2nd Annual Transition Care Conference

TRANSITION CARE: IT’S A MATTER OF CHOICE

Barbara Anderson A/Assoc Director Aged Care Unit Integrated Care Branch NSW Ministry of Health 30 May 2013

45 Transitional Aged Care Services operating across NSW – providing a total 1,378 places

• NSW is largest jurisdiction in Australia.

• At 30 June 2011, AIHW reported that NSW had 49% of total number of Transition Care service outlets followed by Victoria with 19%.

• Program in NSW has nearly doubled in size from an initial allocation of 703 places in 2004/05

• Places now operate in all 16 Local Health Districts. • 1,215 community-based places, • 159 residential places, and • 12 mixed setting places.

Shoalhaven Transitional Aged Care Service (STACS)

Transition Care in Walgett NSW

Background

• Almost all people who use TC services normally live in the community (AIHW 2012).

• More than half of TC episodes provided in community setting nationally, a third in residential, and 1 in 10 in both settings.

• However, wide variation across jurisdictions. • NSW provides 9 in 10 care episodes in the community setting while

Western Australia and Victoria provide most services in a residential setting.

• Wide national variation in proportions of clients returning to the community after a TC episode, ranging from 27% in WA to 69% in the ACT.

• In NSW it is 60%.

• Only 4.6% of NSW clients discharged to residential aged care in contrast to 39% in Victoria and 43% in WA.

‘Access and Equity’ • In December 2011, Australian Government released

discussion paper on ‘Access and Equity’ as part of its Inquiry into the responsiveness of Australian Government services to Australia’s culturally and linguistically diverse population.

• ‘Egalitarianism is a deeply held and enduring Australian value’.

• All Australians have the right to equitable access to Australian Government services and programs.

• Furthermore, they should be able to expect equitable outcomes, regardless of their cultural or language backgrounds.

• Access means that ‘Australian Government services should be available to all Australians who are entitled to receive them’.

• Equity means ‘the Australian Government should respond to and cater for the diversity of clients’ needs to achieve equitable outcomes’.

• Taken together, the concepts of access and equity apply to all Australian Government funded agencies, community organisations or commercial enterprises which are therefore expected to adapt their programs and services to meet the needs of all Australians.

‘Access and Equity’ cont.

Health Access and Equity for Medicare Locals

• ‘Cracks are emerging’ in Australia’s health services and ‘access and equity cannot be taken for granted’.

• ‘The inverse care law predicts that, without deliberate intervention by the health system, those with the greatest health need will be the least likely to receive care’.

• More generally, there are a number of factors contributing to access problems

(Ref: University of NSW Consortium, 2011)

A number of factors contribute to access problems:

• Availability of services – or more correctly services not available.

• Affordability – cost should not be a barrier to accessing Transition Care.

• Accessibility –all services should investigate locally to see whether issues are physical (eg. transport, distance) or more socially oriented (eg. lack of understanding of or information about service, language difficulties, or other cultural barriers).

• Appropriateness –do we have the right mix of residential and community places to meet the needs of the local population?

Factors contributing to access problems :

Factors contributing to access problems: (Cont.)

• Acceptability – services should be seeking ‘customer’ opinion to ensure they are responsive to the needs of clients and their families.

• Reach – utilisation of services relates to how well the service promotes what it does and reaches the people who need to know, and whether members of the community or service providers are able to recognise a potentially suitable client.

Consumer Directed Care (CDC) and Transition Care Program

Key CDC principles (DoHA) :

• Integrated – CDC should be integrated into existing programs as an optional mode of care delivery and operate within the constraints of the current legislative arrangements.

Currently Transition Care not on agenda and therefore not being explicitly integrated into mainstream national aged care reform.

• Responsive – CDC should be responsive to the changing needs and circumstances of care recipients and carers, and enable adjustment of budgets and services to meet those needs.

Transition Care by definition is responsive to the needs, goals and circumstances of clients. However, issue of client controlling their budget has not yet considered. The guideline that a client’s access to Transition Care should not be affected by their ability to pay fees remains in force.

• Inclusive – CDC should take into account the needs of care recipients and their carers and consider its contribution to, or impact on, the social inclusion of care recipients and carers.

Transition Care interfaces between acute care and aged care and promotes and facilitates the capacity of clients to take part in social activities and community life as fully as practicable.

• Equitable – Care recipients with the same or similar needs and circumstances should receive comparable allocations of budgets and services.

This principle highlights the need to discuss the current allocation of TC places and the setting of fees with the intention of improving access to services by clients with the same or similar needs and circumstances.

• Optional – CDC should be offered to care recipients as a voluntary option.

Defined eligibility criteria for Transition Care include that a client and their carer and/or family as appropriate must:

• wish to enter Transition Care

• be fully informed about the program and

• voluntarily enter into an Agreement with the service provider.

Concern is that not all potential care recipients can be given the option of benefitting from Transition Care simply because of where they live.

• Care recipient and carer-centred – CDC should take into account the needs and views of care recipients and carers and support them having control and choice over their care.

Transition Care centres on the older person and their carer and family. As appropriate, it requires them to be fully involved in deciding and choosing the most appropriate care to meet their needs, including in the development of a goal-oriented care plan.

• Supportive – Care recipients and carers should be provided with a range of support to make informed decisions and practise CDC, including education and advocacy.

The rights of TC clients include being given sufficient information, and access to a translator or interpreter services where required, in order to make an informed choice about their care.

Clients also have the right to choose a representative to speak on their behalf for any purpose.

• Sustainable – CDC should provide an affordable, long term option for delivery of care for Government that meets the needs of care recipients and their carers.

The new Home Care packages with a CDC focus and the promised increase in package numbers should help TC providers transition their clients to their preferred long-term care option at the end of their TC episode. A goal of the TC episode in itself might be to assist a client and their carer to understand and optimise the benefits of CDC in the community.

• Transition Care already has a consumer directed focus but, for many potential clients, Transition Care is out of their reach.

• They may believe they will benefit but there is no choice – either there are insufficient places or their choice of service is not available.

• NSW ACAP MDS data 2011-12 indicates that, of the clients assessed in that year, 45.3% did not have a resident carer and 15.9% had no carer at all.

• Therefore some 61.2% of clients eligible for Transition Care needed the option of a residential program if they were to be able to benefit from TC post hospitalisation.

• ABS data shows that, at 30 June 2004, 2.6 million people over the age of 65 lived alone, ie. 13% of the population.

• This proportion is projected to increase to 26% by 2015.

The concept of choice:

• Can equity of access be achieved without being able to provide a client with choice?

• Do clients actually have real choice when it comes to accessing Transition Care?

• Choice is the opportunity or right to choose between different things or to select.

• Involves decision making and implies both the capacity and the opportunity to decide on alternatives.

• Doing something by choice usually means doing it of our own accord

• Because we want to not because there is no option.

• Usually we have the opportunity to express a preference. • We have expectations.

It is generally thought that ageing baby boomers will have different expectations to previous generations; that they will want every opportunity to remain in control of their own lives.

They are more a questioning rather than an accepting generation.

Noeline Brown, Ambassador for Ageing

• At last November’s Fourth National Transition Care Forum in Brisbane, Noeline Brown highlighted that ‘in today’s modern world older people do not spend their retirement years sitting on the porch watching the sun go down’.

• She emphasised that older people are seeking to maintain a high level of independence and social connectedness – they want ageing to be a positive experience.

Noeline Brown, Ambassador for Ageing

• Time is what older people need - especially as none of the decisions they need to make are ‘easily determined when they are surrounded by emotion and fear of the unknown’.

• Transition Care staff help older people and their families and carers come to terms with changes they need to make to their lives and make the decision that will be best for them.

Noeline Brown, Ambassador for Ageing

• Noeline also identified how well the program fits with the Australian Government’s commitment to the principle that older people should have access to the care they need, where they need it, and when they need it.

Armed with objective evidence, we can then turn our collective minds to improving access and providing greater choice.