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Aged Care Assessment Teams

ACAT CHAT - November 2010

Welcome to Volume 30 of ACAT Chat

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Welcome to Volume 30 of the ACAT Chat

This edition of ACAT Chat has a strong focus on reassessments. Knowing the eligibility requirements and whether particular types of care lapse are fundamentals to good assessment and approval practices.

In an update on the legislation changes that remove the need for many reassessments, the article on page 3 and the information outlining when a reassessment by an ACAT is, and is not, necessary, should be of interest to all team members.

Continuing the theme of assessments, page 6 outlines the role of ACATs when they are requested to assess the accommodation and care needs of a resident as part of a security of tenure matter. ACATs are sometimes asked to conduct a reassessment because the Secretary of the Department of Health and Ageing has been requested to reconsider a decision made by an ACAT Delegate. The article on page 6 describes the role of the reassessing team.

An update on the National Carer Recognition Framework is at page 7, as is information on the Residential Care Manual.

Remember the ACAP National Conference in Melbourne on 20-21 May this year? Go to page 8 for a wrap up and a collection of photos taken at the conference. Were you one of the 600 there? Maybe your picture is in this edition.



The Minister for Mental Health and Ageing
The Hon Mark Butler MP

Federally we have a new Minister responsible for Ageing. The Prime Minister, the Hon Julia Gillard MP, has announced that the Member for Port Adelaide, the Hon Mark Butler MP, is the new Minister for Mental Health and Ageing. In future editions we’ll tell you more about what the Gillard Government are doing to improve the aged care system.


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Inside this issue:

New “Front End” for Aged Care

Client loses their ACCR. How do they get a replacement?

Approval for EACH D or EACH. How many boxes to tick?

Update: Legislation changes 12 Months on

Assessments for Security of Tenure

Assessments for Reconsideration of ACAT decisions

The National Carer Recognition Framework

Residential Care Manual 2009, Edition 1, Update 1, (following Legislative Amendments)

National ACAP Conference 2010

ACAT Chat contacts

ACAT Information sheet

ACAP Contacts

“Front End” for Aged Care

The Commonwealth will take on full funding and policy responsibility for aged care, including the establishment of a new ‘front end’ for aged care.

The current aged care system is fragmented and has many entry, assessment, and referral points which makes it difficult for care recipients, their families and their carers to navigate. When fully implemented, the new ‘front end’ of the aged care system will act as central entry points into the aged care so that older people, their families, and carers will have easier access to information, assessment and services.

A phased implementation of the ‘front end’ will commence from 1 July 2011 and we anticipate that the model will be fully operational nationally by 1 July 2013.

An important part of the transition to the Commonwealth taking on full responsibility for aged care will be to ensure the continuity of services for all care recipients and carers. We will be working closely with state and territory agencies and other stakeholders to ensure services are delivered without disruption.

Commencing in November 2010, service providers, local governments, peak bodies, and the workforce including ACATs will be asked to provide their thoughts and ideas about the proposed changes to the aged care system. Initially, these consultations will take place in capital cities and continue early next year in regional Australia.

In early 2011, a range of focus groups will also be held, including sessions targeting care recipients and their carers. These consultations will provide the opportunity for participants to share their views, assist in system change, highlight the strengths of the current system and raise issues to consider.

A discussion paper on Improving Information, Intake and Assessment will be available from 10 November 2010 at www.yourhealth.gov.au. The discussion paper outlines the context for the development of a new ‘front end’ for aged care and is intended to start conversations and generate views throughout the consultation process.

The schedule below outlines the consultation locations and times:
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Consultation Schedule - November - December 2010

	Date	Location	Time/s
QLD	Tuesday 16 November Tuesday 16 November	Brisbane Brisbane	09.00 – 12.00 13.30 – 16.30
NSW	Thursday 18 November Thursday 18 November	Sydney Sydney	09.30 – 12.30 13.30 – 16.30
ACT	Friday 19 November	Canberra	09.30 – 12.30
NT	Wednesday 24 November Thursday 25 November	Darwin Alice Springs	14.00 – 17.00 10.00 – 12.30
SA	Tuesday 30 November Tuesday 30 November	Adelaide Adelaide	09.00 – 12.00 13.00 – 16.00
VIC	Tuesday 14 December Tuesday 14 December	Melbourne Melbourne	09.30 – 12.30 13.30 – 16.30
TAS	Thursday 16 December	Hobart	09.00 – 12.00

If you would like to attend a consultation, please RSVP to: agedcareconsultations@health.gov.au with your name, organisation (if applicable), the date and time of the consultation that you would like to attend.

If you are unable to participate in the consultations, but would still like to provide input please email us at
agedcareconsultations@health.gov.au to register your interest in completing an online survey or attending a focus group.

For further information about the upcoming consultation process, please call the Aged Care Consultation Information Line on 1800 057 616 or if you have any questions about the new ‘front end’ for aged care, please contact Angela Braniff, Director, Access Section at angela.braniff@health.gov.au.

Client loses their ACCR. How do they get a replacement?

Clients sometimes lose or misplace their copy of the Aged Care Client Record (ACCR) and their approval letter and don’t know where to get a replacement. The ACAT that conducted the assessment should provide the client with a copy of the ACCR and the approval letter.

The ACAT should not refer a client to Medicare Australia to obtain a copy of an ACCR. Medicare Australia is responsible for providing subsidy payments to approved providers on behalf of the Department. It is not appropriate to direct clients to Medicare to obtain a copy of an ACCR in the event that the original is misplaced.

Approval for EACH D or EACH. How many boxes to tick?

ACAT Chat - Volume 26 outlined the legislative changes made in December 2008 and their relevance to the Aged Care Assessment Program. One of those changes was to the eligibility for approvals for
EACH D and EACH.

Specifically, that if a person is eligible to receive an EACH D package, the person is also eligible for an EACH package or a CACP as an alternative to an EACH D package. Similarly, if a person is eligible to receive an EACH package, the person is also eligible for a CACP as an alternative to an EACH package.

Some ACAT Delegates are unsure how many boxes should be ticked on the ACCR when they are approving a person for an EACH D or EACH package. Some delegates have thought that it is necessary to tick multiple boxes on the one form to reflect these changes to eligibility.

ACAT Delegates should only tick one box for the type of care that is being approved.

Medicare Australia already recognises that a person who is approved for an EACH D is also eligible for an EACH or CACP and that a person who is approved for an EACH is also eligible for a CACP. However, if ACATs are contacted by CACP providers who have not received subsidy for clients with an EACH D or EACH approval, they should advise the provider to contact Medicare Australia.
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UPDATE: Legislation Changes - 12 Months On

It is important to have a good understanding of eligibility requirements and the lapsing of approval rules to be able to correctly identify when an ACAT reassessment is required.

An approval for the following care types does not lapse

• Residential care (high level)
• Residential respite care (high and low level)
• Extended Aged Care at Home (EACH)
• EACH Dementia (EACH D)

Please note that if a client has a current approval for low level residential respite care and their needs have changed, in order for the service provider to claim a high level subsidy they will need to be reassessed and
approved by the ACAT for high level residential respite care.

Approvals for some care types automatically provide eligibility for a person to receive some other types of care, specified as follows:

• Residential Care – high level – the person is also eligible for residential care at the low level.
• 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.

When is an ACAT reassessment required?

The following information sets out the circumstances when an ACAT reassessment is, and is not, necessary. It is divided into two categories that illustrate the different requirements depending upon whether the person has or has not received care.

CARE NOT RECEIVED
ACAT APPROVAL	IS REASSESSMENT REQUIRED?
The client is approved for: High level residential care	No* - Unless the approval is time limited, in which case it will expire on the date specified.
The client is approved for: High level residential respite care Low level residential respite	No* - Unless the approval is time limited, in which case it will expire on the date specified Yes - if a person’s approval is limited to a low level of care and they require high level care.
The client is approved for flexible care in the form of: Extended Aged Care in the Home (EACH) Extended Aged Care in the Home Dementia (EACH D)	No* - Unless the approval is time limited, in which case it will expire on the date specified
The client is approved for: Low level residential care Community Aged Care Package (CACP)	Yes - if care was not provided within 12 months starting the day after approval. OR Yes - if their care needs change. OR Yes - if an approval is time limited, since it will expire on the date specified
The client is approved for: Transition Care	Yes - if care is not provided within 4 weeks beginning the day after the approval date.

*Approvals for these types of care made up to and including 30 June 2008 automatically lapsed after 12 months (if they were not time limited to expire earlier).  This remains the case for low level residential care and community aged care packages

CARE RECEIVED
ACAT APPROVAL	IS REASSESSMENT REQUIRED?
The client has entered: High level residential care	No
The client has entered: Low level residential care	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: an ACFI reappraisal is conducted that results in a High Level classification (e.g. on expiry of an existing classification, or a voluntary reappraisal following a transfer, or following a major change in care needs) or a Departmental Review Officer confirms the resident’s ACFI classification during a classification review. 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: Low or high level residential respite care	No
The client has commenced an episode of: Transition care	Yes – if there is a break in care of at least one day (excluding an overnight stay in hospital) after the 4 week entry period. No – if the client enters hospital from transition care, for longer than an overnight stay, concludes their hospital episode and re-enters transition care (from hospital) within the 4 week entry period. Yes - If the person is only approved as eligible for transition care they may need a reassessment and approval for the appropriate aged care service(s) to meet their long term needs. Yes – A transition care episode can be extended from 84 days up to a maximum of 126 days.  An ACAT reassessment may be needed if the delegate is not satisfied with information about the care recipient’s further transition care needs supplied by the service provider in the Transition Care Extension Form **
The client has commenced a: CACP, EACH or EACH D Package.	No—if care was received on or after 20 March 2008, approvals for these types of care do not lapse.

**A new approval on aged care client record is not required for an extension of transition care.
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Other requests for Assessments

Assessments for Security of Tenure

Under the legislative provisions for security of tenure, an approved residential care provider can ask a resident to leave the service under certain circumstances.

There are four steps that a provider must follow in asking the resident to leave:

1. Providing written notice
2. Considering suitable alternate accommodation
3. Assessing the resident’s long-term needs
4. When the resident is no longer required to leave.

Where the resident is asked to leave because the service can no longer provide accommodation and care suitable for the resident’s long-term assessed needs, and the provider has not agreed to provide the care that the resident presently needs, an ACAT (or at least two medical or other health
practitioners) may be asked to assess the long-term needs of the resident.

Unlike usual ACAT assessments to assess a person’s care needs for eligibility and approval of aged care services, for a security of tenure assessment the ACAT would consider the present care and accommodation and whether it meets the resident’s care needs. For this type of assessment an ACCR is not necessary. The ACAT can provide the findings of their assessment in a letter to the approved provider.

Importantly, the approved provider cannot take action to make the resident leave, or imply that the resident must leave, before suitable accommodation is available that meets the care recipient’s
assessed long-term needs and is affordable by the care recipient. See the Residential Care Manual 2009 and the User Rights Principles 1997 for further details.

Assessments for Reconsideration of ACAT decisions

Any person whose interests are affected by a decision made by an ACAT delegate can request the Secretary of the Department of Health and Ageing (DOHA) to reconsider that decision. These requests are managed by the respective DOHA state or territory office. To help the DOHA delegate make an informed decision, sometimes a different ACAT will be asked to conduct a reassessment of the person’s care needs.

At this type of reassessment, the ACAT should not ask the person to complete Part 1 - the statement of application of the Aged Care Client Record (ACCR). Data from reassessments is not collected for the ACAP Minimum Dataset and the person does not need to complete an application to apply for care, as they have already made an application at the initial assessment.

ACATs should always obtain consent for the reassessment and this should be collected on the ACAT consent form. The ACAT delegate should not complete Part 6 of the ACCR - approval as a care recipient. In these cases, it is the DOHA delegate who is making the decision to approve, not approve or vary a limitation as part of the reconsideration process.
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The National Carer Recognition Framework

The Australian Government tabled its response to the House of Representatives Standing Committee on Family, Community, Housing and Youth report: Who Cares….? Report on the inquiry into better support for carers, and its fifty recommendations on 29 October 2009.

Central to the Government’s response to this inquiry was a commitment from the Commonwealth to lead the development of a National Carer Recognition Framework comprising a national carer strategy and carer recognition legislation.

The Commonwealth Carer Bill 2010, (the Bill), tabled in Parliament on 17 March 2010, has lapsed with the 2010 federal election. The Gillard Government has reiterated its commitment to the legislation and a national carer strategy as part of the 2010 ALP election platform Moving forward for Australians with Disability and their Carers.

The Bill formally acknowledges the valuable contribution that carers make to Australian society and that carers should have the same rights, choices and opportunities as other Australians.

The legislation establishes a definition of a carer, contains the Statement for Australia’s Carers and outlines reporting and consultation arrangements for certain public service agencies. The Statement for Australian Carers sets out ten principles to guide how public service agencies and their funding providers consider carers. A link to the Bill, including the Statement for Australia’s carers can be found at: http://fahcsia.gov.au/about/news/2010/Pages/carer_recognition_bill2010.aspx

The National Carer Strategy (strategy) is expected to address many of the issues raised by carers through the inquiry and shape the Australian Government’s short, medium and long term reform agenda for carers across the health, disability, community care, mental health and aged care systems. The strategy aims to develop coordinated, responsive and targeted policy and supports for carers throughout the course of the caring role.

The Department of Health and Ageing has set up a Carer Policy Section to progress work around the National Carer Recognition Framework. The Department of Health and Ageing and the Department of Families, Housing, Community Services and Indigenous Affairs are co-leading the development of the strategy, working closely with other Commonwealth agencies, state and territory governments and in consultation with key stakeholders.
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Residential Care Manual 2009, Edition 1, Update 1, (following Legislative Amendments)

The Residential Care Manual was updated earlier this year to help approved providers comply with their responsibilities under the Aged Care Act 1997 (the Act) and the Aged Care Principles (the Principles); and to assist the staff of aged care services understand the regulation of residential aged care.

The Manual acts as a plain English guide to Australian Government-subsidised residential aged care, legislated under the Act and the Principles and administered by the Department of Health and Ageing.

Whenever there is a change to either the Act or the Principles, the Department will update the Manual.

Aged care providers were issued with hard copies of the Manual in 2009. However, updates which occur throughout the year, will be made to the online version of the Manual only. Providers can then print out these updates and insert them into the relevant sections of their editions of the Manual.

The Residential Care Manual can be found at http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-manuals-rcm-rcmindx1.htm

National Aged Care Assessment Program Conference 2010

The Department of Health and Ageing hosted the national ACAP 2010 Conference in Melbourne on 20-21 May 2010.  The conference provided approximately 600 ACAT representatives from across Australia the opportunity to share their expertise, explore new ideas and review best practice.

This biennial conference is one of the main components of the ACAP National Training Strategy which aims to formalise a nationally consistent and sustainable training infrastructure for ACAT members. 

The theme of the conference was:  Respect, Recognition and Responsibilities. 

The conference was opened by Lesley Podesta, First Assistant Secretary of the Ageing and Aged Care Division, Department of Health and Ageing.

Lesley welcomed everyone to the conference and provided glimpses into the exciting two-day program, including that the conference would consider the journey of ACATs over the last 25 years and the recently announced health reforms and the impact on ACAP.  Lesley also spoke about the recommended set of core assessment tools and trigger questions identified by the Expert Clinical Reference Group, the implementation of the ACAP National Training Strategy and the exciting training opportunities for ACATs through the online world.

Guest speakers included the former Minister for Ageing - The Hon Justine Elliot MP, Dr Anna Howe, Consultant Gerontologist and ACAP Veteran Merle Mitchell, Community Advocate and many more.  A full list of the speakers, their presentations and conference photos can be found on the ACAT website at:  www.health.gov.au/acats

The conference also provided ACAP stakeholders the opportunity to showcase their individual projects at the national, state and local levels.  Sessions included an overview of the recently recommended set of validated national assessment tools for ACATs, the benefits of eHealth and other specific technological practices, increased awareness of the cultural diversity needs for all clients and an introduction to the revised ACAP national training resources which include eLearning options.

ACAT Information Sheet—Translated Versions

The ACAT Information Sheet  - ‘How ACATs can help you’ - is now available in 17 different languages and can be downloaded from the ACAT specific website. http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-publicats-multi.htm Alternatively, go to www.health.gov.au > click on the “For Consumers” tab > scroll down to “Ageing” > and click “Support for people with special needs” from the menu options on the left. [Top of page

The languages include:

• Arabic
• Chinese
• Croatian
• Dutch
• French
• German
• Greek
• Hungarian
• Italian
• Macedonian
• Maltese
• Polish
• Russian
• Serbian
• Spanish
• Vietnamese
• Tagalog

Your feedback on these translated documents would be greatly appreciated, especially if you find any discrepancies with the actual translations.  Please contact Jenny Hannan (02) 6289 5572.

If you would like to order hard copies, please contact
National Mailing and Marketing
Telephone: (02) 6269 1080
Fax: (02) 6260 2770     
Email: NMM@nationalmailing.com.au
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ACAT Chat contacts

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 600
GPO Box 9848
CANBERRA  ACT  2601

Phone: Jenny Hannan (02) 6289 5572

The information booklet:
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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).

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Commonwealth Government Department of Health and Ageing

New South Wales
Sandra Withers (02) 9263 3779
Victoria
George Pappas (03) 9665 8654
Queensland
Phillipa Stanford (07) 3360 2566
Western Australia
Rebecca McIlroy (08) 9346 5424
South Australia
Kirin Moat (08) 8237 8286
Tasmania
Michelle McLeod (03) 6221 1420
Australian Capital Territory
Alison Phillips (02) 6289 2825
Northern Territory
Chris Galati (08) 8919 3487

Useful Contacts

We're on the web www.health.gov.au/acats

Aged Care Info Line - 1800 500 853

Commonwealth Respite and Carelink Centre - 1800 052 222

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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