009-10 $’000	(B) Actual 2009-10 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2010-11 $’000
Program 4.1: Aged Care Assessment
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	1,143	877	( 266)	1,161
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	5,077	5,236	159	5,596
Revenues from other sources	76	93	17	80
Unfunded depreciation expense¹	-	-	-	168
Operating loss / (surplus)	-	2	2	-
Total for Program 4.1	6,296	6,208	( 88)	7,005
Program 4.2: Aged Care Workforce
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	55,940	53,204	( 2,736)	67,686
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	6,548	7,264	716	7,218
Revenues from other sources	99	129	30	103
Unfunded depreciation expense¹	-	-	-	217
Operating loss / (surplus)	-	3	3	-
Total for Program 4.2	62,587	60,600	( 1,987)	75,224
Program 4.3: Ageing Information and Support
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	38,457	38,210	( 247)	43,329
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	56,162	60,581	4,419	61,906
Revenues from other sources	846	1,077	231	885
Unfunded depreciation expense¹	-	-	-	1,858
Operating loss / (surplus)	-	27	27	-
Total for Program 4.3	95,465	99,895	4,430	107,978
Program 4.4: Community Care
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	324,682	317,191	( 7,491)	293,538
Special appropriations
Aged Care Act 1997 – Community Care Subsidies	508,191	508,733	542	583,973
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	36,066	37,748	1,682	39,754
Revenues from other sources	543	671	128	568
Unfunded depreciation expense¹	-	-	-	1,193
Operating loss / (surplus)	-	17	17	-
Total for Program 4.4	869,482	864,360	( 5,122)	919,026
Program 4.5: Culturally Appropriate Aged Care
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	30,173	29,638	( 535)	31,842
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	7,688	3,950	( 3,738)	8,474
Revenues from other sources	116	70	( 46)	121
Unfunded depreciation expense¹	-	-	-	254
Operating loss / (surplus)	-	2	2	-
Total for Program 4.5	37,977	33,660	( 4,317)	40,691
Program 4.6: Dementia
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	30,784	28,706	( 2,078)	31,278
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	4,078	4,035	( 43)	4,495
Revenues from other sources	61	72	11	64
Unfunded depreciation expense¹	-	-	-	135
Operating loss / (surplus)	-	2	2	-
Total for Program 4.6	34,923	32,815	( 2,108)	35,972
Program 4.7: Flexible Aged Care
Administered Expenses
Special appropriations
Aged Care Act 1997 - Flexible Care Subsidies	517,842	520,753	2,911	724,513
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	6,366	6,540	174	7,017
Revenues from other sources	96	116	20	100
Unfunded depreciation expense¹	-	-	-	211
Operating loss / (surplus)	-	3	3	-
Total for Program 4.7	524,304	527,412	3,108	731,841
Program 4.8: Residential Care
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	65,610	73,884	8,274	89,449
Special appropriations
Aged Care Act 1997 – Residential Care Subsidies	5,896,807	6,027,657	130,850	6,239,441
Aged Care (Bond Security) Act 2006	15,900	25,149	9,249	-
Unfunded Expenses – zero interest loans concessional loan discount	16,329	-	( 16,329)	128,408
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	50,556	47,854	( 2,702)	55,725
Revenues from other sources	761	851	90	797
Unfunded depreciation expense¹	-	-	-	1,672
Operating loss / (surplus)	-	21	21	-
Total for Program 4.8	6,045,963	6,175,416	129,453	6,515,492
Outcome 4 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	546,789	541,710	( 5,079)	558,283
Special appropriations	6,938,740	7,082,292	143,552	7,547,927
Unfunded expenses	16,329	-	( 16,329)	128,408
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	172,541	173,208	667	190,185
Revenues from other sources	2,598	3,079	481	2,718
Unfunded depreciation expense¹	-	-	-	5,708
Operating loss / (surplus)	-	77	77	-
Total expenses for Outcome 4	7,676,997	7,800,366	123,369	8,433,229
Average Staffing Level (Number)	1,149	1,142	( 7)	1,273

¹ Reflects the change to net cash appropriation framework implemented from 2010-11.

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