The Aged Care Assessment Program 25 years on: Time for a comprehensive reassessment?

1. The Aged Care Assessment Program 25 years on:Time for a comprehensive reassessment? ACAP 2010 Melbourne, May 20-21 Anna Howe PhD Consultant Gerontologist and ACAP Veteran

2. Comprehensive Reassessment • Take a history • Make a diagnosis • Develop recommendations

3. Taking the history 1. Pre – ACAT Era • Weak control over nursing home and hostel admissions • 37,000 NH5 forms processed in NSW 1973 -1980, only 1 refused • No Ax for hostels admission, only for Personal Care Subsidy • High level of inappropriate admissions • And long waiting lists • Community care • Rudimentary services • Uneven assessment e.g. GP referral for MoW!

4. Taking the history 2. Getting started Pre 1983 • The pioneers • Community Health Program, DVA Establishment of the Program 1981 Auditor General 1981-82 McLeay Inquiry HofR 1983- 86 Annual budget allocations - pilot projects > national network 1985 Giles Inquiry Senate, Review of Hostel Subsidies 1986 Nursing Homes and Hostels Review Keeping track • MDS of 17 items • Progress Reports 1987-2000 – 26 in Victoria, 2 per year, National Evaluation Reports • Some trends, but more stability

5. Taking the history 3. Guidelines 1987 Commonwealth Guidelines for Assessment Services 2002ACAP Operational Guidelines (post Aged Care Act 1997) 2006 Aged Care Assessment and Approval Guidelines Purpose: To inform and guide Aged Care Assessment Team members in the assessment and approval of people for residential, community and flexible care, under the Aged Care Act 1997 (the Act).

6. Read in conjunction with: • Aged Care Act 1997 and the Aged Care Principles • Aged Care Assessment Program Operational Guidelines 2002 • Other ACAP documents to assist ACATs include: • ACAP Financial Guidelines 2004 • Data Dictionary 2002 • Aged Care Client Record User Guide 2006 • Other Program specific resources • the Residential Care Manual • Payment Essentials Publication • Community Aged Care Package (CACP) Program Guidelines 2004 • EACH Dementia Draft Program Guidelines 2005 • Transition Care Program Guidelines 2005 • Ageing in Place Guidelines for Residential Providers • National Respite for CarersGuidelines

7. Taking the history 4. Reviews ACATS State Reviews 1999 Victoria (Elton) 2003 Tasmania (Howe & Robinson) National 1999-2000 Alt Beatty 2007 National Review (COAG – Communio) 2008 Government response Aged Care • Two Year Review of Aged Care Reforms 2004 Hogan Review • The Way Forward • Senate Quality & Equity in Aged Care • Subsidies and services review • Productivity Commission • Senate Better support for carers 2009 Senate Residential and Community Aged Care in Australia • NHHRC • Productivity Commission

8. Taking the history 5. Why does the ACAP have to change now? • Initial program shaped by • Concerns about GP ‘boycotts’ • Providers accepting external assessment • Other interest groups • C’w unable to control assessment for community care • Resulted in ACATs being open access/primary care services • Little recognition of Special Needs Groups in early 1980s • None of these concerns still apply • NHHRC places aged care in wider health care system

9. Diagnosis 1. Not providing equitable access

10. Diagnosis2. Become confused and wandering • “We’re different”, attribute to differences in clients • BUT found to be due to differences in • Client characteristics • Population characteristics • Local characteristics (metro, regional, remote, etc) • Services , incl. aged care places • Team work patterns • Not adapting to change • In external environment • In internal environment, IT, e-business

11. Diagnosis 3. Behaving irresponsibly & inconsistently • Recommendations far exceed admissions

12. Diagnosis 4. Trying to do too much High risk clients In hospital/ post acute/rehab Psychogeriatic Transition Care RACH / ACFI/respite CACPs/ EACH/ EACHD Compre- hensive CALD Indigenous Rural/Remote In community at Ax/ remain in community No or some HACC services at Ax No or some HACC services after Ax Home mods/equipment Carer support Intake Own shop fronts Carer Resource Centres Centrelink Community education Basic Assessment Access & Information

13. NHHRC recommendations on Assessment • 12 recommendations on Aged Care • focus on increasing choice • On assessment • Transfer ACATs to Commowealth • Develop new tools for assessing need • Integrate assessment for HACC with more rigorous assessment for higher levels of community and residential care • 5 recommendations on sub-acute care

14. For my ideal ACAP 1. Develop a typology of ACATs • ACATs one part of wider assessment systems • Rebalance generalist/specialist roles • One size doesn’t fit all, but not 120 different sizes • Metropolitan areas • Regional Centres serving rural areas • Remote areas with MPS

15. For my ideal ACAP 2. Improve match between recommendations and services • Large pool of clients approved/recommended means • providers decide who to take > cherry-picking • undue stress for clients and carers • Control waiting lists and excess recommendations by • Following through to outcomes • Screening and referral • Limit validity to 6m • Set number of places that can be recommended • Better indicators of need to address resource constraints • Consumer Directed Care is coming your way

16. For my ideal ACAP 3. Look to the horizon • National Disability Insurance Scheme • Few people under 50 seen by ACATs (Brisbane study) • Very different life course needs • Need different, specialist assessment • Assistive Technology Benefits Scheme (like PBS) • well accepted by clients • ACATs well placed to be prescribers

17. My ideal ACAP 4. Redesign to relieve pressure Enhance Hospital Geriatric Medical Services Higher risk clients REFERRAL Formalize and strengthen community-based assessment Lower risk clients SCREENING Entry Points

18. If we don’t restructure, run risk of imploding or exploding