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Aged Care Assessment Teams

ACAT Chat - July 2011

Volume 32 of ACAT Chat - Information for ACATs

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Welcome to Volume 32 of ACAT Chat

On 1 July 2011, the Hon. Mark Butler MP, Minister for Mental Health and Ageing, announced the introduction of a new national telephone number to make it easier for older Australians, their families and carers to access information about aged care. 

The new number 1800 200 422, along with improvements being made to the national aged care website www.agedcareaustralia.gov.au are the first steps in the implementation of a new ‘front end’ for aged care.

Also in this edition, there is lots of valuable information to help you in your role as an ACAT Assessor or Delegate. There is also an update on the Review of the Aged Care Funding Instrument (ACFI)  and news on Transition Care Program Guidelines.

ACATs will be pleased to read about what Continuing Professional Education credit can now be claimed for undertaking the National ACAT Training. Recognition has been obtained from the peak professional organisations representing:  Nursing; Physiotherapy; Occupational Therapy and Social Workers.

Queensland Health has provided a report (with photos) on their ACAT workshop which was held in Brisbane 12-13 April 2011 with the theme ‘Reform, Rebuild and Recharge’. 

We hope you enjoy this edition of the ACAT Chat.

Inside this issue:
New phone number for Aged Care
Review of the ACFI
Transition Care Program Guidelines
Continuing Professional Education
ACAT Delegation Processes
Delegation & Assessment
Approval for Residential Respite while a person is in hospital
ACAT Assessment Eligibility
Queensland ACAT Workshop 2011
Part 6 Changes to an ACCR
21 day extensions for Residential Respite
Moodle Tip
In Memory of Jenny Hannan

New phone number for Aged Care

Improving Information, Intake and Assessment for Aged Care

The Australian Government  is making  it easier for older Australians, their families and carers to access the Aged Care System.

On 1 July 2011, the Minister for Mental Health and Ageing, Mark Butler, announced the introduction of single, national information line to make it easier for older Australians, their families and carers to access information about aged care. The new number 1800 200 422 along with improvements being made to the national aged care website www.agedcareaustralia.gov.au are the first steps in the implementation of a new ‘front end’ for aged care.

The reform is supported by investment of $36.8 million to improve information, intake and assessment and make it easier, not harder, to access the aged care system. It is part of the Australian Government’s national health reform efforts to build a nationally consistent and integrated aged care system.

The new national phone number will initially be answered by the experienced aged care workforce of the Commonwealth Respite and Carelink Centres. The Government is working with Centres and other key stakeholders on continuous improvement to the quality and consistency of aged care information available, both over the phone and online. These improvements will provide information that is more comprehensive, up-to-date and relevant to people’s needs.

By implementing the new front end in stages, it allows time for service providers, care recipients and carers to adjust to the changes and be involved in the development of later stages. It means having sensible steps towards reform and continued opportunities to talk with people about how to roll out the later stages. We will continue to talk with state and territory governments, service providers and the aged care workforce. We will also be talking with older people, their families and carers.

The continuing development of the new front end will need to take into account existing regional infrastructure, partnership arrangements, and resources while considering opportunities to build on elements that are currently working well. The system will also be closely aligned with Medicare Locals and Local Hospital Networks to help ensure people’s health needs are detected and addressed, with services coordinated across the health and aged care systems.

As we continue to work towards improving access and navigation of the aged care system, we urge you to stay informed and up to date by visiting www.yourhealth.gov.au and to participate in the opportunities to have your say in the future of aged care in Australia.

Review of the Aged Care Funding Instrument (ACFI)

In November 2009, the Australian Government (‘the Government’) announced that a review of the new funding instrument would be undertaken by the Department of Health and Ageing (‘the department’). The final report of the Review of the Aged Care Funding Instrument (‘the review’) was released on 9 May 2011. The report is available at the following link http://www.health.gov.au/acfi-review

The review found that the ACFI has met its three key objectives: better matching funding to the complex care needs of residents; reducing the documentation created by providers to justify funding; and reducing the level of disagreement between providers’ appraisals of the care needs of their residents and the findings of Departmental Review Officers.

An important issue examined as part of the review was the interface between the ACFI and the broader aged care framework, including the Aged Care Assessment Program. Data analysis following the implementation of the ACFI revealed issues with the definition of high level care implemented
initially, which was also reflected in concerns raised by the industry.

The Government responded by changing the definition of high and low level care from January 2010. The review found that the new definition has effectively restored the level of agreement between ACAT approvals and provider appraisals to its historical level, noting that further improvement may be possible through additional ACAT training.

The review also recommended that the Department undertake further work to improve how the ACFI interfaces with other parts of the aged care system and to further improve alignment with ACATs, as well as the Specified Care and Services framework.  Current work to develop a national aged care system, and the Productivity Commission’s inquiry Caring for Older Australians, will provide further opportunities to progress these issues.

The review also recommended that a new Technical Reference Group be established to consider technical enhancements and explore possible refinements to the ACFI including:

• refinement to the pain management items in ACFI Question 12 − Complex Health Care;
• the use of culturally sensitive behaviour assessment tools;
• extending the list of individuals entitled, for ACFI claiming purposes, to make diagnoses,
  provide directives and undertake interventions to all registered health professionals acting within their scope of practice;
• operationalising new continence management resources; and
• issues relating to palliative care, medication administration, stoma care and skin management.

email: acfi@health.gov.au or telephone 1800 500 853 (Department of Health and Ageing)
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Transition Care Program Guidelines

TheTransition Care Program Guidelines 2011 are now available as a web-based only publication on the Department of Health and Ageing website: Transition Care Program Guidelines

The Transition Care Program Guidelines 2011 (the Guidelines) have been updated by the Department of Health and Ageing in partnership with all state and territory health departments represented on the Transition Care Working Group.

The Guidelines, which supersede the 2005 Transition Care Program Guidelines,

• clarify the roles of the key entities in TCP and include additional information on eligible clients, such as
  • older Aboriginal and Torres Strait Islander people;
  • older people with dementia;
  • older people who usually reside interstate;
  • older people from overseas; and
  • existing recipients of residential or community aged care; and
• provide new information on
  • the referral and assessment/approval process for Transition Care, e.g.
    assessment and approval in a short stay unit of an Emergency Department, where appropriate;
  • movement of clients between care settings and services during the same Transition Care episode;
  • re-admission to hospital; and
  • accessing long-term residential or community aged care after  Transition Care.

If you have any questions about the Guidelines, please email: TCPfeedback@health.gov.au or call Elke Zimmemann on (02) 6289 8823.

Continuing Professional Education Credit for National Training Resources

Hooray! You can now claim continuing professional education (CPE) credit for completing National ACAT Training
Resources. Recognition of the National Resources has been obtained from the peak professional organisations
representing four of the six core delegate disciplines:

• Nursing – Royal College of Nursing, Australia
• Physiotherapy – Australian Physiotherapy Association
• Occupational Therapy – Occupational Therapy Australia
• Social Worker – Australian Association of Social Workers

Credit can be claimed for completing a training course after the approval dates of the courses as listed in the table
below. The number of hours that can be claimed is also listed in the table. Note that the Australian Association of Social Workers is offering double hour credit.

You may notice that the number of hours varies slightly between organisations. The hours were assigned by the peak professional body based on the information regarding the course training provided by Department of Health and Ageing.

Course	Professional Organisation	Approval Date	CPE Hours
Generic	APA	11/05/11	7
Assessor	APA	11/05/11	7
Manager	APA	11/05/11	5
Delegate	APA	11/05/11	9
Generic	AASW	14/02/11	2 x 7
Assessor	AASW	14/02/11	2 x 7
Manager	AASW	14/02/11	2 x 5
Delegate	AASW	14/02/11	2 x 9
Generic	OTA	10/02/11	6
Assessor	OTA	10/02/11	6
Manager	OTA	10/02/11	5
Delegate	OTA	10/02/11	6
Generic	RCNA	3/03/11	7
Assessor	RCNA	3/03/11	7
Manager	RCNA	3/03/11	5
Delegate	RCNA	3/03/11	9

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Separate Certificates of Completion are now available on ACAT Moodle for each of these peak professional organisations. Each certificate includes information as specified by the peak body. To download your certificate, click on the link identified for your peak professional body. Certificates will be printed with your name and the current date as evidence of completion. The generic Certificate of Completion is also still available.

For the remaining two core disciplines, psychologist and medical officer, the Psychology Board of Australia has advised that they do not certify CPE hours and it is the responsibility of the psychologist to appraise the quality of the activity and justify the hours claimed. An application for medical officers with the Royal College of General Practitioners is in progress.

What about the refresher courses you ask? Recognition of the refresher courses is next on the agenda. Stay tuned!

ACAT Delegation Processes

With the ACAT delegation round recently being signed by the Secretary of The Department of Health and Ageing (DoHA), May 2011, it’s a good opportunity to explain the process involved to   become an ACAT delegate in one of the 109 Aged Care Assessment Teams (ACATs) across Australia.

Each ACAT has a notable variation in its operation and practice.  This variation may reflect the diversity of health systems and local environments in which ACATs operate across each State or Territory. Notwithstanding the differences, core principles underpin the selection of ACAT delegates across Australia.

Particular ‘Powers’ given to the Secretary under the Aged Care Act 1997 are delegated to various position numbers across Australia, of which only one person can occupy at any one time. These positions are commonly known as ACAT delegates.

Each position number is unique and contains a code to distinguish the name of the ACAT, the profession of the Delegate and a suffix to distinguish between individual delegates. The individual delegate position numbers are important as they derive from a document called the Instrument of Delegation.

The Instrument of Delegation, completed as part of the ACAT delegation round, is a document that the Secretary of DoHA signs delegating certain powers to positions specified in the Instrument (ACAT delegate positions). Twice a year, the Department requests each State and Territory to
review the number of these delegate positions in consultation with each ACAT team leader and recommend positions that are no longer required or nominate new numbers that are required. The delegation rounds are not a review of a person occupying the position, but rather a review to identify the need for the creation of new positions or ones that have now become obsolete. This process is commonly known as the Delegation rounds, which happens twice a year in May and November.

To become, or continue to be an ACAT delegate, each person who holds a delegate position is required to meet the national selection criteria as outlined in the Aged Care Assessment Team Delegations Policy.

The selection criteria for ACAT delegates to meet consist of the following 5 criteria:

1. Employed 0.5 FTE* or greater on the ACAT program
2. an employee on the ACAT program for at least 12 months
3. routinely engaged in the full spectrum of the ACAT Work – including community assessments
4. one of the core disciplines for the ACAT (i.e. physiotherapist)
5. has successfully completed National Delegation Training.

* The 0.5 FTE criterion was also designed to ensure that delegates have enough time to attend
appropriate training and keep abreast of communication and changes.
(It is important to note that the Commonwealth does not require ACAT delegates to conduct any set number of ACAT assessments to obtain or maintain their ACAT delegation)

Once a person has been approved or nominated for a delegation position, delegates must follow the principles of delegation. These principles guide the ACATs actions in approving government subsidised aged care. 
The ACAT National Training Strategy outlines the requirements for the National Delegation Training. Further information is available at: the National Training Strategy link

Delegation and Assessment within the catchment area of the ACAT

Throughout Australia, each ACAT has a geographical region which they service to conduct assessments and approve aged care types/level for older frail Australians. This regional area is also identified in each ACAT delegate’s unique position identity number provided to each delegate through the Instrument of Delegation.

From time to time, the Department of Health and Ageing may specifically request an ACAT team to conduct an ACAT assessment out of their area, for example in the reviewable decision process. This process is however an exception to the standard operation as set out in the ACAP Guidelines ACATs are required to conduct ACAT assessments on clients if they fall within their state, region or catchment area at the time, regardless of a client’s permanent address.

Can Residential Respite Care be approved while in hospital

Residential Respite care can be approved while a person is in hospital if the person meets the eligibility criteria for at least low level residential care.

Residential respite care may be used on a planned or emergency basis to help with carer stress, illness, holidays, or the unavailability of the carer for any reason. An ACATs role is to assess a persons current care needs and approve for the type and level of care that a client is eligible for.

When a client is deemed eligible to receive residential respite care at high or low level, this approval of care does not lapse, but can expire if it is time limited.

Respite care can not be taken in a residential aged care facility if the person is already a resident of another facility.

Respite care is not intended for rehabilitation or convalescence following a post acute episode, unless there is a genuine respite element involved. Nor is it to be used as a waiting facility for people seeking a permanent bed. This does not mean that a person cannot be approved for respite care if they are in hospital at the time of assessment.

ACAT Assessment Eligibility

Older frail Australians have access to Government subsidised aged care if they meet the eligibility criteria outlined under the Aged Care Act 1997. There is no age cut off for these services. Individuals who have age related conditions and symptoms at any age can be eligible for aged care and an ACAT assessment should be conducted to determine their care needs and eligibility for services.

The aged care assessment program guidelines make reference to people over 70 years of age for Non Indigenous and over 50 years of age for Indigenous Australians is for planning purposes and does not limit people to accessing aged care if they do not fall within these age brackets. An ACAT can not refuse to accept a referral to conduct an assessment based solely on a person’s age.

Queensland ACAT Workshop 2011

Brisbane: 12th—13th April 2011 - ‘Reform, Rebuild, Recharge’

The Queensland Aged Care Assessment Program holds a workshop every two years. This year the workshop was held at the Royal Brisbane and Women’s Hospital Education Centre on the 12th and 13th April, 2011. The theme was ‘Reform, Rebuild, Recharge’.

There were 133 ACAT staff who attended the first day and 129 on the second day. The program reflected work undertaken in areas of service provision and quality activities by individual Aged Care Assessment Teams over the past 2 years. Other presentations were received from representatives from the Department of Health and Ageing, Older Peoples Health and Extended Care Unit and Specialist Clinicians addressing topics identified in a training needs analysis and feedback from the Queensland ACAT Workshop in 2009.

The Keynote Speaker was a Corporate Physician who proved that laughter is the best medicine. The aim was to make the session light hearted and to give staff a chance to find their inner smile.

There was a presentation by Dr Gerry Fitzgerald who spoke of Disaster Management and the Impact on Aged Care. This led onto a panel discussion around the recent Queensland disasters and the   impact on ACAT and the community. The panel included team leaders and their representatives.

Queensland ACAT Staff were presented with certificates for 10, 15, 20 years of service by the Director of the Older Peoples Health and Extended Care Unit. There were 11 ACAT teams who participated in posters this year with the theme of ‘Recharge’. The winners were RBH, Brisbane South and Gold Coast.

This year we organised a tour off campus at the end of the first day to LifeTec Queensland who is a provider of information, consultation, and education on assistive technology that can help individuals improve their quality of life and remain independent.

The workshop has been a very valuable education and networking opportunity for ACATs in Queensland which was reflected in the workshop evaluations. If you would like a copy of the agenda please email Jodie-Anne_Kairl@health.qld.gov.au
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Part 6 Changes to an ACCR

Part 6 of the Aged Care Client Record (ACCR) contains the approvals for care which have been authorised by the ACAT Delegate. From time to time, Delegates make mistakes in completing Part 6 of the ACCR.  When this happens, corrections may only be approved by the Department of Health and Ageing (DoHA), and the ACAT Delegate must request that correction.

Detailed instructions on how the request to correct Part 6 of the ACCR are included in the ACCR User Guide – December 2010, available at www.health.gov.au/acats. Delegates who need to request a correction should review the ACCR User Guide to ensure that the process proceeds smoothly.
Delegates who need to request a correction should review the ACCR User Guide to ensure that the process proceeds smoothly.

DoHA has recently reviewed the Part 6 changes which have been requested during 2010-11 in states and territories which use the eACCR process. There were 129 requests to the end of April 2011. Of these, 120 were approved and 9 were rejected.  In 3 instances where the requests were rejected, the matters were referred to the appropriate state to be addressed through an own
motion reconsideration process.

Some of the common errors which occur in Part 6 can be avoided by Delegates taking time to ensure that the correct approval is ticked prior to transmitting the eACCR to Medicare Australia.  Many errors occur when permanent residential care is approved instead of residential respite, and when residential respite care is approved instead of permanent residential care.  Delegates should check to ensure that the correct type of care is ticked on every occasion. Although this may take a few moments of time for a busy Delegate, much more time will be lost for the Delegate and for DoHA staff in correcting any errors that are made and more importantly may adversely impact on the client.

Another error which occurs at times involves the Delegate omitting to approve emergency care when a client has entered care without an approval. Emergency care is the only circumstance where the date of effect of an approval is different to the delegation date. When a Service Provider has accepted a client in an emergency and the ACAT receives an Application for Approval within five business days, and the Delegate is satisfied that the person urgently needed care, then the Delegate should enter the date the care started in the emergency approval area of Part 6, and the actual delegation date in its usual place. The delegation date should not be backdated to the date the care started. Section 22-5 of the Aged Care Act 1997 is relevant to this. If the ACAT Delegate has forgotten to give the emergency approval, the DoHA Delegate will need to see the ACCR Application Form, showing the service provider’s signature, the date care started and evidence that the Application Form was received by the ACAT within five business days.

At times, a Part 6 correction request is received which seeks to change the date of an approval.  Such a request can only be approved if the DoHA Delegate sights the paper ACCR on which delegation took placeshowing the Delegate’s signature and the earlier delegation date.  Some requests have been received where the paper ACCR has not been completed, but it appears the assessor has assured a Service Provider that a particular approval will be given at the time of the assessment.  The Service Provider can then act as though there is an approval in place from the date of the assessment, but the Delegate does not give an approval until one or more days have passed. This does not justify a Part 6 change to backdate an approval. In fact, that change would be a breach of Section 22-5 of the Aged Care Act 1997.

Residential Respite – 21 Day Extensions

Residential Respite Care is one of the types of care which requires approval by an ACAT Delegate, with an option to limit the care to a low level of care. A client can access up to 63 days of residential respite in a financial year. An ACAT Delegate may approve an extension of residential respite care by 21 days if he or she considers it is necessary, and may approve more than one extension.

The approval of a 21 day extension of residential respite care is given on a paper titled “Residential Respite Extension Form – 21 Day Extension.” The current version of the Form is 2670 (0709). Copies of the Form are available from Medicare Australia. Every ACAT should ensure that it has adequate supplies of the Form.

The Form includes the following instructions:

The Residential Respite Extension Form – 21 Day Extension

This Form is to be used by Aged Care Assessment Team (ACAT) members only to extend existing residential respite care approvals.

• There is no provision to backdate a 21 day extension so the extension must be granted prior to a person commencing additional residential respite care.
• An extension may be granted an indefinite number of times, provided the original ACAT approval is still valid. The 21 day extension form must be completed each time an extension is required.
• When extending residential respite care, the justification should be based on circumstances such as carer stress, a temporary or unexpected increase in the severity of a care recipient's condition, absence of the carer, or in other cases where ACATs consider it appropriate for respite to be extended.
• Consideration should be given to the care recipient’s needs, abilities and wishes, access to, and use of, appropriate community and social supports.
• In extending residential respite care, delegates must consider the appropriateness of continued respite care arrangements or whether permanent residential care may be a more suitable option.
• Any extension must be at the same level of care as approved on the Aged Care Client Record. If an approval is limited to a low level of residential respite care and the person now requires high level residential respite care, reassessment and approval by an ACAT is required.

ACATs should take particular notice of the second dot point. A 21 day extension cannot be backdated, therefore the extension must be granted prior to the commencement of the additional care. If a Service Provider has provided care beyond the client’s current approval, the ACAT is not able to give a backdated extension. Any request to do so should be refused by the ACAT.

Where an ACAT is uncertain about any aspect of approving a 21 day extension, they should consult their state or territory office of the Department of Health and Ageing.

Moodle Tip

Annoyed by the sunglass-wearing yellow smiley face in Moodle?

Free yourself of the dreaded smiley by personalising your profile.

Go to your profile page, click on “edit profile”, scroll down to “picture of”, load your picture in the “New picture” block and enter your picture description in the next block.

Scroll to the bottom of the page and click on “Update profile”.

Your picture will now replace the smiley throughout your Moodle activities.

In Memory of Jenny Hannan

It is with great sadness we advise that our ACAP Section colleague, Jenny Hannan, passed away 23 June 2011 after a long battle with illness. Jenny was a valuable member of the ACAP team for many years and despite recent obvious physical discomfort, continued to work until only a couple of weeks prior to her death.

You would have had contact with Jenny via email and possibly met Jenny in person at the ACAP 2010 National Conference. Jenny was excited to attend her first conference in Melbourne last year, even though she could only attend for one day.

Apart from supporting the entire ACAP Section in so many ways, Jenny was our finance and budget expert and in more recent times, compiled ACAT Chat. This activity provided Jenny with a great deal of personal satisfaction. I encourage you to appreciate the collage of photos from the 2010 ACAP Conference that Jenny included in the Volume 30 edition, an edition that Jenny was
particularly proud of, and together with other editions of ACAT Chat form a lasting tribute to her flair and creativity. Follow this link: ACAT Chat - Vol 30 - November 2010

Jenny loved the colour purple and often included it in the clothes she wore and the jewellery she made. Jenny was also a great supporter of the pink ribbon national breast cancer foundation, and we encourage you to join us in continuing that support.

The next pink ribbon day is being held on Monday 24th October 2011.
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