Aged Care Assessment Teams

Aged Care Assessment Program: Financial Guidelines

Financial Guidelines for the Aged Care Assessment Program, November 2004.

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Aged Care Assessment Program Financial Guidelines (pdf 41kb)

BACKGROUND

1. Program Background

The Aged Care Assessment Program, (ACAP) is an initiative of the Australian Government. Under a cooperative working arrangement the Australian Government provides funds to State and Territory Governments specifically to operate Aged Care Assessment Teams (ACATs) – known as Aged Care Assessment Service (ACAS) in Victoria

At present Australian Government funding for the ACAP supports 119 regionally based Aged Care Assessment Teams (ACATs), seven Evaluation Units (EUs) and 27 Dementia Support for Assessment (DSA) Projects.

1.1 Aged Care Assessment Teams (ACATs)

The primary role of ACATs is to comprehensively assess the physical, medical, psychological and social needs of frail older people and to assist them and their carers to access available services appropriate to their care needs. The program also promotes the coordination of aged care and other support services to improve the appropriateness and range of services available to frail older people.

Some teams are located in community health centres or independently although the majority are located in public hospitals. Australian Government funding is provided on condition that Assessment Teams operate in accordance with the current Aged Care Assessment Program Operational Guidelines, Aged Care Assessment and Approval Guidelines, the Aged Care Act 1997, The Aged Care Principles, ACAP Funding Agreement and the ACAP Financial Guidelines.

The ACAP Operational Guidelines (2002) state that in undertaking their role, ACATs/ACASs:

• focus on the needs and preferences of people being assessed;
• take into account the needs and preferences of the carer/advocate;
• have the capacity to refer to a range of services (including community and rehabilitation services);
• actively encourage client and provider involvement in the planning, development and management of assessment services at the regional and state/territory level;
• promote community awareness of ACATs and how they can assist the target group;
• establish and maintain links with providers of residential care, community care, health services and general practitioners in their region;
• ensure equity of assessment services by clients and potential clients, including those from special needs groups;
• ensure that their clients understand and are able to exercise their rights;
• advise health professionals and the public on aged care issues; and
• participate in ACAP data collection processes.

As well as the ACAT assessment and referral role, ACATs have a unique and important role in that they also have the ability to approve people for Australian Government subsidised care
under the Aged Care Act 1997, including residential aged care, residential respite care, community care (Community Aged Care Packages (CACPs)) and flexible care (eg. Extended Aged Care at Home (EACH)). This important responsibility is delegated to certain ACAT positions under the Aged Care Act 1997 by the Secretary of the Australian Government Department of Health and Ageing.

While ACATs are responsible for assessing and approving people for these types of care, other health professionals are not precluded from the assessment process. Australian Government guidelines encourage ACATs to develop linkages and involve community and acute care service personnel and the client’s local doctor in the assessment process.

1.2 Evaluation Units

Evaluation Units (EUs) are funded by the Australian Government under the ACAP in each State and the Northern Territory (ACT data is managed by the NSW EU). The main function of the EUs is to provide a central point for timely data collection to enable data receipt and validation, monitoring, evaluation and reporting of the national Minimum Data Set (MDS) for the Program.

The reporting framework, including quarterly and annual reports, provides for analysis of MDSv2 (MDSv1 in QLD) at State and Territory levels. It is expected that the activities of the EUs will:

• contribute to effective ACAP program management and performance monitoring;
• ensure that data is ‘cleansed’;
• inform aged care policy development and service planning;
• respond to the more immediate need for analysis of current critical service provision issues;
• enable the impact of assessment intervention to be evaluated;
• facilitate consistency and comparability between ACAP data and other aged community care and health data collections;
• enable gaps in service provision to be identified and quantified; and
• assist in the needs-based planning of national, regional and local care services.

To carry this function out effectively, Evaluation Units train and support ACATs to code data accurately and consistently. They also provide training to help Teams use and maintain the computerised data collection systems employed by Teams to meet the Australian Government Funding Agreement requirements.
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1.3 Dementia Support for Assessment (DSA) Program

The Dementia Support for Assessment (DSA) Program commenced in 1997-98 to assist people with dementia and their carers. The funding is intended to assist ACATs in rural and remote areas to maintain their capacity to assess people with dementia.

DSA Program Funds are used by rural/remote ACATs to:

• Employ staff with psycho-geriatric expertise to enable teams to diagnose and assess people who have or may have dementia;
• Purchase other resources such as training materials and diagnostic tools to support teams without psycho-geriatric expertise to assess people who have or may have dementia.

Funds under the DSA Program are provided and approved by the Minister for Ageing for specific projects nominated by States/Territories.

2. Australian Government, State /Territory Contributions

While the Australian Government provides funding to the States/Territories for ACAP operations, the States and Territories have responsibility for the day to day operational management of ACAP projects, ensuring compliance against the ACAP guidelines and Funding Agreement and for monitoring the performance of the ACATs.

Australian Government funds are provided to support “assessment” services and are not intended to provide “treatment/rehabilitation” services for aged people. The funds are provided for “frontline” general assessment staff, assistance with clerical support, identified training, data collection, information and publicity and some major equipment items such as computers and vehicles essential to Team operations. In many cases the State/Territory also funds permanent Assessment Team staff. Australian Government funds are also used to employ research staff within the Evaluation Units and for DSA projects.

Specialist staff, such as neurologists, psychiatrists, psychologists, speech therapists and podiatrists would not normally be funded by the Australian Government unless they were used for “generalist” functions. Such specialist staff are usually available as part of State/Territory health services and should be accessed by the Teams as required.

State/Territory contribution also includes the provision of accommodation including fixtures and fittings, furniture, equipment required to carry out assessments, infrastructure services such as accounting and personnel, and access to specialist staff not normally on teams. In addition, it is expected that Teams will have access to hospital beds for assessment purposes.

Australian Government funds cannot be used to provide services normally provided by the State/Territory such as rehabilitation services. However, it is very important that Assessment Teams are linked to acute hospitals and geriatric centres (where they exist). The advantages include access to in-patient facilities for more difficult assessments, and treatment and rehabilitation services provided by non-ACAT staff.

Australian Government funds cannot be substituted to provide services previously provided by the States/Territories. It is expected that States/Territories will continue to contribute to resourcing Assessment Teams in recognition of the benefits gained through the assessment process which minimises inappropriate entry into acute and residential care in conjunction with ensuring appropriate referrals to a range of aged care services.
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FUNDING

3. Funding Issues

3.1 Appropriation of Funds

Australian Government funding for the ACAP is subject to the annual Parliamentary Appropriation for these funds.

3.2 Funding Model

A new ACAP Australian Government funding model, aimed at achieving equity on a per capita funding basis across comparable ACAT regions nationally was developed and implemented in 2003-04.

This new ACAP funding model is, as intended, a needs adjusted population based resource allocation model that can be applied to a set of geographically defined areas. It is calculated at the Statistical Local Area (SLA) level and reported at the ACAT region level. The model is designed to:

• take specific account of the target population (frail older people 70 years and over plus Indigenous people aged 50-69);
• exclude utilisation data to avoid equity being distorted by existing utilisation patterns;
• provide an equitable method of estimating the relative needs for aged care assessment;
• distribute the total available resources for the ACAP as equitably as possible;
• allow for the ACAT boundaries to be redefined;
• allow for the grouping of ACATs by state region and locality;
• allow for additional significant and non-significant funding variations to be recorded; and
• ensure the resource allocation process is efficiently administered and easily understood by all stakeholders.

The primary feature of the funding model is that it is “needs adjusted” ‘Need’ is interpreted as either service need, resource need or both, eg older clients may require more services per head of population, and assessments for this group may take longer. Similarly, clients living in geographically isolated areas may not need assessment services any more than clients living in highly populated centres, but the unit cost of the service may be higher due to higher component costs, ie travel, communications and other ancillary costs associated with geographical isolation. The model provides the facility to weight the contribution of each of the remaining needs adjustment indices, Aboriginality, Culturally and Linguistically Diverse and Socio-Economic Status, to be applied to the target population.
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3.3 Recurrent Funding

3.3.1 Program Funding

Program funds are indexed annually and included in base level funds approved each year. The level of indexation is determined by the Department of Finance. The indexation factor incorporates a weighting given to a wage component based on the Safety Net Adjustment

determined from time to time by the Australian Industrial Relations Commission and to a non-wage component which is the Treasury measure of underlying inflation.

3.3.2 Aged Care Assessment Teams (ACATs)

Funding for each individual Team while based on the previous years approved level of recurrent funding plus indexation is allocated according to the funding model. This allows for existing and any new funding to be distributed in an equitable fashion to Teams. It should be noted that the ACAP Officials agreed that there would be no reduction in funding to particular ACATs from the recurrent amounts provided in the previous year, provided they continue to operate within the same SLAs.

Recurrent funds are provided to enable each ACAT to continue to undertake the Australian Government's service delivery with respect to approving clients as care recipients to enter aged care residential facilities, community care (ie. Community Aged Care Packages) and some flexible care services (eg. Extended Aged Care at Home Packages) as well as providing service information and assistance to older people.

3.3.3 Evaluation Units

Funds are provided annually by Australian Government for the operation of the EUs in each State and the Northern Territory. Current levels of funding to States/Territories reflect moves to a more equitable spread of the ACAP evaluation funding available.

3.3.4 Dementia Support for Assessment (DSA) Program

Funds provided to rural and remote ACATs were originally allocated in 1997-98 using a population based approach, except in Tasmania where funding was specifically targeted to develop and implement a more integrated approach to dementia diagnosis, assessment and support. Projects are required to be updated annually and approved by the Minister for Ageing before renewed funding is allocated. Appropriations are indexed annually.

3.4 Payments to State/Territory Authorities

Following all funding approvals by the Australian Government Minister for Ageing, formal letters of offer are sent to State/Territory Ministers responsible for the program containing:

• a list of the individual ACATs, DSA projects and the Evaluation Unit including the approved upper limits of funding for each of these projects; and
• a copy of the Funding Agreement.

Letters are also sent to the ACAP Officials to inform them of the approval. Two copies of the Funding Agreement are also attached to this letter, which the State/Territory Authority signs to signal their Minister’s acceptance of the funding and associated conditions for the use of these funds.

These two copies are then returned to the State/Territory Office of the Department of Health and Ageing for their signature. A copy is then forwarded back to the State/Territory Authority for their records.

Payments to the States/Territories will not commence until the Funding Agreement has been signed by both parties. Once the Agreement is signed, payments are made to the State/Territory Authority through monthly instalments by the State/Territory Office of the Department of Health and Ageing.

The Australian Government provides States/Territories with funding calculated to the Assessment Team level. To enable Teams to manage and monitor their funds expenditure efficiently and to keep within their allocated budgets it is recommended that each State or Territory advise Assessment Teams of their respective financial resources. State/Territory Authorities and ACATs should also be aware that any deficit or over-expenditure incurred involving program allocations will not be funded by the Australian Government. Similarly it should not be assumed that unexpended funds will automatically be rolled over into the next funding year. (see section 6.2)
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4. Use of Funds

4.1 General

All funds must be used for the purpose for which they were approved and must be acquitted in line with procedures outlined in the Funding Agreement and in section 6 of these guidelines.

Any unspent funds must be returned to the Australian Government (in practice funds are not actually returned but subsequent advances are adjusted to take account of unspent funds), unless a proposal to spend the funds is approved by the Australian Government Minister for Ageing (see section 6.2). If a project consistently underspends, the Australian Government and the State/Territory Authority will review that project's baseline funding level.

4.2 Aged Care Assessment Teams

Australian Government funds are provided to assist with expenditure associated with salaries for “frontline” general assessment staff, such as; geriatricians or community physicians, nurses, social workers or welfare officers, physiotherapists, occupational therapists and clerical support staff.

Operating costs associated with service delivery such as travel allowances, telephone, stationery, interpreter services, training costs including conference fees, and vehicle running costs may also be provided under the Australian Government’s Funding Agreement. Funds may also be used for information and publicity and some major equipment items such as computers and vehicles essential to Team operations.

A revised National Minimum Data Set version 2 (MDSv2) was implemented in April 2003 and all ACATs receive Australian Government funds to collect accurate MDSv2 (and MDSv1 in Qld) data and send to the State/Territory EU in a timely fashion. The Teams are also required to provide information for an annual narrative report.

The collection of data is an integral and important part of the work of an Assessment Team, which contributes to monitoring, evaluation and planning at the local level.

4.3 State/Territory Training Projects

Some States/Territories have established State/Territory-wide “training projects” the objective of which is to support the development of regional and/or State/Territory-wide staff development initiatives of direct relevance to the work of ACAT members. These resources can be legitimately used for staff development purposes, including attendance at appropriate training courses and conferences.

The “training project” is not a substitute for expenditure on staff development that would normally be met from operating costs available to each Team through Australian Government funding. Training referred to in this section does not include training provided through other program funding bases.
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4.4 Evaluation Units.

Australian Government funds are provided to assist with the operations of the EUs. Funds provided for this purpose can be used:

• for receipt and validation of data using accepted validation rules;
• for interpreting and analysing the data;
• to provide de-identified client data to the National Data Repository within the specified time frames;
• to produce State/Territory quarterly reports using the standard accepted quarterly reporting template;
• to produce State/Territory annual reports using standard template;
• for MDS software development and maintenance; and
• for ACAT training and support.

EUs may also be funded to carry out special research studies, often in conjunction with Teams, in areas of interest to the Australian Government.

It is expected that the States/Territories will fund any other special EU research projects required for their own purposes.

4.5 Dementia Support for Assessment (DSA) Program

Funding for the DSA Program is directed at rural and remote ACATs and focuses on initiatives, which intend to complement existing ACAT and other resources and are meant to facilitate:

• employment of staff with psycho-geriatric expertise to enable ACATs to diagnose and assess people with dementia;
• purchase of other resources such as training materials and diagnostic tools to increase the skills of general assessment workers;
• access specialist staff for ACAT members, clients and carers;
• increasing skills and communication abilities of teams in relation to dementia assessment;
• improved communication and networks with service providers and others in relation to the care of people with dementia;
• access to a referral pathway for specialist assessment;
• exposure to in-depth information and assessment regarding cognitive deficits and relevant management strategies;
• more accurate and timely assessments;
• improved care management and care planning; and
• greater and more effective use of existing resources such as respite services and psycho-geriatric beds.

Funding for the DSA Program is indexed annually and is contingent upon States/Territories providing an updated project plan on how funds might be best applied within their jurisdictions. The project outline becomes part of the Funding Agreement and funding must be used in accordance with the project plan, unless varied by a Non-Significant Variation (NSV) as outlined in Section 5.5 of these guidelines.

4.6 Capital Items

Capital items include items such as cars and computer equipment. The cost of computer equipment will depend on the equipment's capability and approval will depend on the requirements of the Team and the compatibility of the equipment with that used by other Teams, and with the EU. Computers for data collection purposes must be purchased in consultation with the State/Territory EU.

It should be noted that when the Australian Government provides funding for cars and other capital items, the items must be available for the exclusive use of the ACATs for the performance of their functions and duties whenever required. An asset register should be maintained of all capital items purchased with Commonwealth allocated funds and Commonwealth agreement should be sought prior to the disposal of any items that fall within this category.

Funding for capital items can be drawn from ACAT recurrent funding, only within the limits of the NSV or with the agreement of the Australian Government Minister for Ageing.
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VARIATION TO FUNDING

5. Non-Significant Variations (NSV)

5.1 Use of Non-Significant Variations

A Non-Significant Variation (NSV) in funding is a variation to an ACAP or DSA project’s approved funding base, which does not require the approval of the Australian Government Minister for Ageing.

The ability to approve NSVs may be undertaken unilaterally by the State/Territory Minister responsible for the Program. NSVs may be used for ACAT and EU projects or within DSA

Projects (individual ACATs or EUs) covered under the ACAP Funding Agreement. NSV’s cannot occur between allocations from different program funding bases such as the ACAP and the DSA Program or any other current or future pilot projects which might be funded through different funding bases unless otherwise agreed by the Australian Government Minister for Ageing. Funding can, however, be redistributed between Assessment Teams and Evaluation Units within a State or Territory or between DSA Projects. NSVs can be used to increase, decrease or change the purpose of the funding (from recurrent to capital) approved for the project or region within set funding limits as detailed below.

The intent of NSVs is to meet the operational resource and support requirements of projects, and/or to top-up a project's/region's funding base when it is unable to adequately meet increased demand for services. Unilaterally approved NSVs obviate the need for the previous annual Australian Government one-off funding rounds.

The use of NSVs to adjust funds will ensure projects can operate at maximum effectiveness by enabling small changes to be made to approved upper limits quickly and efficiently. State/Territory authorities should be aware that the limitation to the use of NSVs applies not only to the receiving project but also the relinquishing project. In considering requests for NSVs close regard should be given to the broader aims and objectives of the Program. The overall capacity of projects to continue to provide effective service delivery to the community must be maintained.

Details of NSVs are to be forwarded to the Australian Government's State or Territory offices biannually in May and November of each year. This information is to include the purpose of the variation including details of use and consultations undertaken, funding details, and the new approved upper limits for both the relinquishing and receiving projects and/or regions. NSVs used for recurrent purposes will NOT be reflected in the approved upper limits for projects in subsequent years, unless otherwise advised. The alteration of recurrent funding to projects to reflect NSVs of this nature will also depend on the date notification is received by the Australian Government.

The NSV process is not to be used as a bookkeeping tool to balance accounts.

5.2 Project by project funding limits.

The Australian Government approved funding base for a project at the commencement of each financial year is the standard against which the NSV applies. Any variation to the project's level of funding during the financial year will not require Australian Government Ministerial approval unless the variation proposed exceeds 15% or $50,000, whichever is the lesser.

Should more than one NSV be applied to a project and the total variation to that project’s funding in the financial year reaches the limit applying at the commencement of the year, Australian Government Ministerial approval will be required for any further adjustments to the project's funding.

The NSV limit applies to both the relinquishing and receiving project. For example, a transfer from one project with a large budget may be well within the NSV limit for that project but if the transfer is to a project with a low budget, the intended transfer may be over the NSV limit for the receiving project and therefore would require Australian Government Ministerial approval.

5.4 General Comment on the Use of NSVs

The number and quality of assessments will continue to be monitored by the Australian Government through data and feedback provided to the Evaluation Units to ensure that service delivery is not compromised through the allocation of recurrent and capital funds or other adjustments made through NSVs.
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ACQUITTALS

6. Acquittal of Funds

6.1 Acquittance of Australian Government Funding

The Funding Agreement for the Aged Care Assessment Program requires that each respective State/Territory authority provides a certification that funds provided by the Australian Government under the Program have been expended in accordance with the terms and conditions under which the funding was approved. This certification must be provided to the Australian Government within three months of the end of the financial year (ie by the end of September).

Certification includes :

1. a statement of compliance signed by an appropriate officer appointed by the State/Territory for the purpose of administering the Funding Agreement which sets out whether the funds have been used for the purpose for which they were provided and whether the conditions included in the Agreement have been met and if not why not; and
2. a Statement of income and expenditure certified by an appropriate officer, in respect of each Funded Project. This statement will include: income and expenditure against recurrent and capital items and certification that salaries and allowances paid to people employed under the Funding Agreement are in accordance with award salary rates or any enterprise agreement or the general rates in force at the institution.

State/Territory Authorities need to ensure that Australian Government funds are acquitted on a project by project basis with a recurrent/capital split based on the ministerially approved upper limits for recurrent funding (including adjustments made by the States/Territories through NSVs). A template, (ACAP/ DSA Acquittal Template) for recording income and expenditure has been developed to enable States/Territories to provide the required details of expenditure against ACAT, EU and DSA activities and to establish an audit trail of approved expenditure against the program.

Any funds not expended or committed by the date specified in the Funding Agreement, may be offset against any subsequent funding approval, or be required to be repaid to the Department.

6.2 Treatment of unexpended funds in a financial year

Any State/Territory funds uncommitted/or unexpended in any financial year, as indicated in annual acquittances, will as a general rule be recouped by the Australian Government.

However, the use of any identified underspends in the year after the funds were allocated is at the discretion of the Minister for Ageing. If States/Territories identify an underspend through the acquittal process, they may submit a proposal for consideration by the Minister for use of these funds for one-off projects. Proposals should state the reason for the underspend, and provide information on the purpose and outline of the projects being proposed, the team/s involved and the amount of funds requested.

The proposals will need to be received by the Department of Health and Ageing by 1 November each year to allow for assessment and approval of the projects proposed and for the project to be completed by the end of that financial year.

The Minister for Ageing will consider any such proposal in terms of national priority. Where the Minister approves a project funded from an underspend in the previous year, a variation to the Funding Agreement will be required.
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