Aged Care Assessment Teams
ACAT Chat - Winter 2009
Welcome to Volume 26 of ACAT Chat.
You may download this document in PDF format:
PDF printable version of ACAT CHAT Winter 2009 (PDF 936 KB)
Welcome to Volume 26 of ACAT Chat.
We apologise that the Autumn edition of ACAT Chat was not circulated. This was due to the need to confirm the full implications of the new legislation changes relevant to ACATs.In this issue you will find lots of new information, advice and reports on a wide variety of matters affecting ACATs.
This will include the latest information on:
- how the recent changes to the Aged Care Act 1997 will affect assessment and approval processes;
- what you need to advise clients when they are refused an assessment or reassessment (a “Reviewable Decision”);
- an outline of changes to Part 6 of the eACCR; and
- a Q & A Guide for frequently asked data management questions.
- accommodation and day respite facilities;
- entry for same - sex couples in residential aged care facilities; and
- accommodation bonds.
A big thank you to all attendees for your feedback and enthusiasm. Your comments are already being used to improve the program and future training courses.
Michelle Roffey
Director, Aged Care Assessment Program (ACAP) Section
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Inside this issue:
Legislative Changes Relevant to the Aged Care Assessment ProgramAged Care Assessment Team Reassessment Requirements
Disclosure of criminal history
Changes to Part 6 of the eACCR
ACFI advice on ‘Ageing in Place’
Delegation Training resources
ACAT Finder
Same-sex couples entry to residential care
Reviewable Decisions
Accommodation bonds
Demonstration sites for day Respite
HACC key new arrangements
Advanced Care Planning
DBMAS
Dementia Training Study Centres
FAQs — Data Management
Upcoming Events
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Important Notice
ACATs may experience a temporary increase in enquiries from clients in response to a letter sent by the Department.
The Department has recently written to all clients approved for the following care types on or after 1 July 2008 who have not yet entered care:- Residential respite care (high and low level)
- High level residential care
- Extended Aged Care at Home (EACH)
- EACH Dementia (EACH D) Package
- Clients were notified that their approval no longer lapses and they do not require routine reassessment by the ACAT to retain eligibility. However, clients approved for residential respite care limited to a low level were advised they should contact the ACAT at any time if their care needs change.
ACAT CHAT
ACAT CHAT provides ACAT members with updates on the program from a National perspective. We would like to encourage our regional members to share information of interest from their local area. Informative articles and experiences give members a chance to connect with their interstate counterparts. Your feedback, contributions and suggestions for articles to ACAT CHAT, are most welcome. Staff of the Department of Health and Ageing respond to all correspondence, promptly.Please forward any contributions to either of the following contact points:
Email: acats@health.gov.au
Mail: ACAT CHAT
Aged Care Assessment Program Section
Department of Health and Ageing
MDP 32
GPO Box 9848
CANBERRA ACT 2601
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Legislative Changes Relevant To The Aged Care Assessment Program
What are the legislative changes?
A number of changes affecting aged care were made in December 2008.Changes were made to the:
- Aged Care Act 1997 (see Aged Care Amendment (2008 Measures No. 2) Act 2008)
Aged Care Principles 1997 (see Approval of Care Recipients Amendment Principles 2008 (No.2)).
Why were the legislative changes made?
The key objectives of the amendments were to:- Reduce the number of unnecessary assessments (and reassessments) performed by ACATs to improve assessment waiting times
- Ensure that ACAT reassessments are conducted only for the people who genuinely need them
- Improve the equity of access for some forms of flexible care by allowing a person to access care at a lower level in the community
What are the benefits to ACATs?
The introduction of these legislative changes will reduce the number of ACAT assessments needed and is expected to improve timeliness in assessments.How do the changes affect ACATs?
There are changes to the lapsing of some approvals as follows:
Care not receivedFrom 1 July 2009 all current approvals for the following care types will not lapse if a person has not received the type of care:
- Residential respite care (high and low level)
- High level residential care
- Extended Aged Care at Home (EACH)
- EACH Dementia (EACH D) Package
Approvals will continue to lapse for Community Aged Care Packages (CACPs) if a person is not provided with community care within 12 months starting on the day after the approval is given.
Approvals will also continue to lapse for low level residential care if a person is not provided with the care within 12 months starting on the day after the approval is given.
Approvals will also continue to lapse for transition care if a person is not provided with the care within 4 weeks beginning on the day after approval.
Break in care From 1 January 2009 all current approvals for people who have received high level residential care or residential respite care (high and low level) will not lapse irrespective of when the approval was made and even if there is a break in care. This was already the case from 20 March 2008 for CACP, EACH and EACH D.
Approvals will continue to lapse for low level residential care if a person has commenced receiving care, and there is a break in care lasting more than 28 days which occurs after the lapsing period of 12 months (beginning on the day after approval) ends.
Approvals will also continue to lapse for transition care if a person has commenced receiving care, and there is a break in care of at least one day after the lapsing period of four weeks (beginning on the day after approval) ends.
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There are changes to eligibility for approvals for EACH D or EACH Package as follows:
From 1 January 2009 if a person is eligible to receive an:- EACH D Package - the person is also eligible for an EACH Package or a Community Aged Care Package (CACP) as an alternative to an EACH D Package
- EACH Package - the person is also eligible for a CACP as an alternative to an EACH Package
What strategies have been developed to support the implementation of these new legislative changes?
The Commonwealth is currently revising and updating the following:Guidelines
- Aged Care Assessment Program Guidelines
- Residential Care Manual
- Draft Community Packaged Care Guidelines
- National Training Resources
- ‘An Introduction to the Aged Care Assessment Program’ Learning Package
- The recently updated National Delegation Training Resources
Forms
- Aged Care Client Record (ACCR) (3020(0709))
- 21 day extension form (2670(0709)) for residential respite care
- Template letters for notification
What communication strategies will be used to ensure all stakeholders understand the benefits of the legislative changes?
The Commonwealth will:- Write to all clients with a current approval at 1 July 2009 who are yet to receive care
- Inform Peak Bodies
- Update script for the Department of Health and Ageing’s Aged Care Information Line
- Write to all Service Providers – Residential and Community
- Inform ACAP Officials and Evaluation Units
- Inform ACATs by:
- A letter written to each ACAT Manager
- ACAT Chat articles
- ACAT specific website
What implementation strategies are currently being undertaken by the Commonwealth to distribute new forms?
- Medicare Australia will send new forms to each ACAT by mid-June 2009.
- ACAT Managers will be responsible for ensuring their teams have enough copies of the following forms to commence use on 1 July 2009:
- ACCR
- 21 day extension form for residential respite care
- Template letters for notification
What happens to old forms?
- Medicare Australia is monitoring the printing of current forms to limit surplus supplies after 1 July 2009.
- Team Leaders were requested to order only enough of the current forms to last until 30 June 2009 as they cannot be used after that date.
- Destroy all old forms through secure waste after 30 June 2009. Under no circumstances should ACCR forms be disposed of by garbage or recycling collection unless it has been through an approved destruction process, such as shredding.
How does this affect Template Letters?
- Updated Template letters to notify clients of approvals, non approvals and variations will be available to download from the ACAT specific website (www.health.gov.au/acats) and MUST be used from 1 July 2009.
What happens to those teams who use the eACCR?
- Where necessary, Aged Care Evaluation (ACE) and non ACE software will be adapted to support the legislative changes.
- In most places the ACE software will automatically implement the changes from midnight 30 June 2009. Please check with your Evaluation Unit.
Aged Care Assessment Team - Reassessment Requirements
This document explains the circumstances when a reassessment by an Aged Care Assessment Team (ACAT) is, and is not, necessary.It is important to note this information is divided into two categories that set out the requirements for people that are approved and:
- Have Not received care; and
- Have received care
- High level residential care
- High level residential respite care
- Low level residential respite
- Extended Aged Care in the Home (EACH)
- Extended Aged Care in the Home Dementia (EACHD)
- Low level residential care
- Community Aged Care Package (CACP)
- Low level residential respite care
- Transition Care
Care Not Received | |
Acat Approval | Is Reassessment Required? |
| The client is approved for: | No – from 1 July 2009 all current approvals will not lapse. All approvals made on or after 1 July 2008 – and which were not time limited so they expired before 1 July 2009 - will not lapse. |
| The client is approved for: | No – as above. |
| The client is approved for flexible care in the form of: | No – as above. |
| The client is approved for: | Yes – if care was not provided within 12 months starting the day after approval. Or Yes – if their care needs change. |
| The client is approved for: | Yes – if their care needs change and they require high level residential respite care. |
| The client is approved for: | Yes – if care is not provided within 4 weeks beginning the day after the approval date. |
Care Received | |
ACAT Approval | Is Reassessment Required? |
The client has entered:
| No – from 1 January 2009 all current approvals will not lapse if care has commenced and there is a break in care. |
The client has entered:
| Yes – if there is a break in care of more than 28 days (excluding approved leave) outside the 12 month lapsing period. Yes - if the first ACFI results in a High Level classification and the provider wishes to claim a high care ACFI subsidy rather than the interim low subsidy. No – if the resident has aged in place as follows:
Yes – on transfer if the resident has aged in place and wishes to pay an accommodation charge to the new home rather than rolling over an existing bond. |
The client has received:
| No – if care was received on or after 1 January 2009 approvals for these types of care will not lapse. |
The client has commenced an episode of:
| Yes – if there is a break in care of at least one day after the entry 4 week entry period. No – if the client enters hospital from Transition Care, concludes their hospital episode and re-enters Transition Care (from hospital) within the 4 week entry period. |
The client has commenced a:
| No – if care was received on or after 20 March 2008, approvals for these types of care will not lapse. If the client has received care on or after that date, the client does not need to be in care on the ‘entry period’ lapsing date. |
All Types Of Care | Prior to 20 March 2008, approvals for all care types lapsed if care had commenced and there was a break in care of at least one day after the ‘entry period’ ended. |
Disclosure of criminal history by an ACAT - Questions & Answers
1. Does an ACAT have a duty to disclose information relating to the criminal history of a person whom the ACAT is assessing for the purpose of the potential provision of Commonwealth-funded aged care?
ACATs conduct assessments of the care needs of potential recipients of Commonwealth-funded aged care as delegates of the Secretary of the Department of Health and Ageing and pursuant to section 22-4 of the Aged Care Act 1997 (the Act).In conducting such assessments, ACAT delegates will inevitably acquire information about matters both relevant and irrelevant to the care needs of the persons they assess.
Although it could be said that ACAT delegates have a statutory duty to disclose matters relevant to the care needs of persons assessed, it cannot be said that they have a duty to disclose matters irrelevant to the care needs of potential care recipients.
In many, probably most, cases the criminal history of a potential care recipient will be irrelevant to the provision of care by a provider of aged care. Thus there will be no requirement or duty to disclose such information. In fact, disclosure of such information may constitute a breach of the privacy of the potential care recipient. The Department is not in a position to provide advice on privacy law – other than on the protection of information provisions in the Act – as the relevant statutes do not fall within the portfolio responsibilities of the Minister for Health and Ageing. The office of the Commonwealth Privacy Commissioner or the office of the appropriate state privacy commissioner should be consulted for advice on the implications of privacy law.
In some cases, aspects of a potential care recipient’s criminal history may be relevant to the conditions under which Commonwealth-funded aged care is provided. For example, a potential recipient of residential aged care whose parole conditions include a condition that s/he may not have contact with children under a certain age would need to inform the relevant approved provider of the parole condition since it is common for children to visit residential aged care services. Arrangements would need to be in place at the residential aged care service that would enable the care recipient to conform to his or her parole condition and not be put a situation where they would be able to have access to children under the age specified in the parole conditions.
It should also be noted that it would be in the interests of the care recipient that the approved provider know of such a parole condition. In such circumstances, consent should be sought from the potential care recipient to disclose the parole condition to an appropriate member of the staff of the approved provider. Since the information is of a sensitive and personal nature, however, the information should be given to a senior member of the management team of the approved provider and be given separately from information recorded on the Aged Care Client Record (ACCR). ACCRs may be open to scrutiny by an unnecessarily large number of persons and by persons not actually providing care to the care recipient in question.
Another circumstance in which the care needs of a care recipient would require the disclosure of a parole condition would be in the case of a parole condition that a care recipient report to police on certain days. Travel arrangements would need to be in place that would enable the care recipient to conform to such a parole condition and hence an ACAT – with the consent of the care recipient – would be acting within the primary legislative purpose of their role if they disclosed such a parole condition to an approved provider or other organisation which is to provide care to the person.
2. Would ACAT members be ‘informed persons’ for the purposes of the recording of the names of persons to whom the District Manager of Probation has disclosed information about the criminal history of potential care recipients?
This is a matter for the relevant state parole service to determine; however, it is likely that ACAT team members would be recorded as being ‘informed persons’ if the information is given to them.Top of page
3. What role (if any) does an ACAT have in ensuring service providers get information regarding the criminal history of a potential care recipient from a parole officer?
An ACAT member’s role in disclosing personal information about potential care recipients is set out in section 86-4 of the Act as follows:- provision of *aged care, or other community, health or social services, to the person;
- assessing the needs of the person for aged care, or other community, health or social services;
- reporting on, and conducting research into, the level of need for, and access to, aged care, or other community, health or social services.
- 86-4 Disclosure of protected information by people conducting assessments
A person to whom powers under Part 2.3 have been delegated under subsection 96-2(5), or a person making assessments under section 22-4, may make a record of, disclose or otherwise use *protected information, relating to a person and acquired in the course of exercising those powers, or making those assessments, for any one or more of the following purposes:
Whether or not information about a prospective care recipient’s criminal history is relevant to the purposes specified in section 86-4 of the Act would depend on the facts and circumstances of each individual case (see discussion above in response to Question 1).
Changes to Part 6 (Approvals) of the Aged Care Client Record (ACCR)
The Department of Health and Ageing has found that changes to Part 6 of the ACCR have not been correctly completed in many cases.In particular, the following points have been identified:
- Full unique event IDs must be lodged. Please do not abbreviate as it may compromise the request for Changes to Part 6.
- The correct form is Version 2.3 (written on the lower right hand side).
For further information, please contact the Evaluation Unit in your State/Territory.
The Aged Care Client Record (ACCR) Interim User Guide – 2007 is available on the ACAT specific website at www.health.gov.au/acats and go to ‘Guidelines’.
- Or by the following links:
Aged Care Client Record (ACCR) Interim User Guide – 2007
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acat-secure-accr-2007-guide.htm
Changes to Part 6 of the eACCR (Approvals)
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acat-secure-accr-2007-guide.htm~ageing-acat-secure-accr-2007-guide-part6.htm
The ACAT Delegate, on receipt of the Department’s rejection of the changes and the confirmation of the REJECTION by Medicare Australia, will perform a ROLLBACK of that record on the system.
It will be necessary to undertake a new assessment.
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Changes
A new assessment must be undertaken where an incorrect selection has been made in Part 6 while recording the type of care for which the client is approved, and clear intent is not evident in the ACCR.If clear intent is evident in the ACCR it is necessary to undertake the following procedure.
Step 1
The ACAT Delegate should correct the error on the eACCR through ACE and electronically resubmit the record to Medicare Australia. Medicare Australia will then HOLD the record until they receive advice from the Department of Health and Ageing (the ‘Department’) of its decision whether to Accept or Reject the changes.Step 2
The ACAT Delegate must complete an electronic ACAT REQUEST to Correct an eACCR form . The ACAT Delegate should send an email of the changed approval to the Department of Health and Ageing Program manager in their State/Territory.Step 3
The Department’s Delegate will examine the changes to determine whether they reflect the intent of theoriginal assessment.
Step 4
The Department’s Delegate will advise both Medicare Australia and the ACAT Delegate by email of theirapproval or rejection of the change.
Step 4.1
If the changed approval is agreed by the Department’s Delegate — Medicare Australia,on receipt of Department’s agreement to the changes, will release the HELD record to be processed. The ACAT Delegate, on receipt of the Department’s agreement to the changes and the confirmation of successful processing by Medicare Australia, will formally advise the client of the changes and provide them with a copy of the updated approval.
Step 4.2
If the changed approval is rejected by the Department’s Delegate — they will advise bothMedicare Australia and the ACAT Delegate.
Medicare Australia, on receipt of Department’s rejection to the changes, will REJECT the record and electronically advise the ACAT Delegate of that rejection.
The ACAT Delegate, on receipt of Department’s rejection of the changes and the confirmation of the REJECTION by Medicare Australia, will perform a ROLLBACK of that record on the system.
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ACFI advice on ‘Ageing In Place’
Under the Aged Care Funding Instrument (ACFI) an ‘ageing in place’ event defines when the full ACFI high care subsidy may be paid if the resident’s ACAT approval is limited to low care.A resident may 'age in place' in any the following three ways:
- 1. a reappraisal is conducted that results in a HIGH CARE ACFI classification (e.g. on expiry of an existing classification, or a voluntary reappraisal following a transfer, or following a major change in care needs);
- 2. an ACAT approval for care is provided which is not limited to low care; or
3. a Departmental Review Officer confirms the resident's ACFI classification (as high) during a classification review.
ACATs who require further information should be referred to the ACFI Frequently Asked Questions website, in the first instance. If the information in ACFI FAQ’s does not fully address the particular circumstance, they should submit the question in an email to the ACFI Inbox for a response at acfi@health.gov.au
Update to ACAT Delegation Training Resources
The Commonwealth has recently conducted a series of Workshops in Brisbane, Perth, Sydney, Melbourne and Adelaide to promote the new ACAT Delegation Training Resources. Approximately 300 ACAT members attended the Workshops, while many other teams linked in by video-conferencing,Marlene Hall, Principal Legal Advisor from the Department, presented an ‘Introduction to Administrative Law’ session which highlighted the importance of good decision making under the Aged Care Act 1997 and the Aged Care Principles. Sandra Linsley, Assistant Director of the ACAP Section, presented an ‘Introduction to Delegation Training Resources’. Attendees were informed of the different delivery options available, including workshops, one-on-one training, self directed delivery using the Training Workbook, a CD and an eLearning website. The Assessment Criteria and Guidelines as well as how to use the training workbook were also highlighted.
The feedback from the Workshops has been both positive and encouraging. The Department is also planning to make a video-recording of Marlene Hall’s ‘Introduction to Administrative Law’ presentation. This will be available as a resource to assist in improving the quality of Delegates’ decision-making in the future.
ACAT Finder
The Department has developed an ‘ACAT Finder’ where a search will quickly identify the nearest ACAT (ACAS in Victoria) for a given location. The ACAT finder will allow the client to input a suburb or postcode and receive a page detailing the contact details for the ACATs that service that area.The ACAT Finder is part of the Department’s Aged Care Australia web site (www.agedcareaustralia.gov.au) and draws the ACAT information from the Commonwealth Carelink Centres Information System (CCCIS) database. The nature of the content of the Aged Care Australia web site means many visitors to the site are potentially interested in ACAT information.
The ACAT Finder provides another option for the consumer to easily access ACAT contact details.
ACAT Managers are asked to ensure your contact details are current with your local Commonwealth Respite and Carelink Centre — Phone 1800 052 222.
(N.B. please do not provide a personal email address for release on the website).
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Same-sex couples entry to residential aged care
From 1 July 2009, members of same-sex couples will be treated in the same way as members of opposite-sex couples in the income and assets tests for entry to permanent residential aged care.Members of same-sex couples will be taken to have 50% of the total value of the couple’s income and assets when determining aged care fees and charges. The value of the couple’s home will be excluded from the assets assessment if the person’s partner or dependent child still lives there, or if a child of the couple, who is eligible for an income support payment, has lived there for the past five years.
Income tested fees for some current residents and some residents who enter care from 1 July 2009 will be affected by the changes. Accommodation payments (bonds and charges) for some residents who enter care from 1 July 2009 will also be affected. Accommodation payments for residents who enter care before 1 July 2009 will not change.
There are provisions under the Aged Care Act 1997 to assist residents who face genuine financial hardship in paying their aged care costs due to special circumstances.
For further information on the changes, please call the Department of Health and Ageing Aged Care Information Line on 1800 500 853 (toll free).
Reviewable Decision — Further information
There may be times when an ACAT will refuse a referral for assessment or reassessment. DOHA suggests that a decision not to accept a referral is treated as a reviewable decision so that any person refused anassessment is provided with an opportunity to request a review.
Even though a telephone or fax referral may not meet the requirements of subsection 22-3(1) and (3) of the Aged Care Act 1997 in relation to a valid application for aged care, as the person making the referral in this way has no other way to make an application to meet the requirements of the Act, it is DOHA's view that there should be some review mechanism available.
ACATs should ensure that the following advice is provided (in writing or by telephone) to all clients where a referral for assessment (or reassessment) is not accepted:
- “If you or any other person affected by this decision are not satisfied with the decision, you can write to the Secretary of the Department of Health and Ageing. You must write within 28 days of receiving this advice and give the reasons why you think the decision should be changed.
- The Secretary
- Department of Health and Ageing
C/- State Manager
Ageing and Aged Care Division
GPO Box 9848
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Accommodation Bond Protections
As an ACAT member you may be asked by potential aged care residents about aged careaccommodation bonds (bonds) and how they are protected.
There are several factors that affect the charging of accommodation bonds:
- People assessed as requiring a low level of residential care may be asked to pay a bond.
- High care residents entering an Extra Service place may be asked to pay a bond.
- Residents may only be asked to pay a bond if their assessed assets are greater than a minimum benchmark, currently $36,000
- Only approved providers of certified residential aged care services can charge accommodation bonds.
Prospective residents may request and must be provided with information about the number of bond balances that the approved provider did not refund on time in the last financial year. Prospective residents can also ask to see evidence that the approved provider has complied with the Prudential Standards, such as:
- a written statement and an auditor's opinion about the approved provider’s compliance with the Prudential Standards; and
- the approved provider’s most recent audited financial accounts.
When the person becomes a resident they do not have to pay a bond or make any periodic payments unless they have entered a bond agreement. They have up to 21 days after entering the service to enter a bond agreement.
The 5 Steps to Residential Care booklet explains what they can expect to be included in their bond agreement.
After they have become a resident and have agreed to pay a bond the approved provider must provide them with a copy of their agreement within 7 days. They must also receive a written guarantee from the approved provider that their bond balance will be refunded in accordance with the Aged Care Act 1997.
A resident can request a copy of their entry on the bond register and a copy of the approved provider’s most recent audited financial statements at any time. This information must also be provided to them annually, four months after the end of the approved provider’s financial year.
The Australian Government’s Accommodation Bond Guarantee Scheme protects residents who have paid accommodation bonds by guaranteeing to refund the balance in the event that their approved provider becomes bankrupt or insolvent and is unable to refund the bond.
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Demonstration Sites for Day Respite in Aged Care Facilities
As reported in the March 2008 edition of the Carer Support Newsletter, 30 residential aged care facilities have been awarded funding to operate demonstration sites for day respite in aged carefacilities.
The facilities are each using existing infrastructure, services and skills within residential aged care homes to provide new day respite services for the carers of frail older people. In doing so, they are providing the government and industry with an opportunity to explore a number of innovative ways of delivering day respite.
An important aspect of the day respite project is to provide an opportunity for detailed study and
evaluation including:
- The reaction of carers utilising day respite in aged care facilities;
- The costs and value for money of providing day respite for services, government and care recipients;
- The effects of providing day respite on the operations of residential aged care facilities and the impact on full time residents; and
- Appropriate options for future funding of this type of respite.
Aged care facilities providing day respite are actively contributing to the evaluation process including data collection and quantitative and qualitative assessment. This includes attendance at two workshops in May 2009 and Autumn 2010. AISR will visit 12 of the sites covering a range of facilities including urban, rural, regional and remote, different models of care and those targeting different cultural groups.
The evaluation will be an ongoing process for the duration of the project. The final evaluation report will be presented to the Department in September 2010.
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The Home and Community Care (HACC) Program - Key New Arrangements over the Last 12 Months
In 2007, the HACC Review Agreement was negotiated between the Australian Government and state and territory governments, and took effect from the 1 July 2007.The Review Agreement included several new arrangements, such as the introduction of triennial planning and Key Performance Indicators (KPIs). In 2008, state and territory governments were required to submit plans for the 2008-2011 triennium, which constituted the first three year planning period in the HACC Program’s twenty-three year history.
Each state and territory had the option of submitting a full triennial plan identifying the priorities, regional funding allocations, service outputs and more detailed funding information for the full three years. Alternatively states and territories are able to submit partial triennial plans identifying high level priorities and regional funding allocations. This partial plan is to be supported by annual supplements that identify service outputs and more detailed funding information for each year.
Three of the states and territories submitted full triennial plans - Queensland, South Australia, and the Northern Territory - with the remaining jurisdictions choosing to submit partial plans with annual supplements.
The use of triennial planning, as well as the other new arrangements under the Review Agreement, is anticipated to have significant benefits to the HACC Program in a number of areas. These include earlier allocation of funds, better planning and improved relationships between governments.
The move to triennial planning has so far been successful. The majority of states and territories submitted plans by the due date, with these plans meeting the agreed administrative requirements and being accepted by the Minister for Ageing, the Hon Justine Elliot MP.
Another new arrangement featured in the Review Agreement is the development and introduction of a KPI
framework for the HACC Program. State and territory governments agreed to begin reporting on seven KPIs in their respective annual business reports, with a basic level of reporting on the first 5 KPIs to commence from
2007-08.
The KPI framework aims to provide meaningful outcome measures for the HACC Program. The KPIs require data to be collected and analysed in a consistent manner across states and territories to ensure comparison of
performance across the HACC Program. It is anticipated that this comparison will improve evaluation, planning and accountability.
The first five KPIs are as follows:
- KPI 1 - the number of clients as a percentage of the HACC target population
- KPI 2 - the percentage of Aboriginal and Torres Strait Islander clients as a proportion of this group in the total population
- KPI 3 - the number of culturally and linguistically diverse (CALD) clients as a proportion of this group within the target population where CALD is identified as country of birth other than Australia that is non-English speaking
- KPI 4 - the percentage of eligible HACC agencies who receive a rating of ‘good’ or higher over the three year reporting cycle
- KPI 5 - the percentage of active agencies in the National Data Repository providing data to the HACC Minimum Data Set (MDS)
The first HACC Annual Report, due to be published in 2009, will include performance information in relation to the HACC KPIs 1-5 as well as additional data from the HACC Minimum Data Set (MDS) for 2007-08.
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Advance Care Planning: Information Resources For ACATs
All people aged 18 years or more who are mentally competent have a legal right to decide whether they wish to accept or refuse medical treatment. However, sometimes we aren’t able to make those decisions. This happens when, for example, we are unconscious as a result of an accident. It also happens if we have conditions like advanced dementia or lose consciousness as a result of a serious illness.An advance care plan (ACP) allows people to state their directions and express their wishes about medical treatments and other care, in the event that they are unable to, through accident or illness. An advance care plan may also be called an advance health directive or a living will.
ACATs can help their clients by asking them if they have thought about their wishes for future health care and medical treatment. ACATs can also assist their clients by providing information about advance care planning either directly or by providing their clients with links to relevant information and resources.
One model of advance care planning is Respecting Patient Choices (RPC). Austin Health, in Melbourne, has been funded by the Australian Government to implement the project. It has a website with free downloadable booklets and leaflets on advance care planning.
As part of another project, in February 2009 the Aged Care and Housing Group (ACH) launched the newly developed Palliative Dementia Care Resource Kit to provide valuable support and resources for staff to assist in supporting choices for people with dementia and their families.
The resource kit is funded by the Australian Government’s Department of Health and Ageing and is available as a free download via www.ach.org.au or for purchase as a CD for $30.
For further information please call (08) 8349 3515.
Other useful information about advance care planning can be obtained from:
- Alzheimer’s Australia’s help sheet on early planning for people who have been diagnosed with Dementia: www.alzheimers.org.au/upload/HS8.2.pdf
- Austin Health’s brochures and forms on Respecting Patient Choices www.respectingpatientchoices.org.au
- CareSearch’s clinical practice information which provides communication resources and links to State and Territory legislation www.caresearch.com.au/caresearch/ForPatientsandFamilies/TopicInformation/AdvanceCarePlanning/tabid/312/Default.aspx
- The Royal College of General Practitioners’ guidelines and information sheets www.racgp.org.au/guidelines/advancecareplans
Dementia Behaviour Management Advisory Service
The Dementia Behaviour Management Advisory Service (DBMAS) has been established in each State and Territory to provide appropriate clinical interventions to help aged care staff and carers improve their care of people with dementia. The service is available to support staff and carers in managing Behavioural and Psychological Symptoms of Dementia (BPSD).The aims of the DBMAS project are to:
- up skill, assist and support aged care staff and providers to improve care for people with challenging behaviour related to dementia; and
- ensure care services for people with dementia are responsive to their individual and diverse needs and circumstances.
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Defining Behavioural and Psychological Symptoms of Dementia
Behavioural and Psychological Symptoms of Dementia (BPSD) are defined by the International Psychogeriatric Association (IPA) Taskforce on BPSD (1996) as 'symptoms of disturbed perception, thought content, mood, behaviour frequently occurring in patients with dementia. BPSD include aggression, agitation, wandering, social and sexual dis-inhibition, verbal outbursts, delusions, hallucinations, and anxiety.'Such behaviour is usually only considered 'challenging' and therefore a 'problem' when it affects other people, causes harm to, or indicates distress of the people with dementia themselves.
BPSD are recognised as potential complications throughout the course of any form of dementia and because they can be unpredictable, they are often stressful and sometimes dangerous, for the person with dementia, their carers and care staff. The burden of care in domestic situations and care institutions is increased by BPSD.
One of the aims of the DBMAS is to deal with the 'crisis' caused by the BPSD and so help care staff and family members to be able to resume a 'normal' pattern of caring.
Brodaty et al (2003) proposed a 7 tier model for describing people with behavioural psychological symptoms (BPSD) and the interventions/strategies appropriate at each tier. The tiers reflect an ascending order of symptom severity and descending order of prevalence indicating that the term BPSD covers a wide range of symptoms and severity.
DBMAS can be contacted by telephone on 1800 699 799. Additional information is available at www.dementia.unsw.edu.au.
For further information please contact the Department on 6289 5256 or email ann.atkinson@health.gov.au
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What type/s of BPSDs are indicative of a referral to DBMAS?
Physical BPSDs
Physically ViolentPhysically Aggressive
Physically Threatening to Self or Others
Physical Agitation
Severe Physical Agitation
Physically Resisting Care
Chronic Substance Abuse
Verbal BPSDs
ScreamingSwearing
Verbally Aggressive
Verbally Disruptive
Verbally Inappropriate Sexual Advances
Verbally Resisting/Refusing Care
Night Time Disturbance
Social BPSDs
Paranoid Ideation that Disturbs OthersDressing/Undressing
Shadowing
Sexual Disinhibition
Hiding/Hoarding
Consuming Inappropriate Substances
Stealing
Faecal Smearing
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Dementia Training Study Centres (DTSCs)
As part of the Australian Government’s Dementia Initiative four Dementia Training Study Centres were established to promote dementia studies in Australian graduate and undergraduate curriculum and to provide dementia career pathways.The four DTSCs are:
- the Eastern Australia Dementia Training and Study Centre (EADTSC) – covers New South Wales, Queensland and the ACT;
- TIME for dementia DTSC (TIME DTSC) – covers Victoria and Tasmania;
- the Western Australian Dementia Training Study Centre (WA DTSC); and
- the South Australian and Northern Territory Dementia Training Study Centre (SA & NT DTSC)
workshops.
DTSC target groups include nurses – those training to be registered, RNs or Nurse Practitioners, GPs, medical specialists (e.g. geriatricians and psychiatrists), Social Workers, Occupational Therapists, Diversional Therapists, Psychologists and other allied health disciplines.
For more information on the DTSCs please visit their websites:
EADTSC – http://dementia.uow.edu.au/
TIME DTSC – http://dementia.uow.edu.au/
WA DTSC - http://cra.curtin.edu.au/wadtsc/wadtsc_index.html
SA & NT DTSC - http://www.santdtsc.edu.au/
Frequently Asked Questions
Data Management
1. In a situation where a client dies after the completion of assessment and recommended long term care, should the reason for ending assessment be:- 1 (assessment complete – care plan developed); or
- 3 (assessment incomplete – client died)?
Answer:
- Answer: The delegation date can NEVER be before the assessment end date.
Emergency care started, entered. If the delegate didn’t agree that there was an emergency or the application was outside the time limit (5 Day Rule), then the provider would not be paid for the time the client entered care until the actual approval date. 3. In areas where there are Multi Purpose Service (MPS) respite beds within residential facilities – should these be included as part of the individual’s respite care?
- Answer:
4. Does the client need to sign the Aged Care Client Record (ACCR)?
Answer: YES The client MUST sign the ACCR. The ACCR is an Application Form:
- for the client to seek approval to receive care under the Aged Care Act 1997; and
- for the Department of Health and Ageing to use the information to report on, and conduct research into, the level of need for aged or other community, health or social services.
- ACATs must provide the client with the opportunity to understand the role of the ACCR, which may involve providing the client with the opportunity to read the ACCR (including the Privacy Notice) and / or informing the client of the purpose of the ACCR.
To allay client fears, it is important the ACAT explains to the client that even if they are approved to receive a type of aged care, this does not mean the client must agree to receive that type of care.
N.B. The ACCR is NOT a substitute for the normal Consent Form signed by the client before the ACAT conducts the Assessment.
Please refer to ACAT CHAT Volume 20 — August 2007 for further information.
Upcoming Events
Translating Research into Practice National Dementia Research Forum 2009
Are you interested in learning more about dementia?
Hosted by the Dementia Collaborative Research Centres (DCRCs), the Annual National- Dementia Research Forum will be held at the Wesley Conference Centre in Sydney on 24-25 September 2009.
The theme of the Forum is ‘Translating Research into Practice’ and there will be an emphasis on how lessons from academia can translate into best practice at the clinical coalface. The Forum will showcase the latest research in diagnosis, treatment and management of dementia, as well providing updates on drug treatments, prevention of dementia and maintaining quality of life with dementia.
This unique event will bring together a diverse group of participants, including health professionals, aged care workers, researchers, clinicians, service providers, carers and people with dementia.
Highlights of this year’s program include:
- The Hon. Justine Elliot MP, Minister for Ageing, opening the Forum. Presentations by
prominent local and international key note speakers on a wide range of topics.
Providing dementia care in the community: an evidence based approach.
Professor Constantine Lyketsos
Elizabeth Plank Althouse Professor
The Johns Hopkins Bayview Medical Centre, USA
Dementia in Indigenous People
Professor G.A. (Tony) Broe
Senior Principal Research Fellow and Professor of Geriatric Medicine
University of New South Wales
Knowledge Translation in Dementia
Doctor Sue Phillips
Executive Director
National Institute of Clinical Studies
Advances in Drug Treatments of Alzheimer’s Disease
Associate Professor Michael Woodward
Director, Aged and Residential Care
Austin Health
- A hypothetical featuring a panel of experts on the topic of Behavioural and Psychological Symptoms of Dementia.
The opportunity to network and mingle with the experts gathered together for the forum at ‘Breakfast with the Experts’.
The information booklet:
5 Steps to Entry into Residential Aged Care is available on line at:
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-resentry_a.htm-copy3 or by calling the Aged Care Information Line on :1800 500 853 The Aged Care Information Line has advised that callers often seek a replacement Pack after they have discarded the original given by their ACAT, because they did not understand why it was given to them. The are also receiving calls about the use of the Nominee Form, which they fill in immediately (instead of at the time of entry to a Facility).
Aged and Community Care Information Line - 1800 500 853
Commonwealth Carelink Centre - 1800 052 222
Useful Websites
www.health.gov.au/acats
www.health.gov.au/ACFI
www.aihw.gov.au
www.dva.gov.au
www.seniors.gov.au
www.rhef.com.au
www.agedcareaustralia.gov.au
www.commcarelink.health.gov.au
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ACAP Contacts
Commonwealth Government Department of Health and AgeingNew South Wales
Sandra Withers (02) 9263 3779
Victoria
Kerry Sugars (03) 9665 8127
Queensland
Denise McDonald (07) 3360 2852
Western Australia
Stephanie Turkich (08) 9346 5247
South Australia
Ann Podzuweit (08) 8237 8052
Tasmania
Lois Jenkins (03) 6221 1474
Northern Territory
Jean Carvolth (08) 8919 3461
Australian Capital Territory
Suzanne Pointon (02) 6289 3374
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