Transcript No Slide Title

Changing
Demographics Changing Services
A Northern Region
Perspective
May 2005
Home and Community Care Program
Far North Coast 1985 - 2005
2005 is the 20th anniversary of the HACC
program
What has been “the well worn path” for the
HACC program on the FNC?
and
What does this experience offer us in
shaping the HACC program for next the
decade?
May 2005
1985 HACC program
The HACC program
• commenced in 1985 following the
establishment of the Commonwealth
Home and Community Care Act 1985
• was developed as a strategy to
support people in their own homes and
reduce expenditure on nursing homes
• Is a joint Commonwealth and
State/Territory initiative
May 2005
Overview of the HACC Program
The HACC program provides funds
for basic maintenance and support
services to help frail older people and
younger people with disabilities
continue to live in the community. (1)
The aim of the Program is to assist these
groups to live at home longer
May 2005
1.National HACC Program Guidelines 2002
The first 10 years
• The HACC program experienced rapid
growth with National HACC
expenditure increasing from $154m in
84/85 to over $945m in 00/01 (2)
• The establishment of the HACC
program saw the emergence of new
service types Community Transport,
COPS Home Modification and
Maintenance and Respite care.
May 2005
2. Aged and Community Services Australia, Fact sheet 3, page 2, March 2002
A decade later…. two key reports
1994 “Home But Not Alone”(3) report on the
HACC program identified key issues for the
program to address - these included;
• Improving the Focus and Targeting of the Program
• Enhanced Access for Special Needs Groups
• Improving continuity between Health Care and
Community Care
• Stronger linkages with other Programs
• Improvements in Assessment
• Service Delivery and Costs
• Quality Assurance
• Service Availability, Planning and Administration
May 2005
3. House of Representatives Standing Committee on Community Affairs,
Parliament of Australia
Efficiency and Effectiveness Review
1995 release of the Efficiency and
Effectiveness Review of the HACC
Program (4)
The final report recommended
– Carers to remain a key emphasis of the
program
– Strengthening of assessment
– Move to focus on outcomes for clients
– Streamlining of administrative arrangements
between the States and Commonwealth
– Nationally consistent eligibility and assessment
criteria for the program
May 2005
4. Final Report, Aged and Community Care Division Department of Human Services
and Health, Australian Government.
Subsequent and related Initiatives
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May 2005
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CIARR
Comprehensive Assessment projects
Unit Cost Study
Access projects for special needs
groups
Minimum Data Set
Abuse protocols
NSW Plan on Dementia
Consortiums
New Commonwealth funded initiatives
Carer Respite Centers, CAPS and
EACPs,
Coordinated Care Trials
What the program delivers
Current HACC Service Types
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May 2005
Nursing Care
Allied Health Care
Meals and Other Food Services
Domestic Assistance
Personal Care
Home Modification and Maintenance
Transport
Respite Care
Social Support
Centre Based Day Care
Current HACC Service Types
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Assessment
Case Planning /Review and Coordination
Case Management
Formal Linen Service
Intake
Counselling/Support, Information and
Advocacy
• Screening Non Output Services
May 2005
FNC population trends 1996 - 2016
350000
300000
65 +
250000
200000
150000
0 - 65
100000
50000
0
May 2005
1996
42404
65 +
0 - 65 207802
2001
2006
2011
2016
46803
219627
50990
229590
58670
236070
71140
237090
FNC population issues
May 2005
• Intrastate and interstate migration is a significant
driver of population growth on the FNC
• Migration to the FNC by retirees can be at the cost
of reduced family support and an inability to afford
to return to original location should the need arise.
• FNC has a significant aboriginal population often
clustered around particular locations. Concerns
remain that the Aboriginal population is still under
reported in ABS data
• CALD population is small, diverse and spread
across the FNC
• Population projects are hotly debated as
development along the coastal fringe continues at
a rapid pace.
FNC HACC Expenditure
98/99 - 2003/04
$3,000,000
$2,000,000
$1,000,000
$M are ss M od sp c S sp AH S
e C
A HM Fo Re o an & og
s
S Tr
N Pr
Ca ers om
D
P
May 2005
98/99
2003/04
10
0%
FNC population and HACC funding %
increases 96 - 2006
54%
20%
12%
96 -06
0%
96-06
P
n
Ge
May 2005
u
op
98 - 04
on
i
t
la
65
o
p
+
n
o
i
t
a
l
pu
C
C
HA
Percentage
n
u
F
g
n
i
d
FNC HACC funding
May 2005
• FNC Funding for HACC services has increased by
over 54% between 98 – 04 significantly higher
than population growth for the FNC Area.
• Establishment and rapid expansion of social
support services.
• Respite, Transport and Social Support service
types have received the highest level of funding
growth – underlies emphasis on expanding basic
support services.
• Services for ATSI communities has been an area
of significant growth (Access workers, targeted
Transport and Elders’ programs)
• Rapid expansion of case management services
(COPS) to enhance coordination of service
provision for people with complex needs
FNC recent Initiatives/Innovations
• Dementia projects
– Early Interventions service
– Small group home based dementia respite
– Evening Center Based Respite services.
May 2005
• FROC consortium – Collaborative
approach to accessing and managing the
allocation of respite funding
• Establishment of COPs services across
the FNC.
• Rapid increase in social support services
to reduce isolation
• Aboriginal Access Workers
• Mobile Day Service in rural locations
2005 local Issues
May 2005
• Supply versus increasing demand
• Maintaining the volunteer
base/screening of volunteers
• Increasing costs
• Meeting legislative and administrative
requirements (OH&S, Food standards)
• Access by special needs group
• Shaping the service system to meet
growing and changing needs
• Integration and navigation of the
complex and changing service provision
environment.
Delivering the HACC program
In the FNC (as is the case for all of NSW)
HACC services are delivered by a variety of
Organisations;
• State Government Agencies
• Local Government
• Large State-wide NGOs
• Large Area-wide NGOs
• Town or LGA based NGOs
• Partnerships or Consortiums of Service
Providers
• For Profit Providers
May 2005
NSW Government Service Provision
May 2005
The NSW Government delivers a significant
level of HACC funded services through 2
Government Agencies…
• NSW Health through the North Coast Area
Health Service provides Nursing, Allied
Health Care and Dementia Information
Services across the Area. NCAHS also
provides a COPS service to the
Lismore/Ballina/Byron Bay LGAs.
• Home Care Service of NSW provides
Domestic Assistance and Personal Support
across the FNC
• Aboriginal Home Care offers a broad array
of HACC services to FNC Aboriginal
communities.
Local Government
Each Council on the FNC is involved
with the HACC program in a number of
ways
• Clarence Valley Council is a significant
provider of services within its own
boundaries and across the Area.
• Tweed Council provides services within its
LGA boundaries.
• All Councils have some input into the
planning of HACC service provision
through their social planning process or
participation in HACC consultations.
May 2005
Community Based Management
29 FNC based Non Government
Organisations provide the back bone of
HACC service delivery on the FNC
• The majority are LGA focused and service
type specific (eg Brunswick Valley MOW)
• 2 flexi services covering Kyogle and
Evans Head
• A small number of larger Orgnisations
providing a variety of HACC service into
their specific LGA.
• Most if not all have a significant volunteer
work force
May 2005
Large State-wide NGOs and
For Profit Organisations
Both large State-wide NGOs and The For
Profit Providers have not been successful
in receiving HACC funding for the FNC.
(some Organisations may be receiving small
amounts of brokerage funding from HACC funded
organisations).
• DADHC’s move in early 2000 to a
competitive tendering process does not
appear to have shifted local auspice of
service provision.
May 2005
Community Based Management
May 2005
Local Community Based Management is likely to
remain the significant provider of FNC HACC
Services over the next 10 years –
however the challenges will be;
• Maintaining active local community interest
• Managing the increasingly complex
obligations/accountabilities in running an NGO,
particularly risk management issues (eg. Client
well-being, OH&S, Staff and financial
management.)
• Building expertise within and/or across local
Community Based Organisations (IT, HR, Legal
etc)
• Adapting to changing needs/demands
• Delivering a quality services – efficiently and
effectively
FNC DADHC - HACC Planning, Funding
and Service Provision issues 2006 - 16
May 2005
• Effectively and strategically managing future
increases in HACC funding for FNC.
• Ensuring equitable distribution of service provision
based on current and future populations.
• Improving inclusive planning processes
• Shaping the service system to be sustainable and
accessible.
• Focus on Planning and Service Development at
the LGA level including an emphasis on planning
partnerships with Local Government.
• Ensuring the service system is flexible enough to
adapt to new demands and responding to
emerging needs
• Development of IT capacity to improve
administrative and reporting processes.