Client record central to aged care assessments

The National Aged Care Alliance (NACA) has released a discussion paper on aged care assessments and the aged care service system, recommending that an amended PCEHR be used as the central client record being developed as part of the Aged Care Gateway.

The Gateway was developed by the Labor government after it was recommended by the Productivity Commission in its 2011 Caring for Older Australians report. The Coalition government has not confirmed that it will be fully rolled out, but has continued with the previous government's tender process for a delivery prime contractor, which will be responsible for the majority of the ICT considerations in the plan.

A central client record was to have been launched this year and linked to the PCEHR.

Last year, NACA released a paper on its views of the gateway, with recommendations on what should be included in the client record and how it should be shared with GPs and other health professionals.

“This would include a system that allows an opportunity to diagnose and treat potentially treatable or ameliorable conditions by triggering specialist medical, nursing or allied health involvement,” the paper stated.

It also emphasised that adequate investment in technology “cannot be underestimated”.

“It will be crucial that the IT systems can enable effective information transfer between the Gateway and all providers. This will need to be automated as manual uploading of data from providers will be unsustainable.

“It will be important to ensure that the new system is more efficient and places less administrative burden on providers over time. The ability for providers’ IT systems to integrate with the Gateway, eliminating the need for manual data uploading or duplication of data for different funding programs, should see longer term savings in the system.”

In the new paper, released earlier this month, NACA has made a number of recommendations about the assessment approach being considered as part of the development of the Gateway.

The current assessment approach for aged care services, including services provided to people in their own homes and residential care facilities, predominantly uses a “deficit” model, in which the assessment gathers information on the things the older person can't do and equates them to a need for existing government funded services.

NACA points out that under this approach, older people often have to provide and repeat their information many times. The Gateway is aimed at streamlining this approach, predominantly through a call centre, the centralised electronic client record system and a matching and referral service.

Supporting the assessment framework will require the Gateway to match services for the older person, handle referrals to service providers, keep the client record and manage waiting lists.

“The Productivity Commission’s original recommendations had these functions managed at the regionalised Gateway services,” the paper states. “When [the previous government] introduced the Gateway these functions were seen to be able to delivered nationally.

“The Alliance believes that these functions will be more effectively delivered by regionalised assessment services with the client record and waiting lists driven by an IT solution through the national Gateway.”

It recommends that the secure electronic client record be developed, integrated with the PCEHR and IT capacity built to support its implementation.

“The client record should be the PCEHR amended to keep details of aged care and offered on an “opt out” basis,” it says.

Under the Gateway plan, the framework for the assessments includes three levels, the first of which will be handled over the phone by staff at the call centre launched as part of the first phase of the plan in July 2013.

Level 2 assessments, in which consumers require a more substantial use of services including elements of personal care, home modification or nursing, is proposed to be conducted both by telephone and face to face.

Level 3 assessments are those in which consumers will require a more comprehensive clinical assessment for higher levels of care and will be conducted face to face.

NACA says a tool was designed and trialled for levels 1 and 2 with the aim of beginning the assessment function of the Gateway from July 1 this year. However, the trial highlighted some of the limitations of deficit-based telephone assessments, and further work is still required for the Level 3 assessment.

NACA says that as a result of the trial and the change of government, the start date for the assessment function is likely to be delayed.

Posted in Aged Care

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