Aged Care Assessment Program

As part of the Commonwealth Aged Care Assessment Programme (ACAP), it is a requirement of funding that all Aged Care Assessment Teams (ACATs) record a minimum set of data on every client assessed. These data are known as the National Minimum Data Set. An elderly person is likely to be assessed by an ACAT in order to gain access to residential care or community services. In Western Australia there are 16 ACATs - seven in the metropolitan area and nine in rural and remote areas :

The Evaluation Unit collects and analyses these data every three-months. The Unit is also involved in software development for data collection at the hospital sites where the ACATs are situated. Hence, the Unit provides the software for the data collection, offers advice and assistance to the ACATs on matters related to information handling, and is responsible for collecting the data from the ACATs every three months and providing feedback on the data analysis.

Collection and analysis of the National Minimum Data Set is completed on a quarterly basis to enable the Unit to prepare an Evaluation Report for Western Australia; the data are then sent to the National Data Repository.

The reported data comprise of the number of assessments completed by each ACAT in the three-month period, the rate of assessment per head of elderly people in the population, the reasons for assessment, location at assessment, housing and living arrangements, diagnosis and services used before assessment. The data also record the care plan after assessment showing services recommended.

Status:

Continuing

Reports:

Every six months from July 1989 till December 2002.

Every three months from January 2003.

Central Nursing Home Waiting List

Since 1993 all persons admitted to a nursing home or hostel in Australia must have been previously assessed and approved by an Aged Care Assessment Team (ACAT). A central nursing home waiting list system has been developed for Western Australia and has been in effect since 1989. This records data for all clients assessed by ACATs and approved for admission to nursing homes. These data include the date of approval, location at assessment, nursing homes to which admission is sought, preferred suburb, important characteristics of the client (such as cultural preference, preferred language, dependency factors, dementia). Also recorded in the system are the date of admission and the nursing home to which the client is admitted, along with the date and reason of disharge if a resident dies or leaves a nursing home.

The Unit provides a continuous service to both ACATs and nursing homes, identifying vacancies and producing individual waiting lists for each nursing home.

The data are analysed both regularly and on an ad-hoc basis to examine issues related to residential care provision; waiting times are monitored for clients in different geographic areas and different special needs groups (such as those with dementia, behavioural problems, ethnic background, location at assessment etc.) and reports presented to State and Commonwealth officials.

Similar data are collected for hostel residents though at the present no waiting list is available for the hostel sector.

Status:

The central nursing home waiting list was closed on 28th September 2001.

Reports:

Every six months since July 1989; also ad hoc reports as requested.

File-Linkage Projects in Aged Care

It is proposed to use linked data from a number of sources to study the care needs and service use of individuals accessing the Aged Care system. This will then enable flow data to be compiled which can lead to modelling studies to assist in resource allocation, service substitution studies and cost-effectiveness analyses. The discussion below outlines the sources of data currently available and possibly able to be accessed in future.

Currently Available:

• the ACAT data - Commonwealth minimum data set since 1992 complete for all of Western Australia and comparable data from 1990 to 1992. These two data sets would have to be integrated including only items common to both sets.
• the Nursing Home Waiting List data - complete since 1990
• hospital data for all metropolitan government hospitals in Western Australia (since 1990). These data will be linked internally by the end of 1996
• hostel data 1994 and 1995
• Silver Chain Nursing Association data (largest home care service provider in Western Australia)
• death data for Western Australia - all years

Other data sets that might be accessible in future:

• mental health data
• Medicare data
• other HACC service providers' data

It is noted that the first four data sets may be linked via common Unit Record Numbers (URNs). An incomplete link also exists with the Silver Chain data via a 'flag' but since 1993 this has not been set consistently and the linkage is incomplete. Further work is planned with the flagging data.

It is proposed to develop a 'key' based on names which can be used to effect the linkages without incurring problems with privacy. The known links (using the URN) can be used to test the key in the first instance.

Objectives of the File Linkage Project

The following resource-use questions can be answered:

1. case-mix - are ACAT clients different from GP clients in terms of resource use?
2. post-acute care - what resources do people coming out of hospital use?
3. is resource use different for new ACAT clients from old clients?
4. Flow-data:

   Clients will be 'tracked' from first contact with the aged care system through to death and the patterns of resource use examined for people entering the system at different entry points (GP, ACAT, hospital etc.)

5. Collection of appropriate flow data with a dependency measure in each care sector leading to modelling studies for resource utilisation and resource allocation.
6. Evaluation of restorative care - examine the use of hospital beds and subsequent use of community care and residential care resources as well as repeat admissions to hospital.
7. Examine home care/hostel interactions and the community care resources used to support hostel residents.
8. Use of community care resources (and hospital admissions) by clients awaiting admission to nursing homes and hostels
9. Community Aged Care Packages (CACPs) - examine the resource use and pathways of CACP recipients
10. If there are data on carer availability within any of these sectors, compare home care resource use for the GP and ACAT groups including the dynamics of carer support, particularly whether carers are co-resident or not
11. Examine existing distribution of resource usage by geographic location; establish mechanisms to monitor equitable resource allocation across regions.
12. Investigate resource use by clients on the 'boundaries' of existing care programmes and identify 'substitution' where this occurs. Examples are:
    • the use of community care to support hostel residents (already mentioned)
    • hospital admissions to support potential nursing home clients
    • nursing home admissions for hospital patients without access to restorative care
    • Psychiatric Extended Care Unit (PECU) admissions to support people with severe dementia and behavioural problems who wait a long time for admission to nursing homes
    • 'care awaiting placement' beds instead of acute beds for patients approved for nursing home admission
    • additional community care for clients coming out of 'transition care packages';
    • additional community care support (especially nursing) for CACP recipients
    • restorative care in hospital for hostel and nursing home residents - not substitution but often neglected as a care need of people in residential care;
    • determine what is being substituted for the care that used to be (to some extent still is) provided by the State Government nursing homes?

Status:

Initial stages - funding sought

Evaluation of Clustering Project and Transition Care Packages (TCP)

These two projects were Commonwealth government initiatives designed to address particular inequities and perceived problems in the aged care system. The Clustering Project is designed to assist nursing homes to provide more culturally appropriate residential care services to people from non-English speaking backgrounds. This is achieved by encouraging people from similar cultural backgrounds with particular preferred languages to be admitted to specified 'clustered' homes where the staff receive special training in cultural awareness. The Unit completed an evaluation of the clustering project in Western Australia.

The Transitional Care Packages Project is a nation-wide project that began in 1992, with the primary goal of organising and purchasing home care services for frail older people who have been discharged from hospital and require short-term intensive care in order to regain their independence. Six Aged Care Assessment Teams were selected across Australia from high need areas to pilot the project. The project was run in Western Australia by the Bentley Aged Care Assessment Team.

The Bentley team ran the pilot study with 248 subjects split into two groups; a control group and an experimental group, who received the Transition Care Package. The aim of the project was to establish whether high dependency older people, could stay home longer rather than enter residential care after receiving the Transitional Care Package, and thus maximize their level of independence within the community.

Progress of subjects over a six month period was recorded, analysed and documented in a Client Outcome Evaluation report. The results of the Bentley pilot project strongly supported the use of Transition Care Packages to assist the independence of frail elderly within the community. It was found that relative to control subjects, the subjects who received the Transitional Care Package showed improvement in cognitive functioning, the need for fewer community services, and a lesser likelihood to require admission into residential care.

Unfortunately, these results have been found to contrast with those of the pilot study by the New South Wales Aged Care Assessment Team, where it was found that the Transitional Care Package made no difference to the independence of subjects. It has been suggested that the analysis be repeated with the three years worth of data that are now available, which are likely to provide stronger support for the present findings.

Status:

Completed

Reports:

• Clustering Project Evaluation Report - 1994
• TCP Evaluation Reports - 1996
• TCP Client Outcomes Evaluation (revised) - 1998