Be Prepared: CDC Practicalities Paul Sadler, Chief Executive Officer Presbyterian Aged Care NSW & ACT Indra Arunachalam, Strategic Projects Manager integratedliving Australia Limited AAG / ACS Regional Conference, Port Macquarie, March 2014

Presbyterian Aged Care Residential Care 10 aged care homes – 816 residents 3 high & low care; 2 ageing-in-place; 2 high care; 3 low care Community Care 17 services – 840 clients 1 Home Care Package Level 4 service – 11 packages 4 Home Care Package Level 2 services – 144 packages 2 Day Therapy Centres – 88 clients per week 4 Day Respite services – 72 clients per week 6 Home & Community Care (HACC) services – 376 clients per fortnight plus 122 from brokered service Retirement Villages 12 Retirement Villages – 191 units 4 co-located with residential care

Services across regional NSW, QLD and Victoria: - Home Care Packages – 37% - HACC – 37% - NRCP – 2% - Disability – 10% - Mental Health Respite – 2% - Other (brokerage, DVA) - 12% 25 offices – from Rockhampton to Bendigo 3,400 clients delivering over 300,000 hours of service 400 staff and 340 volunteers With HACC 2013 – expansion into ACT and Tasmania 3

What are your challenges? 4

Policy Background Productivity Commission Caring for Older Australians Living Longer Living Better aged care reforms Home Support / Home Care context 5

Home Support Program Commonwealth Home Support Program (CHSP) to replace HACC, NRCP, DTC and ACHA from 1 July 2015 Will include all service types currently covered Regular annual growth for HACC likely each year, and all elements of Home Support Program from July 2015 No change to HACC services until 2015; reviews of some HACC service types during 2013 / early 2014 Respite care Home modifications and maintenance Meals Community transport Service Group 2 (assessment, case management, etc) 6

Latest on CHSP DSS CHSP Design Discussion Paper, incl. service type reviews, due out in weeks, not months (probably March 2014) Final CHSP framework by mid 2014 Impact of new Govt and DSS views on contracts and practical funding mechanisms being considered All affected services will be consulted No decision yet on CHSP respite link with residential respite CHSP to start 1 July

Home Care Packages Home Care packages (HCP) adjusted up from 25 to 45 places per 1,000 people 70+ Additional 84,538 Home Care packages over 10 years 2 new levels of Home Care package (piloted over ) Movement from HCP levels 1/2 to 3/4 requires ACAT assessment 8 Home Care PackageAnnual Subsidy Level ( ) Level 1$7,501 Level 2 ( formerly CACP)$13,644 Level 3$30,003 Level 4 (formerly EACH)$45,607

Home Care Packages Dementia and Cognition Supplement for all HCP levels Veterans Supplement For veterans with mental health condition verified by DVA User charges: Basic fee of 17.5% of Age Pension retained Income tested fee introduced (similar to residential care), reducing subsidy payment Annual cap of up to $10,000 and lifetime cap of $60,000 on income-tested care fees Hardship provision available 9

Consumer Directed Care Pilot undertaken HCP Guidelines released June 2013 All Home Care packages allocated in and future Aged Care Approvals Rounds must be CDC Evaluation of CDC packages due to start shortly All Home Care packages to be converted to CDC from mid

CDC Capacity Building Service Funded by DSS, auspiced by COTA in conjunction with ACSA & LASA Paper on Principles and Defining Characteristics of CDC Initial resource pack available A.Organisational self-assessment for readiness to implement consumer direction B.Implementation checklist example ( provided by Feros Care ) C.Resources to support CDC implementation D.What works in implementing new programs: a discussion paper 11

CDC Capacity Building Service Additional projects for future Assistance with service costing and individualised budgets Training resources for staff in having consumer-directed conversations Legal issues and risk management Assisting organisations with consumer engagement and feedback on CDC E-learning resources on CDC Leadership and cultural changes CDC Service website available from late March 2014 COTA also running project for consumers titled Controlling My Own Life: Making the Most of CDC 12

integratedliving’s PDF Projects 2 NDIS Practical Design Funds Closing the Gap – Indigenous Workforce Risk and Change Management  Transition Guide Preparing for NDIS is similar to preparing for CDC 13 Business Process Mapping Consumer Focus Group Develop Transition Guide Workshops for NFP

Pressure Points for Providers Placing people with disability at the centre of service delivery Strengthening community connections Building workforce capacity Operating in a competitive market Being effective and accountable Page 6 of the Transition Guide 14

Transition Guide Person-centred approach NDIS and the Pressure Points How to Prepare for the New Paradigm Service enquiry Service delivery Recruitment and training Subcontracting Accounting and reporting pdf copy of Transition Guide from:

Organisational Strategy 16 integratedlivingPAC Strategic PlanningCDC pilot 8 CDCL packages in Inner West; 3 in Walcha Person-centred leadership training Strategic Plan Consumer focus groupService Growth Strategy Embracing Life service model and change management People At Centre care strategy

Service Enquiry Marketing – making it easy to find us Call centres / first contact – making it easy to navigate Gateway assessment process v HACC service provider assessments ACAT assessments for HCP 17

Service Delivery Assessment and care planning Assessment and client selection Goal setting and care planning Individual budgets Conversations with clients Service delivery Dignity of risk and Duty of care Case Management Standards 18

PAC Enabling CDC Care Plan Questions, e.g. What is a good day for you? What are your goals? Identify supports needed to achieve my goal Client profile information From ACCR and ONI questions Service plan to achieve my goals Services to be provided What client will do What care staff will do Cost Other areas of assessed need for monitoring Emergency plans Additional services (at cost) Client consent 19

Recruitment and Training integratedlivingPAC Person-centred Leadership Training Leadership development framework New Staff Model – Nurses, Case Managers, Service Coordinators Re-examining enterprise agreement classification structure integratedliving Leadership Capabilities Framework Case Manager / Coordinator Skills Customised & contextualised training courses on priority skills and attributes ACS CDC Courses 20

Sub-Contracting Responsive to consumer choice Special needs e.g. CALD or ATSI Specialist services e.g. allied health, home maintenance, meals Support consumer’s relationships with their pre-existing providers e.g. chemist, cleaners Network of established and reliable providers As back up when staff not available Enable quick operationalisation of new services Templates of contracts or service level agreements Quickly respond to new situations or partnerships Subcontracting to family members Only in exceptional circumstances e.g. remote services 21

Accounting and Reporting Business Process Analysis Costing service components Reporting Individual budgets Reporting and monitoring systems (including client statements) IT platform selection and implementation 22 integratedlivingPAC Existing platform - TRACCSPaper-based rostering / client management & electronic finance Work with developer for CDC Budget + Statement (was already doing roster) Tendered for new platform – Procura including Budget + Statement + Roster

PAC Client Statement Client name Statement period (including leave days noted) Income received Subsidy Supplements (e.g. dementia, veterans, oxygen, enteral) Client fees Total Expenditures Care services (agreed, actual, variance) Additional cost services Administration fees Care management fees Total Net income less expenditures Balance Beginning of month, carried forward this month, at end of month (including contingency) 23

integratedliving Case Study Our first CDC consumer in a new region Had sacked previous providers Expected to be treated like a queen Within two months, we have had to change regular staff three times Last induction, consumer was invited to talk to new staff about what it was like to have a stranger coming into her home to provide services Consumer shared her experiences and hit it off with one of the staff, consumer regards that staff very highly 24

Challenges Moving clients with packages with greater than average hours back to new package limit Rural/remote clients outside major towns – travel time Setting up financial systems to manage individual budgets Changing the Case Manager’s mindset – money matters 25

Useful links National Aged Care Alliance Australian Government Living Longer Living Better website Aged & Community Services NSW & ACT 26

Contacts Indra Arunachalam Strategic Projects Manager Integratedliving Australia Paul Sadler Chief Executive Officer Presbyterian Aged Care