be prepared: cdc practicalities paul sadler, chief executive officer presbyterian aged care nsw...
TRANSCRIPT
Be Prepared:CDC Practicalities
Paul Sadler, Chief Executive OfficerPresbyterian Aged Care NSW & ACT
Indra Arunachalam, Strategic Projects Managerintegratedliving Australia Limited
AAG / ACS Regional Conference, Port Macquarie, March 2014
Presbyterian Aged Care
Residential Care
• 10 aged care homes – 816 residents• 3 high & low care; 2 ageing-in-place; 2 high care; 3 low care
Community Care
• 17 services – 840 clients• 1 Home Care Package Level 4 service – 11 packages
• 4 Home Care Package Level 2 services – 144 packages
• 2 Day Therapy Centres – 88 clients per week
• 4 Day Respite services – 72 clients per week
• 6 Home & Community Care (HACC) services – 376 clients per fortnight plus 122 from brokered service
Retirement Villages
• 12 Retirement Villages – 191 units• 4 co-located with residential care
• Services across regional NSW, QLD and Victoria:- Home Care Packages – 37%- HACC – 37%- NRCP – 2%- Disability – 10%- Mental Health Respite – 2%- Other (brokerage, DVA) - 12%
• 25 offices – from Rockhampton to Bendigo• 3,400 clients delivering over 300,000 hours of
service• 400 staff and 340 volunteers• With HACC 2013 – expansion into ACT and
Tasmania3
What are your challenges?
4
Policy Background
• Productivity Commission Caring for Older Australians• Living Longer Living Better aged care
reforms• Home Support / Home Care context
5
Home Support Program• Commonwealth Home Support Program (CHSP) to
replace HACC, NRCP, DTC and ACHA from 1 July 2015• Will include all service types currently covered
• Regular annual growth for HACC likely each year, and all elements of Home Support Program from July 2015
• No change to HACC services until 2015; reviews of some HACC service types during 2013 / early 2014• Respite care• Home modifications and maintenance• Meals• Community transport• Service Group 2 (assessment, case management,
etc)
6
Latest on CHSP
• DSS CHSP Design Discussion Paper, incl. service type reviews, due out in weeks, not months (probably March 2014)
• Final CHSP framework by mid 2014• Impact of new Govt and DSS views on contracts
and practical funding mechanisms being considered
• All affected services will be consulted• No decision yet on CHSP respite link with
residential respite• CHSP to start 1 July 2015
7
Home Care Packages• Home Care packages (HCP) adjusted up from 25 to 45
places per 1,000 people 70+• Additional 84,538 Home Care packages over 10 years• 2 new levels of Home Care package (piloted over
2013-2015)
• Movement from HCP levels 1/2 to 3/4 requires ACAT assessment 8
Home Care Package Annual Subsidy Level (2013-14)
Level 1 $7,501
Level 2 ( formerly CACP) $13,644
Level 3 $30,003
Level 4 (formerly EACH)
$45,607
Home Care Packages• Dementia and Cognition Supplement for all HCP
levels• Veterans Supplement• For veterans with mental health condition verified
by DVA
• User charges:• Basic fee of 17.5% of Age Pension retained• Income tested fee introduced (similar to
residential care), reducing subsidy payment• Annual cap of up to $10,000 and lifetime cap of
$60,000 on income-tested care fees• Hardship provision available
9
Consumer Directed Care
• Pilot undertaken 2011-12• HCP Guidelines released June 2013• All Home Care packages allocated in 2012-13
and future Aged Care Approvals Rounds must be CDC• Evaluation of CDC packages due to start
shortly• All Home Care packages to be converted to
CDC from mid 2015
10
CDC Capacity Building Service• Funded by DSS, auspiced by COTA in conjunction
with ACSA & LASA• Paper on Principles and Defining Characteristics of
CDC• Initial resource pack available
A. Organisational self-assessment for readiness to implement consumer direction
B. Implementation checklist example (provided by Feros
Care)C. Resources to support CDC implementationD. What works in implementing new programs: a
discussion paper• Email: [email protected] 11
CDC Capacity Building Service• Additional projects for future• Assistance with service costing and individualised
budgets• Training resources for staff in having consumer-
directed conversations• Legal issues and risk management• Assisting organisations with consumer engagement
and feedback on CDC• E-learning resources on CDC• Leadership and cultural changes
• CDC Service website available from late March 2014
• COTA also running project for consumers titled Controlling My Own Life: Making the Most of CDC
12
integratedliving’s PDF Projects• 2 NDIS Practical Design Funds• Closing the Gap – Indigenous Workforce• Risk and Change Management Transition
Guide
• Preparing for NDIS is similar to preparing for CDC
13
Pressure Points for Providers• Placing people with disability at the centre of
service delivery• Strengthening community connections• Building workforce capacity• Operating in a competitive market• Being effective and accountable
Page 6 of the Transition Guide
14
Transition Guide• Person-centred approach• NDIS and the Pressure Points• How to Prepare for the New Paradigm
• Service enquiry• Service delivery• Recruitment and training• Subcontracting• Accounting and reporting
pdf copy of Transition Guide from:http://c.cld.pw/134/articles/resources/TransitionGuide-eCopy.pdf
15
Organisational Strategy
16
integratedliving PAC
Strategic Planning CDC pilot• 8 CDCL packages in
Inner West; 3 in Walcha
Person-centred leadership training
Strategic Plan 2013-2017
Consumer focus group Service Growth Strategy
Embracing Life service model and change management
People At Centre care strategy
Service Enquiry
• Marketing – making it easy to find us• Call centres / first contact – making it
easy to navigate• Gateway assessment process v HACC
service provider assessments• ACAT assessments for HCP
17
Service Delivery
• Assessment and care planning• Assessment and client selection• Goal setting and care planning• Individual budgets• Conversations with clients
• Service delivery• Dignity of risk and Duty of care• Case Management Standards
18
PAC Enabling CDC Care Plan• Questions, e.g. What is a good day for you? What are your
goals?• Identify supports needed to achieve my goal• Client profile information• From ACCR and ONI questions
• Service plan to achieve my goals• Services to be provided• What client will do• What care staff will do• Cost
• Other areas of assessed need for monitoring• Emergency plans• Additional services (at cost)• Client consent 19
Recruitment and Trainingintegratedliving PAC
Person-centred Leadership Training
Leadership development framework
New Staff Model – Nurses, Case Managers, Service Coordinators
Re-examining enterprise agreement classification structure
integratedliving Leadership Capabilities Framework
Case Manager / Coordinator Skills
Customised & contextualised training courses on priority skills and attributes
ACS CDC Courses
20
Sub-Contracting• Responsive to consumer choice
• Special needs e.g. CALD or ATSI• Specialist services e.g. allied health, home maintenance,
meals• Support consumer’s relationships with their pre-existing
providers e.g. chemist, cleaners
• Network of established and reliable providers• As back up when staff not available• Enable quick operationalisation of new services
• Templates of contracts or service level agreements• Quickly respond to new situations or partnerships
• Subcontracting to family members• Only in exceptional circumstances e.g. remote services
21
Accounting and Reporting• Business Process Analysis
• Costing service components
• Reporting Individual budgets• Reporting and monitoring systems (including client
statements)
• IT platform selection and implementation
22
integratedliving PAC
Existing platform - TRACCS Paper-based rostering / client management & electronic finance
Work with developer for CDC Budget + Statement (was already doing roster)
Tendered for new platform – Procura including Budget + Statement + Roster
PAC Client Statement• Client name• Statement period (including leave days noted)• Income received
• Subsidy• Supplements (e.g. dementia, veterans, oxygen, enteral)• Client fees• Total
• Expenditures• Care services (agreed, actual, variance)• Additional cost services• Administration fees• Care management fees• Total
• Net income less expenditures• Balance
• Beginning of month, carried forward this month, at end of month (including contingency) 23
integratedliving Case Study• Our first CDC consumer in a new region• Had sacked previous providers• Expected to be treated like a queen• Within two months, we have had to change
regular staff three times • Last induction, consumer was invited to talk to
new staff about what it was like to have a stranger coming into her home to provide services
• Consumer shared her experiences and hit it off with one of the staff, consumer regards that staff very highly 24
Challenges• Moving clients with packages with greater
than average hours back to new package limit• Rural/remote clients outside major towns –
travel time• Setting up financial systems to manage
individual budgets• Changing the Case Manager’s mindset –
money matters
25
Useful linksNational Aged Care Alliancehttp://www.naca.asn.au
Australian Government Living Longer Living Better websitehttp://www.livinglongerlivingbetter.gov.au
Aged & Community Services NSW & ACThttp://www.agedservices.asn.au
26
Contacts
Indra Arunachalam
Strategic Projects Manager
Integratedliving Australia
.au
0437 900 237
Paul Sadler
Chief Executive Officer
Presbyterian Aged Care
0418 208 232
27