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Viability Supplement - Additional Support for Aged Care Homes Specialising in Care for Indigenous Australians and the Homeless

Dear Approved Provider

As part of the 2011–2012 Budget, measures were introduced to expand existing funding under the Viability Supplement to provide additional support to:

• aged care homes in very remote to moderately accessible locations that target low care;
• eligible aged care homes that provide specialist aged care services to Indigenous Australians; and
• eligible aged care homes that provide specialist aged care services to people with a history of (or who may be at severe risk of) homelessness

The extension of the viability supplement to services that target low level residential care in very remote to moderately accessible locations will automatically be paid by the Department of Human Services (DHS), formerly known as Medicare Australia. Approved providers will not need to notify DHS of eligibility in this instance.

This letter provides information on the arrangements for aged care providers seeking to register for the extension of the viability supplement in relation to specialist services for Indigenous Australians and Australians with a history of homelessness.

Who is eligible to register?

Eligible providers are those funded by the Australian Government with aged care homes specialising in caring for homeless and/or Indigenous Australians. Funding is only available to residential aged care providers that receive subsidies for care recipients based on Aged Care Funding Instrument (ACFI) appraisals. Funding is not available to community care and other services supported through the flexible care provisions of the Aged Care Act 1997.

How do providers register their eligibility?

To qualify for the expansion component of the Viability Supplement, an approved provider’s service must register with the Department of Health and Ageing (DoHA). To be considered for registration, providers should send an email to Viability Supplement Expansion. The email should comment briefly on:

• a history and track record in providing access for people who are homeless or at risk of homelessness and/or Indigenous Australians;
• a continuing commitment to target and predominantly focus on the needs of one or both of these groups;
• the capacity to provide high quality care that meets the specific needs of these groups;
• the capacity to promote access to the broad range of services relevant to the needs of these groups; and
• the capacity to link with relevant local services and communities, including agencies which may provide sources of client referrals.

Email nominations should be received by DoHA no later than 15 October 2011. Upon request, supporting evidence must be made available to DoHA.

Appraisal of care recipients

It is important to note that while registration is necessary to receive payment, it does not automatically result in additional payments. To be eligible for additional payments, providers must also have appraised more than 50 per cent of care recipients as meeting the criteria for homelessness and/or Indigenous Australians. Appraisal Tools are provided for reference at Attachments A and B.

More information will be provided to eligible providers, upon successful registration, on the process to provide notification to DHS on eligible care recipients for inclusion towards the 50 per cent requirement quota.

How are payments calculated?

Payments under the existing Viability Supplement Scheme are determined through a points system, with points being awarded to providers based on the criteria of:

1. location/provider type;
2. occupied places; and
3. special needs.

Targeting of homelessness and/or Indigenous Australians is now included in the ‘location/provider type’ criterion and attracts a total of 60 points (provided the total under location/provider type does not exceed 65 points). In addition, services that score 60 points for homeless and/or Indigenous Australians will automatically score the maximum of five points under the ‘special needs’ criterion.

Points are calculated for each day of care. To be awarded points for a particular day, more than 50 per cent of care recipients of the service (excluding respite care) must have been appraised as having complex behavioural and/or social needs and:

• have a history, or be at severe risk, of homelessness; and/or
• be of Aboriginal or Torres Strait Islander origin.

Further details of criteria and associated points are provided at Attachment C.

The amount payable to eligible providers corresponds with total awarded points. From 1 July 2011, payment rates under the Viability Supplement Scheme are payable up to a maximum of $39.03 (for a maximum score of 100 points) per care recipient per day. Full details of payment rates under the Viability Supplement are provided at Attachment D.

When will payment take effect?

The Viability Supplement expansion came into effect on 1 July 2011. DHS is making changes to the automated payment system which will be in place by December 2011. DHS will commence making retrospective payments at that time.

Further Information

Viability Supplement dedicated email address.
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Attachment A - Checklist A - Homelessness Related Care Needs

The care recipient must be considered to be part of the Special Needs group recognised under the Aged Care Act 1997 and described in Part 2A 4.4C of the Allocation Principles 1997 and have demonstrated complex behavioural and/or social support needs. They must meet each of the following four criteria:

1. Homelessness background
   1. The person has a history of homelessness or is at severe risk of homelessness, including people who immediately prior to entering care at the current or a previous residential aged care home:
      1. Were living in a public place or temporary shelter; short-term crisis, emergency or transitional accommodation; boarding house, rooming house or private hotel; or supported community accommodation; and/or
      2. Had no recent housing address; and/or
      3. Had a long history of unsuccessful tenancies/ unstable housing arrangements.



2. Financial Status
   • The person is eligible for the maximum basic rate of social security pension or benefit as defined in the Social Security Act 1991 or service pension or disability pension as defined in the Veterans Entitlement Act 1986.



3. Relevant behaviour diagnosis
   • The person has mental and behavioural diagnosis associated with one of the following disorders (ACAP codes shown in brackets). This checklist aligns with the range of conditions recognised by the Mental and Behavioural Diagnoses section of the ACFI :
     1. Dementia, Alzheimer’s disease including early onset, late onset, atypical or mixed type or specified.(ACAP code 500)
     2. Vascular dementia eg multi-infarct, subcortical, mixed (ACAP code 510)
     3. Dementia in other diseases, e.g. Pick’s Disease, Creulzfeldt-Jakob, Huntington’s, Parkinson’s, HIV (ACAP code 520)
     4. Other dementia, e.g. Lewy Body, alcoholic dementia, unspecified (ACAP code 530)
     5. Delirium (ACAP code 540)
     6. Depression, mood affective disorders, Bi- Polar (ACAP code 550A)
     7. Psychoses e.g. schizophrenia, paranoid states (ACAP code 550B)
     8. Neurotic, stress related, anxiety, somatoform disorders eg post traumatic stress disorder, phobic and anxiety disorders, nervous tension/stress, obsessive–compulsive disorder (ACAP code 560)
     9. Intellectual and developmental disorders e.g. intellectual disability or disorder, autism, Rhet’s syndrome, Asperger’s syndrome etc.(ACAP code 570)
     10. Other mental and behavioural disorders eg due to alcohol or psychoactive substances (includes alcoholism, Korsakov’s psychosis), adult personality and behavioural disorders (ACAP code 580)
   For the purposes of the checklist, the diagnosis can be made by any health professional acting within their approved scope of practice.



4. Challenging behaviours and/or need for intensive social support
   1. The person requires intensive assistance with continuing to perform activities of daily living, including initiation of and assistance with:
      1. Personal care and hygiene matters (for example, shows aversion to showering and washing hands, has problems with toileting and dressing, requires assistance or guidance with meals) ; and/or
      2. Social and recreational activities, with significant one-on-one staff intervention necessary to enable the client to participate in community activities.

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Attachment B - Checklist B - Indigenous Australian Related Care Needs

The care recipient must be considered to be part of the Special Needs group described at Section 11-3 (a) of the Aged Care Act 1997 and have demonstrated complex behavioural and/or needs and social support needs. They must meet each of the following four criteria:

1. Indigenous status
   • Is the person of Aboriginal or Torres Islander origin?



2. Financial disadvantage
   • The person is eligible for the maximum basic rate of social security pension or benefit as defined in the Social Security Act 1991 or service pension or disability pension as defined in the Veterans Entitlement Act 1986.



3. Relevant behavioural diagnosis
   • The person has mental and behavioural diagnosis associated with one of the following disorders (ACAP codes shown in brackets). This checklist aligns with the range of conditions recognised by the Mental and Behavioural Diagnoses section of the ACFI :
     1. Dementia, Alzheimer’s disease including early onset, late onset, atypical or mixed type or specified.(ACAP code 500)
     2. Vascular dementia eg multi-infarct, subcortical, mixed (ACAP code 510)
     3. Dementia in other diseases, e.g. Pick’s Disease, Creulzfeldt-Jakob, Huntington’s, Parkinson’s, HIV (ACAP code 520)
     4. Other dementia, e.g. Lewy Body, alcoholic dementia, unspecified (ACAP code 530)
     5. Delirium (ACAP code 540)
     6. Depression, mood affective disorders, Bi- Polar (ACAP code 550A)
     7. Psychoses e.g. schizophrenia, paranoid states (ACAP code 550B)
     8. Neurotic, stress related, anxiety, somatoform disorders eg post traumatic stress disorder, phobic and anxiety disorders, nervous tension/stress, obsessive–compulsive disorder (ACAP code 560)
     9. Intellectual and developmental disorders e.g. intellectual disability or disorder, autism, Rhet’s syndrome, Asperger’s syndrome etc.(ACAP code 570)
     10. Other mental and behavioural disorders eg due to alcohol or psychoactive substances (includes alcoholism, Korsakov’s psychosis), adult personality and behavioural disorders (ACAP code 580)
   For the purposes of the checklist, the diagnosis can be made by any health professional acting within their approved scope of practice.



4. Challenging behaviours and/or need for intensive social support
   1. The person displays challenging behaviours which require ongoing management and prevention including:
      1. Episodic catastrophic behaviours such as severe physical and verbal abuse, violent mood swings, aggression; and/or
      2. Is considered at high risk of leaving without warning with ongoing staff intervention required to prevent this from occurring.
   And/or
   2. The person requires intensive assistance with continuing to perform activities of daily living including initiation of and assistance with:
      1. Personal care and hygiene matters (for example, shows aversion to showering and washing hands, has problems with toileting and dressing, requires assistance or guidance with meals) ; and/or
      2. Social and recreational activities, with significant one-on-one staff intervention necessary to enable the client to participate in community activities.

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Attachment C - New Criteria - 2005 Viability Supplement Scheme

Item	Criterion	Points
1	Location/provider type: The sum of points for each of the following three elements, up to a maximum total of 65: Location: very remote location remote location moderately accessible location accessible location highly accessible location Targets Homelessness and/or Indigenous people with complex behavioural and social needs1 Targets low care needs in above locations (very remote), (remote) or (moderately accessible location)2	65 55 40 30 0 60 15
2	Places: less than 20 more than 19 but less than 25 more than 24 but less than 30 more than 29 but less than 35 more than 34 but less than 40 more than 39 but less than 45	30 25 20 15 10 5
3	Special needs: More than 50% of care recipients are people with special needs (other than people who are people with special needs only because they live in rural or remote area or are financially or socially disadvantaged)3.	5

Attachment D - Residential Aged Care Viability Supplement - Payment Rates

These rates are applicable from 1 July 2011 to 30 June 2012.

2005 Scheme Services

Score	Amount of Supplement
Eligibility score of 100	$39.03
Eligibility score of 95	$34.58
Eligibility score of 90	$31.03
Eligibility score of 85	$26.61
Eligibility score of 80	$22.16
Eligibility score of 75	$17.73
Eligibility score of 70	$14.22
Eligibility score of 65	$9.74
Eligibility score of 60	$7.97
Eligibility score of 55	$5.32
Eligibility score of 50	$3.55
Eligibility score of 45	$0.00
Eligibility score of 40	$0.00
Less than a score of 40	$0.00

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