Elements of competency 1.The structure of the residential aged care sector 2.The structure of the Home and Community Care Sector 3.Philosophies of positive ageing 4.Physical and Psychosocial aspects of ageing 5.Changes associated with ageing 6.Rights and interests of the older person 7.Experiences of loss and grief for older people 8.Delivering Quality Services
Structure of Aged Care -Governing Bodies • Commonwealth Department of Health and Ageing: • information, access to services, general information and advisory to government and lobbyists. • Medicare Australia • Funding of Aged Care Funding Instrument • NSW Department of Health: • legal and procedural control and standardscomplaints process, • Aged Care Standards and Accreditation Agency • every 3 years full application against 44 standards and support visits when scheduled.
Structure of Aged Care -Governing Bodies • NSW Nurses and Midwives Board • Validation of Registered Nursing staff practice and Enrolled Nursing staff practice. • NSW Food Authority: • Yearly assessment of food safety program and practice • Council food inspectors: • quarterly review of environment. • Work cover: • Monitor the safe work environment of all staff.
Legislation • At least 40 different pieces of legislation affect the delivery of aged care services. • Each legislative body has their own validation process – often these are contradictory. • Major legislation areas: • Accreditation Agency, Aged Care Act, Poisons Act, Therapeutic Good Act, Retirement Villages Act, Continuous Improvement
Aged Care Act 1997 • The act was designed to: • account for the quality of the care • the type and level of care • the access and equity of that care • the outcomes of the care • and the accountability of the providers of the care.
Residential Aged Care Services • Guided by Aged Care Act 1997. • Residential Care provided in: • High Care- ‘Nursing home’ • Low Care- ‘Hostel’ • Multi-purpose services- self care facilities and high/low care. • Both high & low care providers.
Policies and procedures • documents that describe an organization's policies for operation and the procedures necessary to fulfill the policies. • often initiated because of some external requirement, such as environmental compliance or other governmental regulations • Policies and procedures aka • business policies and procedures • standard operating procedures(SOP) • department operating procedures (DOP)
Common policies in organisations • Infection control policies and procedures • Documentation responsibilities • Staff agreement • Fire and emergency procedures • Job description and duty lists • Mission Statement • Philosophy of care • Occupational health and safety policy • Manual handling policies and procedures
Summary Be aware that they must not breach their scope of practice and role. Know your responsibilities in terms of legislation and policies and procedures
Structure of Residential Aged Care Facilities Board of Management/ Approved Provider Senior Management Middle Management Workers who deliver care or services
Levels of Care • Independent Living • Retirement Village or Care at Home • Low Care • Hostels, Serviced Apartments • High Care • Nursing Homes
Funding and Service Delivery • Funding by Medicare Australia • Currently funding levels operate on a domain funding system • Assessment, diagnoses and documentation are the primary tools needed for current funding • Service providers are finding funding very difficult due the recent changes in the funding system.
Funding Aged Care services • Federal funding • based on Accreditation • Licensing of beds • Aged Care Funding Instrument (ACFI) • Main source – • Federal and State government • Contribution fee • Paid by the residents toward costs of their care
Daily care fees and Other payments • Daily Care Fees • income tested fees for personal care, living expenses, meals, linen and laundry. • Residents can not be asked to pay more then they can afford • Accommodation Payments • May be a bond as in a hostel • Accommodation charge in a nursing home • There are strong protections for those not able to pay • The national target for concession beds is 27% (Refer to p.49 in your text for a table of fees)
Funding categories 3 categories/ domains: 1. Activities of Daily Living 2. Behaviour Supplement 3. Complex Health Care Supplement • Each domain has three funded levels • Low • Medium • High.
How does the ACFI work? ACFI uses information from 12 questions and 2categories of diagnosis to place a resident in the Low, Medium, or High category of each of the three funding domains. No funding will be provided for a domain if the resident has no or minimal assessed care needs.
Aged Care Assessment Team • Government body determines suitability to move into residential aged care • Recommends services if client is remaining at home. • Provides a full personal medical and social profile for clients, families services and facilities • Required prior to entering any aged care facility Aged Care Client Record
Accreditation Formal recognition • provided to a residential aged care service by the aged care standards and accreditation standards. • when the assessed service operates according to the requirements of the Aged Care Act 1997 • providing a high quality of care within a framework of continuous improvement ( Dept. Health and Ageing 2003)
Continuous Improvement Cycle Do Plan Act Check
Continuous Improvement Cycle • Plan • Do • Check • Act
Auditing and Quality Management • auditing program • where all systems are reviewed to ensure system effectiveness for clients. • quality management plan/program
Accreditation Four main steps to acquiring accreditation • Self-assessment by facility • Desk audit by agency • On-site audit by registered assessors • Decision & outcome of accreditation assessment.
Standards to be Met • Management Systems, Staffing and Organizational development • Health and Personal Care • Resident Lifestyle • Physical Environment and Safe Systems
Additional Accreditation Requirements • Residential Care Standards ‘ Benchmarking’ • Certification • inspection and approval of the building against legislative requirements • Prudential Requirements • Finance e.g.Insurance • Concessional Ratio • financially disadvantaged care recipients gain access to aged care Regardless of financial situation 27% of recipients must be Concessional • User Rights • Ensures a process for residents e.g. Charter of residents Rights
Government Community Care Directions To support older people and people with disability • to be more independent at home and in the community • reduce the potential or inappropriate need for admission to a residential care facility. Federal Government -provides approximately 60 per cent of funding for the program -maintains a broad strategic policy role. State and territory governments -provide the remaining percentage of funding -are the primary point of contact for HACC service providers and consumers. -responsible for program management -approval and funding of individual HACC services
Services • Commonwealth Respite & Carelink Centres; • Community Care Programs • Community Aged Care Packages (CACP’s) • Home & Community Care Packages (HACC) • Dept. Veterans Affairs • ACAT- Aged Care assessment Team
Home and Community Care • Aged Care Services • HACC • Transport, shopping • MOW, personal care, home maintenance • Community health centres • Education, counselling • Mental health • Respite programs • Residential care • In home respite • Activity centres • Day Therapy centres • Dementia Care • CACP packages • EACH packages
Department of Veterans Affairs • A government funded program designed to provide care and support to Veterans of war service in Australia. • Services depend on the level of assessed disability or impairment and the level of assistance to government can provide for each individual. • Services are determined by the colour of their card eg Gold • Community Services • medical care, nursing care, some domestic, meal preparation and maintenance of homes. • Once Veterans have moved in residential care they are only entitled to a limited amount of services eg: specialised equipment, transport.
Commonwealth Respite Care Centres • provide free • confidential information on community aged care and disability services available anywhere within Australia. • Commonwealth Respite and Carelink Centres • 65 'walk-in' shopfronts throughout Australia. Many shopfronts are conveniently located near, or within, shopping centres