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This section was contributed by the Australian Government Department of Health and Ageing (October 2004).
System of aged care programs
The main purpose of aged care programs is to support healthy ageing for older Australians and quality, cost effective care for frail older people and support for their carers. The system of aged care programs in Australia is structured around two main forms of care delivery - residential and community care. There are various other associated aged care programs such as Day Therapy Centres, Multi-purpose Services and Advocacy Systems, that also form part of the aged care system (diagram 7.18).
7.18 AGED CARE SYSTEM, Australian Government expenditure - 2003-04
(a) Individual programs are described within this chapter.
(b) The larger programs are discussed within this chapter and the total ($511.0m) includes expenditure on smaller programs ($133.7m).
Source: Department of Health and Ageing.
Aged Care Assessment Program
The Australian Government provides grants to state and territory governments specifically to operate Aged Care Assessment Teams (ACATs). In 2003-04 the Government contributed $48.4m for the operation of 119 ACATs throughout Australia, as well as an evaluation unit in each state.
ACATs assess the care needs of people and their eligibility for accessing the required services. The main professional groups represented on ACATs are geriatricians, social workers, nurses, physiotherapists, occupational therapists, psychologists and psychogeriatricians.
ACATs assess the whole care needs of an individual, using a multi-disciplinary and multi-dimensional approach. As part of the holistic assessment process, a person's medical, physical, social, psychological and restorative care needs are assessed before an approval for care is made. ACATs are also well positioned to provide advice on aged care services and to act as an interface between aged care services and the health care system.
Clients need to be assessed as eligible by an ACAT before they can receive a subsidy for residential care, a Community Aged Care Package, or some forms of flexible care, such as under the Extended Aged Care at Home Program.
Residential Aged Care Program
The aim of the Residential Aged Care Program is to enhance the quality of life of older Australians through support for the provision of a cohesive framework of high quality and cost effective residential care services for frail older people. There are two types of residential aged care - high level care ('nursing home') and low level care ('hostel'). Aged care places are allocated in proportion to the number of people aged 70 years and older.
The Australian Government subsidises the costs for each person in a residential care setting. The level of funding depends on the care needs of the resident. Also, residents can be asked to pay fees and charges. Each aged care home that provides care is required to meet specific care and building standards and to be accredited by the Aged Care Standards and Accreditation Agency in order to receive Government funding. Capital funding is available on a competitive basis to support residential aged care where the aged care provider is unable to fund necessary building works. Australian Government expenditure on residential aged care in 2003-04 is shown in table 7.19.
Community care programs
The main aim of these programs is to assist people being maintained in their own homes. The main community care programs are the Home and Community Care, the Community Aged Care Packages and the Extended Aged Care at Home programs.
Home and Community Care (HACC) Program
The HACC program is a joint Australian Government and state government cost-shared program which provided $1.2b nationally for the 2003-04 financial year to service provider organisations. Of the total, the Australian Government made available $732.8m or 60%, with the states and territories providing the remaining 40%.
The Australian Government provides funding for HACC, but the day-to-day administration, priority setting and approval of project allocations is the responsibility of the state and territory governments.
The aim of the HACC program is to provide basic maintenance and support services to enable frail older people (and younger people with disabilities) to remain living in their home and the community and to prevent premature admission to long-term residential care. HACC funded services also assist the carers of these groups. The types of HACC funded services available include home maintenance and modification, as well as domestic assistance, food services, personal care, community nursing, transport and respite care.
Community Aged Care Packages (CACP) Program
The CACP program is funded by the Australian Government to provide a community alternative to low level residential care to assist frail older people with complex needs to remain living in the community.
Service providers use a case management approach to develop and monitor care delivery to eligible older people. One of the benefits of the CACP program is its flexibility in service delivery which is designed to meet individual needs. This flexibility enables people to be given assistance through a package of care services which may include personal care, assistance with preparing meals, home help and assistance with transport.
By June 2004, 27,626 packages have been approved under the program. Total expenditure for 2003-04 was $308.6m.
Extended Aged Care at Home (EACH) Program
The EACH program commenced as a three-year pilot in 1998 to test the feasibility of providing the equivalent of high level residential age care to people living at home. The program has expanded to a total of 924 places at 30 June 2004, with funding in 2003-04 of $15.4m.
EACH service providers are required to deliver individually tailored, coordinated packages of care in keeping with a client's care plan. Services can include, but are not limited to, the following:
The 2001 Budget Initiative on EACH provided an additional $2m over two years for development work to lay the foundations for possible expansion of the EACH Program and address data management, quality and accountability issues. During 2003-04 substantial progress was made on the development of an accountability framework for both the CACP and EACH programs. The primary objectives are to ensure that care recipients continue to receive the levels of care they need and to improve measurement and reporting of the operation of the programs. There has been work on each of three critical aspects of accountability included in the framework - financial accountability, quality of service delivery and levels of service provision.
Community Partners Program
A dedicated program of aged care support services for established culturally and linguistically diverse communities, worth $11.6m over the next four years, is to commence on 1 January 2005.
It has been frequently observed that older people from culturally and linguistically diverse backgrounds make less use of residential aged care services than the rest of Australia’s older population. This difference intensifies as the level of English proficiency of these people decreases. As established immigrant communities become relatively more aged, it is becoming more important to ensure that these communities receive support to access culturally appropriate aged care services across the full continuum of care.
The new program will build links between established communities and services, and will help aged care service providers understand the needs of established migrant communities.
Other aged care programs
The Australian Government also provides funding for other support and community services. The following are the main programs funded by the Government.
Assistance with Care and Housing for the Aged (ACHA) Program
The ACHA program assists frail, low-income older people who are renting, are in insecure/inappropriate housing or are homeless, to remain in the community by accessing suitable housing linked to community care.
The Australian Government contributes recurrent funds to organisations that provide support through paid workers and/or volunteers, assisting clients to access and be maintained in secure and affordable housing. The primary role of program workers is to link clients to appropriate mainstream housing and/or care services.
In 2003-04 the program funded 46 projects nationally through funding of $2.7m. The funding for each project varies according to identified community need, the number of staff employed by individual services and the tenure of employment (i.e. full time or part time). Most projects are located in inner city areas where there is a concentration of frail elderly people living in insecure accommodation.
National Respite for Carers Program (NRCP)
The aim of the NRCP is to contribute to the support and maintenance of caring relationships between carers and their dependent family and friends. It provides information, respite care and other support or assistance appropriate to carers' individual needs and circumstances, and those of the people for whom they care.
A national network of over 90 Commonwealth Carer Respite Centres and regional office outlets has been established to improve coordination of respite service provision and help meet emergency and unplanned respite needs. Commonwealth Carer Respite Centres provide carers with a single contact point for respite care assistance whether the respite service required is in an aged care facility, in the community or in the carer's home. The NRCP provides funding for over 450 carer respite services, which include in-home, family-based, centre-based and peer support services, to supplement mainstream respite services offered through the HACC and other state-based programs as well as local government and community initiatives. An allowance is also paid to carers who are looking after people with high level needs.
Funding for the NRCP increased from $19m in its inception year, 1996-97, to $99.7m in 2003-04. The NRCP funds Commonwealth Carer Resource Centres, Commonwealth Carer Respite Centres and respite services.
Commonwealth Carelink Program (CCP)
Over 60 Commonwealth Carelink Centres across Australia provide information on local community aged care, disability and other support services to an average of 16,000 clients each month. Clients include care professionals such as general practitioners, service providers, individuals and their carers. Program funding in 2003-04 was $13.9m.
Psychogeriatric Care Units (Dementia) Programs (PCUP)
The Australian Government funds a number of care programs that exclusively or partly target people with dementia and their carers. The Dementia Education and Support Program with funding of $1.5m, has the primary function of operating a 24-hour National Dementia Helpline that provides an information and referral service as well as acting as a 'gateway' to other more intensive support services. A second telephone support service for carers of people with dementia and challenging behaviours and respite workers is provided under the National Dementia Behaviour Advisory Service. The funding in 2003-04 for this service was $0.4m.
The Early Stage Dementia Support and Respite Project, with funding of $1.5m, provides a nationally coordinated support and respite service for people in the early stages of dementia and their carers. In 2003-04 the Carer Education and Workforce Training project with $1.1m provided a coordinated national education and training program, focusing on carers and respite workers. In addition to these services, the Psychogeriatric Care Units, with funding of $4.3m for 2003-04, provide specialist psychogeriatric support to residential aged care homes and community carers looking after people with dementia who exhibit significant behaviours of concern.
Day Therapy Centres Program (DTCP)
The DTCP has been in operation since 1988 when rationalisation of nursing home funding led to the separate funding of the therapy function. There are 155 centres across Australia providing a wide range of therapy services to frail older people living in the community and to residents of Australian Government funded aged care homes. Funding provided by the Government in 2003-04 was $31.6m.
National Continence Management Strategy (NCMS)
The 'Staying at Home - Care and Support for Older Australians 1998' package included $15m over four years to address the needs for improved continence management for older Australians through the NCMS. In 2002 an additional $4m per year over four years was approved for the continuation of the strategy. Under this Strategy, a number of national research and service development initiatives are being trialed to complement existing continence care.
The Australian Government also funds the Continence Aids Assistance Scheme (CAAS) which was established to assist people of working age who have a permanent disability-related incontinence condition. CAAS currently provides a subsidy to eligible individuals of $470 per year. CAAS funding for 2003-04 was $8.7m.
Australian Government Hearing Services Program (AGHSP)
The role of the AGHSP is to reduce the consequence of hearing loss for eligible clients, and reduce the incidence of hearing loss in the broader community. Administration of the AGHSP is the responsibility of the Office of Hearing Services (OHS), in the Department of Health and Ageing.
Access to hearing services for eligible adults - 21 years and over - is provided through the Hearing Services Voucher System. The Voucher System expenditure in 2003-04 was $178m. Eligible adults include:
There are 164 accredited hearing services providers contracted by the OHS to provide services under the Hearing Services Voucher System. Services are provided at 408 permanent sites and around 990 visiting sites throughout Australia by qualified hearing services practitioners (audiologists and audiometrists). OHS also has supply contracts with 15 hearing devices suppliers for the supply of quality hearing devices into the program.
In addition, the Australian Government funds Australian Hearing to provide specialised hearing services for children and young adults under the age of 21 years, and to ensure access to appropriate hearing services for eligible adults with special needs. These clients include those who live in remote locations, who are Aboriginal or Torres Strait Islander peoples, or who have complex hearing needs. Funding is also provided to Australian Hearing Services to undertake, through its research arm, the National Acoustic Laboratories, research to increase understanding of issues related to hearing loss, hearing rehabilitation and the harmful effects of noise. Total funding of these Community Service Obligation activities in 2003-04 was $29.9m.