The evaluation process which residential aged care services must undergo to continue to receive Commonwealth government funding (residential care subsidy) under the Aged Care Act 1997 after 1 January 2001. The process involves a self-assessment by the service, which is then validated by an assessment team by desk and site audits. Following this an accreditation decision is made by the Aged Care Standards and Accreditation Agency.
Aged Care Access Initiative
The Aged Care Access Initiative aims to improve access to primary care services for residents of Commonwealth-funded aged care facilities. The Aged Care Access Initiative, announced in the 2008-09 Federal Budget, will support primary care provision for aged care residents through a GP incentive payment to encourage GPs to provide increased and continuing services in residential aged care facilities; and a payment for Allied Health Professionals for clinical care services in residential aged care facilities, where these services are not covered by Medicare or other government funding arrangements
Aged Care Approvals Round
The Aged Care Approvals Round is an annual application process that enables prospective and existing approved providers of aged care to apply for a range of new Australian Government funded aged care places and grants.
Aged Care Funding Instrument
The ACFI has been developed in response to the Review of Pricing Arrangements in Residential Aged Care (Hogan 2004) and the RCS Review (2003). It has been designed to better match funding to the complex care needs of residents; reduce the documentation created by aged care providers to justify funding; and achieve higher levels of agreement between aged care staff and departmental review officers in review audits (known as validation). The ACFI is based primarily on the resident’s dependency (need for care) rather than on care planning or care provided by an aged care home. Unlike the RCS, ACFI does not use ongoing care documentation as evidence to support funding claims. The ACFI consists of twelve care need questions. Diagnostic information about mental and behavioural disorders and other medical conditions is also collected. This information is used to categorise residents as having low, medium or high care needs in each of the following care domains: Activities of daily living (ADLs), Behaviour, Complex Health Care.
Allied Health Professionals
For the purpose of the ACAI, an allied health service may include services provided by:
Aboriginal Health Workers, Aboriginal Mental Health Workers, Audiologists, Chiropodists, Chiropractors, Counsellors, Diabetes Educators Dieticians/nutritionists, Dental/Oral Hygienists, Diversional Therapists, Exercise Physiologists, Occupational Therapists, Orthoptists, Orthotists/Prosthetists, Osteopaths, Physiotherapists, Podiatrists, Psychologists, Radiographers, Registered Nurses, with specialist roles, Social Workers, Speech Pathologists
Better Oral Health in Residential Care
The Better Oral Health in Residential Care training project will be rolled out nationally to all residential aged care facilities in 2010. The project aims to provide an increased awareness of oral hygiene issues for the staff in daily contact with residents. Better Oral Health in Residential Care Training project which commenced in December 2009 and will continue throughout 2010. The training aims to provide an increased awareness of oral hygiene issues for the staff in daily contact with residents. It is important to note that the training is not a replacement for professional dentistry services.
Community Visitor Scheme
The Community Visitors Scheme (CVS) is a national program that provides companionship to socially isolated people living in Australian Government-funded aged care homes. The Community Visitors Scheme arranges community volunteers to visit selected residents on a regular, one-to-one basis. The Community Visitors Scheme is funded by the Australian Government and operates in every State and Territory. Any resident whose quality of life could be improved by the companionship of a regular community visitor can be referred to the Community Visitors Scheme. The CVS also helps to establish links between people living in aged care homes and their local community
A community visitor is a volunteer who is matched with a resident of an aged care home, and visits them regularly.
Commonwealth Funded Residential Aged Care Facility
A Residential Aged Care Facility which is funded by commonwealth government of Australia.
A physician whose practice consists of providing ongoing care covering a variety of medical problems in patients of all ages, often including referral to appropriate specialists. Also called family doctor.
Practice Incentive Program
Practice Incentives Program (PIP) was developed to provide incentives that encourage general practices to improve the quality of care provided to patients. Administered by Medicare Australia on behalf of the Department of Health and Ageing (DoHA), PIP is a part of a blended payment approach for general practice. Payments made through the program are in addition to other income earned by general practitioners (GPs) and the practice, such as patient payments and Medicare rebates. There are 12 broad elements to the payments: After Hours Incentive, Practice Nurse Incentive (PNI), Quality Prescribing Incentive (QPI), Teaching, Rural loading, Cervical Screening Incentive, Asthma Incentive, Diabetes Incentive, Procedural GP Payment, Domestic Violence Incentive, Aged Care Access Incentive, eHealth Incentive
Qualifying Service Level
According to Aged Care Access Initiatives, there are two payment levels under the GP component. Payments will be calculated by Medicare Australia based on the number of relevant MBS items claimed in one financial year. Tier one provides a payment of $1,000 when the first qualifying service level (QSL1) of 60 services is claimed in 2008-09. Tier two provides a payment of $1,500 when the second qualifying service level (QSL2) of 140 services is claimed in 2008-09. The maximum payment any one GP can receive in one financial year is $2,500
Residential Aged Care Facility
A special-purpose facility which provides accommodation and other types of support, including assistance with day-to-day living, intensive forms of care, and assistance towards independent living, to frail and aged residents. Facilities are accredited by the Aged Care Standards and Accreditation Agency Ltd to receive funding from the Australian Government through residential aged care subsidies.
Registered Nurse, Registered Nurse Division 1 in Victoria
Registered nurses include persons with at least a three year training certificate and nurses holding post graduate qualifications. Registered nurses must be registered with the state/territory registration board. This is a comprehensive category and includes community mental health, general nurse, intellectual disability nurse, midwife and psychiatric nurse.
First and foremost, I would like to thank GOD Almighty; with his grease I could finish my assignment under the given circumstances without any trouble.
It is a great pleasure for me to express my sincere thanks to Dr.(Prof.) Lynette Stockhausen, Head of School and Ms. Theresa Dawson, Administrative Officer of School of Nursing, University of Ballarat for enrolling me into the program for the January 2010 batch.
I would like to thank Ms. Fiona O’Toole, Course Co-ordinator, for the continuous support given to me in till the final touch up of this assignment.
I utilize this opportunity to thank Ms. Debbie Ware, unit co-ordinator, for the guidance provided for the completion of this assignment.
I thank Mr. Marcus Hovey and Fiona Strauss, clinical teachers, who had given full support for me throughout this assignment.
I would like to thank Department of Health and Ageing, Australian institute of health and ageing, Australian Bureau of statistics and Australian Journal of Advanced Nursing, for the provision of materials in the internet.
I thank my mother, who supported me throughout in this course.
Last but not the least; I thank all my colleagues and friends, who helped me in completing this report.
Australia is one of the leading countries with regards to life expectancy globally. Currently (as on June 2009), Australia has 175225 RACF and 46,709 community packages are functioning. This report is based on ACAI, BOHRC training, CVS and ACFI.
Purposes of the Report
> Analysing the above mentioned initiatives
> Outline the key strengths
> Describe the key weaknesses
> Identify the key opportunities
> Figuring out the key threats
> Formulate the possible recommendations for future action.
Findings of the report
Key strengths are continuity of care, training for the trainers, posters, which are excellent source of sound information, enhanced social support, and maximum utilizations of time for caring elderly. Key weaknesses include restriction of care to residents of CFRACF, less number of training centres for BOHRC, ensuring residents’ likes may not be possible in all situations and who is assessing the ACFI. Key opportunities constituters, more AHP services, clarify the duration of initiatives, more employment opportunities and use of these as a tool for research and education. Key threats identified were restricted PIP payment, lack of information regarding evaluation methodology and duration of ACFI and lack of multidisciplinary co-operation.
These include more training for RNs in BOHRC and ACFI assessment. Encouraging RN to be as an evaluator for programs and work as CV. PIP payments should be done according to the services given by GP. Multidisciplinary team approach should be developed for all initiatives. There should be no bias in provision of care.
If these recommendations are implemented, then Australia can expect the maximum life expectancy of Australia and Australia will be ranking first in life expectancy rates globally.
Australia is one of the longest life expectant countries in the world. The life expectancy for male is 79 years, ranking second and in female it is 84 years, ranking third globally. Australian Productivity commission found that demographic destiny is moving from pyramid to coffin (Appendix 1) (15).Australia is increasing the life expectancy (Appendix 2) (1) by various initiatives. It is noted that 1 in 4 Australians will be over 65 years by 2056 (2). In 2001 Australia had 2959 RACF in which 2938 were accredited (5). As on June 2009, there are 175,225 RACF and 46,709 Community Places were functioning. For 2009 – 10 ACAR, there are 8140 RACF and 4078 Community Places were available. The indicative places in 2010 – 2011 ACAR are 9076 RACF and 1298 Community Places (Appendix 3) (15).
1.1 NEED FOR THE INITIATIVES
Australian government is concerned about the care that elderly receives in the RACF and made many initiatives and programs for them. This report is incorporating some of the main initiatives and schemes that are available to elderly in RACF by Australian government.
; Analysing the above mentioned initiatives
; Outline the key strengths
; Describe the key weaknesses
; Identify the key opportunities
; Figuring out the key threats
; Formulate the possible recommendations for future action.
1.3 INITIATIVES ANALYSED
; Aged Care Access Initiative (ACAI) (7).
; Better Oral Health in Residential Aged Care (BOHRC) training (10).
; Community Visitors Scheme (CVS) (9), and
; Aged Care Funding Instrument (ACFI) (11).
1.4 SOURCE OF INFORMATINON
The source of this information is website of Department of Health and Ageing for the initiatives ie. www.health.gov.au . So the source is a relevant one.
2. OUTCOME / IMPACT OF INITIATIVES
2.1 SWOT ANALYSIS
* Continuity of the care
* Training for the trainers
* Posters – a brief overview
* Enhanced social support
* Maximum time for caring the elderly
* Restriction of the services
* Less number of training centres for BOHRC
* Ensuring residents likes may not be practical always
* ACFI assessor
* More AHP services
* Clarity in the duration of initiatives
* More employment opportunities
* Tool for research and education
* Restricted PIP payment
* Evaluation methodology not mentioned
* Lack of multidisciplinary cooperation
* Lack of duration information on ACFI
2.2 ANALYSIS OF FINDINGS
* Continuity of the care (7)
ACAI, with its two components ensures that the maximum continuity of the care for the residents of RACF.
* Training for the trainers (9)
The BOHRC training started in December 2009 and is continuing throughout 2010 to train the trainers of RACF.
* Posters – a brief overview (13)
The posters are explaining all about BOHRC.(Appendix 4;5)
* Enhanced social support (14)
Under CVS, residents of RACF are linked to the wider community by CV.
* Maximum time for caring the elderly (12)
ACFI ensures that no time is spent on funding justification and thus maximum utilization of time in provision of care to the elderly.
2.1.2 Key Weakness
* Restriction of the services (7)
All the services are only for the residents of CFRACF. Others actually have to pay for the services.
* Less number of training centres for BOHRC (10)
Less training centre means less trained trainers, ultimately resulting in fewer outcomes.
* Ensuring residents likes may not be practical always (4)
Residents may change their like frequently or if the co-ordinator failed to monitor the like properly, residents won’t get the CV with same likes and hobbies.
* ACFI assessor (12)
No clear cut information on the ACFI assessor.
2.1.3 Key Opportunities
* More AHP services (7)
The AHP services are purchased by SBO, so that the maximum clinical services are ensured for the elderly. ACAI clearly mentioned about the AHP to provide care. This makes more opportunities for AHP.
* Clarity in the duration of initiatives (7),(10),(11)
ACAI will work for 4 years, BOHRC training will be throughout 2010 and ACFI will be reviewed after 12th March 2010.
* More employment opportunities (7),(10),(11)
With all these initiatives the employment opportunities for AHP will increase.
* Tool for research and education
These are a good tool for education and research in health care system and related studies.
2.1.4 Key Threats
* Restricted PIP payment(7)
The restricted 2 tier payment of $2500 will result in lessened services by individual GP to 200 elderly only.
* Evaluation methodology not mentioned (7),(10),(11)
Other than ACFI, no programmes are having a good evaluation or review methodology, so that the weaknesses will never be rectified.
* Lack of multidisciplinary cooperation (7),(10),(11)
These initiatives failed in ensuring a multidisciplinary approach which is a part of success of the program.
* Lack of duration information on ACFI (11)
The duration of ACFI is not mentioned, so that the next government can change or avoid it.
To put everything into a nutshell, Australia had come up with lot of initiatives for elderly residing in RACF. The continuity of care is maintained by ACAI (7). BOHRC training started because government identifies that oral hygiene plays a vital role in overall health (14). Loneliness was one of the social problems to be resolved. So the CVS (9) was introduced. Government found that maximum time was spent unnecessarily in justification of the funding and to avoid that ACFI (11) was introduced. These all ensures a better continued care to elderly in RACF. These are good tools for education also. Upon all these, the services were offered only for residents of CFRACF (7). Lack of proper evaluation won’t rectify the weaknesses of these initiatives (7), (10), (11). The restricted PIP payments will result in reduced number of services to the elderly (7). If all the given recommendations are implemented, then Australia can expect a better outcome from these initiatives and the ageing population will be healthy and active. These all will ultimately increase the life expectancy of Australia and Australia will be ranking first in life expectancy rates globally.
* More RNs have to be trained on BOHRC.
* RNs have to be encouraged to work as CV.
* RN can be trained in assessing the ACFI.
* PIP payments should be according to the services GPs offered. It shouldn’t be restricted to the maximum number of QSL.
* RNs have to be given the role of evaluator of the programs.
* Multidisciplinary team approach must have to be developed for all the programs.
* No services should be restricted to the residents of CFRACF. It should be open to all.
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