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Aged Care Essentials - January 2010

The January 2010 edition of Aged Care Essentials is designed for approved providers and the staff of Australian Government-subsidised residential aged care services. It carries news and announcements about residential aged care services, as well as information about current rates for subsidies, supplements and charges.

You may download this document in PDF format;

PDF printable version of Aged Care Essentials January 2010 (PDF 390 KB)

If you would like a hard copy sent to you in the post; or if you would like to go on the mailing list to receive the newsletter via email (PDF format) email agedcare_essentials@health.gov.au

Addenda to page 5:

The Maximum permissible interest rate for accommodation bond agreements:

• for all new residents from 1 October - 31 December 2009 is 7.30%; and
• for all new residents from 1 January - 31 March 2010 is 7.95%.

New Application Form for Approval to Provide Care

The Aged Care Act 1997 (the Act) and Approved Provider Principles 1997 (the Principles) set out the requirements for applicants seeking to be approved as providers of Australian Government-subsidised aged care through residential, community or flexible care services.

Amendments to the Act made through the Aged Care Amendment (2008 Measures No.2) Act 2008 came into effect on 1 January 2009.

These amendments provide greater certainty for care recipients and providers about their respective rights, obligations and protections.

Following the introduction of these amendments, the Department reviewed the application form for approval to provide aged care and the supporting guidelines, to ensure that both documents were user friendly and reflected the legislative amendments to the Act.

In conducting this review the Department consulted representatives of the aged care sector - Aged and Community Services Australia, Aged Care Association Australia, Baptist Community Services and Catholic Health Australia—through the Ageing Consultative Committee.

Their feedback, and the feedback of stakeholders within the Department, was used to develop the revised application form and supporting guidelines.

The questions in the revised application form are more closely aligned to the matters the Secretary of the Department must consider when assessing the suitability of an applicant to provide aged care against the Act and Principles.

The questions are also more structured and focused to provide applicants and their proposed key personnel with the greatest possible opportunity to demonstrate their suitability and experience to provide aged care under the Act.

The supporting guidelines have also been revised to ensure they complement the application form. The revised application form (Application for Approval to Provide Aged Care) and supporting guidelines (Guidelines for Applicants Seeking Approval to Provide Aged Care) were released in November 2009 and are available at www.health.gov.au/internet/main/publishing.nsf/Content/ageing-approvedp-index.htm

For more information about the approved provider program, the application form or the supporting guidelines, or to provide feedback on the revised documents email ApprovedProviderProgram@health.gov.au

2009 Budget Changes - Measures to Support Older Australians

28 Day Income Tested Fee Exemption Ends January 2010

From 1 January 2010, residents who have the means to pay an income tested fee will be asked to pay this fee from the first day that they receive care in a Government subsidised residential aged care facility.

Currently, people entering a residential aged care facility are exempt from paying income tested fees for the first 28 days (inclusive of pre-entry leave). This was introduced to allow for a new resident’s income test assessment to be completed.

However, for the majority of new residents, these details are now available from the day of entry.

From 1 January 2010 provisional fees no longer apply and there will be no provisional income tested subsidy reduction for new residents prior to determination of their income tested fee.

If the information needed to complete a resident’s income assessment is not available on their day of entry, from 1 January 2010 they can be asked to pay an interim fee. This fee will then be adjusted when the necessary information is available.

To assist providers in setting an appropriate amount for an interim fee, the current medians for income tested fees are approximately $4 for pensioners and $25 for self funded retirees. These figures are only a guide, and the decision on whether an interim fee is to be paid and the amount of that fee, is a matter to be agreed between the resident and the provider.

This measure brings the income tested fee into line with all other aged care fees, which residents pay from their day of entry or pre-entry commencement date.

The measure only affects residents who enter care or commence pre-entry leave on or after 1 January 2010 and who have the means to pay an income tested fee. No existing residents will be affected and the rate of the income tested fee will not change as a result of the measure.

The end to the 28 day exemption was one of several changes to aged care fees contained in the 2009 Budget. Top of page

Changes to the ACFI Definition of High Care

From 1 January 2010, the definition for high care under the Aged Care Funding Instrument (ACFI) will be changed to make it much more like it was before the ACFI was introduced.

An unintended consequence of the ACFI is that some residents who would have previously been appraised by providers as low care are now being appraised as high care.

Subsidies have increased for many such residents, which is a positive and intended outcome. However, in some cases it has resulted in aged care homes having to provide specified care and services that they are not equipped to provide and which their residents do not need.

This anomaly has also increased the level of misalignment between ACAT assessments and ACFI appraisals by providers, increasing the need for ACAT reassessments and leading to an increase in the proportion of residents classified and paid at the default Interim Low rate (currently $44.98 per day). These are residents who have an ACAT approval limited to low care but are appraised by the provider in a high ACFI care category.

In the May 2009 Budget, the Government announced action to address this anomaly in the new arrangements by modifying the definition of high care. Extensive consultations have been held with consumers, providers and health professionals through the ACFI Technical Reference Group, the ACFI
Industry Reference Group and the Ageing Consultative Committee. The proposed approach has been endorsed by each of these committees.

What will the new definition look like?

Under the current definition, to be appraised under the ACFI as a high care, the resident must have a score of:

• medium or high in the activities of daily living (ADL) domain
• high in the behaviour domain
• medium or high in complex health care (CHC) domain.

Under the new definition that has been developed, to be appraised as high care, the resident must have:

• a score of high in the ADL domain
• a score of high in the CHC domain of high in the behaviour domain together with a score above nil in at least one of the ADL or CHC domains
• a score of medium or high in at least two of the three domains.

What effect will this change have on funding?

There will be no effect on the level of subsidies provided for different ACFI categories.

The only thing that is changing is the categorisation of residents into low and high, which will be much the same as it was before the ACFI was introduced.

As a result, some ACFI categories will shift from high to low care, which will reduce the proportion of residents funded at the Interim Low rate.

How will this change effect residents currently in care?

Grand-parenting arrangements will be put in place to ensure that existing residents do not face an increase in their care costs, while at the same time ensuring aged care homes are not required to provide unnecessary services such as ongoing nursing care, where residents do not have a need for these services.

The change to the definition for high care under the Aged Care Funding Instrument (ACFI) was one of several changes contained in the 2009 Budget.

For more information go to www.health.gov.au/acfi, contact the Aged Care Information Line, Ph 1800 500 853 or email acfi@health.gov.au

Boost to Rural and Remote Services with Increase to Viability Supplement

The viability supplement paid to eligible residential care providers for care provided in a residential setting in Multi-purpose Services and Aboriginal and Torres Strait Islander Flexible Aged Care Services will increase from 1 January 2010. The increase will apply to those services eligible to receive viability supplement through the 2005 viability supplement scheme.

The supplement is paid to eligible aged care services in rural and remote areas, in recognition of the higher costs of delivering care in those regions.

As a result of this increase, the average viability supplement will increase by more than 40 per cent in real terms over two years—ie, an increase from $3.43 per person per day in 2008–09 to an estimated $5.12 in 2010–11. The increased supplement will be paid for more than 15,000 residents in over 400 eligible services across Australia.

The amount of viability supplement paid to an aged care homes depends on the location of the service, the number of places in the service, and the proportion of care recipients with special needs.

The increase to the viability supplement will assist with the extra cost of operating in rural and remote areas, helping aged care services to run viable businesses. This will in turn ensure that older Australians living in these locations continue to have access to vital aged care services.

Payment of the additional viability supplement will automatically be made through the existing aged care payment system. Providers do not need to apply for the supplement.

The increase to the viability supplement was one of several changes to aged care funding arrangements contained in the 2009 Budget.

Schedule of Resident Fees and Charges: From 1 January 2010

Fee/Charge/Thresholds	Rates
Maximum Basic Daily Fee 1
- Standard Resident contribution2 – includes respite residents	up to $36.94
- Protected resident contribution2	up to $33.74
- Phased Resident Contribution2	up to $33.74
- Non-Standard Resident Contribution2	up to $42.02
Residents who were in a hostel on 30 September 1997 and who are NOT currently at a home that was a nursing home before 1 October 1997 will receive a reduction of 80 cents per day to their basic daily fee.
Residents who are currently receiving care in the same hostel where they were living on 30 September 1997 and who are paying ‘grandparented’ variable fees.	Agreed amount of fees, less any allowance for rent assistance (until the prescribed basic daily fee is greater than the agreed amount).

Maximum Daily Income Tested Fee	up to $59.38
Income tested fees are calculated at 5/12th of total assessable income over the income tested fee thresholds per fortnight.	Income Tested Fee Thresholds
	Single	Each member of a couple
Standard	$783.70	$765.70
Non-Standard	$783.70	$765.70
Protected	$721.50	$703.50
Phased	$721.50	$703.50
Pensioner allowable limit for Accommodation bonds Residents who initially entered care prior to 20 March 2008 and agree to roll over a bond of more than 9 times the annual single age pension	$144,000

Minimum Assets Amount A resident must be left with this amount when calculating the maximum accommodation bond.	$36,000
Asset Cut-off Level*
- for fully supported3 resident status	$36,000
- for partially supported3 resident status	$91,910.40

Previous Schedules of Fees and Charges can be found on the Ageingweb website at :
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-archive-feesinfo-0109.htmTop of page

Maximum Permissible Interest Rate
- for accommodation bond agreements (for all new residents from 1 January – 31 March 2010)	7.95%
- for accommodation charge agreements (for all new residents from 20 March 2009)	4%

Maximum Accommodation Charge5
Maximum Accommodation Charge for new entrants to residential aged care 20 Sept 2009 - 19 March 20104
- for fully supported residents	N/A
:non-supported residents, if their assets at entry are at least $91,910.40 - who are not in receipt of a means-tested Australian pension - who are in receipt of a means-tested Australian pension :supported residents, if their assets at entry are equal to or less than $91,910.40	$26.88 $25.05 calculated amount6

Maximum Accommodation Charge for pre-20 March 2008 residents who enter your home during the period 20 Sept 2009 - 19 March 20107
- for concessional residents and charge exempt residents	N/A
Residents who first entered residential aged care between 1/7/2004 – 19/3/20048. - assisted residents, if their assets at entry are at least $56,221 - assisted residents, if their assets at entry are less than $56,221 - other residents, if their assets at entry are at least $71,351 - other residents, if their assets at entry are less than $71,351	$11.08 calculated amount3 $19.37 calculated amount3
Residents who first entered residential aged care before 1/7/20048 - assisted residents, if their assets at entry are at least $51,458 - assisted residents, if their assets at entry are less than $51,458 - other residents, if assets at entry are at least $66,076 - other residents, if assets at entry are less than $66,076	$8.47 calculated amount3 $16.48 calculated amount3

Pensioner Supplement

$6.95

Deeming Thresholds and rates from 1 July 2009 Threshold (single) Threshold (couple – combined) Lower rate Higher rate

$42,000 $70,000 2% 3%

1. Residents in designated remote areas may be asked to pay an additional $1.06 per day (See section 4 page 135 of the Residential Care Manual).

2. See Information Sheet 12 – Basic daily fees for Residential Aged Care.

3. Contact the Department on 1800 500 853.

4. Rate remains unchanged for resident's stay in the one home, regardless of annual indexation of the maximum rate for new entrants.

5. From 20 March 2008, accommodation charges are capped, even if a resident moves from one home to another, provided that there is not a break in care of more than 28 days (excluding leave).

6. The Department of Health and Ageing sends letters to advise amount (does not include flexible care residents).

7. And who haven't left permanent residential aged care for more than 28 days before entering care after 20 March 2008.

8. Accommodation charge limited to a maximum period of five years and is fixed at date of entry even if they have a break in care of more than 28 days.

For information please contact the Department on 1800 500 853.
Top of page

Continence Aids Payment Scheme (CAPS) to Replace CAAS

The new Continence Aids Payment Scheme (CAPS) will replace the Continence Aids Assistance Scheme (CAAS) from 1 July 2010.

This change will allow a direct payment to clients, providing increased flexibility and choice about where and when they purchase their continence products. The new payment will be made into people’s bank accounts by Medicare Australia from 1 July 2010. The payment amount will be in line with the current subsidy of $489.95 and will be indexed annually.

Eligibility for the Continence Aids Payment Scheme remains unchanged. People who are five years of age or older and have permanent and severe incontinence due to an eligible neurological condition, or have permanent and severe incontinence caused by another condition (provided they have a Centrelink
Pensioner Concession Card), will continue to be eligible.

However, high care residents in Australian Government aged care homes are not eligible for the CAAS or CAPS. Residents or their carers should notify Intouch on 1300 366 455 if they have moved from low to high level care.

Information sessions will be conducted for clients, health professionals and suppliers to inform them of the changes. Sessions will be held in all states and territories. Information regarding dates and venues will be provided through mailouts and general media and on the Bladder Bowel website. Fact sheets and FAQs have also been developed to inform people about the changes.

For more information about CAPS and CAAS go to the Department’s Bladder Bowel Website at www.bladderbowel.gov.au or for specific enquiries email continence@health.gov.au

September Increase To Packaged Care Fees

Fees for CACP, EACH and EACHD packaged care programs increased on 20 September 2009, in line with increases to the single and married age pensions.

As a result of these fee increases, the Community Programs Branch has received many queries from care recipients, and particularly from care recipients on a married pension, asking if they are being charged the correct fees. The September 2009 increase to CACP, EACH and EACHD fees was much higher than previous increases.

The process for calculating fees is outlined in the Community Packaged Care Guidelines. The Guidelines state that for care recipients whose sole source of income is the aged or equivalent pension, the maximum fee an approved provider can charge is 17.5 per cent of the basic rate of the single pension. This applies regardless of whether the care recipient receives a single or married pension. Clients who have additional or alternative income above the single rate of pension can also be asked to pay up to 50 per cent of that additional income.

The Guidelines outline the maximum fees which care recipients can be charged. However, approved providers do not have to charge all clients the maximum allowable fee. Fees should be based on a client’s income or ability to pay. If a care recipient is unable to pay the maximum fee, the provider must negotiate a fee which both the care recipient and approved provider agree on.

All providers recently received information about the increase to packaged care fees, which is also available online at www.health.gov.au/internet/main/publishing.nsf/Content/ageing-mailfax-2009-2409.htm

The current schedule of fees and charges, including packed care fees, is available at www.health.gov.au/internet/main/publishing.nsf/Content/ageing-subs-supp-sep09.htm

For more information on packaged care fees, contact the Community Programs Branch, Ph (02) 6289 8220

Apology Sees Care Leavers Included in Special Needs Group

Care leavers are now included in the list of people with special needs, considered when the Government allocates aged care places to providers, following an amendment to the Allocation Principles 1997.

This amendment fulfils an undertaking made by the Prime Minister, the Hon Kevin Rudd MP, in his address at the apology to the forgotten Australians and former child migrants on 16 November 2009.

In the apology, which was formerly moved in Federal Parliament and supported by the Opposition, the Prime Minister said the Government would “identify care leavers as a special needs group for aged care purposes, to ensure that providers are assisted to provide care that is appropriate and responsive”.

Care leavers are people who were placed in institutions or out-of-home care as children or young people, including child migrants from Britain.

Other people defined as having special needs under the Aged Care Act 1997 are people from Aboriginal and Torres Strait Islander communities, people from non-English speaking backgrounds, people who live in people in rural or remote areas, people who are financially or socially disadvantaged, veterans and people who are homeless or at risk of becoming homeless.

This amendment ensures that the Secretary of the Department can now also cater for the needs of care leavers when making allocations of aged care places to approved providers.

The change also reflects recommendations contained in two Senate reports - Lost Innocents and Forgotten Australians Revisited.

The amendments to the Allocation Principles 1997 came into effect on 1 December 2009.

Check the Residential Care Manual which has been updated to provide further information on care leavers
www.health.gov.au/internet/main/publishing.nsf/Content/Residential+Care+Manuals-1 Top of page

Charter of Rights and Responsibilities for Community Care

A new Charter of Rights and Responsibilities for Community Care became law on 1 October 2009, following an announcement in 2008 by the Minister for Ageing, the Hon Justine Elliot MP, that the Government would develop the Charter.

The Charter covers people receiving Community Aged Care Packages (CACP), Extended Aged Care at Home (EACH) and Extended Aged Care at Home Dementia (EACHD) packages, which are legislated under the Aged Care Act 1997.

The Charter is a simple but historic document that articulates the rights and responsibilities of older Australians receiving community care packages. It explains the rights of people receiving aged care services in the community, as well as their responsibilities, including their responsibilities towards care workers.

Under the Charter, a care recipient’s rights include to:

• be involved in identifying the community care most appropriate for their needs
• choose the care and services that best meet their assessed needs, from the community care able to be provided and within the limits of the resources available
• be given a copy of the Charter
• be offered a written agreement that covers all agreed matters
• be given information on how to make comments and complaints about the care and services they receive.

In consultation with the Ageing and Consultative Committee and other key stakeholders, the Department will also be developing additional supporting material about the Charter, for service providers and care recipients.

Copies of the Charter are available at www.health.gov.au/internet/main/publishing.nsf/Content/ageing-charter-rights.htm

Hard copies of the Charter can be ordered from National Mailing and Marketing, Ph 02 6269 1060, email health@nationalmailing.com.au

For other enquiries regarding the Charter, contact the Aged Care Information Line, Ph 1800 500 853.

New Aged Care Online Claiming Website Training

Medicare Australia’s new and improved Aged Care Online Claiming website training environment has replaced the Aged Care Funding Instrument (ACFI) training environment.

The Aged Care Online Claiming website training environment allows you to:

• familiarise yourself with the Aged Care Online Claiming website
• access the Care Recipient Profile
• view residential and community care web forms
• practise registering, updating and deleting residential and community care web forms
• view electronic Aged Care Client Records (eACCRs)
• view claims and payment statements.

To use the training environment you will need user IDs and passwords as well as care recipient and service data. You can access this information on the Aged Care Online Claiming website training environment section of the Medicare Australia website www.medicareaustralia.gov.au/aged

For more information about the training environment go to www.medicareaustralia.gov.au/aged or call 1800 195 206 and select option 1 to talk to an Aged Care Business Development Officer.

Medicare’s New Perth Office

Medicare Australia’s Perth office relocated to new premises on 31 October 2009. The new address is:

130 Stirling Street
NORTHBRIDGE WA 6003

The existing PO Box and telephone numbers for the Perth office remain the same.

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