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Session 4 – DSS Paper 4.1
Potential approaches to client entry and assessment in the Commonwealth Home Support Program
Purpose
The purpose of this paper is to invite discussion by the Commonwealth Home Support Program Advisory Group on issues relating to client entry into the Commonwealth Home Support Program (CHSP) and the role of the Aged Care Gateway, particularly regarding faceto-face assessments for CHSP clients. The paper does not necessarily represent a preferred or settled approach to implementation.
The paper builds on discussions with a range of stakeholders, including the Gateway Business Design Sub-Group, and the Review of HACC Service Group 2. This paper also draws on elements of NACA’s draft discussion paper, “Assessment and the Aged Care Service System”.[1]
There is further context and discussion about the role of assessment and service delivery within the aged care system more broadly, based on a wellness and reablement approach, in NACA’s draft discussion paper. To assist the discussion at the CHSP Advisory Group meeting, NACA’s suggested definitions of “wellness” and “reablement” are reproduced at Attachment A.
Current arrangements
At present, there is no single entry point to the Commonwealth HACC Program in most jurisdictions[2]. My Aged Care (website and national contact centre) provides a consolidated source of information about aged care services, including locally available services, but there is no requirement for clients to contact My Aged Care in order to receive services under the Commonwealth HACC Program. Potential clients usually contact individual service providers directly, with varying degrees of co-ordination between service providers.
There is not a consistent approach to assessment nationally. Assessment may be conducted by Access Points in some states and regions, or by individual service providers using a variety of tools. There is no central client record.
There are different entry points and approaches to assessment across the other home support programs – National Respite for Carers Program (NRCP), Day Therapy Centres (DTC) Program and the Assistance with Care and Housing for the Aged (ACHA) Program.
The current assessment and service delivery system is largely based on the underlying assumption that an older person will require services and support, and that over time, the person’s needs will escalate requiring an increasing level and intensity of services. Nationally, there is currently only a limited focus on wellness and reablement in home support programs, although this is more prominent in WestAustralia and Victoria.
Long–term goals
The long-term goal is to have a single identifiable entry point to the aged care system and a network of regionally based assessment services across Australia that can assess a client’s needs and eligibility for services across programs (eg home support, home care, residential care or transition care). The assessment would be focused on the needs of the individual client, rather than be specific to a particular funding program or care type. This could potentially involve consolidating assessment resources and functions over time.
In the future, the aged care assessment and service delivery system would be underpinned by a wellness philosophy and reablement approaches/interventions. In the CHSP, this would enable services and support to be offered as:
· a one-off event – such as a home modification;
· short-term services (eg 6 to12 weeks) – such as support to a person to restore function, therapy and assistance with daily living tasks after a fall or illness (after which the person may not require further services/support or perhaps need a lower level of services/ support);
· intermittent support – such as periodic transport, one-off household maintenance; or
· ongoing services – to meet long-term goals and needs.
Commonwealth Home Support Program
As a first step, the Aged Care Gateway provides an opportunity to introduce a screening and faceto-face assessment capability for entry into the CHSP, supported by a standardised national assessment tool and a central electronic client record. The program would have a strong focus on wellness and reablement.
Entry point and phone-based screening
From July 2015, it is proposed that all new clients will enter the CHSP through the Aged Care Gateway[3]. If a client contacts a service provider directly seeking services, the client will be directed or referred to the Gateway (although the service provider may assist the client to call the Gateway contact centre or to facilitate online client self-registration)[4].
The Gateway contact centre will conduct an initial telephone-based screening for clients seeking to access Commonwealth funded aged care services. The contact centre will find out the reason for contact, screen current health status including a client’s ability to undertake basic daily activities, identify any carer support, and register the client on the central client record. This record will reduce the likelihood of clients having to tell their story multiple times as they move through the aged care system, and over time, data from the client record will reduce the need for separate reporting on service activity.
The screening will check eligibility for the CHSP and whether the client should be directed to:
· individual CHSP providers for service delivery[5];
· a face-to-face assessment where appropriate – this will depend on the client’s needs and whether there is the capacity to undertake a face-to-face assessment locally;
· an Aged Care Assessment Team (ACAT) – if the client is potentially eligible for home care, residential care or transition care; or
· other carer support programs, eg residential respite or counselling services.
A central electronic client record will be established by the Gateway at the point of initial contact for clients seeking access to Commonwealth funded aged care services.
Alternatively, the client may be provided with information about other non-aged care services and programs, with no further assessment or service delivery under the CHSP.
Regional based face-to-face assessment services
A key issue for the design of the CHSP is the extent to which clients should receive afacetoface assessment through the Gateway following the initial phone-based screening. If so, what are the triggers or criteria for determining which clients should receive a facetoface assessment by the Gateway, and how and when could face-to-face assessment services be introduced within the CHSP?
What would the face-to-face assessment service cover?A face-to-face assessment provides an opportunity to more comprehensively assess a client’s needs, and to have a greater reablement focus in the planning, delivery and review of CHSP services. The Review of HACC Service Group 2 and consultations with stakeholders highlighted the importance of understanding a client in their home environment to more holistically address a client’s needs, particularly for clients from special needs groups.
An outcome of the face-to-face assessment would be that the Gateway assessor[6] works closely with the CHSP client to develop an individually tailored support plan that places greater emphasis on identifying the goals of a client, particularly client independence, community connectedness and social and emotional wellbeing.
The support plan would identify suitable basic support services to meet the client’s needs. The support plan would not be confined to Commonwealth funded aged care services, but may include other services that will support a client to achieve their goals. Regional based assessment services will be able to draw on their knowledge of local services that would be most suitable to meeting a client’s needs. The assessment service will also be responsible for referring clients to suitable services and for shortterm case management. Where there is a regional based assessment service, all new clients should be provided with a review of their services and needs by the Gateway assessor, preferably within the first 6-12 weeks after the commencement of services.
For some clients, the face-to-face assessment may identify the need for more intensive services over a short period (sometimes referred to as “'restorative care’ services) to help the client achieve a greater level of function and independence, potentially reducing the need for ongoing services. This service would be a planned program of interventions delivered or coordinated by a multi-disciplinary health professional team. This could be funded as a separate service type within the CHSP, potentially building on existing activities within Day Therapy Centres and allied health services. A restorative care stream could be implemented on a small scale initially, with the potential for expansion in the longer-term.
Where short-term restorative care services are offered to a client, at the conclusion of these services, the client would either be referred to service providers for continuing services or exit the CHSP.
For all clients receiving ongoing CHSP services, the service provider will be responsible for monitoring clients’ care needs. Where there is a significant change in the client’s needs or circumstances, the service provider should initiate a reassessment by the regional assessment service.
Which clients should receive a face-to-face assessment?
There are differing views on how many and which clients should receive a face-to-face assessment under the CHSP.
One view is that face-to-face assessment should be provided to most clients under the CHSP, on the basis that it is difficult to fully assess a person’s needs and to develop an appropriate support plan (particularly with a re-ablement focus) through phone-based screening. It is preferable to assess a client in their home environment.
Alternatively, a face-to-face assessment could be provided to clients with more complex needs and/or where there are communication issues at the point of screening. Under this approach, clients with relatively simple needs (those seeking 1-2 services across particular services types) or those requiring short-term support only could commence service delivery quickly without a faceto-face assessment by the Gateway.
Further work is required to identify appropriate “trigger” questions that could be used in the telephone screening to identify whether a face-to-face assessment is required. For example, do clients requiring transport or meals require a face-to-face assessment, or could they be referred directly to a service provider? Could clients requiring nursing or allied health services be referred directly to the practitioner without a face-to-face assessment by the Gateway?
During consultations, some stakeholders have emphasised the importance of considering why a particular service is being sought by the client, not just what type of service is being requested.
To what extent is it feasible for Gateway contact centre staff to collect information about a person’s needs during a phone-based screening and make judgements about whether a facetoface assessment is required?
What can be implemented by July 2015?
Victoria and West Australia already have a network of regional based assessment services which provide the infrastructure for undertaking face-to-face assessments and reviews for a significant proportion of their HACC clients. However, this capability will need to be developed or significantly expanded over time in the other jurisdictions.
In its draft discussion paper[7], NACA has suggested a number of potential options for the delivery of regional based assessment services more broadly across the aged care system. These include:
· maintaining the current approach (eg face-to-face assessments by service providers or ACATs);
· developing independent regional assessment services (these Gateway outlets could be provided under contractual arrangements by a number of agencies such as local governments, individual or networks of service providers, existing Government agencies, or ACATs with different/expanded roles);
· a combination of regional assessment services and “approved provider assessors”; or
· GP assessment.
While a model for regional based face-to-face assessment services is still to be determined, there are a number of key issues that need to be considered in the implementation.
· Workforce capability – assessment will need to be undertaken by an appropriately skilled regional workforce, trained and accredited under the Aged Care Gateway, to provide assessment services in a culturally safe manner. It will take time to develop this workforce and to embed a wellness and reablement approach into assessment and service delivery.
· Independence – should regional based assessment services be independent of service providers, or could some or all of the assessment functions (including case management, care co-ordination and referral of clients to local service providers) be contracted to suitable organisations (which might include existing service providers)? If the latter, there would need to be sufficient separation of assessment, service delivery and client review functions within the contracted organisations.
· Funding – for the purposes of the CHSP, assessment services will need to be established within the funding available for the program, which is likely to require a re-direction of some existing resources, eg those currently funded under Service Group 2.
These issues will influence the timeframes for introducing face-to-face assessment services within the CHSP. It is likely that the implementation of face-to-face assessment services will need to be staged, with a progressive rollout across some state and territories, or selected regions within jurisdictions, commencing in July 2015.
In practice, this means that in areas where a regional assessment service has not been established, CHSP clients would be directed or referred to service providers following the phone-based screening, without a face-to-face assessment by the Gateway. Protocols will need to be established for clients who have difficulty communicating with the Gateway over the phone[8].
An implementation plan, including potential models and timeframes for the full implementation of regional based assessment services across Australia, will be developed following further consultation with stakeholders.
Issues for discussion
- What would be the impact on service providers and clients of the introduction of regional based face-to-face assessment services? Is there a preferred model?
- Is the range of potential functions associated with the face-to-face assessment appropriate for the CHSP – taking into account the increased focus on reablement and restorative care and the nature of the CHSP as a basic support program?
- Where there is a regional based assessment service, to what extent should clients be referred for a face-to-face assessment, ie what should be the triggers or criteria for determining when clients should be referred directly to a service provider rather than receive a face-to-face assessment?
- Where clients are referred directly to CHSP service providers from screening by the Gateway, is the service provider expected to undertake further needs based assessment or base service planning on the referral?
- What are the implications for service providers of introducing a reablement approach to assessment, particularly the expectation of a review of care needs after an initial period of service?
- Is the concept of a specific restorative care stream or service type within the CHSP, potentially building on DTCs and allied health services, worth considering?
- What are the key implementation and transitional issues that would need to be considered as part of a staged introduction of regional based assessment services? What would be a realistic timeframe for implementation?
Attachment A