(CR

CO

S) #

002

12K

Data for Persons Seeking Aged Care

Tracy Robinson

Assistant Professor in Nursing (UC)

University

SYNERGYNursing and Midwifery Research CentreUniversity of Canberra and ACT Health

(CR

CO

S)

#0021

2K

Review of Aged Care Reforms

(g) the effectiveness of workforce strategies in aged care services, including strategies for the education, recruitment, retention and funding of aged care workers

– The last national aged care workforce census and survey was for 2011-12

– returns for the 2015-2016 census & survey due 23/9/16.

– Results may not be available in time to help the review of aged care reforms.

(CR

CO

S)

#0021

2K

Aged care workforce numbers

(CR

CO

S)

#0021

2K

Average ages of direct care workers

(CR

CO

S)

#0021

2K

Composition of residential direct care workforce

(CR

CO

S)

#0021

2K

New Models of Care Needed

• Scoping study (Community Services & Health Scoping Project, 2014 ) found emerging needs for aged care workforce:– Person centred care

– High acuity & diverse clients

– Recovery approaches

– Advocacy skills

– Social inclusion & social wellbeing

(CR

CO

S)

#0021

2K

New Roles for Workforce

• Lifestyle Coordinator

• End of life consultant

• Broker

• Case manager

• Business development (grants etc.)

• Field technician (assistive technology)

• How can we measure quality?

(CR

CO

S)

#0021

2K

Complaints as guide to

Workforce Quality• One guide to quality is Aged Care Complaints Scheme.

• Report on operation of the Aged care Act (1997) identified 8,888 issues / "in-scope“ complaints in 2014-15 :

– 4% financial issues,

– 2% security of tenure/agreement.

– 94% workforce failures

– 29% of workforce issues related to health & personal care: infections, infection control, clinical care, continence management, behaviour management & personal hygiene.

• Of in-scope complaints in 2014-15. – 17.6% were from approved providers,

– 37.3% from a representative or family member,

– 8.2% were from the care recipient / service users

(CR

CO

S)

#0021

2K

Trends in ‘in-scope’ Complaints

Issue 12-13 13-14 14-15

Health and personal care 2373 2714 2557

Consultation and communication 1096 1156 1050

Physical environment 896 999 839

Personnel 903 957 835

Medication management 714 705 674

All other 3075 3113 2933

Total issues 9057 9644 8888

(CR

CO

S)

#0021

2K

Examples of Workforce

Indicators

• Workforce size

• Percentage of staff who are Aboriginal or from CALD backgrounds

• Leadership & management skills

• No. accredited clinical training positions

• Qualifications currently undertaken

(CR

CO

S)

#0021

2K

(i) the effectiveness of arrangements for

protecting refundable deposits and

accommodation bonds

• According to "RSM aged care sustainability review 2016” accommodation bond guarantee scheme triggered 3 times in 2006-09

• twice in 2009-11, not in 2011-12, three times in 2013-14.

• Not triggered in 14-15.

• Total payments shown by RSM approx $34m.

• To date, failures rare, - present arrangements seem effective in protecting bonds.

• Residents of failed providers may have difficulties transferring to other providers.

• Should there be some form of published financial index for each provider, to help people choose ?

(CR

CO

S)

#0021

2K

(i) the effectiveness of arrangements for

facilitating access to aged care services

The My Aged Care website allows anyone to find aged care services near them. Details shown for each aged care home include

• Suburb

• Accreditation period

• Certified

• Commonwealth Government subsidised

• Current sanctions and notices of non-compliance

• Participation in the quality indicator program

• Services meeting particular needs

• For each room type, maximum occupancy, room size, number of rooms, maximum deposit, maximum daily payment, extra service fees

(CR

CO

S)

#0021

2K

What’s missing from My Aged

Care?

• Homes do not normally show numbers of rooms currently vacant.

• No details are available of actual payments for currently occupied rooms, or of past payments for unoccupied rooms.

• (By contrast, allhomes.com.au provides the past sale price and sale date for each dwelling in the ACT, back to 1993)

• The identity of the entity owning the home is not shown.

• No financial ratings or financial data are provided for the entity owning the home.

Providing extra data, particularly the numbers of each type of room currently vacant, would place persons seeking aged care in a more equal bargaining position with providers.

(CR

CO

S)

#0021

2K

Should numbers of persons seeking care

be shown on My Aged Care?

• To measure unmet demand and ensure equitable access, Health needs to know who is seeking care at any time.

• The numbers of persons seeking care in each suburb could be posted daily on My Aged Care.

• These numbers would marginally help persons seeking care, as it would give them some indication of the competition for places.

• But the numbers would be very valuable to aged care providers, helping them mke investment decisions and set maximum prices.

(CR

CO

S)

#0021

2K

Quality of Care Indicators for

RACF• From Jan 2016, 3 QCI are reported on

voluntary basis– Pressure ulcers

– Use of physical restraint

– Unplanned weight loss

• In ACT only 2 of 26 RACF’s participating

• Small no. indicators – 35 QCI’s are derived for long term care homes in Ontario

• Data for ACFI and accreditation could generate quality indicators

(CR

CO

S)

#0021

2K

Examples of QCI’s

• Need to balance process and outcome

indicators

• Patient experience an important indicator –

not same as patient satisfaction

• Healthcare system performance for

vulnerable populations

• Effects of informal care on carers

• Differences in health & wellbeing for

disadvantaged groups, rural & remote etc.

(CR

CO

S)

#0021

2K

Data for the Current Review

• Current review has less than 12 months to report

• Productivity Commission Report (2011) processes:– Issues paper

– Call for submissions

– Draft report and revisions

– Final report

• Lack of time a concern

(CR

CO

S)

#0021

2K

What is needed?

• In depth analysis of data already held by National Aged Care Data Clearinghouse

• Linkages between approval and acceptance data - can help estimate unmet need?

• Analyses prepared for inquiry could be retained for future general use?

• Programs AIHW writing to analyse RAC approvals and admissions by ACPR intended for general use?

(CR

CO

S)

#0021

2K

Who Needs the Data?

• Policy makers

• Aged care regulators

• Aged care providers

• Service users

• Consultants

• Researchers

• Changes in service delivery to more home care requires longitudinal data

(CR

CO

S)

#0021

2K

Longitudinal data

• Follows individuals through time

• Can help ensure equitable treatment

• Factors affecting service access?

• Value of home care in delaying entry to residential care?

• Costly if not administrative data

• Confidentiality issues have to be managed

(CR

CO

S)

#0021

2K

Proposed Australian Survey on

the Ageing Population • Nationally representative study of

people 50+

• Multidisciplinary design

• Longitudinal data

• Linkages to administrative records

• Publicly available

• Harmonized across many countries

• Promotion of cross-national research