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Consumer Directed Care

Consumer Directed Care (CDC) in Australian Government Packaged Care Programs

2010-2012 Operational Manual

A copy of the CDC Operational Manual can be downloaded in PDF format:

PDF printable version of CDC Operational Manual (PDF 248 KB)

Please note this document is in draft form and as such is likely to change as Consumer Directed Care in the Packaged Care Programs is further refined.

1. Overview of CDC Program

1.1 Introduction

In July 2010 the Australian Government commenced Consumer Directed Care (CDC) across all Australian Government funded Packaged Care Programs. This is an innovative approach of the Government for two years to provide programs and services that better meet the needs of care recipients through offering increased choice, control and flexibility.

Consumer (or self) directed care allows people to have greater control over their own lives by allowing them, to the extent that they are capable and wish so to do, to make choices about the types of care services they access and the delivery of those services, including who will deliver the services and when. Evaluations of existing consumer directed care programs show this approach can lead to better outcomes for care recipients in respect to their quality of life, independence and satisfaction with care.

The introduction of CDC responds to calls from care recipients and their carers for increased flexibility, choice and control that have emerged from previous reviews of community aged care and the Government’s consultations on the final report of the National Health and Hospitals Reform Commission. The Government is committed to responding to these needs through the initiative and evidence-based assessment of this alternative service model.

Existing approved providers were invited in 2010 to participate in the initiative through an open and competitive application process run by the Department of Health and Ageing. CDC places are only allocated to existing approved providers as defined under the Aged Care Act 1997. A further 500 CDC places will be advertised and allocated in 2011.

1.2 Background

There is a growing push amongst community care recipients for greater consumer involvement in the delivery of community aged care services. CDC allows community care clients to actively choose the types of services they receive, and direct how, when and by whom they are delivered.

CDC is based on development work undertaken by the Ageing Consultative Committee (ACC), the major forum for consultation, discussion and advice on issues of relevance to aged care. At the request of the Committee’s Chair, the ACC developed options for introducing consumer direction in Australian Government funded community aged care programs.

Under the proposed model, the provider remains the funds’ holder, but expends each client’s budget as directed by the client.
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1.3 Model

The CDC model delivered in packaged care is an individual budget based on a needs assessment and administered on the care recipient’s behalf, by an approved provider, for an agreed percentage of the allocated budget.

An individual budget is:

• allocated to the care recipient, with the funds held by the approved provider;
• based on a care recipient’s needs as assessed by the packaged care provider and agreed by the care recipient;
• prepared following the care recipient’s assessment by an ACAT which determined eligibility for a specific level of packaged care (eg, CACP);
• held and administered by the packaged care provider for an amount agreed with the care recipient from the total budget; and
• set for a one year period.

1.4 CDC Framework

CDC in packaged care is delivered under the Innovative Pool Program and it is offered at three levels, which broadly align with the existing CACP, EACH and EACHD programs.

1.4.a CDC Low Care

This level is similar to a CACP, in that it is targeted to frail older people aged 70 years and over, or 50 years and over for Aboriginal and Torres Strait Islander people living in the community, who require provision of services because of their low level complex care needs.

Unless specified differently in Section 2, program guidelines as outlined in the Community Packaged Care Guidelines for CACPs apply to CDC Low Care packages.

1.4.b CDC High Care

This level is similar to an EACH package, in that it is targeted to frail older people aged 70 years and over, or 50 years and over for Aboriginal and Torres Strait Islander people. CDC High Care packages are aimed to assist older people with high level complex care needs who wish to remain living in their own home.

Unless specified differently in Section 2, program guidelines as outlined in the Community Packaged Care Guidelines for EACH packages, apply to CDC High Care packages.

1.4.c CDC High Care Dementia

This level is similar to an EACHD package in that it is targeted to frail older people aged 70 years and over, or 50 years and over for Aboriginal and Torres Strait Islander people. CDC High Care Dementia packages are aimed to assist those older people living with dementia, who have high level complex care needs and who wish to remain living in their own home. These older people also have behaviours of concern that affect their ability to live independently.

People assessed and eligible for this level have complex high care needs and Behaviours and Psychological Symptoms of Dementia (BPSD) associated with their dementia and are eligible for high level residential care, have expressed a preference to live at home and be able to do so with the assistance of a package of care.

Unless specified differently in Section 2, program guidelines as outlined in the Community Packaged Care Guidelines for EACHD packages apply to CDC High Care Dementia packages.
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1.5 CDC Principles

In line with the general policies governing the delivery of aged care services in Australia and in the light of the specifics of the Australian care context identified above, CDC in aged care is based on the following key principles:

• Integrated – CDC should be integrated into existing programs as an optional mode of care delivery and operate within the constraints of the current legislative arrangements.
• Responsive – CDC should be responsive to the changing needs and circumstances of care recipients and carers, and enable adjustment of budgets and services to meet those needs.
• Inclusive – CDC should take into account the needs of care recipients and their carers and consider its contribution to, or impact on, the social inclusion of care recipients and carers.
• Equitable – Care recipients with the same or similar needs and circumstances should receive comparable allocations of budgets and services.
• Optional – CDC should be offered to care recipients as a voluntary option.
• Care recipient and carer-centred – CDC should take into account the needs and views of care recipients and carers and support them having control and choice over their care.
• Supportive – Care recipients and carers should be provided with a range of support to make informed decisions and practise CDC, including education and advocacy.
• Sustainable – CDC should provide an affordable, long term option for delivery of care for Government that meets the needs of care recipients and their carers.

1.6 Legislation

The legislative base for CDC Packaged Care is the Aged Care Act 1997 (the Act) and its subordinate Aged Care Principles 1997 (the Principles). The Standards applying to the existing community care packages also apply to CDC packages. The Consumer Rights and Responsibilities Charter for Community Care, which became law on 1 October 2009, supports consumer direction through increasing the knowledge and say of consumers about the care they receive.

1.6.a The Aged Care Act 1997

The objects of the Act are as follows:

• The objects of the Act are as follows:
• ensuring the provision of a high quality of care;
• to help care recipients enjoy the same rights as all other people in the community;
• to ensure that care is accessible and affordable for all recipients;
• to encourage diverse, flexible and responsive aged care services that:
  • are appropriate to meet the needs of the recipients of those services and the carers of those recipients; and
  • facilitate the independence of, and choice available to, those recipients and carers;
• to plan effectively for the delivery of aged care services and ensure that aged care services are targeted towards the people and areas with the greatest needs; and
• to provide funding that takes account of the quality, type and level of care.

CDC in packaged care is a form of Flexible Care under the Act, in particular the Innovative Pool Program. The Flexible Care Subsidy Principles 1997 explain what is meant by innovative care services and specify that flexible care subsidy may be payable to an approved provider for providing this kind of flexible care to a care recipient.

Section 49.3 of the Act defines ‘Flexible Care’ as care provided in a residential or community care setting by an aged care service that addresses the needs of care recipients in alternative ways to care provided through residential care services and community care services.
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1.6.b The Aged Care Principles

Section 96.1 of the Act enables the Minister to make Principles that are required or permitted under the Act, or that the Minister considers are necessary or convenient to carry out or give effect to a part or section of the Act.

The Principles relevant to CDC and community care are:

Legislation	The Principles:
Accountability Principles 1998	Provide details on approved provider accountability protocols.
Allocation Principles 1997	Provide details on aspects of packaged care allocation.
Approval of Care Recipients Principles 1997	Deal with issues relating to approving Care Recipients for packaged care.
Approved Provider Principles 1997	Relate to the obligations of approved providers under the Act.
Community Care Subsidy Principles 1997	Specify kinds of care that are, or are not, included in CACPs.
Flexible Care Subsidy Principles 1997	Specify eligibility for Flexible Care Subsidy and on what basis Flexible Care Subsidy may be paid to EACH, EACHD and Innovative Pool Program (including CDC approved providers).
Information Principles 1997	Relate to a number of aspects associated with protecting information about Care Recipients.
Investigation Principles 2007	Relate to the process undertaken in investigating complaints.
Quality of Care Principles 1997	Provide the responsibilities of approved providers for compliance with the Community Care Standards.
Records Principles 1997	Provide the process for keeping and retaining records by approved providers and former approved providers.
Sanctions Principles 1997	Address the sanctions imposed on approved providers as a consequence of non-compliance with their responsibilities under the Act.
User Rights Principles 1997	Outline the Care Recipient’s and approved provider's rights and responsibilities.

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1.6.c The Community Care Common Standards (Common Standards)

Section 54.5 of the Act states that the Quality of Care Principles may set out Flexible Care Standards.

The Standards for Flexible Care CDC places are set out in Attachment 1 of the CDC Payment Agreement.

Details of the requirements of the Standards for each level of CDC are contained in Section 2.

The Standards for CDC are based on the Common Standards and Flexible Care Standards (as set out in the Quality of Care Principles 1997 and Payment Agreement) and provide a structural approach to the management of quality in services delivery. They specify care and services to be delivered to the care recipient and provide clear statements of expected performance.

The Common Standards reflect the importance of both clients and carers in planning, provision, and review of the package of services.

The Common Standards serve four primary objectives to:

• assist approved providers to provide care recipients with quality care;
• inform care recipients of the standard of care they can expect to receive;
• support approved providers in achieving quality in the administration and management of their services; and
• provide a basis for investigating and monitoring service delivery.

Section 64.1 Part 4.4 of the Act states that non-compliance with the Common Standards can result in sanctions action, including suspending or revoking the allocation of some or all of the places allocated to the approved provider.

Approved providers need to have systems in place to:

• ensure compliance with the Standards;
• pursue continuous quality improvement; and
• ensure that staff have appropriate training, knowledge and skills to perform their roles effectively.

1.6.d Approved Providers Rights and Responsibilities

Sections 56.2 and 56.3 of the Act describe the responsibilities of approved providers in relation to care recipients.

User rights refer to the approved providers’ general responsibilities to care recipients and potential care recipients. These responsibilities include:

• limitations as to the fees that can be charged;
• provision of security of tenure;
• resolution of complaints;
• requirement for Care Recipient Agreements;
• protection of personal information; and
• record keeping.

Approved providers must comply with the CDC Payment Agreement.

Approved providers must detail their responsibilities and how these will be managed in the individual Care Recipient Agreement.
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1.6.e Charter of Rights and Responsibilities for Community Care

On 1 October 2009 the Australian Government introduced the Charter of Rights and Responsibilities for Community Care (the Charter).

The Charter is a legal document that explains the rights of people receiving aged care services in the community, as well as their responsibilities, including their responsibilities towards care workers.

Copies of the Charter are available electronically on the Department of Health and Ageing website www.health.gov.au

1.6.f Advocacy

Section 56.2 (h) and Section 56.3 (i) of the Act require approved providers to allow care recipients to have access to the services specified in the User Rights Principles.

A care recipient has the right to call on an advocate of their choice to represent them in the management of their care. This may include:

• establishing or reviewing their Care Recipient Agreement;
• negotiating the fees they may be asked to pay; and
• presenting any complaints the care recipient may have.

Approved providers should give care recipients information about the role of advocates.

The Common Standards require that approved providers accept the care recipient’s choice of advocate.

1.6.g The National Aged Care Advocacy Program

The National Aged Care Advocacy Program (NACAP) is a national program funded by the Australian Government under the Aged Care Act 1997. The NACAP aims to promote the rights of people receiving Australian Government funded aged care services.

Under the NACAP, the Department of Health and Ageing funds aged care advocacy services in each State and Territory. These services are community-based organisations which are there to provide Care Recipients advice about their rights, and help them exercise their rights. Aged care advocacy services also work with the aged care industry to encourage policies and practices which protect consumers.

Advocacy services are free, confidential and independent.

Further information about advocacy can be found on the Department of Health and Ageing website at
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-advocacy.htm
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1.6.h Complaints

Section 54.4 of the Act requires the approved provider to establish a complaints resolution mechanism.

Approved providers must have appropriate processes in place to receive, record and resolve complaints. They are required to inform care recipients about the mechanisms available for dealing with complaints made by or on behalf of the care recipient such as the Complaints Investigation Scheme. Further information on the Scheme can be found on the Department of Health and Ageing website www.health.gov.au

Information on complaint mechanisms must be included in the Care Recipient Agreement between the approved provider and the care recipient.

If care recipients are concerned about any aspect of service delivery, they should approach the approved provider in the first instance.

In most cases, the approved provider is best placed to resolve complaints and alleviate care recipients’ concerns.

Approved providers must handle and address any complaints fairly, promptly, confidentially and without retribution.

Care recipients and carers should be actively encouraged to provide feedback about the services they receive.

1.6.i Aged Care Complaints Investigation Scheme

Care recipients of Australian Government care packages and their representatives have access to the Aged Care Complaints Investigation Scheme (CIS) operated by the Department.

The CIS is a free service and is available to anyone who wishes to make a complaint about an Australian Government aged care service, including an approved provider.

Complaints can be in relation to anything that may be a breach of an approved provider’s responsibilities under the Act and Principles. For care packages this may include:

• quality of care issues;
• quality of life issues;
• the Care Recipients Agreement;
• security of tenure; and
• access to a packaged care service following an ACAT approval.

Approved providers must include information in the Care Recipient Agreement about internal complaint mechanisms and how to access these. They must also promote information, such as telephone contact numbers, for the CIS. Further information on the Aged Care Complaints Investigation Scheme can be found on the department of Health and Ageing website at: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-quality-guidelines-cis-ap.htm

1.7 Application Process for CDC places

1.7.a Who can apply for CDC

Only approved providers of flexible care can be allocated a place under the CDC Innovative Pool Program.

1.7.b How to apply for CDC

To apply for CDC places, applications for allocation are made through an “Invitation to Apply” process managed by the Department of Health and Ageing.

The Invitation to Apply for the 2010 – 2011 Innovative Pool Program for CDC Places, was advertised through major metropolitan and regional newspapers during May 2010. The Invitation to Apply for the 2011-2012 Approvals Round will be advertised in early 2011.

Further information is available on the Department’s website at http://www.health.gov.au/cdc
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1.7.c Assessment Criteria for Providers

The application process includes approved providers addressing the following criteria:

i. Status of Organisation

• approved provider status, including any compliance action in progress or taken in the past;
• if an existing approved provider, consideration of current services being delivered;
• suitability of the organisation to provide CDC; and
• confirmation that the applying organisation will be the provider delivering CDC.

ii. Organisational Management

• appropriate expertise and experience of the people responsible for the management of the organisation;
• the expertise and experience of the people who will provide the day to day coordination and care service, including dementia care; and
• skill levels, qualifications and experience of staff and their understanding of CDC.

iii. Service Size and Mix

• the impact to the service if less than the maximum number of places sought are allocated;
• timeframes and steps that will be taken to ensure CDC places are ‘filled’ as soon as possible; and
• appropriate infrastructure and access to other allied services to successfully deliver CDC.

iv. Quality

• how quality of care will be ensured and how care standards will be met; and
• commitment to undertake quarterly care quality checks at the care recipient’s home.

v. Functions

Approved providers must be able to demonstrate the ability to perform the following functions as a provider of consumer directed care:

• develop care plan in consultation with the care recipient;
• administer the budget (pay invoices, provide monthly budget statements);
• undertake some case management for all care recipients and additional case management as agreed in the care plan;
• formally engage workers (hire and fire on behalf of care recipient, monitor employee work conditions, undertake training of workers in OH&S, etc);
• provide any specific training to the care recipient and their carer;
• provide advice on the formal and informal services available to ensure diversity of choice for care recipients;
• keep a portion of budget for contingencies (‘emergency’ scenarios) where needs change; and
• broker services – contact services and arrange visits etc.

vi. Assessment of Care Recipients

Approved providers must be able to demonstrate:

• how new and existing care recipients will be informed of the availability of CDC places to ensure they will be ‘filled’ as soon as possible;
• how you will manage the individual care budgets;
• identify where a care recipient representative is required; and
• the care recipient’s capacity to manage a CDC approach.

vii. Exit Strategy

Approved providers must be able to demonstrate:

• how the ongoing needs of care recipients will be addressed if they choose to exit CDC, including arrangements for transfer to a ‘regular’ package care place.

viii. Evaluation

Approved providers must be able to demonstrate:

• the organisation’s willingness and agreement to participate in evaluation of CDC.

1.7.d Allocation of CDC Places

Allocation of the CDC places under the Innovative Pool Program are made through the following process:

Part 2.2 of the Act, and the Allocation Principles 1997 state that the “decision to allocate places will be based solely on a consideration by the First Assistant Secretary of the Ageing and Aged Care Division acting as the delegate of the Secretary of the Department of Health and Ageing (the Delegate) of the matters set out in section 14-2 of the Act and the Allocation Principles.

Allocation is subject to conditions under sections 14-5 and 14-6 of the Act. The formal conditions of allocation form part of the Payment Agreement. The following conditions may be determined from time to time, for an allocation of CDC places:

• the number of packages for which the flexible care subsidy is payable;
• the aged care planning region in which the packages must be provided;
• the minimum number or proportion of packages that are to be provided to people from special needs groups;
• specific undertakings made by the approved provider in their application and agreed to by the Secretary of the Department as a condition of allocation; and
• other conditions as appropriate, for example, eligible residents of retirement villages.

1.8 Eligibility of Participating Care Recipients

The eligibility of care recipients who wish to participate in CDC in packaged care is limited to those people who:

• are assessed by an Aged Care Assessment Team (ACAT) as being eligible for the equivalent level of existing community packaged care;
• are either existing or new packaged care recipients;
• are assessed as being likely to benefit from increased choice over their care;
• have a variety of service needs that maximise the choice that CDC offers;
• willingly choose to participate;
• are assessed for their capacity to make informed decisions and have a representative nominated if appropriate;
• an approved provider has assessed as having the capacity and ability to manage a CDC approach; and
• are willing to participate in the initiative’s evaluation.

1.9 Funding

CDC in packaged care is funded by the Australian Government through the allocation of flexible care places in the Innovative Pool Program to approved providers at a funding rate that was determined by the then Minister for Ageing (Aged Care Amount of Flexible Care Subsidy Innovative Care Services Determination 2010 No.1). The rate is dependent upon the nature of the care needs and the settings in which the care will be delivered.

Essentially though, there are three levels of subsidy depending on the assessed level of care to be provided. These three levels align with the subsidy levels of the current Packaged Care Programs, namely, CACP, EACH and EACHD packages. The three CDC levels are:

• CDC Low Care – aligning with CACPs;
• CDC High Care – aligning with EACH packages; and
• CDC High Care Dementia – aligning with EACHD packages.

1.10 Payment of Subsidy

Approved providers are required to complete a monthly claim form to receive subsidy payments. Claim forms need to record the actual/direct hours of care. Actual/direct hours of care does not include hours provided under the activity of case management. The payment process will initially be managed directly by the Department of Health and Ageing and not Medicare Australia. Approved providers need to electronically submit (followed by a posted hard copy) a completed claim form to the Department monthly to ensure payment. Oxygen and enteral feeding supplements are also payable in some circumstances.

The claim form has been issued electronically to Approved Providers by the Department.

1.11 CDC Payment Agreement

Successful approved providers are required to enter into a CDC Payment Agreement with the Australian Government, which is legally binding on the parties signing. The agreement outlines how the provider will deliver consumer directed care and include commitment to areas such as maintenance of quality of care, reporting requirements and provisions for clients leaving the program.

The Payment Agreement includes the Standards for service delivery of the CDC Low Care, CDC High Care and CDC High Care Dementia levels.

1.12 Service Types Supported

Under CDC in packaged care, the same service types that are currently available under the Australian Government Packaged Care Programs (CACPs, EACH and EACHD) will be available.

Further information on each individual level is explained later in this information.

1.13 Development of Individual Budgets

The service provider should assess the needs of the care recipient and their carer together to develop a budget for the care recipient based on those needs. For each provider, care recipients with the same or similar needs should receive comparable allocations of budgets and services. Development of budgets should operate within the legislative constraints of the current community aged care system.

Funds for an individual’s allocated budget will be drawn from the provider’s income, which is obtained from government subsidies and care recipients’ contributions (refer to Section 1.15). It is not intended that in each case an individual’s allocated budget would exactly match the income received by the provider in respect of that care recipient.

Under CDC, the care recipient should participate in the developmental and ongoing management of their budget to the extent in which they wish to be involved.
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1.14 Administration Fee/Contingency

The service provider should administer the budget on behalf of the care recipient. Administration includes duties such as paying invoices, scheduling appointments with providers, and sending the care recipient a monthly balance statement.

Care recipients will pay the provider an amount of their budget for this service which will include a small amount to cover contingencies. The amount should be transparent and agreed between the service provider and the care recipient, dependent on the level of administration provided. The remainder of the allocated budget is available to the care recipient to direct to services of their choice.

As the CDC initiative initially runs until 30 June 2012, it would be expected that accumulated funds would be exhausted by this date. However, accumulated funds can operate over the 2010-11 financial year as CDC is funded for a two year period.

1.15 Care Recipient Contributions

As with the current Packaged Care Programs, approved providers may ask care recipients of CDC packages for an ongoing fee as a contribution towards the cost of their care. Any fees being charged should be fully explained and the amount charged must be documented in the Care Recipient Agreement between the care recipient and approved provider.

The calculation of fees will be based on the existing arrangements; that is, where the care recipient is receiving the basic rate of the single age pension, the maximum fee is 17.5 per cent of the basic rate of the single pension. This applies to both single and married care recipients.

Where a care recipient’s income is more than the basic rate of the single age pension, the maximum fee is 17.5 per cent of the person’s income to the level of the basic pension plus up to 50 per cent of income above the basic pension.

A care recipient’s access to a care package must not be affected by their ability to pay fees, but should be decided on the basis of need for care, and the capacity of the approved provider to meet that need.

1.16 Individual Care Plans

The service provider and care recipient should develop a care plan, which details the services needed and who will provide them. Care recipients should not be limited to choosing care and services from Government subsidised providers – alternative options could include informal services and other commercial organisations.

Care recipients should be provided with options to withdraw from a CDC package at any time, if they decide a CDC approach is not for them. These options should be discussed and clearly explained with the care recipient and/or their carer.

Security of tenure and continuity of care needs to be considered if a care recipient chooses to terminate a CDC package. Arrangements must be outlined in the care plan on how the ongoing needs of the care recipient will be addressed, including arrangements to transfer to a ‘regular’ packaged care place.

1.17 Care and Services

Care and services to be provided are outlined in Section 2 later in this information.
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1.18 Leave

Care recipients will have the same leave entitlements as those specified under the individual Packaged Care Programs and outlined in the Act, Principles and Community Packaged Care Guidelines. They are specified in Section 2 later in this information.

The care recipient will not be charged by the approved provider where the care recipient is in Transition Care, as the Transitional Care service provider may ask the care recipient to pay a care fee as a contribution to the cost of their care.

1.19 Role of the Approved Provider

The role of the approved provider is to:

• undertake a needs assessment to identify services needed (and undertake regular reassessment);
• develop a care plan in consultation with the care recipient and carer;
• administer the budget (pay invoices, provide monthly budget statements);
• undertake some case management for all care recipients and additional case management as agreed in the care plan;
• formally engage workers (hire and fire on behalf of care recipient, monitor employee work conditions, undertake training of workers in OH&S etc);
• provide any specific training to the care recipient and their carer;
• undertake quarterly care quality checks at the care recipient’s home;
• provide advice on the formal and informal services available;
• keep a portion of budget for contingencies (‘emergency’ scenarios) where needs change;
• broker services – contact services and arrange visits etc; and
• identify where a care recipient representative is required.

1.20 Role of the Care Recipient

The role of the care recipient is to:

• develop a care plan and budget for the year, in consultation with the provider;
• direct providers on who they wish to deliver their services;
• have input into any specific training provided to the workers employed (eg, specific to needs);
• follow up issues with service providers (eg, no shows);
• nominate a representative if required; and
• pay an agreed amount from their budget to their care provider for basic administration and case management.

1.21 Accountability and Reporting

1.21.a Innovative Pool Program

Participating providers will be accountable to requirements under:

• their approved provider status;
• the Flexible Care, Innovative Pool Program; and
• the CDC Payment Agreement.

As this is a new initiative, approved providers allocated CDC places will be required to participate in program evaluations when required. They will also be required to provide information to the Department as requested.
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1.21.b Accountability Framework

As with the Packaged Care Programs (CACP, EACH and EACHD), approved providers of CDC places will be required to participate in the Quality Reporting process. However, where a provider has CDC places, these places will be reviewed within the service as a whole.

The Quality Reporting Program, implemented in 2005, is the Australian Government’s process for encouraging flexible care providers to improve the quality of their service delivery. The process involves completion of a self assessment that looks at the systems a service has in place to ensure they are meeting the relevant program standards and identifying priorities to improve service delivery. It will also involve a review of this report and a site visit from officers from the Department who are trained in Quality Reporting.

Every service outlet is required to complete a Quality Report at least once in a three-year Quality Reporting cycle. A service outlet is defined as the location from which services are coordinated and where service recipient files are kept.

For the CDC initiative, an approved provider’s CDC service outlets have up to two years from commencement of CDC places service delivery before being required to participate in Quality Reporting. This allows the provider time to establish systems and policies in order to meet its obligations for CDC. It is important to note that approved providers with existing CACP, EACH, EACHD places or NRCP funding will still be required to undergo Quality Reporting. However, where a service provider is undergoing a quality review and also provides CDC places, the CDC places will not be specifically reviewed by quality review staff.

In this case as part of the quality review process, Quality Reviewers may review CDC processes and practices, if necessary, as part of establishing a picture of the operation of a service outlet as a whole.

CDC and CDRC places cannot be reviewed at the request of a provider, as was done in the rollout of EACHD.

As of March 2011, the Common Standards replaced the previous Community Care Standards for the existing packaged care programs. In order to simplify and streamline the way community care is delivered. The Community Care Common Standards apply to the CDC program as of 15 April 2011.
Information about Quality Reporting is available from the Department’s website at:

http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-commcare-qualrep-about.htm
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1.21.c Police Checks

The Quality Reporting Program also reports on police check requirements for all staff and unsupervised volunteers who have or are reasonably likely to have access to care recipients in Australian Government funded flexible aged care services. These flexible aged care services are required to ensure that staff and volunteers are assessed as suitable to work in the aged care service by obtaining a national criminal history record check (police check).

For further information about the requirement for police checks in aged care please contact the Aged Care Information Line on 1800 500 853 or follow the links at www.health.gov.au/OACQC

1.22 Maintenance of Quality

Participating providers will need to be vigilant in maintaining quality of care under consumer direction as more informal services (unfamiliar to the provider) may be selected by care recipients. To help monitor quality, the provider will be required to undertake quarterly care quality checks at the care recipient’s home.

1.23 Case Study – how the model might work

Mrs Robinson is an 80 year old, middle class woman who lives alone without a carer. She likes to have a clean house and personal cleanliness is very important. She is mobile, only needing support from her four wheeled walker. She can still make vegemite sandwiches but would prefer more variety in her diet. She has occasional incontinence and needs assistance showering. She has 4-5 different medications which have specific instructions as to when and how they are taken. These instructions sometimes confuse her. Otherwise she loves to get out socially and spend time with friends while they play a game of bingo at the local community centre.

Approved Provider X is allocated a CDC Low Care place which is aligned with a CACP subsidy and offered to new client Mrs Robinson. She has had an ACAT assessment which identifies a CACP is appropriate for her. Service Provider XX now conducts a detailed needs assessment to develop a care plan and determine the services she requires and their approximate cost over the one year period. Her (needs-based) individual budget is set at $10,400 for the year.

Service Type	Level of Service (per week)	Estimated Cost
Personal care and medication assistance	4 days	$70
House cleaner (private)	Once a week	$50
Meals on Wheels	4 days	$20
Shopping (pays local store to deliver)	Once a fortnight	$15
Taxi to Community Centre	Once a week	$15
Fee paid to provider for administration (15%)	15% of total budget	$30
Total per week		$200

Information based on a budget of $200 a week with a total of $10,400 a year. In this case Mrs Robinson and Provider X have agreed that 15% of the package goes to Provider X for administration.

Funds for an individual’s allocated budget will be drawn from the provider’s income, which is obtained from government subsidies and care recipients’ fees.

Note: If Mrs Robinson paid a Care Recipient Contribution this would also need to be included in the budget.
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2 CDC - DELIVERY GUIDELINES

2.1 CDC The Three Levels

Consumer Directed Care (CDC) in packaged care comprises three care levels. They include:

• CDC Low Care (CDCL);
• CDC High Care (CDCH); and
• CDC High Care Dementia (CDCHD).

Specific information for each level is contained in the following pages. Note that these levels align with the Packaged Care Programs — Community Aged Care Packages (CACPs), Extended Aged Care at Home (EACH) and Extended Aged Care at Home Dementia (EACHD) packages. Where something is not expressly specified in this information, please refer to the Aged Care Act 1997, Aged Care Principles 1997, Community Packaged Care Guidelines and CDC Payment Agreement for guidance.

2.1.a CDC Low Care

CDC Low Care (CDCL) is equivalent to a CACP in that it is an alternative for older people with low level complex care needs who wish to remain living in their own homes and are able to do so with the assistance of a care package. This includes residents of retirement villages.

CDCL packages are individually planned and coordinated packages of community aged care services, targeted at frail older people living in the community who require management of services because of their complex care needs. These people would otherwise be eligible for at least low level residential care.

To access a CDCL care package, a person must first be assessed by an ACAT as eligible for a CACP, EACH or an EACHD Package. (Refer to Section 2.4).

2.1.b CDC High Care

The CDC High Care (CDCH) level is equivalent to an EACH package in that it is a community alternative to high level residential care by providing the equivalent of high level residential care to frail older people with high level complex care needs, who wish to remain living in their own homes, and are able to do so with the assistance of a care package. This includes residents of retirement villages.

CDCH packages are individually planned and coordinated packages of community aged care services provided to approved care recipients and managed by an approved provider.

CDCH packages differ from the CDCL packages in that they are specifically targeted at frail older people living in the community who would otherwise be eligible for high level residential aged care.

The packages are flexible in content, however the expectation is that a package would include qualified nursing input, particularly in the design and ongoing management of the package.

To access a CDCH package, a person must first be assessed by an ACAT as eligible for an EACH or EACHD package. (Refer to Section 2.4).
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2.1.c CDC High Care Dementia

The CDC High Care Dementia (CDCHD) level is equivalent to an EACHD package in that it is a community alternative to high level residential care. CDCHD packages are individually planned and coordinated packages of care tailored to help frail older people who have been assessed as having high complex care needs and experiencing behaviours of concern and psychological symptoms associated with dementia.

These behaviours and symptoms significantly impact upon their ability to live independently in the community and may also impact on their functional capacity to remain living at home. This includes residents of retirement villages.

To access a CDCHD package, a person must first be assessed by an ACAT as eligible for an EACHD package (Refer to Section 2.4).

2.1.d Difference between CDC High Care and CDC High Care Dementia

As with EACH and EACHD packages, the key difference between a CDC High Care and CDC High Care Dementia package of care is that CDC High Care Dementia specifically targets the behaviours of concern and psychological symptoms associated with dementia and provides methodologies and services that are targeted towards managing these behaviours.

2.2 Individualised Budget

2.2.a CDC Low Care

The main difference in budgets between a CACP and a CDCL package is that the CDCL package recipient will develop with their service provider a budget for the care based on the assessed needs of the care recipient.

The CDCL Care package aligns with the CACP subsidy level, bearing in mind that in each case an individual’s allocated budget may not exactly match the income received by the provider in respect of that care recipient.

2.2.b CDC High Care

The main difference in budgets between an EACH package and a CDCH package is that the CDCH package recipient will develop with their service provider a budget for the care based on the assessed needs of the care recipient.

The CDCH package aligns with the EACH subsidy level, bearing in mind that in each case an individual’s allocated budget may not exactly match the income received by the provider in respect of that care recipient.

2.2.c CDC High Care Dementia

The main difference in budgets between an EACHD package and a CDCHD is that the CDCHD package recipient and their representative will develop with their service provider a budget for the care based on the assessed needs of the care recipient.

The CDCHD package aligns with the EACHD subsidy level, bearing in mind that in each case an individual’s allocated budget may not exactly match the income received by the provider in respect of that care recipient.

2.3 Eligibility Criteria

2.3.a CDC Low Care

CDCL packages are designed for frail older people (aged 70 years and over and 50 years and over for Aboriginal and Torres Strait Islander people) living in the community who would be assessed by an ACAT as eligible for a CACP level of care package.
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2.3.b CDC High Care

CDCH packages are designed for frail older people (aged 70 years and over and 50 years and over for Aboriginal and Torres Strait Islander people) living in the community who would be assessed by an ACAT as eligible for an EACH level of care package.

2.3.c CDC High Care Dementia

CDCHD packages are designed for frail older people (aged 70 years and over and 50 years and over for Aboriginal and Torres Strait Islander people) living in the community who would be assessed by an ACAT as eligible for an EACHD level of care package.

In addition, a person is eligible to receive a CDCHD package only if they:

• experience significant impacts on their capacity to live independently in the community due to behaviours of concern and psychological symptoms associated with dementia;
• have complex care needs because of behaviours of concern and psychological symptoms associated with dementia;
• prefer to receive a CDC High Care Dementia package; and
• be able to live at home with the support of a CDC High Care Dementia package.

Care recipients may also:

• experience difficulty with Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL), associated with their behaviours of concern, which will require the provision of additional supports and specific approaches by care workers;
• have high care needs that are associated with their behaviours of concern, rather than the need for care being associated with functional deficits; and
• be at risk of unnecessary admission to a ‘dementia specific’ residential care facility.

Note: Legislation requirements which took effect from 1 January 2009 enable people to receive a lower level of community care than they are initially assessed as eligible for by an ACAT. Under these arrangements, a person approved to receive a CDCH or CDCHD package is also eligible to receive a CDCL package. While these arrangements provide greater flexibility for care recipients and providers, a CDCL alone would not be expected to adequately meet the person’s needs and is only intended as an interim measure under such circumstances.

2.3.d Existing Community Packaged Care Recipients

Existing care recipients receiving a:

• a CACP package are also eligible to access a CDC Low Care package.
• an EACH package are also eligible to access a CDC High Care package.
• an EACHD package are also eligible to access a CDC High Care Dementia package.

Only one package type is permitted to an individual at any given point in time. There are no citizenship or residency restrictions on accessing a CDCL, CDCH or a CDCHD package. However, the programs are intended for ongoing care and should not be used for temporary care.

2.4 ACAT Assessment

2.4.a CDC Low Care

To access a CDCL package, a person must first be assessed by an ACAT as eligible for a CACP, EACH or EACHD.
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2.4.b CDC High Care

To access a CDCH package, a person must first be assessed by an ACAT as requiring an EACH, or an EACHD package.

2.4.c CDC High Care Dementia

To access a CDCHD package, an older person must first be assessed by an ACAT as requiring an EACHD package. Typically, care recipients eligible for CDC High Care Dementia packages may require a joint approach to assessment and case management between ACATs, approved providers and specialists (which may involve referral by a General Practitioner) such as psycho-geriatricians, geriatricians, mental health services and behavioural management specialists (including Australian Government funded behavioural management specialists). Given the nature of the care recipient’s condition, ACATs should take steps to ensure that a care recipient’s carer or advocate are consulted in determining the care recipient’s care needs where appropriate.

Note: A person approved as eligible for an EACHD package must display Behavioural and Psychological Symptoms of Dementia (BPSD). A formal diagnosis of dementia is not a requirement of eligibility for a CDC High Care Dementia package.

A care recipient may present to an ACAT exhibiting the signs and symptoms of dementia, but may not have a formal diagnosis of dementia. However, care recipients with dementia who require high level residential care will usually have well established dementia that has been present for a number of years and the characteristics that allowed the syndromic criteria to be met will be readily identified.

As part of a holistic ACAT assessment, ACATs would be expected to ensure that the symptoms of a dementia are medically assessed to ensure that any reversible causes of the symptoms, such as infections (delirium), contra-medication combinations and/or depression are identified and treated.

The ACAT will then determine if these signs and symptoms of dementia continue and are sufficient to approve an individual for an EACHD package. This does not preclude a person to receive an EACHD, CDCH or CDCL package, or set limits on an approval; it is a ‘reviewable’ decision’ under the Act.

To get contact information for the local ACAT, a potential care recipient or their representative can contact the Commonwealth Respite and Carelink Centre on 1800 052 222 (free call), or view their website http://www.commCarelink.health.gov.au. Referrals can be self-referred or through a hospital, community clinic, community nurse, General Practitioner or other community services.

2.5 Acceptance by an approved provider

Once a person is approved by the ACAT as eligible for a CACP, EACH or EACHD package, an approved provider may offer the prospective care recipient a CDCL, CDCH or CDCHD package respectively, subject to an assessment that the care needs of the prospective care recipient can be met and that a consumer directed care approach can be managed. The final decision to accept a person for a CDC package remains with the approved provider.

The result of an ACAT assessment, and the decision to approve or reject the person to receive a CACP, EACH or EACHD package, must be provided in writing by the ACAT to the person and, if appropriate, the person’s representative.

A decision by an ACAT to reject a person’s application for approval as a care recipient to receive a CACP, EACH or EACHD package (and therefore to receive a CDCL, CDCH or CDCHD package), or to set limits on an approval, is a ‘reviewable decision’ under the Act. However, a decision by an approved provider not to offer a CDCL, CDCH or CDCHD package to an approved care recipient is not a ‘reviewable decision’ under the Act.
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2.6 Service Delivery

2.6.a CDC Low Care

While the nature of care needs will vary depending on the care recipient’s individual situation, complex care needs can commonly be identified using the following principles:

• a requirement for coordination of services, without which the care recipient would be at risk of entry to a residential aged care facility; and
• more than one service is expected to be required from the CDC Low Care package (excluding case management).

Each package of services should be designed to meet the individual’s specific care needs and take into account the particular circumstances of each care recipient.

Range of formal and informal services available through a CDC Low Care package

Formal Services

As with a CACP, the services provided as part of a CDC Low Care package are principally to meet a care recipient’s daily needs including personal assistance, which may include any of the following:

• bathing, showering, or personal hygiene;
• toileting;
• dressing or undressing;
• mobility;
• transfer;
• preparing and eating meals;
• assistance with nutritional needs;
• sensory communication, or fitting sensory communication aids;
• laundry;
• home help;
• gardening; and
• short-term illness.

In conjunction with these services, a CDC Low Care package may also include:

• assistance with a special diet;
• control and administration of medication prescribed by a medical practitioner, subject to legal restrictions on providing the medication;
• rehabilitative support, or helping to access rehabilitative support, to meet a professionally determined therapeutic need;
• administration of treatment such as eye drops, back rubs, dressings and urine tests, subject to legal restrictions on providing the treatment;
• emotional support;
• direct supervision;
• having at least one responsible person or agency, approved by the organisation providing the CDC Low Care, reasonably near and continuously on call to give emergency assistance when needed;
• transport to help the person shop, visit a medical practitioner or attend social activities;
• temporary respite care;
• home maintenance, including modification, reasonably required to maintain the home and garden in a condition of functional safety and provide an adequate level of security;
• arranging social activities, providing or coordinating transport to social functions at a reasonable frequency and other out-of-home services that help prevent social isolation;
• advocacy services to help protect the person’s interests;
• support services to maintain personal affairs; and
• other services required to maintain the person at home.

Informal Services

Informal services are those that may be provided by people already known to the family and not employed by the approved provider. Services or care they provide may also be included in a CDC Low Care package. If this is the case, their details must be maintained on a register by the approved provider.

Informal services may include:

• paying a taxi for transport to medical appointments or shopping;
• a private house cleaner;
• deliveries from the local store; and
• other private services suitable to meeting the care recipient’s assessed need.

In order to record the transaction that takes place between the approved provider and the informal care worker, a tax invoice/receipt may need to be provided as proof of the service taking place where the organisation/provider or individual is registered for GST purposes.

For informal services, the same existing arrangements will apply in regard to worker’s compensation, police checks, insurances, superannuation, etc. Where applicable, providers will need to seek their own advice from their own advisors (eg workers compensation authorities, insurers, legal advisers, accountants) on how those requirements apply to their particular circumstances.

Note: The Department does not support payment of family and friends for services as part of this model. The CDC informal and formal support services should be designed to complement and supplement the assistance and support provided by family/carers, friends and social and community networks.
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2.6.b CDC High Care

There is a range of care and services which may be provided to care recipients of CDC High Care packages. These specified care and services must be provided in the best way to:

• meet the CDC High Care Standards; and
• suit the care recipient’s needs, within the limitations of the funds available.

The approved care and services that may be provided to recipients of CDC High Care packages fall into four categories:

• general;
• specialist clinical services;
• care services; and
• support services.

Range of formal or informal services available through a CDC High Care package

Formal

The tables below list the specific services provided in each category and a description of that service.

1. General
Service	Description
Administration	General operation of the service including care recipient documentation.
Care planning and management	Initial and on-going assessment, planning and management of care by appropriately qualified and trained staff, with the involvement of the care recipient, (or his or her representative), and their carer, where appropriate.
2. Specialised Clinical Services
Service	Description
Clinical care	Clinical care provided as part of a CDC High Care package is to be carried out by a registered nurse, or under the direct or indirect supervision of a registered nurse or other professional appropriate to the service. Services include, but are not limited to, the following: assessment for pain and a plan implemented to keep the care recipient as free from pain as possible; care and maintenance of tubes, enteral feeding and naso-gastric tubes; establishment, review and maintenance of urinary catheter care and/or stoma care program; complex wound management; enema administration or the insertion of suppositories; suctioning of airways and tracheostomy care; oxygen therapy requiring ongoing supervision because of a care recipient's variable need, including the provision of oxygen and oxygen equipment at no additional cost to the recipient; assistance with medication management; and on-call access to nursing services, if required. For care recipients receiving any of the above nursing services, they also include the provision of 24-hour per day on call access to care provided by or under the supervision of a qualified nurse.
Access to other health and related services	Referral to appropriate health specialists and other service providers in accordance with needs and preferences and assistance to attend appointments whether the care provider, care recipient (or his or her representative), relatives or carer make the arrangements.
3. Care Services Note: Excludes services if the care recipient and carer chooses and/or is able to provide these for him or herself.
Service	Description
Activities of daily living	Personal assistance, including individual attention, support, supervision and physical assistance with: bathing, showering including the provision of shower chairs if necessary, personal hygiene and grooming, dressing and undressing, and using dressing aids; communication including assistance to address difficulties arising from impaired hearing, sight or speech, or lack of common language, assistance with the fitting of sensory communication aids, checking hearing aid batteries, cleaning spectacles, and assistance in using the telephone; and assistance with shopping and transport to and from appointments; and support with performing household tasks including house cleaning, removal of household waste, ironing; personal laundry services including laundering of clothing and bedding that can be machine-washed, but excluding cleaning of clothing requiring dry cleaning or another special cleaning process.
Nutrition, hydration and meal preparation	Assistance, as necessary, in the preparation of meals and special diets for health, religious or cultural reasons. The provision of enteral feeding formula and equipment, without additional charge, as required. Assistance to use eating utensils and eating aids and assistance with actual feeding if necessary. Payment for food (except enteral feeds) is the responsibility of the care recipient (or his or her representative).
Management of skin integrity	Provision of, without additional charge, bandages, dressings, and skin emollients, excluding goods prescribed by a health practitioner for a specific health condition.
Continence management	Assessment for and, if required, provision of, without additional charge to care recipient, disposable pads and absorbent aids, commode chairs, bedpans and urinals, catheter and urinary drainage appliances and enemas. Assistance in using continence aids and appliances and managing continence.
Support for care recipients with cognitive impairment	Individual therapy, activities and access to specific programs designed and carried out to prevent or manage a particular condition or behaviour, enhance the quality of life and provide ongoing support.
Mobility and dexterity	Provision of, without additional charge, crutches, quadruped walkers, walking frames, walking sticks and wheelchairs where needed and the care recipient does not already have them. Where assessed as required, provision of, without additional charge, mechanical devices for lifting, bed rails, slide sheets, sheepskins, tri-pillows, and pressure relieving mattresses. Assistance in using the above aids. Excludes motorised wheelchairs and custom-made aids.
4. Support Services
Service	Description
Leisure, interests and activities	Encouragement to take part in social and community activities that promote and protect the care recipient’s lifestyle, interests and wellbeing. Assistance to access support services to maintain his or her personal affairs.
Emotional support	On-going support in adjusting to a lifestyle involving increased dependency and assistance for the care recipient, and carer if appropriate.
Therapy services	Maintenance therapy, such as diversional, recreational or speech therapy, podiatry, occupational, physiotherapy services, designed to minimise deterioration in function. Excludes: intensive, long-term rehabilitation services required, for example, following serious illness or injury, surgery or trauma, and services which the care recipient is able to claim through their private health insurance (if held).
On-call access	24-hour on-call access to at least one responsible person or agency located reasonably close to the care recipient, which will organise emergency assistance when required. This includes access to an emergency call system if the recipient is assessed as requiring it.
Home safety	Advice for care recipient (or his or her representative) of areas of concern in their homes that is a danger to the provider’s staff, the care recipient (or his or her representative) or carer.
Home maintenance	Maintenance of the care recipient’s home, gardens and yard to provide for function, safety and adequate security.
Home modification	Minor modifications to the home, if required, eg, easy access taps, shower hose and or bath rails. Providers will assist the care recipient and homeowner, if the home owner is not the care recipient, in accessing further technical advice, in the consideration of more comprehensive home modifications. Major home modifications are not met as part of CDC High Care services.

Informal Services

Informal services are those that may be provided by people already known to the family and not employed by the approved provider. Services or care they provide may also be included in a CDC High Care package. If this is the case, their details must be maintained on a register by the approved provider. Informal services may include:

• paying a taxi for transport to medical appointments or shopping;
• a private house cleaner;
• deliveries from the local store; and
• other private services suitable to meeting the care recipient’s assessed need.

In order to record the transaction that takes place between the approved provider and the informal care worker, a tax invoice/receipt may need to be provided as proof of the service taking place where the organisation/provider or individual is registered for GST purposes.

For informal services, the same existing arrangements will apply in regard to worker’s compensation, police checks, insurances, superannuation, etc. Where applicable, providers will need to seek their own advice from their own advisors (eg workers compensation authorities, insurers, legal advisers, accountants) on how those requirements apply to their particular circumstances.

Note: The Department does not support payment of family and friends for services as part of this model. The CDC informal and formal support services should be designed to complement and supplement the assistance and support provided by family/carers, friends and social and community networks.
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2.6.c CDC High Care Dementia

As with an EACHD package, a CDC High Care Dementia package involves a significant level of care plan reviewing and monitoring of the care recipient’s condition. This requires innovation, flexibility and an approach to service delivery that continuously modifies strategies to meet the changing needs of the care recipient.

A CDC High Care Dementia package:

• requires coordination and case management to support access to behavioural management specialists and other health and community service providers and the use of strategies and service approaches to address the underlying causes of behaviours of concern; and
• generally includes qualified nursing input, particularly in the design and ongoing management of the package and also where there are complex technical care needs.

The range of approved care and services which may be provided to recipients of EACHD packages fall into four categories:

• General;
• Specialist clinical services;
• Care services; and
• Support services.

Range of formal and informal services available through a CDC High Care Dementia package

Formal Services

The tables below list the specific services provided in each category and a description of that service.

1. General
Service	Description
Administration	General operation of the service including care recipient documentation.
Care planning and management	Initial and ongoing assessment, planning and management of care by appropriately qualified and trained staff, with the involvement of the care recipient, (or his or her representative), and their carer, where appropriate.
2. Specialised Clinical Serrvices
Service	Description
Clinical care	Services are to be carried out by a registered nurse, or under the direct or indirect supervision of a registered nurse or other professional appropriate to the service. Where appropriate, the provision of 24-hour per day on call access to care provided by or under the supervision of a qualified nurse. Services may include, but are not limited to, the following: assessment for pain and a plan implemented to keep the care recipient as free from pain as possible; care and maintenance of tubes, enteral feeding and naso-gastric tubes; establishment, review and maintenance of urinary catheter care and/or stoma care program; complex wound management; enema administration or the insertion of suppositories; suctioning of airways and tracheostomy care; oxygen therapy requiring ongoing supervision because of a care recipient’s variable need, including the provision of oxygen and oxygen equipment at no additional cost to the recipient; assistance with medication management; and on-call access to nursing services, if required.
Access to other health and related services	Referral to appropriate health specialists and other service providers in accordance with needs and preferences and assistance to attend appointments whether the care provider, care recipient (or his or her representative), relatives or carer make the arrangements.
3. Care Services Note: Excludes services if the care recipient and carer chooses and/or is able to provide these for himself or herself.
Service	Description
Activities of daily living	Personal assistance, including individual attention, support, supervision and physical assistance with: bathing, showering including the provision of shower chairs if necessary, personal hygiene and grooming, dressing and undressing, and using dressing aids; communication including assistance to address difficulties arising from impaired hearing, sight or speech, or lack of common language, assistance with the fitting of sensory communication aids, checking hearing aid batteries, cleaning spectacles and assistance in using the telephone; and assistance with shopping, transport to and from appointments; support with performing household tasks including house cleaning, removal of household waste, ironing; personal laundry services including laundering of clothing and bedding that can be machine-washed, but excluding cleaning of clothing requiring dry cleaning or another special cleaning process.
Nutrition, hydration and meal preparation	Assistance, as necessary, in the preparation of meals and special diets for health, religious or cultural reasons. The provision of enteral feeding formula and equipment, without additional charge, as required. Assistance to use eating utensils and eating aids and assistance with actual feeding if necessary. Payment for food (except enteral feeds) is the responsibility of the care recipient (or his or her representative).
Management of skin integrity	Provision of bandages, dressings, and skin emollients, without additional charge, excluding goods prescribed by a health practitioner for a specific health condition.
Continence management	Assessment for and, if required, provision of, without additional charge to care recipient, disposable pads and absorbent aids, commode chairs, bedpans and urinals, catheter and urinary drainage appliances and enemas. Assistance in using continence aids and appliances and managing continence.
Support for care recipients with cognitive impairment	Individual therapy, activities and access to specific programs designed and carried out to prevent or manage a particular condition or behaviour, enhance the quality of life and provide ongoing support.
Mobility and dexterity	Provision of, without additional charge, crutches, quadruped walkers, walking frames, walking sticks, wheelchairs where needed and the care recipient does not already have them. Where assessed as required, provision of, without additional charge, mechanical devices for lifting, bed rails, slide sheets, sheepskins, tri-pillows, and pressure relieving mattresses. Assistance in using the above aids. Excludes: motorised wheelchairs and custom-made aids.
4. Support Services
Service	Description
Leisure, interests and activities	Encouragement to take part in social and community activities that promote and protect the care recipient’s lifestyle, interests and wellbeing. Assistance to access support services to maintain his or her personal affairs.
Emotional support	On-going, appropriate support for the care recipient and carer in adjusting to a lifestyle involving increased dependency.
Therapy services	Maintenance therapy, such as diversional, recreational or speech therapy, podiatry and occupational or physiotherapy services, designed to minimise deterioration in function. Excludes: intensive, long-term rehabilitation services, required, for example, following serious illness or injury, surgery or trauma, and services which the care recipient is able to claim through their private health insurance (if held).
On-call access	24-hour on-call access to at least one responsible person or agency located reasonably close to the care recipient, which will organise emergency assistance when required. This includes access to an emergency call system if the recipient is assessed as requiring it.
Home safety	Advice for care recipient (or his or her representative) of areas of concern in their homes that is a danger to the provider’s staff, the care recipient (or his or her representative) or carer.
Home maintenance	Maintenance of the care recipient’s home, gardens and yard to provide for function, safety and adequate security.
Home modification	Minor modifications, if required, eg, easy access taps, shower hose, bath rails. Providers will assist the care recipient and homeowner, if the home owner is not the care recipient, in accessing further technical advice in the consideration of more comprehensive home modifications. Major home modifications are not covered by CDC High Care Dementia services.

Informal Services

Informal services are those that may be provided by people already known to the family and not employed by the approved provider. Services or care they provide may also be included in a CDC High Care Dementia package. If this is the case, their details must be maintained on a register by the approved provider. Informal services may include:

• paying a taxi for transport to medical appointments or shopping;
• a private house cleaner;
• deliveries from the local store; and
• other private services suitable to meeting the care recipient’s assessed need.

In order to record the transaction that takes place between the approved provider and the informal care worker, a tax invoice/receipt may need to be provided as proof of the service taking place where the organisation/provider or individual is registered for GST purposes.

For informal services, the same existing arrangements will apply in regard to worker’s compensation, police checks, insurances, superannuation, etc. Where applicable, providers will need to seek their own advice from their own advisors (eg workers compensation authorities, insurers, legal advisers, accountants) on how those requirements apply to their particular circumstances.

Note: The Department does not support payment of family and friends for services as part of this model. The CDC informal and formal support services should be designed to complement and supplement the assistance and support provided by family/carers, friends and social and community networks.
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Methodologies

Service Strategies

A range of service methodologies can be considered for CDC High Care Dementia, including:

• the capacity and skills of staff to respond to circumstances where a care recipient may experience increased levels of agitation, distress or risk, for eg; during sundowning, support with activities of daily living or settling of night time behaviours;
• support in relation to accessing :
  • respite care, including short term community respite care in response to particular emergency or unplanned events. Regular respite to prevent carer strain, which may include residential respite, home and community respite care and other carer services available through the National Respite for Carers Program
  • specialist behavioural management services (including those funded through the Australian Government), psycho-geriatricians, geriatricians and Mental Health Services for Older People;
  • dementia specific services and supports, for eg; dementia specific day care, dementia specific carer support and education programs;
  • 24 hour ‘emergency’ or crisis management services; and
  • specialist advice on home modifications and home safety improvement to ensure that the home environment is safe and risks are reduced;
• additional assistance with Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL), which may include additional time to provide care and additional care workers involved in the delivery of care. Language and memory deficits result in difficulty with IADLs, the ability to recognise objects or inability to hold a thought long enough to complete a task; and
• an emphasis placed on psycho-social approaches to providing care and support to care recipients, which assist in addressing the underlying causes of behaviours of concern.

Behaviours may often be best managed by means of appropriate strategies by care workers, carers and others with whom the care recipient has contact. The main strategies may include behavioural strategies.

Behavioural Strategies
There is a range of behavioural strategies available that can be utilised by the specialists in behavioural management and/or by the approved provider, with advice, support and training from specialists in behaviour management. These include:

• assessment of multi-faceted, historical, situational, inter and intra personal context which produced or exacerbated the behaviour;
• differentiation between those aspects of behaviour which were, or were not, causing distress, including perceptions of distress of carer, care worker and care recipient;
• appropriate communication, which will offer attention and empathy and will avoid coercion, impatience or ignoring the person;
• support for positive behaviours;
• creative approaches to supporting the IADLs, for instance, those involving distraction or familiarisation techniques;
• using spared memory;
• support and attitude change, including emotional support for carers, validation of carers, empowerment of carers to set limits;
• modifying nursing care practices;
• development of behavioural therapy plans; and
• purchasing, on a short term basis, an occupational therapist to work with care recipient and carer, to identify triggers of the behaviour and implement a therapy program.

2.7 Aids and Equipment

Availability and use of permanent aids and equipment for CDC packages will be carried out in accordance with the packaged care programs. This is outlined in the Community Packaged Care Guidelines.
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2.8 Service Management

2.8.a CDC Low Care

Approved providers, case managers and case workers have key roles in managing the effective delivery of care and services to recipients of a CDC Low Care package. The table below outlines requirements and suggested considerations for effective service delivery.

Role	Requirements and Considerations
Approved providers	Are required to: assist with referral to appropriate health specialists and other service providers in accordance with the needs and preferences of the care recipient; provide assistance to the care recipient to attend appointments whether the approved provider, care recipient or his or her representative make the arrangements; and administer a CDC budget. May wish to: enable care workers to undertake Community Services Training CHC30102 – Certificate III in Aged Care Work; and where applicable: ensure care workers are appropriately trained and skilled in dementia care; provide care support which is responsive to the specific nature of dementia.
Case managers	Will typically have: knowledge, skills and experience in the delivery of quality care; a knowledge of the methods in facilitating the involvement of General Practitioners in case management; an understanding of best practice in the delivery of quality care; flexibility and innovation in responding to the changing, and individual needs of the care recipient; a capacity and willingness to learn and to modify service approaches in response to changing circumstances and current relevant evidenced based care; a capacity to actively facilitate and maintain service partnerships; and appropriate formal qualifications, generally nursing and allied health.
Care Workers	Will typically have: an affinity with the target group and well developed communication skills; flexibility for the care recipient’s needs, including the ability to monitor the condition and changing circumstances of the care recipient and, under supervision of the case manager, modify approaches to service delivery as required; the capacity and willingness to update knowledge on quality care, including undertaking formal opportunities for training and informal skills improvement; the ability to work in partnership with a range of health and community service providers and specialists, adopting a multi-disciplinary approach to service delivery; and a caring and respectful attitude towards the care recipient and carer.

2.8.b CDC – High Care

Approved providers, case managers and case workers have key roles in managing the effective delivery of care and services to recipients of a CDC High Care package. The table below outlines requirements and suggested considerations for effective service delivery.

Role	Requirements and Considerations
Approved providers	Are required to: assist with referral to appropriate health specialists and other service providers in accordance with the needs and preferences of the care recipient; provide assistance to the care recipient to attend appointments whether the Approved Provider, care recipient or his or her representative make the arrangements; and administer the CDC budget; May wish to: enable care workers to undertake Community Services Training CHC30102 – Certificate III in Aged Care Work.; and where applicable: ensure care workers are appropriately trained and skilled in dementia care; provide care support which is responsive to the specific nature of dementia.
Case managers	Will typically have: knowledge, skills and experience in the delivery of quality care; a knowledge of the methods in facilitating the involvement of General Practitioners in case management; an understanding of best practice in the delivery of quality care; flexibility and innovation in responding to the changing, and individual needs of the care recipient; a capacity and willingness to learn and to modify service approaches in response to changing circumstances and current relevant evidenced based care; a capacity to actively facilitate and maintain service partnerships; and appropriate formal qualifications, usually involving nursing.
Care Workers	Will typically have: an affinity with the target group and well developed communication skills; flexibility for the care recipient’s needs. The ability to monitor the condition and changing circumstances of the care recipient and, under supervision of the case manager, modify approaches to service delivery as required; the capacity and willingness to update knowledge on quality care, including undertaking formal opportunities for training and informal skills improvement; the ability to work in partnership with a range of health and community service providers and specialists, adopting a multi-disciplinary approach to service delivery; and a caring and respectful attitude towards the care recipient and carer.

2.8.c CDC High Care Dementia

Approved providers, case managers and case workers have key roles in managing the effective delivery of care and services to recipients of CDC High Care Dementia packages. The table below outlines requirements and suggested considerations for effective service delivery.

Role	Requirements and Considerations
Approved providers	Are required to: assist with referral to appropriate health specialists and other service providers in accordance with the needs and preferences of the care recipient; provide assistance to the care recipient to attend appointments whether the Approved Provider, care recipient (or his or her representative), relatives or carer make the arrangements; and administer the CDC budget. May wish to: enable care workers to undertake Community Services Training CHC30102 – Certificate III in Aged Care Work; ensure care workers are appropriately trained and skilled in dementia care including behaviour management; and provide care support which is responsive to the specific nature of dementia and behaviours of concern.
Case managers	Will typically have: knowledge, skills and experience in the delivery of dementia care and behavioural management strategies; a knowledge of the methods in facilitating the involvement of General Practitioners in case management; an understanding of current evidence based best practice in the delivery of both complex care and specifically dementia care; flexibility and innovation in responding to the changing, and individual needs of the care recipient; a capacity and willingness to learn and to modify service approaches in response to changing circumstances; a capacity to actively facilitate and maintain service partnerships; and appropriate formal qualifications including dementia specific training, usually involving nursing input.
Care Workers	Will typically have: flexibility, to dedicate additional time to the delivery of care (for eg; assistance with activities of daily living) and to monitor the condition and changing circumstances of the care recipient and modify approaches to service delivery as required; the capacity and willingness to update knowledge on dementia care, including undertaking formal opportunities for training and informal skills improvement; the ability to work in partnership with a range of health and community service providers and specialists, adopting a multi-disciplinary approach to service delivery; and a caring and respectful attitude towards the care recipient.

2.9 Case Management - CDCHD

Case management for people with dementia who experience behaviours of concern is an essential component of care planning and delivery of packaged care services requiring specific expertise and skill. Issues to be considered include:

• preparation of a detailed care plan, including a behaviour management plan, which clearly identifies:
  • risks;
  • the range of service partners;
  • continuous regular review processes;
  • types of services to be delivered; and
  • service strategies;
• proposed involvement of a range of service partners (including General Practitioners, behavioural management specialists, psycho-geriatricians and other health and community service providers) in the assessment processes, through a mix of case conferencing, care planning, service delivery, monitoring and regular review;
• maintenance of partnerships with specialists in the provision of advice, support, consultation and regular review; and
• ongoing monitoring of approaches and strategies used in the delivery of care and regular review of approaches and strategies in response to the changing needs of care recipients and carers.

2.10 Monitoring and Service Delivery

There are four broad categories of changed needs to which a provider may need to respond.

Change Categories	Responses
	CDC Low Care	CDC High Care	CDC High Care Dementia
Short term change	Undertake a review of the care plan.	Undertake a review of the care plan.	Undertake a review of the care plan. These changes can be the result of temporary fluctuations in health, behavioural or psychological symptoms.
Changes resulting from improved care processes	Some issues may respond to the provision of improved or additional care services. The change in level of care required may be contingent on the care services, and specific strategies and approaches being maintained.	Some issues may respond to the provision of improved or additional care services. The change in level of care required may be contingent on the care services, and specific strategies and approaches being maintained.	Some issues may respond to the provision of improved or additional care services. The change in behaviour may be contingent on the care services, and specific strategies and approaches being maintained.
Reduction in need	The level of care required may change over time. It may be appropriate to consider whether a CDC Low Care package is still the most appropriate care or whether other forms of community care would be more appropriate. This process must take into consideration Security of Tenure provisions.	The level of care required may change over time. It may be appropriate to consider whether a CDC High Care package is still the most appropriate care or whether other forms of community care would be more appropriate. This process must take into consideration Security of Tenure provisions.	Diseases of dementia are progressive and the symptoms associated with dementia can change over time to the extent that behaviours of concern may settle. It may be appropriate under these circumstances to review whether a CDC High Care Dementia package is still the most appropriate care or whether other forms of community care would be more appropriate. However, this process must also consider whether behaviours of concern will escalate through a reduction in care levels and also must have regard to Security of Tenure provisions.
Increase in need	A CDC Low Care package may no longer be appropriate if care needs escalate to the extent that the care recipient can no longer be supported at home. A review of the care plan should be undertaken. This process must take into consideration Security of Tenure provisions.	A CDC High Care package may no longer be appropriate if care needs escalate to the extent that the care recipient can no longer be supported at home. A review of the care plan should be undertaken. This process must take into consideration Security of Tenure provisions.	A CDC High Care Dementia package may no longer be appropriate if care needs escalate to the extent that the care recipient can no longer be supported at home. A review of the care plan should be undertaken. This process must take into consideration Security of Tenure provisions.

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2.11 Maintaining Links and Partnerships

2.11a CDC Low and CDC High Care

The provision of quality care and support to people receiving a CDCL or CDCH care package will require partnership with a range of services and individuals such as:

• ACATs;
• General Practitioners; and
• other health services, allied health and specialists, to assist in the management of functional, behavioural and clinical issues.

These groups need to work effectively together by:

• case conferencing and case management;
• ongoing review, monitoring and adaptation of strategies according to changing needs, conditions and circumstances; and
• upskilling of care workers and case managers by liaising and the support of other health services, allied health and specialists.

2.11.b CDC High Care Dementia

The provision of quality care and support to people with dementia who experience behaviours of concern, will require partnership with a range of services and individuals such as:

• ACATs;
• behavioural management specialists, geriatricians, psycho-geriatricians, Mental Health Services for Older People in the development of care plans through referral by GPs; and
• other health services and specialists, to assist in the management of functional, behavioural or clinical issues.

These groups need to work effectively together by:

• case conferencing and case management between approved providers, general practitioners, geriatricians, psycho-geriatricians, behavioural management specialists and other services involved in the care of individual care recipients;
• ongoing review, monitoring and adaptation of strategies according to changing needs, conditions and circumstances; and
• upskilling of care workers and case managers by specialists, through the provision of support and advice regarding methodologies in addressing the underlying causes of changed behaviours.

2.12 Community Care Common Standards

The Community Care Common Standards (Common Standards) came into effect on 1 March 2011 for Commonwealth pachaged care programs, and took effect for CDC programs as of 15 April 2011. The Common Standards were part of a reform agenda to streamline administrative arrangements across community aged care programs and jurisdictions. Whilst the CDC initiative is not included in the Quality Reporting cycle, and is being evaluated separately, CDC providers should comply with the same standards as those across Commonwealth packaged care programs.

The information contained in this document forms the basis of expectations of approved providers of the quality of care being delivered. In providing a CDCL, CDCH and CDCHD package, the approved provider will have systems in place to identify and ensure compliance with all relevant legislation, regulatory requirements, professional standards and guideline relevant to care provision.

Further information about the Common Standards can be found at:
www.comcarestandards.com.au

2.12a CDC Low Care

The same standards applying to CACPs apply to CDC Low Care packages and are outlined below. A copy of the Standards are provided at Attachment 1 of CDCL payment Agreement.
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Complying with the CDC Low Care Standards

The lists below show the standards relating to each area of service delivery and what is required of the approved provider to ensure they meet that standard.

Standard 1: Effective management

The service provider demonstrates effective management processes based on a continuous improvement approach to service management, planning and delivery.

• Expected outcome 1.1: Corporate Governance. The service provider has implemented corporate governance processes that are accountable to stakeholders.
• Expected outcome 1.2: Regulatory Compliance. The service provider has systems in place to identify and ensure compliance with funded program guidelines, relevant legislation, regulatory requirements and professional standards.
• Expected outcome 1.3: Information Management systems. The service provider has effective information management systems in place.
• Expected outcome 1.4: Community understanding and engagement. The service provider understands and engages with the community in which it operates and reflects this in service planning and development.
• Expected outcome 1.5: Continuous improvement. The service provider actively pursues and demonstrates continuos improvement an all aspects of service management and delivery.
• Expected outcome 1.6: Risk management. The service provider is actively working to identify and address potential risk to ensure safety of service users, staff and the organisation.
• Expected outcome 1.7: Human resource management. The service provider manages Human resources to ensure that adequate numbers of appropriately skilled and trained staff/volunteers are available for the safe delivery of care and services to service users.
• Expected outcome 1.8: Physical resources. The service provider manages physical resources to ensure the safe delivery of care and services to service users and organisation personnel.

Standard 2: Appropriate access and service delivery

Each service user (and prospective service user) has access to services and service users receive appropriate services that are planned, delivered and evaluated in partnership with themselves and/or their representative.

• Expected outcome 2.1: Service access. Each service user's access to services is based on consultation with the service user (and/or their representative), equity, consideration of available resources and program eligibility.
• Expected outcome 2.2: Assessment. Each service user participates in an assessment appropriate to the complexity of their needs and with consideration of their cultural and linguistic diversity.
• Expected outcome 2.3: Care plan development and delivery. Each service user and/or their representative, participates in the development of a care/service plan that is based on assessed needs and is provided with the care and/or service described in their plan.
• Expected outcome 2.4: Service user reassessment. Each service user's needs are monitored and regularly reassessed taking into account any relevant program guidelines and in accordance with the complexity of the service user's needs. Each service users' care/service plans are reviewed in consultation with them.
• Expected outcome 2.5: Service user referral. The service provider refers service users (and/or their representative) to other providers as appropriate.

Standard 3: Service user rights and responsibilities

Each service user (and/or their representative) is provided with information to assist them to make service choices and has the right (and responsibility) to be consulted and respected. Service users (and/or their representative) have access to complaints and advocacy information and processes and their privacy and confidentiality and rights to independence is respected.

• Expected outcome 3.1: Information provision. Each service user, or prospective service user, is provided with information (initially and on an ongoing basis) in a format appropriate to their needs to assist them to make service choices and gain an understanding of the services available to them and their rights and responsibilities.
• Expected outcome 3.2: Privacy and confidentiality. Each service user's right to privacy, dignity and confidentiality is respected including in the collection, use and disclosure of personal information.
• Expected outcome 3.3: Complaints and service user feedback. Complaints and service user feedback are dealt with fairly, promptly, confidentially and without retribution.
• Expected outcome 3.4: Advocacy. Each service user's (and/or their representative's) choice of advocate is respected by the service provider and the service provider will, if required, assist the service user (and/or their representative) to access an advocate.
• Expected outcome 3.5: Independence. The independence of service users is supported, fostered and encouraged.

2.12.b CDC High Care

The same care Standards applying to EACH packages apply to CDC High Care packages and are outlined below. A copy of the Standards are provided at Attachment 1 of the CDCH Payment Agreement.
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Complying with the CDC High Care Standards

The lists below show the standards relating to each area of service delivery and what is required of the approved provider to ensure they meet that standard.

Standard 1: Effective management

The service provider demonstrates effective management processes based on a continuous improvement approach to service management, planning and delivery.

• Expected outcome 1.1: Corporate Governance. The service provider has implemented corporate governance processes that are accountable to stakeholders.
• Expected outcome 1.2: Regulatory Compliance. The service provider has systems in place to identify and ensure compliance with funded program guidelines, relevant legislation, regulatory requirements and professional standards.
• Expected outcome 1.3: Information Management systems. The service provider has effective information management systems in place.
• Expected outcome 1.4: Community understanding and engagement. The service provider understands and engages with the community in which it operates and reflects this in service planning and development.
• Expected outcome 1.5: Continuous improvement. The service provider actively pursues and demonstrates continuos improvement an all aspects of service management and delivery.
• Expected outcome 1.6: Risk management. The service provider is actively working to identify and address potential risk to ensure safety of service users, staff and the organisation.
• Expected outcome 1.7: Human resource management. The service provider manages Human resources to ensure that adequate numbers of appropriately skilled and trained staff/volunteers are available for the safe delivery of care and services to service users.
• Expected outcome 1.8: Physical resources. The service provider manages physical resources to ensure the safe delivery of care and services to service users and organisation personnel.

Standard 2: Appropriate access and service delivery

Each service user (and prospective service user) has access to services and service users receive appropriate services that are planned, delivered and evaluated in partnership with themselves and/or their representative.

• Expected outcome 2.1: Service access. Each service user's access to services is based on consultation with the service user (and/or their representative), equity, consideration of available resources and program eligibility.
• Expected outcome 2.2: Assessment. Each service user participates in an assessment appropriate to the complexity of their needs and with consideration of their cultural and linguistic diversity.
• Expected outcome 2.3: Care plan development and delivery. Each service user and/or their representative, participates in the development of a care/service plan that is based on assessed needs and is provided with the care and/or service described in their plan.
• Expected outcome 2.4: Service user reassessment. Each service user's needs are monitored and regularly reassessed taking into account any relevant program guidelines and in accordance with the complexity of the service user's needs. Each service users' care/service plans are reviewed in consultation with them.
• Expected outcome 2.5: Service user referral. The service provider refers service users (and/or their representative) to other providers as appropriate.

Standard 3: Service user rights and responsibilities

Each service user (and/or their representative) is provided with information to assist them to make service choices and has the right (and responsibility) to be consulted and respected. Service users (and/or their representative) have access to complaints and advocacy information and processes and their privacy and confidentiality and rights to independence is respected.

• Expected outcome 3.1: Information provision. Each service user, or prospective service user, is provided with information (initially and on an ongoing basis) in a format appropriate to their needs to assist them to make service choices and gain an understanding of the services available to them and their rights and responsibilities.
• Expected outcome 3.2: Privacy and confidentiality. Each service user's right to privacy, dignity and confidentiality is respected including in the collection, use and disclosure of personal information.
• Expected outcome 3.3: Complaints and service user feedback. Complaints and service user feedback are dealt with fairly, promptly, confidentially and without retribution.
• Expected outcome 3.4: Advocacy. Each service user's (and/or their representative's) choice of advocate is respected by the service provider and the service provider will, if required, assist the service user (and/or their representative) to access an advocate.
• Expected outcome 3.5: Independence. The independence of service users is supported, fostered and encouraged.

2.12c CDC High Care Dementia

The same care Standards applying to EACHD packages apply to CDCHD packages and are outlined below. A copy of the Standards are provided at Attachment 1 of the CDCHD Payment Agreement.
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Complying with the CDC High Care Dementia Standards

The lists below show the standards relating to each area of service delivery and what is required of the approved provider to ensure they meet that standard.

Standard 1: Effective management

The service provider demonstrates effective management processes based on a continuous improvement approach to service management, planning and delivery.

• Expected outcome 1.1: Corporate Governance. The service provider has implemented corporate governance processes that are accountable to stakeholders.
• Expected outcome 1.2: Regulatory Compliance. The service provider has systems in place to identify and ensure compliance with funded program guidelines, relevant legislation, regulatory requirements and professional standards.
• Expected outcome 1.3: Information Management systems. The service provider has effective information management systems in place.
• Expected outcome 1.4: Community understanding and engagement. The service provider understands and engages with the community in which it operates and reflects this in service planning and development.
• Expected outcome 1.5: Continuous improvement. The service provider actively pursues and demonstrates continuos improvement an all aspects of service management and delivery.
• Expected outcome 1.6: Risk management. The service provider is actively working to identify and address potential risk to ensure safety of service users, staff and the organisation.
• Expected outcome 1.7: Human resource management. The service provider manages Human resources to ensure that adequate numbers of appropriately skilled and trained staff/volunteers are available for the safe delivery of care and services to service users.
• Expected outcome 1.8: Physical resources. The service provider manages physical resources to ensure the safe delivery of care and services to service users and organisation personnel.

Standard 2: Appropriate access and service delivery

Each service user (and prospective service user) has access to services and service users receive appropriate services that are planned, delivered and evaluated in partnership with themselves and/or their representative.

• Expected outcome 2.1: Service access. Each service user's access to services is based on consultation with the service user (and/or their representative), equity, consideration of available resources and program eligibility.
• Expected outcome 2.2: Assessment. Each service user participates in an assessment appropriate to the complexity of their needs and with consideration of their cultural and linguistic diversity.
• Expected outcome 2.3: Care plan development and delivery. Each service user and/or their representative, participates in the development of a care/service plan that is based on assessed needs and is provided with the care and/or service described in their plan.
• Expected outcome 2.4: Service user reassessment. Each service user's needs are monitored and regularly reassessed taking into account any relevant program guidelines and in accordance with the complexity of the service user's needs. Each service users' care/service plans are reviewed in consultation with them.
• Expected outcome 2.5: Service user referral. The service provider refers service users (and/or their representative) to other providers as appropriate.

Standard 3: Service user rights and responsibilities

Each service user (and/or their representative) is provided with information to assist them to make service choices and has the right (and responsibility) to be consulted and respected. Service users (and/or their representative) have access to complaints and advocacy information and processes and their privacy and confidentiality and rights to independence is respected.

• Expected outcome 3.1: Information provision. Each service user, or prospective service user, is provided with information (initially and on an ongoing basis) in a format appropriate to their needs to assist them to make service choices and gain an understanding of the services available to them and their rights and responsibilities.
• Expected outcome 3.2: Privacy and confidentiality. Each service user's right to privacy, dignity and confidentiality is respected including in the collection, use and disclosure of personal information.
• Expected outcome 3.3: Complaints and service user feedback. Complaints and service user feedback are dealt with fairly, promptly, confidentially and without retribution.
• Expected outcome 3.4: Advocacy. Each service user's (and/or their representative's) choice of advocate is respected by the service provider and the service provider will, if required, assist the service user (and/or their representative) to access an advocate.
• Expected outcome 3.5: Independence. The independence of service users is supported, fostered and encouraged.

2.13 Levels and Type of Service Provision

Approved providers must deliver a range of services to meet prescribed or agreed care needs at a variety of levels whilst adhering to the CDCL, CDCH and CDCHD Care Standards as set out above.

The Government also has expectations that the levels of care provided represent value for money in meeting care needs of older Australians. Approved providers are accountable for the type and amount of assistance provided by the service, both at an aggregate level and against individuals’ assessed needs. They are required to report service provision information to the Australian Government as requested.
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2.14 Leave

Care recipients on CDC packages whether CDCL, CDCH or CDCHD are entitled to the equivalent leave arrangements as those on CACPs, EACH and EACHD.

Therefore care recipients receiving:

• CDCL packages are entitled to the same leave arrangements as those on CACP;
• CDCH packages are entitled to the same leave arrangements as those on EACH packages; and
• CDCHD packages are entitled to the same leave arrangements as those on EACHD packages.

Under CDC in packaged care, approved providers will continue to receive subsidy up to the maximum leave entitlements of care recipients. Approved providers are able to keep their agreed administrative level of the subsidy, while it is expected that the level that was for the care recipient’s use will be put aside for use by the care recipient on their return from leave.

2.14.a Leave entitlements for CDC Low Care, CDC High Care and CDCHC Dementia recipients are:

	CDCL	CDCH	CDCHD
Type of leave	Care recipient leave entitlement	Care recipient leave entitlement	Care recipient leave entitlement
Hospital or intensive outpatient services	Unlimited.	A Care recipient may take unlimited hospital leave and still retain their eligibility to receive a CDCH package upon leaving hospital.	A Care recipient may take unlimited hospital leave and still retain their eligibility to receive a CDCHD package upon leaving hospital.
Alternative care – such as; respite or short term residential care or social leave	Combined maximum of 56 days per financial year. Note: only 28 days per financial year can be taken as social leave.	Combined maximum of 56 days per financial year. Note: Only 28 days per financial year may be taken as social leave.	Combined maximum of 56 days per financial year. Note: Only 28 days per financial year may be taken as social leave.
Transition Care	Accessible directly upon discharge from hospital. Limited to a maximum of 84 days per episode; however in exceptional circumstances Transition Care may be extended up to a maximum of a further 42 days per episode.	A Care Recipient is entitled to take leave from care packages to access the Transition Care Program up to 84 days in allowed with an extension of 42 days.	A Care Recipient is entitled to take leave from care packages to access the Transition Care Program up to 84 days in allowed with an extension of 42 days.
Leave, other than hospital leave, of less than five days	Can be taken any time.	N/A	N/A
Extension of suspension of service	Retention of services will not be affected if fees are paid and extension is requested in writing to the approved provider.	Retention of services will not be affected if fees are paid and extension is requested in writing to the approved provider.	Retention of services will not be affected if fees are paid and extension is requested in writing to the approved provider.

2.15 Financial Management

Financial reporting requirements and responsibilities for CDCL, CDCH and CDCHD are set out in the CDC Payment Agreement in the format provided by the Department.
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3 Glossary

Term	Interpretation
ACAT	Aged Care Assessment Team (ACATs are known as Aged Care Assessment Services in Victoria).
Act	The Aged Care Act 1997.
Allied Health	Refers to professional allied health care services and includes a wide range of specialist services, such as: podiatry; occupational therapy; physiotherapy; social work; speech pathology; advice from dietician or nutritionist.
Approved Provider	A person or body approved by the Department to operate Australian Government funded aged care services. Approved Providers, including key personnel, must meet specified criteria to be approved as a provider.
CACP	Community Aged Care Package – care consisting of a package of care services provided to a person who lives in their own home and is not in residential care.
Care Recipient	A person assessed by an Aged Care Assessment Team as having significant care needs which can be appropriately met through the provision of community care and/or flexible care.
CDC	Consumer Directed Care.
CDCH	CDC High Care Care equivalent to an Extended Aged Care at Home package.
CDCHD	CDC High Care Dementia Care equivalent to an Extended Aged Care at Home Dementia package.
CDCL	CDC Low Care Care equivalent to a Community Aged Care Package.
CIS	Aged Care Complaints Investigation Scheme.
Delegate	Delegate under the Aged Care Act 1997.
Department	Australian Government Department of Health and Ageing.
EACH	Extended Aged Care at Home – care consisting of a package of care services, including nursing and other personal assistance provided to a person who lives in their own home and not in residential care, who requires equivalent to residential high level care.
EACHD	Extended Aged Care at Home Dementia – care consisting of a package of care services, including nursing and other personal assistance provided to a person who lives at home with dementia, has behaviours of concern and is not in residential care, who requires equivalent to residential high level care.
GP	General Practitioner.
GST	Goods and Services Tax.
HACC	Home and Community Care – a program of basic maintenance and support services for frail older people, younger people with disabilities and the carers of these people to prevent premature admission to residential care. Services include home nursing, home help, respite care and assistance with meals and transport. Access to HACC services is on the basis of relative care need and the availability of services.
OH&S	Occupational Health and Safety.
NRCP	National Respite for Carers Program.
Personal Care Services	The services listed in the Payment Agreement.
Principles	Aged Care Principles (made under sub-section 96-1 (1) of the Aged Care Act 1997, reprinted as in force on 30 March 2010).
Provider	See Approved Provider.
Respite Care	Care given as an alternate care arrangement with the primary purpose of giving the carer or care recipient a short term break from their usual care arrangement.
Secretary	Secretary of the Australian Government Department of Health and Ageing.
User Rights Principles 1997	Set out certain rights and responsibilities for care recipients and providers.

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