The Aged Care Reforms give priority to providing more support and care in the home, better access to residential care, more support for those with dementia and strengthening the aged care workforce. The reforms are being progressively implemented to give early benefits to consumers and providers but also to ensure there is a smooth transition and sufficient time to adapt and plan ahead for further reforms.

The fourth and fifth edition of the Aged Care Reform Update includes information on:

Aged Care Approvals Round;
Advice from the Aged Care Financing Authority;
Proposed Legislative Changes;
The National Lesbian, Gay, Bisexual, Transgender and Intersex Ageing and Aged Care Strategy;
The National Ageing and Aged Care Strategy for people from Culturally and Linguistically Diverse backgrounds;
Update on Home Care Packages and Consumer Directed Care.

For further information and Aged Care Reform updates are available at the www.Living Longer Living Better website
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Culturally and Linguistically Diverse Aged Care Strategy

On 20 December 2012 Minister Butler launched the Culturally and Linguistically Diverse (CALD) Aged Care Strategy. The CALD strategy is a part of the Older Australians from Diverse Backgrounds stream of the Living Longer Living Better Aged Care Reform package.

Some older Australians with diverse needs find it difficult to access aged care information and services that are sensitive to their backgrounds and circumstances. The Government recognises the importance of strong stakeholder engagement throughout the process of developing the strategy.

Currently consultations are taking place with groups representing people with diverse needs to assess the necessity for the development of further tools and strategies to support their needs in aged care.

The draft National Aged Care Strategy for people from CALD backgrounds is now available at the www.Living Longer Living Better website
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The Assessment Framework and Tool for Aged Care Project

As part of the Living Longer Living Better aged care reform announcement, the Australian Government’s response to Productivity Commission’s Report Caring for Older Australians outlined key components of the Aged Care Gateway, including the: ‘development of a national assessment framework for aged care, in consultation with consumers, health professionals and aged care providers. This work will include developing and testing standardised assessment processes for entry into the new Commonwealth Home Support program and comprehensive assessments for entry into home care packages or residential care. This will position the Gateway to assess people more consistently so that people with similar needs are able to access similar aged care services across the country’.

The Department of Health and Ageing has been working with the Centre for Health Service Development (CHSD), University of Wollongong, and an Expert Clinical Reference Group including ACAT membership; to develop, validate and trial an Assessment Framework and Tool for Aged Care. Both the Department and CHSD have consulted with key stakeholders such as Aged and Community Care Officials and the National Aged Care Alliance throughout this process, and many recommendations have been incorporated into the Assessment Framework and Tool.

CHSD has proposed an integrated model of assessment which will enable clients to transition smoothly along the assessment continuum.

Level 1: The first level of assessment determines a client’s functional ability and assesses whether the client has more complex issues that need to be addressed. From here the client can be referred to aged care services, proceed to a Level 2 assessment or, where necessary be fast tracked to Level 3.

Level 2: Building on the Level 1 assessment further questions are used to explore complex issues such as existing health conditions, financial and legal status and carer status. From here the client can be referred to aged care services or continue to a Level 3 comprehensive assessment.

Level 3: A comprehensive face-to-face assessment undertaken by a qualified health professional to determine a client’s eligibility for Australian Government-subsided home care packages, transition care, residential permanent or respite care.

CHSD will soon move into a trial phase which will see the validation of the Assessment Framework and Tool. The Department wrote to Aged and Community Care Officials seeking expressions of interest in being involved in this next phase of work. As a result, it is likely that trials will occur in New South Wales, Victoria, South Australia and Tasmania.

The aim of the trial is to:

Validate the items, triggers and algorithms in the Assessment Tool, to align Level 1 and Level 2 assessment with Level 3 Comprehensive assessment;
Review and refine triggers and indicators for phone vs face-to-face assessment at Level 1 and Level 2 to ensure the suitability of the mode of assessment;
Test assessment pathways for all clients, including special needs groups and carers;
Further develop and test the client classification matrix including urgency/priority rating and re-ablement potential;
Develop a user guide and training materials; and train field trial assessors in the application of the Assessment Framework and use of the Tool; and
Develop and test assessor competencies for each level of assessment.

Following completion of the field trials, the Department will review the Assessment Framework and Tool and consider if further refinements are necessary, especially for undertaking assessment of people from special needs groups and pathways for carer assessment.

This project will assist in informing the staged implementation of assessment into the Aged Care Gateway and training of assessors from early 2014.

The Department will continue to inform ACATs on the progress of this project through ACAT Chat.
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Aged Care Gateway

In 2012 the Australian Government committed to deliver an Aged Care Gateway to assist people to navigate the aged care system. It will create an identifiable entry point to the aged care system comprising several key elements:

A national contact centre and the My Aged Care website;
An assessment capability to identify needs based upon a national assessment framework;
A linking service capability, targeting vulnerable people with multiple needs; and
A central client record.

The new My Aged Care website will be established by 1 July 2013 to provide clear and reliable information. A national contact centre will improve the timeliness and consistency of information provided. The My Aged Care website and contact centre will, over time, build to provide a comprehensive system of information enabling Australians to find the aged care services they need.

Healthdirect Australia has been engaged by the Department of Health and Ageing to develop the My Aged Care website and manage a contact centre supplier.

From 1 July 2013 a contact record will be created for clients who contact the Gateway. Initially the contact record will focus on interactions with the contact centre, however this capability will be built on over time to be a comprehensive client record.

The national assessment framework and the linking service will be introduced from March and April 2014 respectively.
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Residential Aged Care (RAC) Hub

In October 2012 Noeline Brown, Australia’s Ambassador for Ageing, launched a new information resource, the Residential Aged Care (RAC) Hub. The Hon Mark Butler MP, noted that ‘the RAC Hub extends the resources available on the CareSearch website by providing peer-reviewed, evidence-based palliative care information relevant to the residential aged care setting’.

The RAC Hub is an online tool, regularly updated to reflect new research and is accessible to anyone with a computer and the internet and is free

Staff and residents in aged care facilities now have access to high quality online palliative care information to support end-of-life care in residential aged care facilities. Ms Brown stated that ‘supporting compassionate end-of-life care for older Australians living in residential aged care is an important part of ensuring that they have the best quality of life until death’.

The RAC Hub can be found on the CareSearch website
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Changes made to Aged Care Online Claiming

Aged Care Online Claiming (ACOC) is a fast and secure solution that allows you to easily transmit Aged Care Client Records (ACCR) electronically to the Department of Human Services (Human Services). ACOC also provides the ability to search for and view electronic Aged Care Client Records online.

Human Services is committed to continually improving online claiming. As a result, Human Services recently made changes to the ACOC system to enhance the ACCR search functionality within ACOC. ACAT’s can now search for an ACCR electronically using either a Medicare card number or a DVA file number.

It is imperative that the ACAT verifies the care recipient’s name at the time of assessment i.e. records the name exactly as it appears on the DVA or Medicare card when submitting an ACCR. The use of other preferred names or aliases will result in the duplicate records being created for the care recipient.

If an exact match cannot be found when an ACAT or Service conducts an ACCR search within ACOC, the ACOC system will return the Care Recipient search results page stating “No record was found matching the search details entered”.

For further information go to the Department of Human Services Website
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Dementia Care, Putting New Developments into Practice

Much can be done right now to improve the lives of those living with dementia by putting new developments in dementia care into practice, according to NSW/ACT Dementia Training Study Centre (DTSC) Director Professor Richard Fleming.

The NSW/ACT DTSC and the Dementia Collaborative Research Centres present regular knowledge transfer events around Australia to inform health professionals and aged care service providers about developments in the care of people with dementia.

Prof. Fleming said the one-day interactive workshops and presentations are designed to equip participants with the knowledge and resources to put these developments into practice.

‘As well as enhancing their knowledge and skills in dementia care, it is also an opportunity for participants to connect with other dementia care professionals and share their ideas on the direction research should take,’ he said.

The workshops are led by researchers from Australia’s Dementia Collaborative Research Centres who are actively researching in the areas of dementia care, so the information provided is the most up to date. There are also presentations by local speakers. Past workshop topics have included: the use of humour therapy to improve the lives of people living with dementia; preventing and managing behavioural and psychological symptoms of dementia; environmental design; younger onset dementia; and pain management.

The next workshops will be held in Perth on 18 April and Adelaide on 13 June 2013.

Visit the Dementia Training Study Centre website for more information.
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Dementia Training Study Centres

As the prevalence of dementia increases worldwide, health professionals from all disciplines will play a key role in responding to the ongoing impact of dementia.

Funded by the Australian Government, the Dementia Training Study Centres respond to the learning and education needs of health professionals from different disciplines throughout Australia, with the goal to enhance the knowledge and skills base of the current and future dementia care workforce, creating a nationally cohesive approach to dementia care.

The Dementia Training Study Centres transfer contemporary knowledge about dementia into practical, effective approaches to helping people with dementia and their families. The five Dementia Training Study Centres place the collective vision of high quality care for people with dementia at the centre of all activities.

The transfer of contemporary knowledge is achieved though a number of activities. Education and training events are held across Australia through the five Dementia Training Study Centres and include a dedicated range of courses, workshops, seminars, scholarships, support, and undergraduate and postgraduate curriculum development.

The national Dementia Training Study Centres website is not only a way to connect to upcoming events; it is also an online learning facility that includes recordings of guest seminars, specifically developed resources, and online learning modules for professional development in areas of dementia care. For information about opportunities near you, online learning resources, and more information about the Dementia Training Study Centres, visit the Dementia Training Study Centre website.

In addition to education and training, the NSW/ACT Dementia Training Study Centre launched the Australian Journal of Dementia Care (AJDC) in May 2012. The AJDC is Australia’s first and only multidisciplinary journal for all professional staff and community carers of people living with dementia, sharing with readers news and views, research, practice and training issues from Australia and around the world. ADJC subscription, editorial and advertising details are available at the Australian Journal of Dementia Care website.
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Correctional Facility, Parole Clients and Forensic Patients

ACAT assessments may be conducted for prisoners who have recently been or are to be released into the community. While prisoners, people on parole and forensic patients may be eligible for assessment and approval of care, ACATs will also consider any impact on staff and clients of residential aged care facilities and community services when undertaking these assessments.

There are some ACATs who regularly receive referrals for assessment from correctional facilities, so other teams may learn from the experience of those teams.

Please refer to your state or territory’s ACAP protocol and procedures for more details on the assessment of people in custody.
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Older Prisoners and the Aged Care Assessment Program in Victoria - two sides to a story

Donna Petrusma, Corrections Victoria
Debbie Senior, Department of Health Victoria

Aged Care Assessment Service (ACAS) spend a lot of time on screening referrals to make sure it is safe for staff to visit people requiring assessment. One cohort of people that create a lot of anxiety for ACAS staff is prisoners and offenders; in prison, sentenced and on remand, and those on parole.

Corrections Victoria is working to address these concerns and similar issues relating to ageing prisoners and offenders in Victoria. Donna Petrusma, Senior Program Officer, from Corrections Victoria is working on a variety of projects to improve programs and processes for assessing this group. Donna has attended one of the ACAS manager meetings to talk about some of the issues for ACAS staff and staff employed in the justice/health system.

National and international research suggests that 50 years and older is an appropriate range for defining ‘older’ prisoners. This is based on evidence that the ageing process may accelerate by 10 years for this cohort because of factors including poor health due to lifestyle, lack of medical care before incarceration, substance misuse and the escalation of age-related illnesses and conditions in a prison environment. As of October 2012, 751 prisoners in Victoria were over the age 50 (14.9% of the prison population). 136 prisoners were aged 65 years or older (of which 6 were women). The most serious offence types vary for this groupwith 42% serving a sentence for sex offences, 17.6% for homicide and 15.4% for drug offences.

There are significant challenges associated with caring for older prisoners who require age related support. These include access to the bottom bunk in shared cells, temperature regulation in accommodation units, sound levels, level pathways and access to programs that promote active ageing.

The Victoria and Tasmania Dementia Training Study Centre at La Trobe University recently granted Corrections Victoria a six-month Fellowship to focus on Dementia in Prison. One key discovery from this project was the ‘masking’ of symptoms of dementia. In prisons the highly structured prison environment ensures that prisoners complete tasks that are associated with activities of daily living – eating, sleeping, cleaning, working and taking medication. For some older prisoners who struggle with these tasks, there are often other prisoners to assist. It isn’t until a prisoner with dementia demonstrates significant decline that it comes to the attention of others.

For Corrections Victoria, there are challenges associated with planning for the transition of these offenders back into the community. In some circumstances, a case-worker planning for an older prisoner’s transition may need to make a referral to ACAS. Currently, there is little understanding about the ACAS process and the broader aged care system.

For ACAS, there are challenges associated with undertaking the assessment including the ability to get the Application for Approval signed. The prison environment can also be confronting for some staff, and challenge them emotionally with regard to undertaking assessments of sex offenders. Additionally, some ACAS may be concerned about a sex offender accessing residential care and the possible implications for other residents and visitors.

Many of the challenges associated with the care and management of older prisoners are experienced in other states across Australia and across the world. There is an increasing body of research from Australia, the UK and USA exploring issues and responses for this cohort and systemic approaches to improve outcomes for the individual and the community.

Improving relationships between Corrections Victoria and the aged care sector is key to addressing these challenges. Corrections Victoria has been working to establish relationships with service providers like Wintringham Specialist Aged Care who provide accommodation and packaged care for elderly men and women at risk of homelessness.

The next step is to strengthen relationships with other relevant stakeholders to provide information and training to support them to meet the care and service needs for this group. Donna or Debbie can keep you updated on how this progresses.

For further information please visit Department of Justice Victoria Australia ‘Growing Old in Prison - A Review of National and International Research on Ageing Offenders’ Corrections Research Paper Series. If you have any questions or comments regarding the care and service needs of older prisoners, please contact Donna Petrusma at Corrections Victoria on (03) 8684 6647 or Debbie Senior at Department of Health Victoria on (03) 9096 7583.
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My Journey into Squalor and Hoarding issues

Frances Taylor CN, Bayside ACAT, QLD

My interest with squalor and hoarding was not high, but like all health care workers, I was aware of the issue and dealt with it on a ‘case by case’ basis. It was at my PAD (Performance and Development) review that I expressed an interest in social issues that affect our clients. My Manager, Monica Barrett, suggested that I look into the issue of squalor and hoarding.

At first it was very frustrating as there was no easy contact numbers to just phone up and talk about squalor. The issue is apparent for all services and all cases are dealt with as a ‘case by case’ basis, but there is no formal pathway to follow for hoarding and squalor issues.

I looked on the computer with no joy. The people who know me will not find this a big surprise. Someone suggested that the librarian at Redlands Hospital may be able to help. So, off went the email highlighting my case to search for information on the topic of squalor and hoarding.

I had made the decision not to re-invent the wheel, instead to read and learn about what was out there. This all started approximately four years ago before the TV program, “Hoarding Program” was broadcast.

Within the week, the librarian had found articles from various Medical Journals on the topic. I found it fascinating reading.

Hoarding and squalor is a global problem and affects more people than you realise. The cost in human terms is difficult to measure, but the social cost and financial cost are incredible.

From the articles it became apparent that Prof. John Snowden and Dr Graham Halliday are leading the research and are experts in this field.

From reading the articles, one of the issues identified with squalor and hoarding is the individual measure of squalor i.e. is it untidy, or is it dusty? How do we have a way to measure level of cleanliness?

A team from the Liverpool district in NSW arranged a vast array of agencies to meet together and identify what squalor and hoarding affected, how they do business, who they referred to, and how they address the issue. Through this information and joint research, the Liverpool team came up with a scale/tool to measure degrees of squalor. The environmental cleanliness and clutter scale was devised so that any level of carer/worker/professional can all use the tool to identify the level of squalor.

Having found this tool, I thought that ACAT could also utilise it. I set about the task of framing this tool and with the help of my Manager to progress this through Queensland Health to have it formatted to draft.

Then we needed a pathway. Loretta Armitage SW EMP gave me her work on the pathway and with the help of Susie Morton SW and Loretta Allen NUM, Bayside we formalised a pathway.

Along my journey to this outcome, in February 2012 there was the 2nd Conference on Squalor and Hoarding in Sydney – I thought all my Christmases had come at once.

With the support of the Age Care Manager, I was sent to Sydney.

I had contacted the group who organised the conference, Catholic Community Services, and had great conversations with them. They invited Susie Morton and me to come and spend some additional time with them.

It was fantastic and they were so generous with time/information and support. I met Prof. John Snowden who was there to do Case Conference with the Mercy team leader and four of their field workers. They were generous and patient with their time, explaining what they do, how they do it and why. They were very customer focused and expressed that it was imperative you get the client to trust you. Even this process takes time.

That there is no ‘quick fix’ to this work clearing out, i.e. an industrial clean is not the solution. The client has to be involved together with their workers, and piece by piece their treasures or clutter has to be negotiated out of the home.

The two day conference was interesting with all speakers being leaders in the field. When there was open discussion at the conference, it became apparent there were members of the audience who have clients with this issue, so the debate was from all aspects and from differing points of view. However, I am still researching and working towards understanding of the subject.

The goal of the conference, from those who are experts/researchers in this field, was to get this subject identified as its own ‘health issue’ under mental health diagnosis.

Late last year Brisbane City Council and Centacare had its 1st Squalor and Hoarding forum. It was an informative two days, and again, Prof. Snowden and Dr Halliday were the key note speakers. It is believed that Squalor and Hoarding will be given its own diagnosis under DMT (Diagnostic and Statistical Manual of Mental Disorders). With this it can then be a formal diagnosis, allowing for research investment into finding out why and most importantly, how best to treat this condition. It is believed that the most of this condition is related to the frontal lobe of the brain. The frontal lobe of the brain contains most of the dopamine – sensitive neurons with the cerebral cortex. The dopamine system is associated with reward, attention, short term memory tasks, planning and motivation.

The executive functions of the frontal lobe involves the ability to recognise future consequences resulting from current actions, to choose between good and bad actions, override and suppress unacceptable social responses, and determine similarities and differences between things or events. Therefore it is involved with higher mental functions.

The frontal lobe also plays an important part in determining long term memories which are not task based. These are often memories associated with emotions derived from input from the brain’s lumbic system. The frontal lobe modifies these emotions to generally fit socially acceptable norms.

My Ongoing Journey -

From a local level, I am satisfied that a pathway and evaluation tool has been developed to measure squalor. On a global level, I am interested in following the outcome of hoarding and squalor being recognised as a formal medical diagnosis, so that funding can:

assist with research;
target the cause of this issue; and
directly increase services to assist clients and their families to address this issue.

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Template Letters for Approval of Care

Templates for letters to advise the approval or non-approval of care are designed to assist with consistency across all ACATs, ensuring people receive appropriate information under the Aged Care Act 1997. Minor adjustments are seldom made, however it is a requirement that any significant adjustment is approved by the DoHA.

If changes to the letter have been made, the decision may not be valid due to the letter not following the criteria set out in the Aged Care Act 1997. For example, if the letter states the name of a specific aged care provider, rather than a ‘care provider by an aged care service of a particular kind’.

Changes made to the template letters without DoHA approval may raise a number of serious concerns:

A client could interpret the letter to mean approval of care is restricted to one provider;
Whether there is an actual or perceived conflict of interest in the ACAT delegate making the decision; and
Whether other approved providers have a claim for defective administration against the delegate. For example, if the care recipient did not take up a place with a provider because they believed the approval was limited to receiving care from the approved provider specified in the letter.

For further information please email ACAP Policy Operations at DoHA.
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ACAT National Training Website

Screen shot of the ACAT National Training System welcome page, with the Library menu circled

The upgraded ACAT eLearning website has now over 1100 registered users and this number is growing every day.

The Department continues to undertake significant work to improve the website, including the development of an ACAT Student Management System which will:
simplify the enrolment process; and
generate more detailed reports on student data for all users.

It is anticipated the new Student Management System will be launched in late March 2013.

Other improvements to the website include a new 'Library' section, as indicated on the front page of the website. If you click on the Library button, you will have a direct link to all the ACAT training workbooks and resources. The Library is designed to provide you with a quick and easy reference source which can be used at any time.

Finally, a new course is currently being developed to keep you informed about the upcoming aged care reforms. To access this information and associated training resources, just click on the button titled 'New Reforms'. This information will be constantly reviewed and updated to ensure currency. All ACAT members are encouraged to access this new course and undertake the training exercises.

screen shot of New Reforms link circled.

screen shot of New Reforms link circled.

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National Training - The Victorian Model

Vicky Stewart, Victorian AEO

Since the first pilot of the national ACAT training resources in 2007 Victoria has continued to deliver face to face orientation and delegation training. Training is delivered by two ACAT Education Officers (AEOs) who are experienced ACAT clinicians. This training model allows clinicians to share their experience, be given consistent messages and to understand they are part of a national program.

Since the re-launch of the ACAT Training website, training is now being delivered in computer rooms in the Victoria Department of Health. Participants register on the ACAT training site prior to attending training and we have found about 18 people in each class is ideal. We offer four orientation sessions and at least two delegation training sessions a year.

The National Training web-site slides are projected onto a screen and participants follow each section on line. Case studies are discussed as a group and then submitted. The knowledge assessment is conducted individually at the end of the day.

Recently we have been asked by two teams to deliver delegation training to their whole team. One was a rural team, the other metro. This is part of the feedback we received from one manager:

“I have received a lot of feedback from staff who are very grateful for the training you provided on delegation. Some comments have been that the training has provided a clear guide around what is meant by personal care and that the notion of approvals is to consider all aspects of a person’s life and that ability in some areas does not necessarily preclude them from accessing Commonwealth types of care”.
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Ordering Resources

5 Steps to Entry into Residential Aged Care and the Assets Assessment Kits

Many ACATs distribute the 5 Steps to Entry into Residential Aged Care and the Assets Assessment Kits.

There are new ordering limits as these items are stored at National Mailing and Marketing in batches of 15, the order limits have been updated to reflect multiples of 15.

Please be aware of the new ordering limits for the 5 Steps to Entry into Residential Aged Care and the Assets Assessment Kits:

All in multiples of 15

Individuals 1
Homes & Centrelink 15 (1 Carton)
Hospitals 60 (4 Cartons)
CRCCs 105 (7 Cartons)
ACATs 210 (14 Cartons)

To place an order please contact National Mail and Marketing on;

(02) 6269 1000
Email National Mail and Marketing

PO Box 7077, CANBERRA BC ACT 2610
11 Tralee Street, HUME ACT 2620

National Mail and Marketing website
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Updates and Contact Details

Delegate Notifications

It is important that any changes to people occupying ACAT Delegate positions are notified to the Department of Health and Ageing as soon as is practicable. Once the ACAT Manager has verified the changes, the State or Territory Government officer confirms the request for changes and submits to the Department. Delays in advising changes to the Department can cause delays in processing resignations, new delegate documentation, or ordering of ikeys.

State and Territory Government contacts please continue to email delegate changes to ACAP Policy Operations

Please Note: ACAT Delegates have been appointed by the Secretary of the Department of Health and Ageing, and are responsible to ensure that the ACAT member has conducted the assessment in accordance with the Aged Care Act 1997.

Seeking ACAT CHAT Articles and Feedback

ACAT CHAT provides updates on the Aged Care Assessment Program from a national perspective. We encourage readers to share information of interest from their local area. A variety of articles gives ACATs opportunities to learn more about initiatives across the country.

We welcome feedback, contributions and suggestions for articles and improvements.
Please forward any contributions to ACATS

Contact us

General enquiries about aged care: Phone: 1800 200 422
Aged Care Australia website

ACAT specific information: Website

Medicare Aged Care Online Claiming: Helpdesk:1800 195 206
Medicare Australia website
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Help with accessing large documents

When accessing large documents (over 500 KB in size), it is recommended that the following procedure be used:

Click the link with the RIGHT mouse button
Choose "Save Target As.../Save Link As..." depending on your browser
Select an appropriate folder on a local drive to place the downloaded file

Attempting to open large documents within the browser window (by left-clicking) may inhibit your ability to continue browsing while the document is opening and/or lead to system problems.

Help with accessing PDF documents

To view PDF (Portable Document Format) documents, you will need to have a PDF reader installed on your computer. A number of PDF readers are available through the Australian Government Information Management Office (AGIMO) Web Guide website.

ACAT Chat - March 2013

In this section:

Welcome to the ACAT Chat

In this issue

The Australian Government Aged Care Reform Package Update