Community Nursing Program Information Session 1 Guidelines for the provision of community nursing services - 2010 Intro

1. Community Nursing Program Information Session 1 Guidelines for the provision of community nursing services - 2010 Introduction, Referral and Assessment December 2010

2. Session Objectives At the end of this session the participants will have • A good understanding of the Guidelines for the provision of community nursing services (Guidelines) applicable from March 2010 • A good understanding of DVA’s requirements regarding referral and assessment criteria • Knowledge of how DVA can support DVA-contracted community nursing providers’ ongoing learning and future education needs regarding the classification system

3. Provider Profile Currently contracts with over 200 community nursing providers (providers) across Australia Providers from public, private and not-for-profit sectors Providers range from very small to very large organisations

4. Client profile Clients include veterans and war widows/widowers (entitled persons) 95% are more than 75 years of age Approximately 50% male, 50% female Approximately 32,000 clients in 2009 Majority of client population are elderly, becoming increasingly frail with complex care needs

5. History 1998 Introduction of: • Episode of care model • 28-day claim period • Community Nursing Guidelines Classification System and Schedule of Item Numbers & Fees 2006 Revised Community Nursing Guidelines and Schedule of Item Numbers & Fees 2006 2010 Revised Community Nursing Guidelines and Schedule of Item Numbers & Fees 2010

6. 2010–13 Contractual Arrangement Deed of Standing Offer (as per RFT) • Guidelines for the provision of community nursing services • Schedule of Item Numbers and Fees Contract performance monitoring • DVA CN Quality Management Framework • Ongoing post-payment monitoring • Ad-hoc as issues arise (eg complaints) Communication and support • Provider education • DVA Contract Manager contact • Day-to-day contact on clinical or administration issues • Provider input through Community Nursing Reference Group and CN industry input through Clinical Advisory Committee • E-mail for program questions – nursing@dva.gov.au

7. Aims of the 2010 Classification System • Simple Classification System • One Classification System for all providers • Contemporary • Provides clear definitions • Aligned to current nursing practice

8. What’s in the 2010 Guidelines • Classification System simplified – one system for both public and private providers • Additional Components – ‘add-ons’ for Wound Management Consumables and Palliative Care phases • Ability to claim a ‘Variation’ Classification for some classifications when care provided for 14 days or less due to a ‘break in service’ • Ability to claim Medication Administration and Personal Care based on number of visits made in the 28-day claim period

9. What’s in the 2010 • Guidelines • Emphasis on • Retrospective classification and claim for payment • Correct processes in place for delegation of care • Greater assistance for palliative care clients through the ECU - all palliative care deteriorating and terminal clients will be registered • In response to CN Industry • Enrolled Nurses able to conduct 28-day review of care for Personal Care • Ability to provide limited clinical services in the Personal Care Schedule • Ability to provide limited clinical or personal care services in Medication Administration

10. What’s in the 2010 • Guidelines • Ability to claim multiple item numbers for the 28-day claim period where required. • The majority of items from the Schedules (Clinical Care, Personal Care or Clinical Care Variations) can be claimed with: • an item from the Additional Component – Wound Management Consumables; and/or • an item from the Additional Component – Palliative Care or an item from the Additional Component – Palliative Care Variation; and/or • an ‘Other Item’ – Bereavement Follow-up and/or Additional Travel

11. What’s in the 2010 • Guidelines • Ability to claim multiple item numbers for the 28-day claim period where required. • An Item from the Exceptional Case Unit Schedule can be claimed with: • an item from the Additional Component – Wound Management Consumables, and/or • an ‘Other Item’ – Bereavement Follow-up and/or Additional Travel • If it is required the Exceptional Case fee would include a component for palliative care

12. Overview Model • ‘Episode of care’ model Referrals • From authorised source • Valid for 12 months Assessment and Care • Comprehensive assessment by RN • Assessed clinical and/or personal care given by RN (Div 1), EEN, EN (RN Div 2 in Vic) or NSS as appropriate and delegated Claiming • Through Medicare Australia either electronically or paper-based

13. The Guidelines DVA ‘Guidelines for the provision of community nursing services’ (Guidelines) set out requirements for community nursing providers The Guidelines are Attachment ‘1’ to DVA’s Deed of Standing Offer(Contract) with providers Compliance with the Guidelines is a contractual requirement The Guidelines may be amended from time to time The current Guidelines are available online The Guidelines came into effect with the contracts on 1 March 2010

14. The Classification System and Schedule of Item Numbers and Fees The Schedule of Item Numbers and Fees is Attachment ‘2’ to DVA’s Deed of Standing Offer (Contract) The Classification System is based on retrospective 28-day claim period The fees in theSchedule of Item Numbers and Fees include all the associated costs for CN service provision and ‘nurses' toolbox’ consumables Fees will be indexed on 1 January each year The current Schedule of Item Numbers and Fees will be on the DVA Website

15. Schedule of Item Numbers and Fees The fees within the Schedule of Fees are based on • DVA CN service provision data from providers’ Minimum Data Set (MDS) information and • Other key cost components, eg: • Total nurses’ time wages • Labour on-costs • Overheads • Profit margin • ‘Nurses’ Toolbox’ consumables

16. Eligibility GoldCard for all medical conditions White Card only for specific accepted war/service related conditions OrangeCard only for pharmaceuticals for Commonwealth veterans, not for CN services (not shown)

17. Providers must obtain written informed consent from the entitled person before commencing CN services If the entitled person is unable to sign their consent, a person who is legally authorised to give substitute consent to treatment under state law may sign on their behalf Informed consent

18. Referrals Entitled persons can be referred by • Local Medical Officer (LMO) or General Practitioner (GP) • Treating doctor in a hospital • Hospital discharge planner • Veterans’ Home Care (VHC) Assessment Agency Referrals must be • In writing • To the nearest suitable DVA contracted CN provider

19. Referrals Referrals are valid for 12 months New referrals are required for an entitled person if: • Discharged and re-admitted • Change provider • Require CN care after 12 month referral period Providers must accept entitled persons referred from authorised source, exceptin certain circumstances set out in Guidelines Section 3.9 and 10 Economic viability is not a criteria for non-acceptance

20. Date of Admission The date of admission is the first face-to-face contact visit by the provider’s personnel to the entitled person where • Personnel visiting is a Registered Nurse (RN) • Visit does not occur in an institutional setting (eg hospital discharge visit) There are some instances where the date of admission is excluded • these are detailed in section 3.11 of the Guidelines

21. Care Environment All CN services must be delivered to an entitled person in their place of residence DVA funded CN care cannot be delivered in • Acute facility (including hospital in the home programs) • High or low care residential aged care facility • Multi-purpose centre • Community centre • Clinic in any location See Guidelines section 15 Definitions for a definition of ‘place of residence’

22. Assessment on Admission Entitled person’s clinical and/or personal care needs must be assessed • Upon referral (initial referral and 12 monthly referrals) • Upon transfer from another provider Assessment must occur prior to provision of CN services Assessment must be undertaken by RN using • A validated CN assessment tool/s and • A validated CN dependency tool

23. Assessment Personal Care Services Entitled persons should receive all of their personal care services through the CN Program where the entitled person • requires more than 1.5 hours per week of personal care services only and/or • has a clinical need

24. Assessment Personal Care Services Entitled persons should not receive their personal care services through the CN Program where the entitled person • Requires 1.5 or less hours of personal care services, and • Does not have a clinical need for any other CN services These clients should receive their personal care services through Veterans’ Home Care (VHC)

25. Delegation of Care Provider’s Responsibility Providers must ensure that all CN services delivered by • Endorsed Enrolled Nurses (EEN) • Enrolled Nurses (EN or RN Division 2 in Victoria) • Nursing Support Staff (NSS) are • Appropriately delegated by a RN and • Planned, supervised and documented by a RN

26. Delegation of Care RN Responsibility RNs are responsible for • Delivery of delegated care by EEN or EN in accordance with State or Territory laws • Delivery of all delegated care by NSS, regardless of the State or Territory laws

27. Commonwealth Funded Packaged Care CN services cannot be delivered to: • A person with a need for personal care only who is receiving a Community Aged Care Package (CACP) • A person receiving an Extended Aged Care at Home (EACH) or EACH Dementia (EACH-D) package CN services can be delivered to: • A person with a clinical care need who is receiving personal care services through a CACP

28. Ongoing Learning and contacts Further Information • E-mail questions/issues to nursing@dva.gov.au • Phone: 1300 550 466 to speak to a DVA Contract Manager or Community Nursing Advisor • Check the DVA Community Nursing website for all up-to-date information and education resources