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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

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

National Ageing Research Institute

Xiaoping Lin, Betty Haralambous, Kirsten Moore

acknowledgements
Acknowledgements

CACPs/EACH Electronic Waitlist Governance Committee and ACAS Victoria for providing funding

ACAS teams

Aged and community care providers

overview
Overview

Background

Methods

Literature review

Scoping survey

Consultation

The POA tool and pilot findings

Implementation

Future considerations

acas electronic waitlist
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
priority in the e waitlist
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
hacc poa
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
slide11
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

methods
Methods
  • A literature review
  • A scoping survey of current approaches
  • Consultation with ACAS teams and service providers
  • Pilot and revision of the draft tool
draft guidelines of community packaged care programs
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?

literature review methods
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
literature review findings
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
literature review findings1
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
scoping survey methods
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
scoping survey findings
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
scoping survey findings1
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
consultation methods
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
consultation findings
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
poa pilot
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
slide28
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

list of indicators
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

examples of indicators
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

examples of indicators1
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

examples of indicators2
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

what the poa tool does not do
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

who when
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

pilot findings
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
pilot findings2
Pilot findings
  • Agreement between clinical judgment and POA tool in completed assessments
pilot findings3
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
slide40
Some suggestions:

Longer trial

Space for summary/comments

Consider extra score outside the listed factors/indicators

Pilot Findings

in summary
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
implementation
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)
findings from the survey
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’
findings from the survey1
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
findings from the survey2
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
further consideration
Further consideration
  • Priority is relative
  • Weighting indicators
  • Separate tool for CACP/EACH
  • Urgency for service
  • Further data collection