Grant Opportunity: Improving respite care for people with dementia and their carers

Robert Day:

Good afternoon everyone and welcome to today’s webinar on the Grant Opportunity for improving respite care for people with dementia and their carers. As we begin today let’s acknowledge that wherever we are around the country of Australia we are meeting on the traditional lands of Aboriginal and Torres Strait Islander people and pay our respects to their Elders past, present and emerging. Today I’m joining you from Ngunnawal country in Canberra.

A really big welcome and thank you to all of you today for your interest in this Grant Opportunity and for your participation in the webinar. I’d also like to welcome and introduce you to my three panel members who will take us through the Grant Opportunity today. So first of all I have Holly Markwell from HammondCare. Thanks very much for being with us Holly. And then I have two of my team with me as well. So I have Frances Healy who’s Director of the Dementia Data Awareness and Engagement Section. Frances is based down in Hobart. And Marianne Madden who’s Director of the Dementia Training and Behaviour Support Section and Marianne’s based in Melbourne. And Holly, Frances and Marianne will take you through the detailed elements of today’s Grant Opportunity.

The purpose of the webinar today is to provide you with an overview of this Grant Opportunity, the program objectives and the available funding. We’re going to outline the three streams of activities that are included in the Grant Opportunity and provide an opportunity to answer any questions that you may have.

Before we jump into it a couple of notes of housekeeping. First of all please note that this webinar is being recorded and we will share a copy of both the presentation and the webinar recording with participants after the event. We do encourage you to submit questions for us to answer and you can do that using the Chat function in the bottom right hand of the screen. We’ll answer questions at the end and get to as many as we possibly can. If there’s any that we don’t get to or any that are more complicated and need a more detailed response we’ll provide a written answer by updating the frequently asked questions section of the Grant documentation on GrantConnect.

But let’s move in to a bit of a broad overview of this Grant Opportunity. The Royal Commission into Aged Care Quality and Safety highlighted the need for enhanced support for family and informal carers, including dementia-specific respite services as a core element of improving support for people living with dementia, their carers and families and dementia care as a whole was one of the areas for immediate priority identified by the Royal Commission.

The Institute for Health and Welfare estimates there are between 135,000 and 327,000 informal carers or family and friend carers who support people living with dementia in the community. Carers of people living with dementia, often the person’s partner, provide a key support along the dementia journey and are often critical to the person with dementia remaining in their own home for as long as possible.

While caring for someone can be a really enriching and positive experience, it also has its challenges and can take a physical, emotional and financial toll on the carer. We know that dementia carers are significantly more likely than other Australians to have low levels of wellbeing and are less likely to report good or excellent health. 47% of primary carers of people living with dementia in 2018 were providing on average 60 hours of more care per week and 41% of primary carers of people living with dementia reported that they frequently felt weary or lacked energy.

In the Department we’ve also heard there is a need for more innovative and flexible approaches to dementia specific respite care and to respite care planning so that it’s flexible in terms of length of stay, in terms of delivered in a home-like environment and preferably delivered within a person with dementia’s own community.

This grant program makes available funding in three streams to support innovative approaches to the provision of dementia-specific respite care. Stream one is dementia carer respite and wellbeing program and that will be trying to expand a model of dementia respite that HammondCare’s been running called Support at Home which Holly will talk you through. Stream two is about innovative approaches to delivering respite care programs and respite care planning for people with dementia and their carers. And stream three is dementia respite care training.

In terms of the technicalities of the Grant Opportunity the Improving Respite for People with Dementia and their Carers Grant Opportunity opened on GrantConnect on Monday 5 December after being open as a forecast opportunity for a number of weeks prior to that. Applications will close at 2:00pm Australian Eastern Daylight Saving Time on Monday the 16th of January 2023.

Questions if you have any can be submitted to Grant.atm@health.gov.au and you can see that email address on the screen in front of you. And we need to receive questions by 5:00pm on 9 January so that we can answer them before the closing date for the Grant Opportunity.

You can apply under one or more streams however we will need a separate application form including the attached requirements for each stream that you wish to apply for. And you can visit grants.gov.au for the grant documentation and application. And to find this easily you can search for the Grant Opportunity number which is GO5835.

Let me talk you through briefly the high level outcomes that we’re looking to achieve through this Grant Opportunity. Each of the three streams has got their own unique objectives and outcomes and Frances and Marianne and Holly will talk you through those in some more detail. But looking across the whole of the Grant Opportunity there are some common objectives that we’re trying to achieve. We’re trying to improve the quality of life and respite experience for the person living with dementia and for their carer. We’re hoping to arm carers with greater knowledge, skills and capability to care for the person living with dementia at home. We’re looking to improve the carer’s wellbeing through the respite experience. We’re looking to support people living with dementia stay at home for longer and to delay entry to permanent residential aged care both by supporting the carer and helping the person with dementia link with the services they need in the community.

We want people living with dementia and their carers in collaboration with the respite care providers to plan for the regular and repeated use of respite care as something that enables that life in the community for a longer period of time. And we want to support the aged care sector and its capacity to deliver high quality dementia respite care and service including respite care plans and make that part of core business for aged care provision.

In terms of the funding that’s available funding has been provisionally allocated across the three streams and you can see the figures broken down by stream and by year on the slide in front of you. There is no minimum or maximum amount set for individual grants. The distribution of funding will be based on the scale or scalability of the proposed activities and when you’re applying for a grant you should clearly outline the amount of funding that you’re seeking for the proposed activities. And you need to clearly articulate the costing that you’ve used and the budget for your proposed activities.

The total value of all the grants that we issue under this Opportunity cannot exceed the total volume of funding but we might make some more small adjustments between the streams based on the quality and the spread of applications that we receive.

I should note and I’m sure you know this already that applying for a grant is not a guarantee of funding. This is a competitive process and there will be an assessment of the best value for money applications.

Now it’s time to start to dive into some of the detail of the streams and I’m first going to hand over to Frances to talk us through Stream 1, Dementia Carer Respite and the Wellbeing Program.

Frances Healy:

Thanks very much Rob. So in terms of Stream 1 which we’re nominally calling the Dementia Carer Respite and Wellbeing Program, the aim of the activities is to improve the wellbeing of carers and people living with dementia through delivery of respite care programs that incorporate both respite type care for the person with dementia and a particular focus on the wellbeing of the carer. Stream 1 envisages a model of care where the person with dementia and their carer stay together, for example for a couple of days with other carers and other people with dementia where they can take part in a program of activities which include opportunities for carers to learn about dementia, about some wellbeing strategies and to receive peer support from other participants who are in a similar position.

So Stream 1 funding offers the opportunity to replicate a model of care that’s currently being delivered by HammondCare which is called the Staying at Home Program and Holly will speak a bit more about this in a minute. The Staying at Home Program delivers combined respite care where carers and the person living with dementia stay together overnight, builds carers’ knowledge and skills and gives them practical strategies for supporting people who live with dementia, as I said has a particular focus on carer wellbeing and helps people living with dementia stay at home and in their community. So providers across all states and territories can apply for funding to deliver this model of care based on the principles and elements of the Staying at Home Program.

So I’ll now hand over to Holly Markwell from HammondCare who will provide a bit more information and detail about the Staying at Home Program.

Holly Markwell:

Thank you Frances. So I’ve divided what we see as the elements of success for running the Staying at Home Program into three areas there and that’s our preparation before a program, our actual delivery and of course our post-program follow up. And the first thing of course to get right is that we have those really sound intake processes, so identifying those people who are best suited to the program. So we are looking for people of course who have that intention to stay living at home and generally we find that there is a reluctance and certainly a degree of uncertainty about when to access respite, how to access respite, and this is of course most relevant generally speaking for people who are approximately six months to two years post‑diagnosis. But we do a lot of time face to face with people, if we can do it in person, if not we do it via telehealth, to really determine whether they are the right fit for the program. And of course we’re looking for that permission from both parties to be involved.

So people are often not thinking about respite as a way to sustain the caring relationship early on in the progression of dementia and we know of course that we’re hoping to influence that by helping them to see respite as an earlier kind of circuit breaker if you like so that that sustainability in the relationship can be maintained.

In terms of the actual program delivery it’s quite flexible, it’s quite dynamic. Every program so far has been just that little bit different because of those six couples that make up that program and what their actual needs are. But the real beauty of it that I see is when we allow that space in the program, not just that we’re there delivering that information but when we allow that peer support and peer learning to really bubble up and for people to make those connections with each other. It becomes a tremendously powerful experience and comments like ‘I came with a black cloud hanging over my head and I leave with the sun shining on my face’ – so comments like that are not unusual for us to get and they really speak to the transformative kind of experience that people have in a reasonably intense and short period of time.

So we have staff who stay overnight. And sometimes it is those connections that people form informally not just with us as the facilitation team that really help people to see things in a different light and give them that quite different perspective. So we’re very fortunate that we have been able to choose very comfortable, physical environments, either respite cottages or occasionally retreat style accommodation, that helps to create those opportunities for engagement, opportunities for one to one with participants, with a medical specialist for example, whatever really that person needs to help demystify dementia and also to help them feel much more comfortable with their access of respite and what they’ll do going forward.

Following the program of course we also want to make sure that we provide that right support. So it might be that we look at a referral to Dementia Support Australia for that more proactive behaviour support and also really point people in the right direction for those linkages to community supports at the right time. So no wrong door approach. It might be that we help people access other services through Dementia Australia, Carers Gateway, My Aged Care, whatever is needed at that time. So really providing that solid follow up so that people feel really very much a part of, that they’re not just left after the program and we give that follow up.

We’re also doing some assessments of course and over time we’ll be collating that data to see what change there is in really one of our key markers as to the evaluation of the program, and that is whether there’s been a shift in the carer stress and the fatigue that can come about. So that’s a key one for us to look at further down the track. We do a follow up point at six weeks after the program and six months after the program. But I think one of the best ways to actually see it is to hear it directly in person from the people, from our participants. So I’m wondering if we could show the short video from one of our very first programs. If we could show that video next that would be fantastic. Thank you.

[START VIDEO PLAYBACK]

• (Music Playing)§

Marie Alford

Head of Dementia Support Australia, Hammond Care

Everyone wants to live at home for as long as they can, and that’s really what we want to help people do.

[Visual of slide with text saying Staying at Home empowers people living with dementia, and their carers, to remain at home for as long as possible’, ‘Staying at Home’, ‘A Carer Wellbeing & Respite Program’]

• (Music Playing)§

Tom Gauci

Team Leader – Dementia Support Australia

For most of us home is a place of security, a place of comfort and a place of familiarity and joy.

[Visual of slide with text saying ‘Connecting carers together to share experiences, challenges and build supports’, ‘Staying at Home’, ‘A Carer Wellbeing & Respite Program’]

• (Music Playing)§

Marie Alford:

So the Staying at Home Program is an Australian Government funded initiative and what it delivers is a carer wellbeing and respite program. If we can help people develop new skills and build new strategies to support themselves, both the carer and the person living with dementia, the ability to stay at home longer becomes more accessible and a better option.

Janice Fitzpatrick

Wife of Bernie living with dementia

I feel a little more in control because now I can see how I can handle the situation, which can be quite challenging at times.

Tom Gauci:

At the same time what we are doing is working really closely with the person living with dementia to really support them and introduce to them things like activity modification, how can they maintain the activities that they love?

Penny Leah

Person living with dementia

I spend a lot of time in the garden, so it’s, yeah – it’s so nice to be amongst it again.

Bernie Fitzpatrick

Person living with dementia

I have to say I’m enjoying it. I’ve learned a few things.

• (Music Playing)§

Marie Alford:

We provide a residential experience to people living with dementia and their carers and that can be their primary carer or their secondary carer.

Tom Gauci:

Introducing respite in a way that’s safe, that’s really positive and really comfortable.

Debbie Sharp

Wife of participant, Colin, living with dementia

I like the fact that we could both stay here together so that Col has not been at all stressed by being alone. The rooms are lovely and it’s been wonderful.

Janice Fitzpatrick:

I’ve come back at each meal time and he has a smile on his face so he’s obviously enjoyed the activities.

Marie Alford:

I think for the carers one of the best things that they get is knowing that they’re not alone. So they’re talking to other people who are experiencing similar things as them and actually learning from each other as well.

Debbie Sharp:

What you’re going through is no different to what everybody else is going through. And the support network that will follow through from this, people that you can ring and, yeah – if you need help, or as they said just to vent to somebody when life gets too hard.

Marie Alford:

All of our participants can contact our service 24 hours a day seven days a week at any time for any reason.

Tom Gauci:

So the Staying at Home Program is a Government funded program so there’s no out of pocket expenses for the person living with dementia or the carer.

Debbie Sharp:

Main object is to try and keep our partners at home for as long as we can, and they’re still helping.

• (Music Playing)§

[Visual of slide with text saying ‘DS’, ‘Dementia Support Australia’, ‘Funded by the Australian Government’, ‘A service led by HammondCare’, ‘Staying at Home’, ‘A Carer Wellbeing & Respite Program’, ‘Supporting carers and people living with dementia to stay at home longer’, ‘1800 699 799 or visit dementia.com.au’]

[END VIDEO PLAYBACK]

I think hearing directly from the participants is probably far more powerful than anything that I can say. We did have somebody in that group who actually was not keen to be there and it was the facilitators in the session who really drew out his strengths and he ended up having an absolute fantastic time. And you can see there that it’s very much a soft introduction to the concept of respite. So hopefully that fills out a little of the picture. And I’m going to hand back I think now to Frances. Thanks Frances.

Frances Healy:

Thanks very much Holly and thanks for that video. That was really great.

So in terms of the scope of this Grant Opportunity for Stream 1 applicants can apply for funding to replicate the model of care that we’ve just seen in the HammondCare video. The aim is to expand the delivery of the model into all states and territories with programs delivered to up to about 1,000 families or couples each year at full rollout which is estimated to be in a couple of years, in 2023-24.

Staying at Home Program principles have been developed to support applicants in preparing their applications for Stream 1 which can be found on GrantConnect. The document outlines the central principles and elements of the Staying at Home model of care.

So applicants for Stream 1 should refer to this document when preparing their applications as well as the objectives and outcomes in the Grant Opportunity document.

However proposals can be tailored to respond to specific needs or gaps in the community, for example to respond to the particular needs of people with dementia and their carers from culturally and linguistically diverse backgrounds or to respond to the specific needs of First Nations people with dementia and their carers. So the delivery of the program can be flexible and the program of activities can be tailored to respond to those specific needs.

Activities offered for people with dementia and their carers should be person and relationship centred and adopt a strengths-based approach and meet the needs of the particular participant cohort. Programs may be delivered in a range of settings including residential respite care or cottage-based respite or other suitable accommodation or setting outlined in the application and by agreement. That proposed setting should be clearly outlined in the applications.

So carers would be offered opportunistic education as we’ve heard to develop their understanding and knowledge about dementia, learn practical strategies to support them in their caring role and have the opportunity to engage with other participants and receive that peer support and peer connection.

When we move to the next stage and we’ve done that assessment that Rob’s talked about in terms of the successful applicants under the program HammondCare will also provide some support to those successful applicants as well in terms of setting up and establishing the program.

So if we move on to the next slide. Thank you. So there are a few things we’ll be looking for in a successful application for Stream 1 and of course the selection criteria are outlined in the Grant documentation. It’s important to consider the entirety of the Grant Opportunity Guidelines including the selection criteria and refer to that Staying at Home Program principles document.

So applications for Stream 1 should describe for example the extent to which the proposal replicates the model of care outlined in the Staying at Home Program principles or where the model has been adapted to respond to a particular need or gap or to practical considerations, for example delivery in a regional or remote setting as opposed to a metropolitan centre.

The reach of the program should also be outlined, for example the proposed number of programs and number of locations, the target number of participants and whether the program will target specific groups in the community such as First Nations people with dementia and their carers.

The applications should also detail how the proposal responds to the particular needs of carers of people with dementia and how it will achieve those carer specific outcomes around wellbeing and reducing carer burden. Applications should also outline the proposed funding model and the cost assumptions as Rob referred to earlier.

Finally applications should demonstrate how the success of the program will be measured including the assessment tools or metrics that can be used to demonstrate how the experience and the quality of respite care for people with dementia and their carers is improved through the program, how the carer wellbeing has been maintained or improved and reduce that carer burden, and as a result of the program that the person with dementia has been able to stay at home for longer. So they’re just a couple of the particular considerations but really important to read through those Grant Opportunity Guidelines in detail, all the documentation to make sure that applicants really address each of the specific criteria.

So I’ll now hand over to Marianne Madden who can speak about Stream 2 and Stream 3.

Marianne Madden:

Thanks Frances. So in terms of Stream 2, Stream 2 supports the delivery of innovative models of respite care and respite care planning particularly for overnight respite stays that meet the unique needs of people living with dementia and their carers. Stream 2 includes the opportunity to trial new approaches. So programs or models should be innovative, scalable and also represent value for money. Respite programs may consist of either day or overnight programs of one or more consecutive days or nights.

Activities should incorporate respite care planning to support a holistic respite stay and regular respite use. And applicants should consider dementia respite care planning as an activity undertaken alongside a person living with dementia and their family to understand the person’s goals and preferences. The care plan should support the improvement of the experience and the quality of the respite stay. And applicants should consider the scheduling of respite stays and occasions of respite use so that occasions of respite are increased and repeated.

So just move to the next slide.

In terms of what’s in scope for dementia care respite planning, this is particularly focused on overnight respite care stays which involve consideration of a person’s life history, culture and individual needs and preferences. The scope of planning and preparation for the successful transitions involves a focus on managing the successful transitions between the home and the respite care setting for the person with dementia and their carer that will underpin a successful respite stay. The Grant Opportunity also includes a focus on innovative approaches which involves models of respite service delivery that support the individual needs of carers of people with dementia and focus on carer wellbeing.

For these models you may consider how information, education and peer support approaches can be used as part of the respite care offering. It is about new models of respite care which are more attractive and practical for people living with dementia and their carers and support a proactive approach to the regular use of respite. In particular applicants should be mindful of whether their proposals duplicate other respite services that are already available and funded under other Commonwealth funded aged care services.

So there’s a few things we’ll be looking for in a successful application and it’s important to consider the entirety of the Grant Opportunity Guidelines including the selection criteria. So really the application should do a number of things. It should outline how improvements to the experience and quality of respite care for people with dementia and their carers will be measured. It should also set out how levels of carer burden will be maintained or reduced. Applications should also articulate how as a result of the program the person with dementia can be cared for at home longer. There should be a focus on how the program will support successful transitions between care settings. That is as I said earlier from the home to the respite care setting and back again.

In addition the application should describe several things including how dementia respite care plans will support a quality and holistic respite care experience, how the planning for the regular and repeated use of respite care stays would occur and how respite care planning is embedded as a core element of service delivery beyond the life of the specific Grant Agreement. And finally the application should demonstrate the success of the program including how assessment tools and metrics will be used to demonstrate that both carer wellbeing is maintained and improved and quality of life is improved, as well as respite care use increasing and being repeated and emergency respite use is reduced.

So that’s just a bit of an overview of Stream 2. I might just turn to Stream 3. So this stream is focused particularly on delivering training for the aged care workforce to improve the quality of respite care specific to the needs of people living with dementia. We know that people living with dementia who access respite may experience distress due to unfamiliar people, environments and routines. So this experience can exacerbate the behavioural and psychological symptoms of dementia and lead to a decline in a person’s cognitive and physical condition. So the aim of the training is to build capability to deliver quality dementia respite care and minimise distress or the potential for decline for people living with dementia accessing respite services.

So the idea is that training should be accessible to the aged care workforce across a range of respite settings with a focus on residential and overnight respite care settings. Again similar to Stream 2 training delivered under this Grant should not duplicate other Commonwealth funding. In particular under this stream it should be noted that the Australian Government funds programs focused on building knowledge and capability of aged care staff in relation to dementia such as through the dementia training program. Respite care training under this Grant Opportunity should demonstrate an awareness of and complement existing investments.

Turning to the next slide. So really to improve the quality of dementia respite care, training and education needs to build understanding of the specific care needs of a person living with dementia accessing respite. So this includes things such as supporting successful transitions between respite care settings and home for people living with dementia and their carers, strategies to help minimise the risk of distress for individuals accessing respite services and understanding and supporting reablement services during the period of respite.

In particular training should reflect the diversity of respite care recipients and consider how an individual’s respite care needs will be identified and met. This might include partnerships with other organisations to deliver or develop culturally appropriate training. I should say that training provided under Stream 3 should reflect best practice dementia care. This may eventually include successful interventions from the innovative grants under Stream 2 as findings from those activities evolve.

But in saying that as a reminder each application will be considered independently and any part of your application that is dependent on an application in another stream must be clearly identified. As we’ve said at various times through the webinar all applications will be assessed on their merits and a successful application in one stream is no guarantee of success in another stream.

Just turning a little bit back to the training explicitly. We expect training will be freely available and accessible to the dementia care respite workforce through both face to face and online delivery. And to ensure as broad a reach as possible and to minimise duplication this stream would ideally suit a single national provider or a combination of providers that can demonstrate national coverage.

So as I said earlier again it’s important to consider the entirety of the guidelines in developing your application. Particularly for Stream 3 applicants should demonstrate expertise in dementia care and a well-developed understanding of respite care and the aged care sector more broadly. They should also have experience in delivering successful training programs and as I mentioned the ability to provide training in every state and territory across Australia.

In terms of what we would consider a strong application we think that that would demonstrate an understanding of existing dementia care training and how the proposed respite care training will complement or leverage those existing resources to avoid duplicating what is already available. It will also demonstrate what training for the dementia respite workforce will include or how it will be developed including any identified priorities. It will also identify and demonstrate how the needs of diverse groups will be met as well as any partnerships with other organisations to develop or deliver the activity including evidence of the agreed arrangements that will be put in place.

As for all streams the successful applicants will be required to participate in evaluation activities for the program and contribute data and information on request.

So that’s an overview of Stream 2 and Stream 3 and I’ll now hand over to Rob for the questions and answers.

Robert Day:

[Visual of slide with text saying ‘Q&A’, ‘Use the chat function to submit your questions’]

Great. Thanks very much Marianne and Frances and Holly, all of you for the information that you’ve shared. And thank you for all of you watching for the questions that are starting to flow through. A reminder that you can use the Chat function on the bottom right of your screen to submit questions. It’s not too late to do that now. And the questions and the answers that we give today will all form part of the Q&A document that goes with this Grant Opportunity and that includes any that we either don’t get to or we decide to take on notice because they need a more nuanced answer.

So let’s jump in to some of the questions that we’ve got already. And the first one that I can see there is:

Q:        Is this grant applicable to online platforms that will ease the life of carers to find respite care support for people living with dementia?

I think the short answer to that one is no. Stream 1 and 2 you probably heard from our speakers today are really about the delivery of respite care services and Stream 3 is really about the education of aged care providers and the aged care workforce on how best to deliver respite care. There are a couple of other measures that Government is working on at the moment that go to that navigation question and it includes things like face to face services through Services Australia, the Care Finder network that is rolling out and expansion of the national Dementia Support Program. So there are measures in place to do that but this Grant Opportunity is not that opportunity.

The next question I’m going to ask you to help me with Marianne, and it’s about what we mean by having national coverage under Stream 3. The exact question is:

Q:        Is it essential to have a national base for training for this application or can training be run at one location in each state and territory?

Marianne Madden:

Thanks Rob. So I think our emphasis in this is around training being available in every state and territory across Australia. So your application should demonstrate how you propose to do that that meets the aims and objectives aligned in the Grant Opportunity. So that’s the emphasis that we’re placing. So as I think I said in the overview we think that potentially this Grant Opportunity for Stream 3 would suit either a national organisation or a group of organisations that have joined together to deliver the respite training.

Robert Day:

Thanks very much Marianne. Another one that we’ve received in advance was about cultural specific training for our First Nations people and whether there was funding particularly for that cohort. There’s not a separate funding stream for that but I think you would have heard from both Frances and Marianne that absolutely one of the things that we want under both Streams 1 and 2 are respite care services that meet the needs of everyone living with dementia regardless of their characteristics and life experiences. And so absolutely – and it’s particularly relevant to selection criteria one – in your application articulate how your model of care meets the needs of First Nations people or a particular culturally and linguistically diverse community or a particular geographic setting that’s under serviced with dementia respite services.

Marianne or Frances is there anything further that you’d add to that answer?

Frances Healy:

No thanks Rob.

Marianne Madden:

Thanks Rob.

Robert Day:

And I guess just to re-emphasise we are really looking for and excited by those prospects of things that might particularly meet the cultural needs of First Nations people or the other diverse groups that we’ve talked about as well.

So a question from Peter. Going to some of them that have come through live today.

Q:        Will the HammondCare Stay at Home Program framework or supporting documents detailing the program be shared?

The short answer is yes Peter. And in fact there’s a principles document that is part of the Grant documentation pack on GrantConnect. Don’t know whether Frances or Holly you’d like to articulate some of the other supports that will be available in helping providers under Stream 1 understand the model.

Holly Markwell:

I can comment on that briefly before Frances. Yep. Look we will have a range of resources as well as putting into it’s likely a community of practice type forum for providers. Really important that we’re able to pass on and share that knowledge that we’ve gained from running the program. So far this year we’ve had seven programs and plenty more to roll out next year. So we will have a provider portal where you will have access to those types of resources to help you run successful programs. Frances I’m not sure if you want to add some more context to that.

Frances Healy:

Thanks Holly. I think that that’s a good overview. I think some of the other things we might do like you said, a community of practice. It might be that we get Holly you and your team back to do a webinar type information sharing to a greater level of detail for those successful applicants once we get to that stage.

Robert Day:

Great. Thanks Frances and thanks Holly. Another question that we received in advance was whether sole traders are eligible for funding. And I’d point the person who asked that question and all of you to section 4 of the Grant Opportunity Guidelines that talks about who is eligible to apply and there is both a list of eligible corporate structures as well as then specific eligibility requirements for each of the streams. Sole traders are not explicitly listed in that list of eligible corporate structures but I’d suggest go and have a look at that in detail and see how it aligns with your personal circumstances, your organisation’s circumstances. There are definitely possibilities in there for partnerships and consortium arrangements if as an individual you can’t apply.

But then also have a look at what the individual specific requirements for elements one and two and three are because there are requirements there to be an aged care provider for example for element one, a registered training organisation or a university for element three for example. So do go and have a look at that section 4 in some detail.

The next question is from Jenny about the point that Grant funding can’t duplicate existing funding.

Q:        How might this be different for cottage respite if the carer already attends those and support is provided?

So I think Jenny the issue with this particular Grant is we’re looking to introduce new and innovative services for respite care. And I guess there’s two sort of possible ways that that might be and I think we’d be looking for you to articulate for us how the funding that you’re seeking would be different to what you’re already offering. So for some providers in some places it might be you’ve already got a residential respite care place or a cottage respite care place and you’re adding something new to that service using this Grant as a top up. For other services it might be that you are operating something brand new and different that has not previously been funded.

Frances or Marianne under elements one or two or Streams 1 or 2 of the Grant are there particular considerations you’d like to highlight?

Frances Healy:

Sure. I think probably Rob a good example of one of those differences would be for the carer specific costs of going to stay together with the person with dementia. So it might be that those would be additional costs, for example the accommodation and the meals for those people. So that’s a good practical example I think of what would be considered a top up part of the Grant funding.

Marianne Madden:

And I think sort of building on what both Rob and Frances have said I think it’s really about for Stream 2 that enhancement to respite services already offered through particularly targeting people living with dementia and their carers. So it is intended to be an enhancement to rather than sort of duplicating existing services. So I think in terms of applications it should really identify what the enhancement will be that’s being proposed.

Robert Day:

Thanks Marianne and Frances. I think that answers directly one of the other questions that’s come through from Joseph about:

Q:        Where overnight respite in cottages is not currently fully funded what can be funded through Stream 2?

And it’s really about really articulating what’s the difference, what’s the funding that you’re already getting and being transparent with us about that, articulating what is the value add for the person with dementia or their carer from your proposal, and that then allows us to make some judgments about where is the greatest need, where is the greatest value for money. And we’ll put all those factors together to make that decision.

A related but different question from Peter is about ACAT assessment and whether this is required for access to overnight care. And Peter that’s going to depend on what your model is that you’re looking at. If you’re looking at a model where you are using this Grant to top up respite care funding that you get through either residential or home care or CHSP then the people with dementia will need to have that assessment and be getting that funding. That will be your responsibility as an aged care provider to organise that. If what you’re providing is a respite care model that’s for people at an earlier stage in their journey with dementia where they haven’t yet had an aged care assessment then obviously you’ll need to reflect the full cost but there won’t be an expectation that they’ve had an aged care assessment.

So Sarah’s got a question then about Stream 1 which is – sorry. My screen’s refreshed too quickly for me. Sarah, Stream 1.

Q:        Given that Stream 1 is building on the Staying at Home model are areas less likely to be funded due to the existing presence of HammondCare and DSA?

I don’t know Frances if you’ve got a thought on that question?

Frances Healy:

Thanks Rob. No. At this stage every state and territory is eligible for funding. HammondCare has started to deliver programs in different states and territories but this doesn’t necessarily rule out an application in that state or territory or that jurisdiction because we’re looking for multiple programs to be run in different states and territories over time.

Robert Day:

Thanks Frances. Next one is from Teresa and it’s in relation to Stream 3 so coming your way Marianne.

Q:        Is the training geared at the workforce or is there scope for family and carer education as well?

Marianne Madden:

Thanks for that. So it is actually intended to be directed to the aged care workforce as part of this program. There are other programs that are available that support family carers more generally but the focus of this in particular is the aged care workforce and training for them.

Robert Day:

Thank you. And sorry I’m just letting my screen refresh again. Thank you for all these questions that are coming in. It’s great to see such a high level of engagement. I might come to you again Marianne with a question about Stream 2 from Sarah. Sarah says:

Q:        It was mentioned that Stream 2 has a focus on overnight respite. Would a combination of models inclusive of overnight but also other models be acceptable?

Marianne Madden:

Yes. So yes it is both overnight but also day respite as well. So it can be either/or or a combination of both and that’s eligible to be considered as part of the program.

Robert Day:

Excellent. Thanks Marianne. I might try and answer Martina’s question next and Martina’s framed it as a question around Stream 1 but I actually think it’s relevant for Stream 2 as well. Martina asked:

Q:        What’s the geographic reach or catchment that is expected from Stream 1 providers?

The short answer is that we haven’t set any parameters around that Martina for either Stream 1 or Stream 2. What we’re asking you to tell us is what is the reach of delivery that you’d expect to provide in the model that you’re proposing, what’s the cost that you see as being associated with that model, and then we when we’re assessing applications need to make judgments about have we got the best possible spread geographically across the country. So we’re not predetermining that in terms of what you should submit as an application. It will be a factor for us about deciding which are the best applications to submit will be how we get that geographic spread across the country.

So I’ve got a question from Tim that I might throw to you Holly because it goes to the Staying at Home principles. Tim says:

Q:        The Staying at Home principles document states a dementia diagnosis is an eligibility criteria. Can you elaborate on what this diagnosis entails? Does it mean Mini-Mental State Exam, does it mean geriatrician diagnosed?

Tim had thought that people in the Support at Home Program just needed demonstrated acknowledged cognitive decline.

Holly Markwell:

Yep. That’s right. We’re fairly kind of I guess inclusive in that regard because we know that we still have a number of people who have an unspecified sort of dementia diagnosis or a very reasonable suspicion of major neurological disorder. But I guess if we have any sense of doubt that perhaps things haven’t been ruled out and adequately managed right at that front end with the primary health carer then of course we’re very keen to make sure that the person is referred back in to establish what might be going on there to rule out anything else which might be occurring which could look like dementia. But for most of the people that we have had enquiries from they have had a diagnosis. And if it’s not from a specialist that’s fine. If it is just an unspecified dementia diagnosis. We’re not looking for any particular rating on the MMSE but really I guess because we are meeting with both the person living with dementia and the carer in that kind of telehealth environment we get a really good sense of where they’re at plus we use the Lawton-Brody Instrumental Activities of Daily Living, we use the Global Deterioration Scale and the Zarit Burden interview to really round out our knowledge so that we’re getting that right target kind of group. So hopefully that answers the question.

Robert Day:

Thanks very much Holly. I’ve got two more questions from Rachel about Stream 1 and I think one I’ll throw to you Holly and one I’ll come to Frances about. The one for you Holly is in terms of the peer support component of the Support at Home Program.

Q:        Is the peer support component an intentional structured element or is it more an informal part of the overall model?

Holly Markwell:

In a sense it’s both. It happens quite naturally in quite an organic way with how people interact in the program because they’re living in a house together. It can feel as I said with some of the locations particularly a bit like a retreat almost. But we allow within the program particularly the carer sessions where for example carers might be away from the person they’re caring for for up to six hours and that can be quite an unusual kind of situation for them to be in – but we really allow within that program – we run it very much as a group session and allowing that space for the peer support to actually – which will arise as a natural consequence of allowing the space within the program. So although it arises quite organically as a function of people being within the home together our facilitators are very conscious of how they can help draw out and when they need to step back effectively in order for people who are in that caring role to have that confidence to speak up to educate effectively and provide that peer support with each other. So a bit of both.

Robert Day:

Great. Thanks very much Holly. And Rachel’s other question that I think Frances is one for you goes to the evaluation part of Stream 1.

Q:        Is the expectation that providers follow a similar evaluation design as outlined in the session or can they propose an alternative design for evaluation?

Frances Healy:

Thanks Rob. I think probably a bit of both. I think it’s important for a program like this to have some consistency in how it’s evaluated across individual programs that are run by different providers so we can bring together the evidence for the success of those interventions as a whole. But of course if the programs have differences in their model and the way they’re implemented then they might need some difference in how they’re evaluated as well. So that would be something that could be negotiated with individual providers as well.

Robert Day:

Great. Thanks very much Frances. I’ve got a question from Sue about:

Q:        If you’ve been trialling a day respite program for a period of time that is not currently Commonwealth funded would that be eligible?

I suspect the answer is probably yes but it will depend a little bit on the circumstances Sue. So I suggest make the application and just be transparent with us about what the story is there. If it’s a case that you have a small amount of philanthropic funding to trial something or the organisation’s made a commitment to use some of its own capital to trial something and this Grant funding would let you take that to scale or make it a more enduring part of your service then yes I can see that as being something that would be eligible. If you’ve got long term State Government funding for the same thing then we’d be more likely to say no. Not that I think that’s probably the situation here. So just tell us that story, tell us how you’ve trialled it, where the funding is coming from, where the Commonwealth funding would let you take that next step, whether it’s longer term, reaching more people. You can tell us that story.

Dianne also asks:

Q:        Can people on a home care package be included or would they need to pay through their package?

And for both Stream 1 and Stream 2 Dianne we’re open to both models. We’re open to models where there is a combination of aged care funding and this provides a top up that let’s you do a little bit more or we’re open to models that this Grant provides the costs for the whole service. And it’s just about you telling us which model you’re choosing to operate in your service and we’ll then make a value for money decision about where we’re going to get best bang for our dollar across all the applications.

Another question from Melissa in terms of Stream 1.

Q:        Is there a minimum number of participants the program has to reach? Is it acceptable to only have three or four couples during a program?

I don’t think we’ve set a really firm number. Part of the decision that we’ll need to make is an assessment of value for money but we certainly haven’t articulated a minimum number. Holly or Frances is there anything that you’d add to that answer?

Holly Markwell:

Yeah. Happy to jump in there if that’s okay. I guess what we’ve found is that we did once run a program where we had five couples and that was okay but there really is a sense of having enough numbers really helps to kind of have the people to bounce off effectively. So I’m not sure that you would have quite the right group dynamic. I think we’ve definitely found that the six couples is a really vibrant dynamic for the group. Potential to run it with slightly less but I would be a little reluctant from my point of view certainly to have less than around about five couples within a group.

Robert Day:

Thanks very much Holly. I think that’s a useful consideration for people to bear in their minds. A question from Deborah about whether the funding under Stream 1 will be part of the Support at Home in terms of the reporting and payment structure or will it be offered as an annual grant. And the short answer is we will be looking to enter into separate one to one Grant Agreements between the Department and the successful applicants under Stream 1. So where we’re talking about the Support at Home Program what we have is a model of respite care for dementia and their carers that has been refined and tested over a number of years, published in the academic literature as having significant benefits to quality of life for both carer and person living with dementia and then savings for the Commonwealth down the track in terms of prolonged entry to residential care.

So that’s why we’re sort of pointing to the model and saying we’d like to replicate this but we’re also conscious that Stay at Home model is being run in one particular set of circumstances and we’d like to try and apply those principles in other circumstances. So that’s the reason for the explicit link back to Support at Home is there is an evidence base for it but we’re looking then for you as individual providers to think about how might you take those principles and apply them in a way that’s meaningful in your location, in your service setting for a particular group of the population whether it was First Nations people, people who speak a language other than English, and tell us how that will work for you. And it will be a one to one grant between ourselves and the successful applicants.

I don’t know Frances or Marianne if you’ve got the GOGs in front of you to answer the question from Erica about capital and whether that can be – I think I’ve got a nod from you Marianne.

Marianne Madden:

Yes. So handily I’ve got it in front of me. So page 17 of the Grant Opportunity Guidelines specify what – actually 16 and 17 – what the Grant funding can and cannot be used for. So it cannot be used for major capital expenditure and major construction and capital works. But I think you can specify and there’s a list of eligible expenditure there so it would be about specifying what purposes you’ll be using the funding for. As it’s not specifically excluded as part of 5.4 then just outline what your intentions are.

Robert Day:

Thanks very much Marianne. And you can keep your microphone on because I’ve got one last question and it will be our last question because we’re right up on 1:30 now. But for Stream 3 for the education can that include a focus on community carers and coordinators in addition to respite or residential aged care carers, and particularly in regards to having respite conversations early?

Marianne Madden:

Yes. So look I think we take a broad interpretation of aged care workforce. So it’s really the kind of key part of the focus within Stream 2 and Stream 3 is around creating a good transition between home and particularly residential aged care. And so Stream 3 it’s really about delivering training to those key workforce that assist with that process. So we are open to proposals that people have in relation to the workforces that they would direct the training towards.

Robert Day:

Great. Thanks very much Marianne. Thank you Frances and Marianne and Holly for your help working through those questions. And a really big thank you to all of you who participated and contributed questions. Really great to have that level of engagement and interest in the program. So thank you all very much for your time and attention today.

A couple of last reminders from me before you go. First is that you can continue to ask questions. Submit them to grant.atm@health.gov.au and any questions that you submit up ‘til 5:00pm Monday the 9th of January we’ll answer. And we’ll also keep updating the frequently asked questions document that’s part of the Grant package to give you some more information as we go. And then obviously the critical date is the closing of the Grant Opportunity which is 2:00pm Australian Eastern Daylight Saving Time on Monday the 16th of January. So thank you again very much for your attention and interest and really looking forward to the outcomes of this Grant Opportunity. Thank you.