Multidisciplinary teams
Multidisciplinary care brings together specialist carers from different fields to provide aged care. It increases the care options available to senior Australians and helps them reach their individual goals.
With STRC, the multidisciplinary team (MDT) involves 3 or more specialist care providers from different disciplines. Either a GP or a geriatrician must always be on the MDT.
Read more about multidisciplinary care in Chapter 3.5 of the Short-Term Restorative Care Programme Manual.
Care services to be offered as part of the MDT can include any care and services in the Quality of Care Principles 2014:
- see Schedule 1 for care and services in a residential care setting
- see Schedule 3 for care and services in a home care setting
Modified Barthel Index (MBI) assessments
You must assess a client using the MBI on their entry to, and exit from, the STRC Programme.
You will add the score to your claim for subsidy form. This is a requirement to claim the flexible care subsidy for that person.
The MBI is a tool to measure a person’s functioning, or their ability to perform certain self-care tasks. The final score is out of 100.
How to use the MBI to do a functional review at a client’s entry and exit are in Chapter 3.13 of the Short-Term Restorative Care Programme Manual. The manual also has an MBI template.
Flexible care agreements
A flexible care agreement is a legal agreement between a client and the STRC provider.
It sets out the care and services you will provide to a client over the 8-week episode, and how much it will cost them.
You must:
- develop the agreement with the client, their carer or family member
- include an interim care plan, which you will then refine and finalise with the MDT
- make sure the client understands and agrees to the fees and conditions before any services begin
A client can exit the STRC Programme before the end of the 8-week episode if they achieve their goals set out in the flexible care agreement.
A client can choose to agree without signing the agreement. If they choose not to sign, you must record your interactions and that they agreed as part of your record keeping responsibilities.
Details on how to draft flexible care agreements and what to include in them are in Chapter 3.3 of the Short-Term Restorative Care Programme Manual.
You are responsible for making sure the client understands their agreement. If needed, use the National Translating and Interpreting Service.
Care plans
The care plan forms part of the flexible care agreement.
It will at first be an interim plan which includes the client’s needs and goals, identified in their Aged Care Assessment Team (ACAT) assessment.
You must then refine the plan with the MDT to meet the full range of care and services, including:
- how services will be delivered
- who will deliver the services
- how the services will address the client’s functional decline
Details on how to draft care plans and what to include in them are in Chapter 3.4 of the Short-Term Restorative Care Programme Manual.
Handling complaints
The flexible care agreement must include how a client, or someone on their behalf, can make a complaint:
- with their service provider
- with the Complaints Commissioner
You should encourage your clients to raise concerns internally, and create a setting where they feel comfortable to do so.
For information on handling and managing complaints, see Chapter 3.13 of the Short-Term Restorative Care Programme Manual.
Ongoing care discussions
Ongoing care discussions help to monitor the client’s care plan’s success.
You must discuss and review the care plan regularly with the client, their representatives, carers and families, clinicians and therapists as part of their flexible care agreement.
Ongoing care discussions are regular conversations with your clients to:
- help you manage their care
- make sure your care and services are meeting their needs
For information on ongoing care discussions, see Chapter 3.3 of the Short-Term Restorative Care Programme Manual.
Leave from STRC
A person can take up to 7 days’ leave from the STRC Programme. These 7 days are in addition to the 56 days of care that they receive.
While the client is on leave:
- the client does not pay daily care fees, but may still be subject to other fees for services under Schedule 5 of the Quality of Care Principles 2014
- you will not receive the flexible care subsidy for that person
- the client will not receive any STRC services
Information on managing breaks in care is in Chapter 3.7 of the Short-Term Restorative Care Programme Manual.
Exiting clients
The flexible care agreement must state an exit strategy for the client, for when they complete the STRC Programme.
The exit strategy includes:
- expected end date
- the service arrangements that should be in place for the client after STRC
- a carer briefing
- the client’s consent for the exit strategy
On a client’s exit, you must:
- conduct an MBI assessment
- assist them to finalise and access their longer-term care arrangements
Read more about ongoing care and exit strategies in Chapter 3.8 of the Short-Term Restorative Care Programme Manual.
Reporting
All approved providers have compulsory reporting requirements. Read about reporting and other approved provider responsibilities.
STRC providers are also required to collect and provide quality indicator data under the National Aged Care Mandatory Quality Indicator Program.
Notification of changes
All approved providers have compulsory notification requirements. Read about notifications and other approved provider responsibilities.
Changes to your services
Email us if there are any changes to your STRC provider contact details.
Contact
Short-Term Restorative Care Programme contact
Resources
Short-Term Restorative Care Programme Manual
