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Update to Aged Care Assessment Program - Operations Guidelines - 2002

Supersedes the Aged Care Assessment Program – Operational Guidelines – 2002 Update of March 2009
Page 23 – “People with psychiatric disorders” should be replaced with the following text, as endorsed by ACAP Officials on 7 April 2010.

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Assessment and approval of people with a mental illness

Not all people with a mental illness are clients of the specialist mental health service system, nor will they have involuntary status under a mental health act. Fostering links between Aged Care Assessment Teams (ACATs) and mental health services will facilitate an understanding of the needs of older people with mental illness and assist to improve linkages, integrated care and access to appropriate care and support services.

In most jurisdictions the majority of people who receive specialist mental health services do so in a community setting. In these circumstances, specialist mental health care is often provided as acute treatment, but individuals who receive treatment are sufficiently stable to be managed in the community.

Involuntary mental health care is governed by separate mental health legislation in each state and territory. It is generally a legislative requirement that people with mental illness receive specialist mental health care in the least restrictive environment possible. Generally people with mental illness with involuntary status are provided with specialist services in a range of community settings, although some people are cared for in mental health residential settings. People who are placed under some form of an involuntary order (eg. to manage their medicines when living in the community) may be eligible for aged care services. ACATs should consider each referral on a case by case basis.

Aged care services usually do not have the capacity to adequately address the support and associated needs of people with a serious uncontrolled mental illness without the support of and treatment by mental health services. Persons who are a danger to themselves or others may not be suitable for entry to an aged care service.

Frail older people with a mental illness however, may require access to a range of supports, including those Australian Government subsidised aged care services that require ACAT assessment and approval.

ACAT assessment and approval is only appropriate if the intensity, type and model of care is the most appropriate to meet the person’s care needs, including that:

• The person has predominately aged care needs and meets the criteria set out in the Aged Care Act 1997 and associated Principles.
• The person’s acute treatment has stabilised the condition. For people with a mental illness, their condition should be stable prior to being assessed although it is understood that many may still have significant symptoms.
• Community mental health services will continue to provide collaborative care for those elderly patients who have significant or unstable psychiatric symptoms.

An ACAT assessment is also required to access residential aged care facilities in jurisdictions where Australian Government subsidised residential aged care facilities are part of the aged mental health service system.

It is important to obtain informed consent (either from the person if they have the capacity to do so or if not, a decision maker consistent with state guardianship legislation who is able to make decisions regarding health, accommodation and daily living care) prior to an ACAT assessment.

In some jurisdictions under certain circumstances, mental health legislation empowers the treating psychiatrist to make accommodation decisions in the best interests of a person receiving treatment under an involuntary order. This power is only exercised when a particular accommodation setting is required to facilitate the treatment of a person’s mental illness. It does not replace the need for Guardianship when mental illness is incidental to that person’s need for placement in residential care.

All jurisdictions should develop protocols that reflect relevant state or territory legislation and regulations, to ensure that older people with a mental illness are directed to the responsible agency to assess and recommend services most appropriate to meet their care and support needs. The protocol should outline mutual obligations and responsibility to provide assistance and expertise in the person’s assessment, and care and service coordination. This could take the form of a memorandum of understanding between the ACAT and aged persons mental health services. It is important that protocols ensure that people with mental illness are not discriminated against in accessing aged care services.

The protocol should support good working relationships between ACATs and mental health services to ensure appropriate, responsive and timely service provision to older people with a mental illness. Information about each service should be included to promote the chain of responsibility and an understanding of the role and target group of each service system.
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