Hawkesbury Community Care Forum Question & Answer Session with DOHA (Kathryne Bradley and Olympia Hollink)

10 July 2013 _________________________________________________________

Please find below notes from a Q & A session held with Kathryne Bradley and Olympia Hollink from the Commonwealth Department of Health and Ageing (DoHA). Questions were provided in advance by HCCF members and discussed at the Forum held on 10 July 2013.
1. Can we have clarification on the progress to date and time frames in relation to the DoHA service type reviews taking place this year? There is no review calendar as such, though Meals Services (Service Group 6) and Assessment, Coordination and Case Management Services (Service Group 2) are currently involved in consultation processes. Respite Care Services, Community Transport and Home Maintenance and Modification Services are also scheduled to be reviewed during 2014. Please refer to the Living Longer Living Better Website for updates. It is recommended that all HACC providers regularly look at this website for the most up to date information. Go to http://www.livinglongerlivingbetter.gov.au/ 2. We understand that future Aged Care Packages will be implemented using the Consumer Directed Care (CDC) approach. Does the Department envisage CDCs wider use in the broader range of HACC services and if so, what will be the implications for block funding in the future? There has been no discussion about a broader use of CDC at this time and there has been no indication that block funding will not continue into the future. The current reviews will help to determine future directions for all HACC services. Be sure to have input into these reviews if you have thoughts that you would like to put forward regarding future directions for HACC. The Commonwealth sees the current period in the HACC transition as a learning and consultation phase which will help to inform future directions. 3. What will be the difference between someone assessed at / receiving a Home Care Package Level 1 ($7,200 pa) and a person receiving 2 or 3 Commonwealth HACC services? Eligibility for a Home Care Package assumes case management is involved with more coordination of care required, whereas someone accessing 2 or 3 Commonwealth HACC services is likely to be more able to coordinate their own services. These are different models and fulfil different functions. Note also that Home Care packages is not the same as the Commonwealth Home Support Program. There has been some confusion around this in the sector. It was noted by the Hawkesbury Community Care Forum that there have been no new Home Care Packages allocated to the Nepean region in the 2012/13 Aged Care Approvals Round. Please contact Bill Berridge on (02) 9263 3778 for any enquiries relating to the ACAR or to arrange feedback on applications. 4. When the Gateway is fully functional, will existing central intake processes and associated 1800 and 1300 numbers, e.g. ACAT, Home Care Service of NSW, Community Health still be operational? The Gateway ( http://www.myagedcare.gov.au) is currently in a transitional period and at this stage the Department is not sure what intake processes will look like at the end of this period. There is more information on My Aged Care on the Living Longer, Living Better website. 5. We received a large amount of additional "Transition Funding" this week with the provision that it had to be either spent or committed by the end of this week [eofy] and used up by 1

December, which makes meaningful spending almost impossible. What we want more than anything else is more or better services for clients. The Department acknowledges that the Transition Funding time frames were not ideal and concerns have been passed on to central office. Central office is currently looking at strategies to assist services to manage the acquittal of the transition funding. It was noted by the forum that it is particularly difficult as some services received more funds than they requested, making it hard to specify how the funds will be spent within the tight time frames. More information will be provided to service providers on this issue via the portal. DoHA also advised that if an organisations auditor is satisfied those funds were committed in the previous financial year, there shouldnt be any issues. With reference to not being able to use transition funds for more or better direct services for clients, the Department noted that this is specifically addressed via growth funding opportunities. The purpose of transition funding is to meet costs associated with the transition, and is therefore, retrospective rather than future focussed. Since the forum, the Commonwealth HACC Funding Round was announced (19 July 2013) Information on this grant process is at www.health.gov.au/tenders 6. We would like to fill the temporary gaps in service provision with brokered services, especially important when dealing with elderly volunteers, who get sick frequently or go on extended holidays. This could be explored as a sub-contract arrangement to fill the gap. If sub-contracting is done, the Department needs to be notified of the arrangements. Please see the DoHA portal or the DoHA website www.health.gov.au/hacc for relevant forms. 7. Our services are still output based. The enabling process, encouraged by DoHA, is theoretically great, but practically interfering with outputs. It would be welcomed by most of our organisations to transition to outcome based services. It was suggested that the sector could explore appropriate models, and develop these with industry peak organisations to present to the department. The National Aged Care Alliance may be a good starting point, www.naca.asn.au. 8. We have great concerns in relation to more and more services relying on phone based assessments or worse as in the case of the Aged Care Information Line online only services. It will take at least another ten to twenty years before online services can be assumed to be accessible to most clients. It was assumed that this question related to the My Aged Care Website. Currently there is no centralised intake and no standard assessment tool. This will be developed in the future. Much work needs to be done to develop appropriate assessment tools. It was noted that current tools also tend to be deficit based. 9. It can be distressing to clients to loose the social support services, e.g. Neighbour Aid, they are receiving through the HACC program when they are approved for a package such as CACP. With the new Home Care Packages, it is the intention that clients can opt to continue to use their service of choice, either via direct purchase of the service or via brokerage on a full cost recovery basis. The option for brokerage should encourage greater capacity for client choice. The final Home Care Packages Program Guidelines and Frequently Asked Questions are now available at http://www.livinglongerlivingbetter.gov.au/internet/living/publishing.nsf/Content/staying-at-home 10. Time frames for consultation are often limited. Consideration by DOHA of the time needed by services to respond to DOHA surveys and getting the surveys to staff on the ground due to the complexities of management structures. Often the requests are sent to the designated organisational contact officer who can be at an Executive Level. 2

Clarification was sought whether 3 weeks was enough time for consultation and feedback. It was noted by the forum that in order for the sector to consult and determine priorities and develop a sector response to some issues, more time is necessary. This is particularly relevant when issues are complex. The IT section in DoHA will be exploring how to expand access to the portal (e.g. using more than one password) to improve the time it takes for information to be disseminated more broadly. An ADHC representative advised that ideally they aim for a 6 week consultation period, though this has not always been possible. DoHA recommends sending this feedback to HACC.Reform@health.gov.au 11. Issues with the DoHA portal some services experienced difficulty with recent online applications for transition funding. It is understood that DoHA are currently in the process of improving and streamlining the portal and appreciate any feedback. DoHA acknowledges the issues with the portal. It was requested that any issues with the portal should be raised with HACCIT@health.gov.au so that improvements can be made. It was noted by the forum that services tend to prefer online application, especially once all the IT issues are resolved. 12. It was suggested that it might be helpful if the Hawkesbury Community Care Forum provide a picture of the Hawkesbury LGA, particularly focussing on the issues of remoteness and isolated communities and the time/costs associated with service delivery in this area. It would be useful to obtain and present demographic information from the Council website to convey specific issues and for individual services to present specific service challenges they experience. At some stage it would also be useful to provide a tour for DoHA representatives (e.g. to Bilpin, Kurrajong) so they can experience the issues for themselves. Debra Hilton presented Hawkesbury LGA demographic information to the DoHA representatives. The particular issues of isolation and distance was discussed and acknowledged by the Department, especially in relation to its impact on unit costings and the fact that the Nepean is classified as metropolitan, not rural and remote. It was suggested that the provision of snapshots would be useful to give a clearer picture of what is involved. What some services are finding is that due to distances (eg. lengthy trips to Day Centres for clients etc), this often puts increased pressure on carers to provide that support). Services are encouraged to note these, and other issues impacting on service cost delivery (such as type of clients), as part of their Output Variation Reports. Providers are encouraged to engage with industry peak bodies for ideas on alternative funding models, particularly in the lead up to the new Home Support Program in 2015. It was noted that it is the Departments intention of getting out to attend Forums such as this and visit individual services but they have competing priorities especially with the upcoming funding rounds. Where ever possible they will try to attend future forums and have particularly appreciated this Question and Answer format so that they can give considered responses. 13. It would be helpful for individual services to have a greater level of face-to-face contact with DoHA Account Managers to improve communication regarding funding. Individual services indicated that when they have had contact with Department officers, they have been helpful and flexible. The Department appreciated this feedback. Services are encouraged to contact them by phone or email. If they can not directly resolve an issue they can refer services to the appropriate person within the Department. As noted above they will attempt to have face to face contact with service providers but that this will depend on competing priorities at the time. Attending targeted Forums will also be a way of improving communication. The DoHA representatives also would appreciate being sent minutes of relevant Forums. 14. Clarification is sought on how HACC growth funding will be allocated. It was noted that there is currently no domestic assistance growth money despite waiting lists.

There is no information regarding growth funding allocations as yet, but it involves an open competitive process. With domestic assistance waiting lists, this will need to be considered as part of the broad policy and review process. Since the forum, the Commonwealth HACC Funding Round was announced (19 July 2013) Information on this grant process is at www.health.gov.au/tenders 15. In relation to the age split between HACC and CCSP, services are seeking reassurance that both Departments will be flexible if age service percentages vary within individual services. Variability is to be expected in relation to aged split percentages and both DoHA and ADHC consider the split as notional only, and work out the financial issues separately. If there is a consistent trend that varies significantly to the allocated split in the longer term, this should be discussed with the Department. Seasonal or smaller fluctuations are not an issue. Services should also consider whether variations are an age split issue or a growth issue. 16. Debra Hilton raised the following additional issue on behalf of providers: Do staff members need to be part of an enterprise agreement to receive the Aged Care Workforce Supplement? The Frequently Asked Question on the Living Longer, Living Better website provides some comprehensive advice about this subsidy. The following is an extract from the FAQs:
Q: Who is required to have an enterprise agreement to be eligible for the Workforce Supplement? A: Approved providers of residential aged care services with 50 or more places allocated for the provision of residential care. Other approved providers or organisations may choose to update enterprise agreements, where they exist, to meet the eligibility criteria of the Workforce Supplement. Q: When does an approved provider or organisation need to have an enterprise agreement in place to access the Workforce Supplement? A: Approved providers of residential aged care services with 50 or more places allocated for the provision of residential care must have an enterprise agreement in place as follows: by 31 December 2013 where there is an existing enterprise agreement on 1 July 2013; or no later than 30 June 2014 where there is no enterprise agreement in place on 1 July 2013; or at time of application for applications after 30 June 2014.

Q: If an organisation is a Residential Aged Care provider with a total of 50 allocated places, spanning three facilities with an enterprise agreement in place from 1 July 2013, what does the organisation need to do to apply for the Workforce Supplement? A: To apply for the Workforce Supplement, the approved provider will notify staff in writing of their intention to apply and undertake to provide the minimum wage requirements and other workforce commitments set out in the Workforce Supplement Guidelines. Where the total allocated places is 50 or more, all eligible employees in each facility must be covered by an enterprise agreement that meets the eligibility criteria for the Workforce Supplement. For applications where there is a current enterprise agreement in place, the enterprise agreement must be varied by 31 December 2013 to include the requirements of the Workforce Supplement. Each year, to ensure that the organisation is compliant against the eligibility requirements of the Workforce Supplement, a certification form must be completed. More information on eligibility criteria can be found in the Workforce Supplement Guidelines.

The full list of FAQs can be found at: http://www.livinglongerlivingbetter.gov.au/internet/living/publishing.nsf/Content/WorkforceSupplement Thank you to Kathryne and Olympia for their attendance and participation in this Forum. The discussions and information provided were greatly appreciated by all present. Louise Sutcliffe HACC Development Officer Western Sydney Community Forum 4