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Community Aged Care e-Waitlist Priority of Access (POA) Tool May 2010

Community Aged Care e-Waitlist Priority of Access (POA) Tool May 2010. National Ageing Research Institute Xiaoping Lin, Betty Haralambous, Kirsten Moore. Acknowledgements. CACPs/EACH Electronic Waitlist Governance Committee and ACAS Victoria for providing funding ACAS teams

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Community Aged Care e-Waitlist Priority of Access (POA) Tool May 2010

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  1. Community Aged Care e-Waitlist Priority of Access (POA) ToolMay 2010 National Ageing Research Institute Xiaoping Lin, Betty Haralambous, Kirsten Moore

  2. Acknowledgements CACPs/EACH Electronic Waitlist Governance Committee and ACAS Victoria for providing funding ACAS teams Aged and community care providers

  3. Overview Background Methods Literature review Scoping survey Consultation The POA tool and pilot findings Implementation Future considerations

  4. 1. Background

  5. ACAS Referral Process

  6. ACAS Electronic Waitlist • Web-based • Accessed through secure online portal • Clients registered on waiting list with appropriate providers • Information is stored in a secure client data repository

  7. Priority in the E-Waitlist • Priority decided using different approaches • Some using locally developed priority tool • Some using clinical judgment • No consistency of decision making in regards to prioritisation

  8. HACC POA • NARI developed the original HACC POA in 2002 (Current version 2006) • Feedback from staff • Quick and easy to use • Systematic process for allocating priority • A means for confirming staff judgments • Provides a transparent process for potential clients and referring agencies • Provides a tool for measuring and recording demand for services

  9. HACC POA4

  10. Aim: to develop, pilot and finalise a statewide priority of access tool for the CACPs/EACH Electronic Waitlist Governance Committee and ACAS Victoria This tool would promote consistency of decision making in regards to prioritisation of client need, benefiting clients by ensuring services are targeted appropriately Background

  11. 2. Methods

  12. Methods • A literature review • A scoping survey of current approaches • Consultation with ACAS teams and service providers • Pilot and revision of the draft tool

  13. 3. Literature Review

  14. Draft Guidelines of Community Packaged Care Programs • Purpose • ‘provide individually planned and coordinated packages of community aged care services; • meet the needs of frail older people with complex care needs assessed as eligible for low or high level residential care; and • enable those who have expressed a preference to live at home to do so with the assistance of a package of care including residents of retirement villages” (DoHA, 2007) How do we define who is most in need?

  15. Literature review - methods • An update of the 2002 HACC POA literature review • Search in medline and grey literatures • Search relevant websites • Key words: indicators of needs, aged care assessment, needs & aged care, risk & aged care, CACPs, EACH, EACHD, community packaged care • Limited to English language, and articles after 2000

  16. Literature review - findings • Limited evidence on • which factor/factors are most important • Who most urgently needs services • Which combination of factors increase the urgency for services • Some evidence that dependency level, carer availability and financial situation were important predictors of use of service • Needs commonly assessed using measurement tools

  17. Literature review - findings • Why a measurement tool? • Evidence suggests different clinicians use different approaches to decision making • Reduce individual styles/judgments • Increase objectivity in assessment and service allocation • Increase transparency for clients

  18. 4. Scoping Survey

  19. Scoping survey - methods • Aim: to gain information on current assessment and prioritisation practices among Victorian ACAS and CACPs/EACH/EACHD service providers • Distributed to/through ACAS managers • Returned by 11 ACAS teams (61%) and 42 providers

  20. Scoping survey - findings • Assessment tools used: Aged Care Client Record(ACCR), Victorian Service Coordination Tool Templates (SCTT) • Various approaches in determining priority • Locally developed POA tools based on client’s need

  21. Scoping survey - findings • Common indicators: dependency level, risk of abuse, carer availability/state, social/psychosocial factors, need for case management • Factors providers considered when choosing clients: Client’s need, target group, resources of the agency

  22. 5. Consultation

  23. Consultation - methods • 4 focus groups • 2 with ACAS staff (one in metropolitan, one in rural area, 20 staff from 13 ACAS teams) • 2 with service providers (one in metropolitan, one in rural area, 28 staff from 20 providers) • Email survey for those unable to attend focus groups • 3 ACAS teams • 9 providers

  24. Consultation – findings • Acceptance of need-based tool • Welcome the idea of a statewide POA tool • Revise some of the indicators • Mixed ideas about weighting indicators • No separate tool for each package • Simplicity of the tool

  25. 6. The POA tool and pilot finding

  26. POA Pilot • Two options developed • Guidelines and training materials developed • Piloted for four weeks • Training/information session • Each team asked to complete 5-10 assessments • Survey to collect general feedback • De-identified copies collected

  27. Need based tool 12 indicators on a single side page Each indicator is assessed on three levels: high/medium/low Priority was determined by total score of the indicators The POA Tool

  28. The POA Tool

  29. List of indicators 1. Instrumental Activities of Daily Life (IADL) 2. Personal Activities of Daily Life (PADL) 3. Cognition 4. Behaviours of concern 5. Mental health 6. Physical health 7. Social health 8. Risk of Abuse/Neglect 9. Formal and informal support 10. Informal carer or client status (coping) 11. Financial situation 12. Communication

  30. Examples of indicators 1) Instrumental Activities of Daily Life (IADL): Consider whether the client has any difficulty at home with domestic activities, e.g. doing his/her housework and laundry, preparing meals for himself/herself, shop for food and household items. High-Mostly dependent; Medium-Partially dependent; Low-Independent

  31. Examples of indicators 9) Informal carer or client status (coping) • This question is not about availability of someone to provide care, but how well the informal carer supports are coping with this care. This question should also consider the sustainability of the informal carer (e.g. are they available for the long term?). • If carer available High-Significant impact on carer; Medium-Moderate impact on carer; Low-Minimal impact on carer

  32. Examples of indicators 9) Informal carer or client status (coping) • If carer not available High-Can’t manage at home without additional support; Medium-have impact on the client’s general well being; Low-Client coping well

  33. What the POA tool does not do Identify individual needs Specify levels or types of service provision for clients Provide a comprehensive assessment tool Determine eligibility for CACP, EACH and EACHD Replace clinical judgment and common sense

  34. Who & When ACAS staff who conduct assessments of potential clients of CACP, EACH or EACHD Can be completed during the assessment with the client and/or carer or in the office after the assessment

  35. Pilot findings • 150 assessments by 12 ACAS teams (67%) • 72% assessors found the tool easy to use • Average time taken to complete the tool was 4.9 minutes • 61% assessors felt confident about the results of the POA tool • 61% assessors reporting agreement between POA and clinical judgment

  36. Pilot findings

  37. Pilot findings • Agreement between clinical judgment and POA tool in completed assessments

  38. Pilot findings • Explanations for disagreement: • Four levels of priority (critical/urgent/routine/low) in old system • Training • Atypical clients/factors outside the tool • Client extremely high on one indicator

  39. Some suggestions: Longer trial Space for summary/comments Consider extra score outside the listed factors/indicators Pilot Findings

  40. In Summary • Promote consistency in prioritisation • Easy to use • Most assessors were confident about results from the tool • Acceptable agreement with clinical judgment • Requires further testing

  41. 7. Implementation

  42. Implementation • Implemented in late 2009 • All ACAS teams who use the E-waitlist are using the tool • No major issues in implementation • A survey in April 2010 • Response from both ACAS (n=49) and providers (n =30)

  43. Findings from the survey • ‘I find the tool satisfactory and easy to use’ • ‘Quick and easy to use’ • ‘I really like the tool ‘ • ‘I find the tool sufficient’ • ‘Happy with current format’

  44. Findings from the survey • 72% respondents received enough training and support when the tool was implemented • 61% respondents found the scoring useful • 68% respondents felt confident about the results • 43% respondents found results from the tool consistent with clinical judgment

  45. Findings from the survey • Explanations for disagreement: • Circumstance changed • No weighting for indicators • Factors outside the tool • Same tool for CACP/EACH • Urgency for service

  46. Further consideration • Priority is relative • Weighting indicators • Separate tool for CACP/EACH • Urgency for service • Further data collection

  47. Thank you!

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