1999-2000
Outcome 8: Enhanced Quality of Life for Older Australians
The 1999-2000 Portfolio Budget Statements, informs Senators and Members of Parliament of the proposed allocation of resources to portfolios outcomes and their objectives and targets including the agencies within the Health and Family Services portfolio.
Support for positive and healthy ageing and high quality and cost-effective services for frail older people, people with disabilities, and their carers.
Outcome Summary - The Year Ahead
The Outcome is achieved through the provision of high quality and responsive residential and community care for frail older Australians, and support for their carers in their caring role, and through encouraging healthy lifestyles for older people and their active participation in community life.
The Commonwealth, working with State and local governments, private providers (both private sector and charitable) and community organisations, is responsible for achieving this Outcome. Residential aged care is financed and regulated by the Commonwealth Government and provided largely by the non-government sector, with a small number of residential services operated by the State and local government sectors. The Commonwealth, together with the States and Territories, funds and delivers community care, as well as provides services to meet the needs of carers.
At the strategic level the Commonwealth carries major responsibility for formulating policy to meet the increasing demand for aged care services into the future, for ensuring the long term viability of the aged care sector, and for providing leadership in promoting cooperative relationships with State/Territory governments and other stakeholders, including international organisations, to improve aged care services.
During 1999-2000, the Department will focus on:
- progressing the reforms to the residential aged care system, in particular ensuring the standards of care for individuals;
- implementing increased support for people in the community requiring support, and their carers, and reform of key elements of the community care delivery system;
- continuing to develop stronger linkages with other programs, including the acute health sector, to secure quality outcomes for individuals; an
- celebrating and implementing a range of activities as part of the International Year of Older Persons, and developing the National Strategy for an Ageing Australia.
The Aged Care Standards and Accreditation Agency (ACSAA) assists in achieving the Outcome by continuing to progress quality improvement in aged care facilities under a purchaser-provider arrangement with the Department to deliver a range of services. These services involve monitoring the quality of care in those facilities not yet ready for accreditation, implementing an accreditation based quality assurance system, providing training and information to providers, and liaising with the Department on any poor performance by aged care facilities.
Some providers may choose to leave the industry and pass on care places to others who are prepared to invest in improvements. The Department will ensure the rights and continuity of care of residents are met during the period of transition.
Key consumer protections provided by the Complaints Resolution Scheme will be strengthened by improved data management, information provision and strategic planning involving all key stakeholders.
Considerable progress is expected on integrating the planning and allocation of new places across the residential and community care sectors. This not only will reduce administrative demands on providers but will lead to faster and better restructuring and more coordinated and efficient distribution of aged care resources
The trend towards community care will continue with the increasing availability of community care packages while the focus on providing support for carers will be progressed.
Emphasis will be placed on the coordinated care of individuals who need it. The Government will implement the case management of people over 65 years with chronic and complex diseases. Priority will also be placed on the transitional care of people moving from acute care to community or residential care.
The initiatives in widening the scope and availability of community aged care packages to older people and support measures for carers assists the Outcome through providing older people with a wider range of options to meet the care needs of individuals. This in turn should lead to greater efficiencies through better targeting of funding to meet those needs.
In particular the Home and Community Care (HACC) reforms will put effect to revised Commonwealth/State funding agreements by developing a HACC Program Minimum Data Set (MDS), developing dependency measures and data definitions, improving referral and coordination between key assessment agencies, and developing priority of access guidelines for HACC services.
The International Year of Older Persons (IYOP) will be an opportunity to recognise and value the past and ongoing contribution of older people in our society. In addition, the IYOP will support activities to encourage positive and active ageing, and will mark the beginning of cultural change in our society with campaigns to combat negative stereotypes of older people and to foster intergenerational understanding.
The National Strategy for an Ageing Australia will shape the policies for an ageing society to ensure that Australia continues to maximise the capacity of older people to participate in, and contribute to, the community. Whole-of-Government policies and programs will be developed, adopted, and maintained to promote better health, better retirement incomes, and more flexible employment and caring arrangements for older Australians.
Budget Measures Affecting Outcome 8
Top of pageCarelink - information on community care
Expense ($m)
 | 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 3.6 | 11.8 | 12.5 | 13.3 |
Explanation
The Government will establish Carelink - single contact points for the 58 Home and Community Care Regions across Australia - to simplify access to community services. This measure forms part of the Government's package of initiatives to achieve a substantial advance in the quality of health care delivered to older Australians.
With the establishment of these contact points, a single telephone call will provide access to information about service availability and eligibility for community care services. This measure will provide a crucial link between the health and community care sectors, and enable health professionals, general practitioners, other service providers, family carers, and individuals to gain easy access to the whole range of agencies providing support services in a region.
100 extra aged care beds in Regional Health Service Centres
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | - | 0.3 | 0.6 | 1.1 |
Explanation
The Government will fund 100 additional residential aged care places for Regional Health Service Centres, building upon its commitment to provide flexible service alternatives for older Australians living in rural and remote areas.
Enhanced respite care services
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 20.0 | 20.4 | 20.7 | 21.1 |
Explanation
The Government is expanding the provision of respite care for carers of people with dementia and other cognitive and behavioural problems. This measure will improve access to available respite services and increase the range of services and support.
Funding will be delivered through the National Respite for Carers Programme.
Aged care capital funding assistance targeted particularly to rural Australia
Top of pageExpense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | - | 19.5 | 6.1 | - |
Explanation
The Government will provide additional funding to improve the infrastructure of residential aged care facilities, particularly those in rural and remote areas and those catering for other special needs groups. The measure provides additional funding for the ongoing targeted capital programme that was established during the 1996-97 Structural Reform of Aged Care. There is currently around $51million of targeted capital funding available over the next four years.
Industry restructuring - an investment in better aged care facilities
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | - | 8.2 | - | - |
Explanation
The Government will provide targeted assistance for residential aged care facilities to restructure to meet accreditation standards by 1 January 2001. This initiative will encourage longer term solutions such as the provision of detailed professional advice on long-term business options for financial viability, assistance in changing work practices to improve long-term viability and assistance to implement best-practice management and business arrangements.
The measure will improve the infrastructure and management capabilities of residential aged care facilities.
Further Information
Accreditation is the formal recognition provided to a residential care service by the Aged Care Standards and Accreditation Agency where that service is considered to be operating in accordance with the legislative requirements of the Aged Care Act 1997, and providing high quality care within a framework of continuous improvement. All services must obtain accreditation by 1 January 2001 to continue to receive Commonwealth government funding. In addition, services must meet certain building standards to receive certification.
The measure builds upon the 1997 measure to assist residential aged care facilities to restructure and meet certification and accreditation requirements.
Targeting residential care funds to those most in need
Top of pageExpense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | -22.7 | -23.1 | -23.5 | -23.9 |
Explanation
The Government has decided to improve the risk management framework for residential aged care. The measure provides for additional audits of residents' classifications. It will ensure that subsidy payments made on the basis of claims by service providers are consistent with residents' confirmed care needs under the Resident Classification Scale.
Further Information
The funding received by service providers for care recipients depends upon the provider's self-assessment of the care recipient's needs under a Residential Classification Scale. This arrangement involves the dual risks that some providers may overestimate the needs of care recipients and that some care recipients will not be assessed as receiving the care that they require.
Pre 1 October 1997 nursing home residents
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 4.5 | 3.2 | 3.0 | 3.2 |
| Deparmtent of Veterans' Affairs | 0.4 | 0.3 | 0.3 | 0.3 |
Total | 4.9 | 3.5 | 3.3 | 3.5 |
Explanation
The Government will provide funding to ensure that the small number of residents who have been in nursing home care since before 1 October 1997, and who move to another (non-extra service) facility, will not pay the accommodation charge.
Providers will be compensated for these residents to ensure that they are not financially disadvantaged by this change and to ensure access for any pre 1 October 1997 residents who move.
Simplifying aged care planning for rural and remote areas
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 1.2 | 1.9 | 1.2 | 1.0 |
Explanation
The Government will fund a review and improve planning arrangements for residential and community aged care. The review will focus on ensuring the needs of communities in rural and regional Australia are met in the planning process. This will provide greater flexibility and responsiveness in the delivery of aged care services to all older Australians.
International Year of the Older Persons - celebration to mark the start of cultural change
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 5.0 | - | - | - |
Explanation
The Government will contribute $5 million towards an improved quality of life for older Australians through the implementation of the second stage of a targeted communication strategy aimed at changing perceptions about ageing. The strategy will:
- enhance awareness of the changing age demographics in Australia and related issues;
- begin a lasting cultural change to improve Australians' perceptions of older people;
- foster intergenerational harmony;
- promote better planning by individuals for their older age;
- encourage community and business groups to respond to issues that are raised; and
- improve awareness of the International Year of Older Persons and inform the community about associated Commonwealth activities and initiatives.
Performance Information and Resource Allocation
The following indicators are designed to measure how effectively this outcome has been achieved.
| Indicator 1: | Improvement in the quality, privacy and dignity of residential accommodation. |
| Target: | From July 1999, new buildings will have a service average of no more than 1.5 residents per room, except where specifically exempted. By 2008, existing buildings will have no more than 4 residents per room. |
| Info source/rept freq: | Administrative by-product of the certification-accreditation process. |
| Indicator 2: | Proportion of Residential Care Services certified. |
| Target: | 98% of Services certified by 30 June 2000. |
| Info source/rept freq: | Certification data - annual. |
| Indicator 3: | Average dependency level of people newly admitted to residential care as measured by scores on the Resident Classification Scale. |
| Target: | Average dependency level rises between June 1999 - June 2000. |
| Info source/rept freq: | Departmental payment system - annual. |
| Indicator 4: | Residential and Community Aged Care Package places per 1000 persons aged 70 and over nationally. |
| Target: | 100 places per 1000 persons aged 70 and over during the year 2001. |
| Info source/rept freq: | Departmental payment system, ABS - annual. |
| Indicator 5: | Residential and Community Aged Care Package places and units of residential care service provision per 1000 persons aged 70 and over by planning region. |
| Target: | Equitable distribution between planning regions in line with national benchmark of 90 residential places (including 2 respite places) and 10 Community Aged Care Packages per 100 places per 1000 persons aged 70 and over by the year 2011. |
| Info source/rept freq: | Departmental payment system, ABS - annual. |
| Indicator 6: | Proportion of people seeking assistance and assessed by Aged Care Assessment Teams who are judged to be able to remain in the community with assistance. |
| Target: | Greater than 50%. |
| Info source/rept freq: | Aged Care Assessment Teams data - annual. |
| Indicator 7: | Service use by, and level of specifically targeted service provision for, older people with dementia, older people from diverse cultural and linguistic backgrounds, older indigenous people and older people in rural and remote areas as compared with levels in the general aged population. |
| Target: | Provision appropriate to proportion of target group in population. |
| Info source/rept freq: | Departmental payment system - annual. |
| Indicator 8: | Usefulness and effectiveness of information provided to carers. |
| Target: | A high level of carer satisfaction with the information provided. |
| Info source/rept freq: | Carer Resource Centre quarterly reports. |
| Indicator 9: | Uptake and usefulness of information provided to the community. |
| Target: | A high level of satisfaction with information provided. |
| Info source/rept freq: | Departmental records of distribution, information line statistics, surveys commissioned by Aged and Community Care Division. |
| Indicator 10: | Awareness of issues important to older Australians through participation in the International Year of Older Persons (IYOP) and National Strategy consultation. |
| Target: | Increased awareness of information/communication provided; level of participation in IYOP. |
| Info source/rept freq: | Feedback on information and consultation processes, and surveys commissioned by the Office for Older Australians - annual. |
Resource Allocation
The allocation of resources for Outcome 8 is described in the following two Tables:
- Table C8.1 describes the relationship between the appropriation structure for Outcome 8 and the 1998-99 appropriation structure; and
- Table C8.2 sets out the allocation of resources across administered items and output groups for the Department for Outcome 8.
Table C8.1: Relationship between old appropriation structure and new Outcome structure for Outcome 8
| Outcome | Program |
| 8. Support for positive and healthy ageing and high quality and cost-effective care for frail older people, people with disabilities, and their carers. | 4.1 Community Care and Support for Carers 4.2 Assessment 4.3 Residential Access and Quality (part) 4.4 Standards Agency |
| Appropriations
Department Special Appropriations Aged or Disabled Persons Care Act 1954 and Aged Care Act 1997 - Community care subsidies National Health Act 1953 - Domiciliary nursing care benefit Aged Care Act 1997 - Residential care subsidies Aged Care Act 1997 - Flexible care subsidies Appropriation Bill 1 Departmental outputs Administered expenses Appropriation Bill 2 Specific payments to the States and Territories
| Appropriations
Sub-program 4.1 Special Appropriations Aged or Disabled Persons Care Act 1954 and Aged Care Act 1997 - Community care subsidies National Health Act 1953 - Domiciliary nursing care benefit Appropriation Bill 1 Other services for residential aged care (340.5.04) (p) Services to rural, remote and other special needs groups (340.5.02) (p) Community based support programs for the aged (340.5.03) (p) Home and Community Care (including expenditure under the Home and Community Care Act 1985) (340.8) Running Costs, including Section 31 receipts (340.1) (p) Appropriation Bill 2 International Year of Older Persons (892.00.07) Home and Community Care (for expenditure under the Home and Community Care Act 1985) (891.6) Sub-program 4.2 Appropriation Bill 1 Other services for residential aged care (340.5.04) (p) Running Costs, including Section 31 receipts (340.1) (p) Appropriation Bill 2 Aged care assessment (891.03) Sub-program 4.3 Special Appropriations Aged Care Act 1997 - Residential care subsidies Aged Care Act 1997 - Flexible care subsidies Appropriation Bill 1 Other services for residential aged care (340.5.04) (p) Services to rural, remote and other special needs groups (340.5.02) (p) Community based support programs for the aged (340.5.03) (p) Best practice funding for dementia specific facilities (340.5.05) Capital assistance for residential facilities (340.5.01) Running Costs, including Section 31 receipts (340.1) (p) Sub-program 4.4 Appropriation Bill 1 Aged care accreditation and quality assurance (340.5.06) Running Costs, including Section 31 receipts (340.1) (p) Other Appropriation Bill 1 Compensation and legal expenses (340.2.01) (p) |
Table C8.2: Resource summary for Outcome 8
Contribution of Administered Items and Departmental Outputs to Outcome 8
Administered funds of $4,063m in 1999-2000 contribute to the achievement of the overall outcome through promoting the broader social policy issues of healthy ageing and enhancing the participation of older people in the community. Administered funds also provide two main forms of care delivery, residential and community care, including the provision of services for carers, and through Aged Care Assessment Teams (ACATs) enable the targeting of funding by assessing the total care needs of older people and recommending the most appropriate care to meet those needs.
To ensure the most effective use of the administered funds allocated to the four priority areas aimed at achieving this Outcome, the Department of Health and Aged Care provides a range of outputs from six departmental output groups.
In terms of a policy advice service to the Minister, the Department's advice covers the operations of the current aged care system as well as policy initiatives to meet the future needs for aged care services.
The Department is involved in funds management and the administration and monitoring of an extensive system of grants payments and other benefits. This reflects the Government's decision to enhance the quality of life of older Australians through the provision of high quality and cost effective care services for the frail aged, and their carers. Grants include Community Aged Care Packages and Commonwealth Respite for Carers as well as payments to Respite Care Centres, and Certification Inspection contractors inspecting residential care facilities. HACC funding grants to the States and Territories are also a major area of grants administration.
Departmental resources are also utilised towards the management of budget appropriations for both departmental and administered items for Outcome 8, through the allocation and monitoring of Branch budgets and monitoring and reporting of expenditure against administered items.
The provision to industry providers of information on aged care services and standards, and training services to improve management skills is another important output funded from Departmental expenses.
In a number of areas the Department plays an important national leadership role particularly in this International Year of Older Persons in enhancing and promoting policy initiatives to improve the health and well being of older Australians, and also in ensuring that all stakeholders work together to achieve the outcome.
The Department carries out a number of regulatory activities determined by the Aged Care Act 1997, and also provides a range of services to the Ministers and Parliament such as drafting responses to the Ministerials and the preparation of question time briefs.
The following performance information provides a comprehensive overview of the administered items and departmental outputs together with performance measures for these items and outputs.
Top of page
Table C8.3:Performance Information for Administered Items
2. Community care and support for carers, including:
| Quantity: 3.8 - 3.9 million units of HACC service output per month (an increase of 3 -5 per cent over November 1997 figures).
50 HACC services appraising their performance against agreed standards. 18,000 CACPs including around 4300 new CACPs, of which 430 will be high level care places. 270 personal alert systems provided to frail aged people through the "Safe at Home" initiative. Baseline data will be established on the number of carers assisted by Carer Respite and Carer Resource Centres. Efficiency: Current average cost to Commonwealth per unit of HACC service output increases no greater than inflation (in 1997-98 the cost per unit of HACC service output averaged $11.25 within a range of $36 for 1hr of community nursing to $1 for a meal). Equity: Equitable distribution of units of HACC service output across States/Territories (units of service per 1000 HACC target population). |
3. Residential care, including:
| Quality: Reduction in waiting period for individuals entering residential care from the current 98-99 waiting period of :
90% of residents who have made complaints indicate satisfaction with the outcomes of their complaints. 99% of providers are provided with regular newsletters, updates to manuals and information. 50% of services accredited in 1999-00. One third of all accredited services achieve accreditation for 3 years. Reduction of the 5% proportion of uncertified services (1998-99) to 2% of services uncertified by June 2000. Quantity: 147,000 -148,000 residential places provided (77,000- high care places, 71,000 - low care places). 16 flexibly funded facilities (286 places) and 37 Multipurpose Service Centres (376 high care places; 448 low care places) funded as part of the flexible care options for rural and remote areas. Efficiency: Average cost to the Commonwealth per resident increases no greater than inflation plus growth in client dependency. |
| 4. Client Assessment by aged care assessment teams (ACAT) and referral to appropriate services. | Quality: Increased acceptance of ACAT assessment decisions measured by number of successful appeals as a proportion of the total number of assessments.
Quantity: 170,000 ACAT assessments. Efficiency: Costs to Commonwealth of $210-220 per client assessed to stabilise (adjusting for increases in dependence) |
Table C8.4: Performance Information for Departmental Outputs
| 1. Policy advice to the Ministers and Government in relation to:New funding arrangements and progress on structural reform;
Review of residential classification scale; Accreditation; New access and referral mechanisms; Suitable project approvals in line with agreed strategic plans and service development; Long term trends and developments related to population ageing and policy settings affecting older people; and National issues of concern to, and affecting the well-being of older people.
| Quality: A high level of satisfaction of the Minister and Parliamentary Secretary with the relevance, quality and timeliness of policy advice provided.
Quantity: Policy, research and advice service commensurate with the funds allocate. Price: $11.174m. |
2. Services to the Ministers and Parliament, including:
| Quality: A high level of satisfaction of the Ministers and Parliament with the relevance, quality and timeliness of services provided.
Agreed timeframes met for ministerial correspondence, Question Time, Parliamentary Questions on Notice, and ministerial requests for briefing. Submission of the annual report to Parliament on the operations of the Aged Care Act 1997 by 30 September 1999. Quantity: Number of responses to ministerial correspondence, Question Time Briefs, Parliamentary Questions on Notice and ministerial requests for briefing will be recorded in 1999-00 and used as a future benchmark. Price: $9.615m. |
3. National leadership, including:
| Quality: A high level of satisfaction of stakeholders with the quality and timeliness of Commonwealth inputs to national policy, planning and strategy development and implementation.
Development by January 2000 of a strategic national framework encompassing major policy areas affected by population ageing. Report to the Minister on Commonwealth's response to IYOP completed by May 2000. Quality: Commonwealth report for Australia provided to the United Nations by June 2000 covering national response (Commonwealth/States/ communities) to IYOP. Quantity: National leadership service commensurate with the funds allocated. 1000 organisations and older people consulted in the development of the National Strategy for an Ageing Australia. Completion of 10-20 national projects by January 2000. Number of older Australians / representative groups receiving Recognition Award Certificates under IYOP Recognition Award Scheme as measured by number allowable:-
|
4. Information and training services on:
| Quality: A high level of satisfaction of service providers with relevance, quality and timeliness of training and information services.
99% of residential care service providers are provided with information and training on quality management. Quantity: Manuals (revised/amendments)
|
5. Contract administration and funds management, including:
| Quality: Budget predictions are met and actual cash flows vary by less than 10% from predicted cash flows.
100 per cent of paymentPayments s are made in accordance with negotiated service standards. Quantity: 26 Funding Agreements with States/Territories. 1140-1155 contracts with organisations. 42-54 consultancy contracts. Price: $44.023m. |
6. Regulatory activity, including:
| Quality: Processes in place (such as the systems Working Group) to consult with providers and review level of regulation.
2 year review of reforms meets planned timeframes. Appeals against Aged Care Assessment Teams assessments processed within maximum period of 90 days. Estimate of 12 internal appeals against hardship decisions (1998 figure representing 3 per cent of total applications received for that year). Estimated 22 out of 28 RCS appeals resolved. Quantity: Estimate of 35,000 Residential Classification Scale (RCS) audits conducted in 1999-00. Appeals handled:
Estimate of 362 hardship applications processed. Quality: A high level of compliance with the elements of the Government's regulation reform agenda, and their particular reporting requirements. Price: $11.063m. |
Performance Assessment: Evaluations and Reviews
No major evaluations or reviews are planned for this outcome in 1999-00.
- 2 Year Review into the impact of the Structural Reforms
- The objective of this review is to assess and report on the extent to which the Aged Care Act 1997 is achieving its objectives and addressing acknowledged deficiencies in the aged care system. While the Review will consider the impact of the reforms on aspects of the aged care system not directly part of the reform package, it will not consider broader issues relating to how the aged care system operates as a whole nor how established elements are functioning. The Review commenced in July 1998 and will be completed in July 2000.
