HACC-anuual-report-210111

Home and Community Care Program1 July 2008 to 30 June 2009

Annual Report

2008–09 HACC Annual Report

ISBN: 978-1-74241-327-3

Publications Approval Number: D0048

© Commonwealth of Australia 2010

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney-General’s Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca

i i iHACC AnnuAl RepoRt 2008–09

Foreword

By the Minister for Mental Health and Ageing

I am very pleased to provide the foreword to the 2008-09 Home and Community Care (HACC) Annual Report. The HACC Program is a joint Australian Government and state and territory government initiative delivering services to older Australians, younger people with a disability and their carers enabling them to remain living independently in their own homes.

The report provides an overview of the HACC Program’s performance, achievements and outcomes for 2008-09. It will provide a very useful reference to providers, program managers and decision makers.

The HACC Annual Report underlines the Gillard Labor Government’s strong commitment to support the desire of many older Australians to remain living at home. Living at home means that older Australians can remain in their communities, close to friends and family. In 2008-09 the Australian Government provided around $1.1 billion in funding for the HACC Program. Together with the states’ and territories’ contributions of about $700 million, the total funding for the Program in 2008-09 was nearly $1.8 billion. As the largest community care program in Australia, HACC assisted 860,000 older Australians, younger people with a disability and their carers in that year.

The publishing of the report comes at an exciting time for the HACC Program as 2010 marks several significant milestones in the Program. Firstly, it marks the 25th anniversary of the HACC Program.

Secondly, 2010 has seen an historic agreement by the Council of Australian Governments (COAG) on the future of the HACC Program. On 20 April 2010, COAG with the exception of Western Australia reached an agreement to establish a National Health and Hospitals Network (NHHN). The agreement provides for the transfer to the Commonwealth of current aged care services, including the HACC Program except in Victoria and Western Australia.

The transfer of the HACC Program to the Commonwealth Government will be an important step in the development of an end to end aged care experience from community care services to residential care.

At 1 July 2012, the Commonwealth Government will fund and administer the HACC Program for all people aged 65 years old and over (aged 50 years for Indigenous Australians). State and territory governments will continue to administer and fund HACC services for all people under these ages.

HACC AnnuAl RepoRt 2008–09iv

I look forward to working with you and other stakeholders, including my state and territory colleagues, to ensure that there is a smooth transition process and that HACC continues to provide basic services to those in the community that require them the most.

I hope the report will provide a useful snapshot against which governments and other stakeholders can measure the progress of the program as they work through the reform process.

The Hon Mark Butler, MP

vHACC AnnuAl RepoRt 2008–09

Contents

Foreword iii

Contents v

Glossary ix

1. overview 1

Introduction to the report 1

Structure of the report 1

The HACC Program 2

History of the HACC Program 2

Governance of the HACC Program 2

Program framework 3

The Review Agreement 3

State and territory triennial plans 4

Annual state and territory business reports 4

HACC Officials 5

National Aboriginal and Torres Strait Islander HACC Reference Group 5

2. HACC at a Glance for 2008–09 6

3. program performance in 2008–09 7

Equity 7

HACC target population – KPI 1 7

HACC clients 8

Carers 9

Age and gender of HACC clients 10

Aboriginal and Torres Strait Islander people – KPI 2 12

Culturally and linguistically diverse clients – KPI 3 16

Main language spoken at home 16

Country of birth 18

HACC service types 21

Client stories 31

Effectiveness 35

Quality of Service Provision – KPI 4 35

HACC Agencies 36

Data reporting by agencies – KPI 5 39

Financial acquittal – KPI 6 40

Efficiency 41

HACC AnnuAl RepoRt 2008–09vi

Unit cost for key service types – KPI 7 41

4. Funding for the HACC program 42

5. Building the evidence Base 43

Appendix 1: HACC Mds Bulletin data tables 44

Appendix 2: HACC service types 52

Appendix 3: data Issues and Quality Considerations 54

A3.1 Participation Rates 54

A3.2 Statistical Linkage Key (SLK) 54

A3.3 Multiple Client Records 55

A3.4 State/Territory and Regional Variations 55

A3.5 Data Item-specific Considerations 56

A3.5.1 Distinct Counts of Clients 56

A3.5.2 Assistance Groups 56

A3.5.3 Location Data 56

A3.5.4 Age 56

A3.5.5 Country of Birth 56

A3.5.6 Main Language Spoken at Home 56

A3.6 Population Data 57

A3.6.1 Population Projections 57

A3.6.2 HACC Target Population 57

A3.6.3 Indigenous Population 57

A3.7 HACC Data Storage Rules 57

Appendix 4: Main languages spoken at Home 58

Appendix 5: Abbreviations 59

Appendix 6: HACC national service standards objectives 60

Appendix 7: Refined Key performance Indicators 1–7 61

Appendix 8: HACC planning Regions 63

viiHACC AnnuAl RepoRt 2008–09

List of Figures

Figure 1 KPI 1: Number of HACC clients as a percentage of the HACC target population, 2008–09 8

Figure 2 Prevalence of unpaid carer by age, 2008–09 10

Figure 3 Distribution of HACC clients by age and sex, 2008–09 11

Figure 4 HACC clients by age, 2008–09 11

Figure 5 Distribution of younger and older HACC clients by state/territory, 2008–09 12

Figure 6 KPI 2: Percentage of Aboriginal and Torres Strait Islander clients as a proportion of this group in the total population, by state/territory, 2008–09. 13

Figure 7 Comparison of Indigenous HACC clients and the Australian Indigenous population, 2008–09 14

Figure 8 HACC clients, languages other than English spoken at home, 2008–09 17

Figure 9 HACC clients, place of birth by major region, 2008–09 19

Figure 10 KPI 3: Number of culturally and linguistically diverse (CALD) clients as a proportion of this group within the target population where CALD is defined as country of birth other than Australia that is mainly non-English speaking, by state/territory, 2008–09 20

Figure 11 HACC services provided nationally, type of assistance received (,000 clients), 2008–09 22

Figure 12 NSW HACC services, type of assistance received (,000 clients), 2008–09 23

Figure 13 Victorian HACC services, type of assistance received (,000 clients), 2008–09 24

Figure 14 Queensland HACC services, type of assistance received (,000 clients), 2008–09 25

Figure 15 South Australian HACC services, type of assistance received (,000 clients), 2008–09 26

Figure 16 Western Australian HACC services, type of assistance received (,000 clients), 2008–09 27

Figure 17 Tasmanian HACC services, type of assistance received (,000 clients), 2008–09 28

Figure 18 Northern Territory HACC services, type of assistance received (,000 clients), 2008–09 29

Figure 19 Australian Capital Territory HACC services, type of assistance received (,000 clients), 2008–09 30

Figure 20 KPI 4: The percentage of eligible HACC ‘agencies’ who received a rating of ‘good’ or higher, by state/territory, 2008–09 36

Figure 21 KPI 5: The percentage of active agencies in the National Data Repository providing data to the HACC Minimum Data Set, by state/territory, 2008–09 39

Figure 22 KPI 6: The percentage of HACC funded organisations that have supplied acquittals, by state and territory, 2008–09 40

Figure 23 KPI 7: Unit cost for key service types, by state/territory, 2008–09 41

HACC AnnuAl RepoRt 2008–09vi i i

List of Tables

Table 1 HACC target population and clients, by state/territory, 2008–09 8

Table 2 HACC clients, carer status, by state/territory, 2008–09 9

Table 3 HACC clients, Indigenous status, by state/territory, 2008–09 12

Table 4 HACC clients, non-English speaking background, by state/territory, 2008–09 16

Table 5 HACC clients, place of birth, by state/territory, 2008–09 18

Table 6 Proportion of CALD clients within the HACC target population and the HACC client group, by state/territory, 2008–09 21

Table 7 HACC agencies, instances of service delivery, by state/territory, 2008–09 38

Table 8 HACC funding, 2008–09 42

appendix tables

Table A1 HACC clients, remoteness by state/territory, 2008–09 44

Table A2 HACC clients, age by state/territory, 2008–09 45

Table A3 HACC clients, sex by state/territory, 2008–09 46

Table A4 HACC clients, main language spoken at home, by state/territory, 2008–09 46

Table A5 HACC clients, country of birth by state/territory, 2008–09 48

Table A6 HACC clients, assistance type by state/territory, 2008–09 49

Table A7 Average HACC services received per client, assistance type, by state/territory, 2008–09 51

ixHACC AnnuAl RepoRt 2008–09

Glossary

Acquittal Certified financial statement of receipts and expenditure provided by a service provider to state and territory governments.

Business report A document that reports on achievements against the program objectives that are contained in the state or territory triennial plan. It contains financial and output activities of the HACC Program by region in each state or territory. Business reports are provided annually by state and territory governments and are a source of information for this annual report.

Equalisation strategy Under the equalisation strategy, the Australian Government distributes its total contribution to real growth so as to give higher levels of growth in those jurisdictions with the lowest per capita funding.

HACC Act 1985 The Home and Community Care Act 1985. The legislation relating to financial assistance to the states and territories in connection with the provision of home and community care services.

HACC Annual Bulletin This is a compilation of statistics describing HACC services published on the Department of Health and Ageing web-site.

HACC agency Generally, this relates to an eligible organisation that is responsible for the direct provision of HACC funded assistance to clients. However, this definition may vary by state or territory.

HACC region The division of a state or territory into smaller geographical areas for planning and funding purposes.

HACC target population The HACC target population is defined as people living in the community who, in the absence of basic maintenance and support services, are at risk of premature or inappropriate admission to long-term residential care, including older and frail people with moderate, severe or profound disabilities, and younger people with moderate, severe or profound disabilities.

Indexation An adjustment to funding based on cost movements in the economy as a whole.

Key performance indicator A measure used to define and evaluate program performance.

Minimum Data Set (MDS) The agreed set of data that is collected nationally and reported on by all HACC service providers.

NEC Refers to not elsewhere classified.

Non-recurrent funding One-off funding for time-limited projects.

HACC AnnuAl RepoRt 2008–09x

Output-based funding Provision of funds to regions and service providers based on an agreed number of units of service.

Outputs A unit of service. The unit of service may be time-based (e.g. one hour of home help) or product-based (e.g. one home delivered meal).

Real growth The increase in funding over a previous financial year minus indexation.

Review Agreement 2007 The revised bilateral funding agreement between the Australian Government and state and territory governments. The Agreement is the legal basis on which funds were provided by the Australian Government and state and territory governments, for the operation of the HACC Program under the Home and Community Care Act 1985.

State-wide region An administrative region to which program funds may be allocated to fund activities that have state- or territory-wide significance.

Triennial plan The mechanism through which state and territory and Australian Government ministers agree the strategic direction, priorities and allocation of funds for the program over the triennium.

1HACC AnnuAl RepoRt 2008–09

1 overview

Introduction to the report

This Home and Community Care (HACC) Program Annual Report covers the period 1 July 2008 to 30 June 2009.

It meets the operational and policy requirements under the HACC Review Agreement 2007 and the HACC Program Management Manual July 2007 that the Australian Government minister responsible for the HACC Program will publish a consolidated annual report on the performance of the program.

Structure of the report

This year, the HACC Annual Report has been structured to include reporting by all states and territories on the full range of key performance indicators that were agreed in 2007. It has also been expanded to include data information that was previously published by the Department of Health and Ageing in the Home and Community Care Minimum Data Set Annual Bulletin.

Chapter 1 of this report provides an overview of the HACC Program including information on policy, governance arrangements and a brief history of the program.

Chapter 2 provides a brief statistical highlight of HACC services in 2008–09. It gives an interesting snapshot of what the statistical HACC client looked like for 2008–09.

Chapter 3 outlines the program’s performance for 2008–09. This chapter reports on access to services, quality of those services and the efficiency of the program in delivering those services. This chapter explores the first year of full reporting on seven key performance indicators that were agreed during the negotiation of the HACC Review Agreement in 2007.

Chapter 4 presents funding information on the program for 2008–09, both nationally and by state and territory.

Chapter 5 provides a brief snapshot of a number of research projects undertaken by states and territories that explore varying aspects of the HACC Program during 2008–09.

This report also has several appendices which provide key definitions and information relating to data used in this report, the definitions of HACC service types, a list of the HACC National Service Standards, the key performance indicators methodologies and an explanation of the abbreviations used in this report. Additionally, Appendix 8 includes maps of each HACC region and specific commentary relating to those regions.

HACC AnnuAl RepoRt 2008–092

The HACC Program

The HACC Program is a jointly funded Australian Government and state and territory government initiative. The program provides funding for services that support people who live at home and whose capacity for independent living is at risk, or who are at risk of premature or inappropriate admission to long-term residential care.

History of the HACC Program

Prior to 1985, community care in Australia was provided through four separate programs:

• the Home Nursing Subsidy Act 1957;

• the States Grants (Home Care) Act 1969;

• the States Grants (Paramedical Services) Act 1969; and

• the Delivered Meals Subsidy Act 1970.

A number of reports and inquiries in the early 1980s identified issues with the adequacy of these community programs to respond effectively to community needs. These reports suggested that existing community services were found to be unevenly distributed, could not meet demand and had insufficient resources to provide the required range of services to adequately support the frail aged and people with a disability to remain living independently within the community.

Two important reports discussing these concerns at that time were ‘In a Home or At Home: Accommodation and Home Care for the Aged’, McLeay Report, House of Representatives Standing Committee on Expenditure, 1982, and ‘Older People at Home’, Department of Social Security and Australian Council on the Ageing, 1985.

To address these community concerns, the HACC Program was announced in the Commonwealth Budget for 1984-85 and established by the Home and Community Care Act 1985. The Act authorised the minister to enter into an agreement with each state to give effect to the program. Responsibility for the HACC Program was shared between the Commonwealth and state and territory governments with the Commonwealth providing on average 60% of the funding.

The program’s formal commencement date was 1 July 1985. However, the program was not fully operational until September 1985 and even later in some states.

Governance of the HACC Program

Nationally, the Australian Government contributes approximately 60% of program funds, with the remaining funding being provided by state and territory governments. In addition, some state and territories and local governments allocate extra funding to that provided by the Australian Government and state and territory governments’ matched funds for the HACC Program.

The Australian Government’s role is to provide national leadership for policy development and to improve the effectiveness and efficiency of the program. State and territory governments are responsible for the day-to-day administration of the HACC Program and the provision of services within their jurisdiction.


1

Overview

Program framework

The Home and Community Care Act 1985 (‘the Act’) is the legislation under which the Australian Government provides funds to state and territory governments for the provision of HACC services.

The HACC Review Agreement 2007 (‘the Review Agreement’) is the legal agreement between the Australian Government and each state and territory government, and sets out the conditions attached to the provision of Australian Government funding for the program.

The HACC Program Management Manual July 2007 (‘the Manual’) sets out the procedures agreed between the two levels of government for implementing the arrangements in the Review Agreement.

The National Program Guidelines for the HACC Program 2007 (‘the Guidelines’) interpret the Review Agreement and provide policy advice on the operation of the program for service providers and the community.

The HACC Minimum Data Set (MDS) is a set of nationally agreed data items that is collected by all HACC service providers about their clients. The objectives of the HACC MDS are to:

• provide HACC program managers with information to assist with policy development, strategic planning and performance monitoring;

• assist HACC service providers with planning for, and providing, high-quality services to their clients by facilitating improvements in the management of HACC funded service delivery; and

• facilitate consistency and comparability between HACC data and other collections of data covering the community care and health fields.

Information from the MDS, as well as demographic data, is used by both levels of government to assist in planning priorities for the program. All information collected is de-identified to ensure clients’ privacy is protected.

All data in this report, unless otherwise stated, are sourced from the HACC MDS. The footnotes to the tables in each section refer to any other sources of data used.

The Review Agreement

Since the introduction of the Home and Community Care Act 1985, the HACC Program has operated under a series of agreements negotiated between the Australian Government and state and territory governments to guide the delivery of services under the Act. The initial agreement, negotiated in 1985, was titled the Principal Agreement.

The Principal Agreement was replaced in 1999 with the second agreement, known as the Amending Agreement. This was negotiated to develop a more comprehensive range of integrated home and community care services for the target group, and to implement measures for more efficient and effective management of services delivered under the Act.

In July 2007, the Amending Agreement was replaced with the current agreement titled the Review Agreement. The renegotiation of the Amending Agreement provided an opportunity for governments to propose changes that would allow greater flexibility and more robust accountability. The Review Agreement saw a focus on developing mechanisms to simplify access for people to the program,


targeting resources more effectively through streamlining planning processes and introducing performance indicators to improve program accountability.

State and territory triennial plans

The Review Agreement provided for new three-year planning cycles, supported by an annual supplement process. The three-year planning period allows for a comprehensive and evidence-based triennial plan to be developed, and facilitates a strategic long-term focus in the program. In addition, triennial plans are designed to provide more certainty to the community care sector than the previous annual plans, facilitating better planning by service providers. In 2008–09, the HACC Program was in the first year of the triennial planning cycle.

annual state and territory business reports

State and territory business reports are the reporting mechanism for ensuring that the program is accountable for the funds provided to it. Under the terms of the Review Agreement, state and territories are required to provide annual business reports by 31 December each year, reporting on the previous financial year.

HACC service providers report to their state or territory government on outputs achieved, and this information is then collated by state or territory governments into regional information and forwarded to the Australian Government minister in an annual business report.

Business reports include information about regional expenditure, service outputs and service quality against the service priorities specified in the triennial plans. They are also a source of information for this Annual Report through reporting against key performance indicators.

A significant inclusion in the Review Agreement was agreement to a performance assessment framework comprising seven performance indicators. The following seven key performance indicators (KPIs) were initially agreed in the Review Agreement:

KPI 1 Number of clients as a percentage of the HACC target population

KPI 2 Percentage of Aboriginal and Torres Strait Islander clients as a proportion of this group in the total population

KPI 3 Percentage of culturally and linguistically diverse people as a proportion of this group within the target population

KPI 4 Percentage of service providers who received a rating of ‘good’ or higher over the three-year cycle

KPI 5 Percentage of agencies providing data to the HACC MDS

KPI 6 Percentage of agencies that have supplied an acquittal

KPI 7 Average unit cost for key service types.

In 2008–09, the Australian Government and states and territory governments have made good progress towards achieving a consistent and meaningful framework. Definitions and methodologies were agreed in 2008–09 for the first five performance indicators to support consistent reporting by all states and territories. Additional work on KPIs 6 and 7 was completed in the second half of 2009 to complete the refinement of all of the initial key performance indicators.


1

Overview

The refined indicators including methodologies and data collection for KPIs 1-7 are at Appendix A7.

HaCC officials

HACC Officials is a national group consisting of senior officials responsible for the HACC Program from each state and territory and the Australian Government. HACC Officials is a sub-committee of the Community Services and Disability Ministers’ Advisory Council, which reports to the ministers responsible for community services portfolios. The responsibilities of HACC Officials include:

• developing strategies on issues of national significance to the HACC Program including policy priorities;

• enhancing collaboration between the Australian Government and state and territory governments in monitoring the efficiency and effectiveness of the HACC Program in meeting its objectives; and

• developing mechanisms to achieve national consistency in the HACC Program.

national aboriginal and torres Strait islander HaCC reference group

The National Aboriginal and Torres Strait Islander HACC Reference Group was formed in 1997 to provide input into national HACC issues and policy and planning processes, with the aim of ensuring that the HACC Program effectively meets the needs of Aboriginal and Torres Strait Islander people. The Reference Group reports to HACC Officials, and its other objectives are to:

• provide leadership to the national HACC Program on matters of interest to Aboriginal and Torres Strait Islander people;

• advise the national HACC Program on strategies to improve its services;

• provide advice on policy and planning processes, implementation and service delivery issues;

• promote debate and discussion on the needs, interests and aspirations of Aboriginal and Torres Strait Islander people within the national HACC Program; and

• provide advice to other key agencies in order to enhance a cross portfolio/agency approach to the issues related to Aboriginal and Torres Strait Islander people in the HACC target group.

Recent reforms to the community care sector being undertaken by the Australian Government under the National Health and Hospitals Network Agreement will involve consideration of the current governance structure (including HACC Officials and the National Aboriginal and Torres Strait Islander HACC Reference Group) of the HACC Program.


2 HACC at a Glance for 2008–09

During 2008-09, approximately 862,500 clients were reported as receiving HACC services. This was an increase of around 31,000 people compared to 2007-08.1

Statistically, in 2008–09 the average HACC client was a 72-year-old woman born in Australia. She spoke English at home, lived with her family and received on average four hours of HACC services a month. This service was most likely to be one type of support, such as domestic assistance. If she received a combination of services, it was likely to include centre-based day care, meal delivery and transport.

Where Indigenous status was recorded, approximately 2.7% (21,000 people) of all HACC clients identified as being of Aboriginal or Torres Strait Islander origin.

Domestic assistance was provided to 31.6% of HACC clients, totalling 8.1 million hours of assistance in 2008–09.

Around 16% of clients received a total of 1.1 million hours of assistance with the maintenance and repair of their home, garden or yard.

Nearly 4.7 million hours of personal care services were provided to 10% of clients, including showering, toileting, eating, dressing and grooming.

A high number of HACC clients received meal services. These were largely meals at home for 105,700 clients and centre-based meals for 49,000 clients. A smaller number of clients (5,400) received assistance with the preparation of food in their own homes.

In 2008–09, 2.7 million hours of nursing care were provided to 20% of HACC clients in their homes, and 501,000 hours of allied health care were provided to 10% of all HACC clients in their homes.

Where country of birth was recorded, approximately 28% of HACC clients indicated being born in a country other than Australia.

Assistance was provided to HACC clients by over 3,300 different HACC agencies across Australia.

Carers who were a spouse or partner were just under half (45%) of the carers reported; 29% were a son or daughter; 16% were a parent; and 3% were a friend or neighbour.

A total of $1.78 billion was available for the HACC Program nationally in 2008–09, representing both Australian Government and state and territory government contributions.

Notes

1. Based on HACC MDS data for 2007-08 and 2008-09. Please note the number of clients reported in the 2007-08 HACC Annual Report was 835,269; this was higher than the number of clients reported through the HACC MDS for the same period (831,472). The number of clients reported in the 2007-08 HACC Annual Report was derived from two sources: client numbers for South Australia and New South Wales were provided through Business Reports in December 2008; all other states’ and territories’ client numbers were sourced from the HACC MDS.


3 program performance in 2008–09

In 2007, the Australian and state and territory governments identified the importance of appropriate mechanisms to provide assurance that the HACC Program is delivering quality, appropriate and consistent service provision. A performance assessment framework comprising seven indicators was agreed to be implemented across the program with the intention of measuring three key outcomes:

• Equity: KPIs 1, 2 and 3 report on the program’s performance in relation to equity of access.

• Effectiveness: 2008–09 program effectiveness regarding appropriateness and quality of services is measured by KPIs 4, 5 and 6.

• Efficiency: the final measure is program efficiency and is measured as a unit cost indicator, KPI 7.

This 2008–09 annual report is the first year of full reporting by states and territories on the complete range of performance indicators.

Equity

HaCC target population – KPi 1

The HACC target population is defined in the Review Agreement as people in the community who, without basic maintenance and support services provided under the scope of the national program, would be at risk of premature or inappropriate admission to long-term residential care. This can include older and frail people with moderate, severe or profound disabilities, and younger people with moderate, severe or profound disabilities.

While the terms ‘older’ and ‘frail’ are used in the definition, eligibility for HACC services is based on the level of difficulty that people experience in carrying out tasks of daily living. Individuals over any particular age are not eligible for HACC services simply based on their age alone, but because they have difficulties in carrying out tasks of daily living and need assistance due to an ongoing moderate, severe, or profound functional disability.

Within the HACC target population there are several groups that may find it more difficult than most to access services. These are people from culturally and linguistically diverse backgrounds, and Aboriginal and Torres Strait Islander people. Both these client groups are discussed in further detail in the next section.

The HACC target population is estimated by applying the age and sex specific rates of the population living in the community with a moderate, severe or profound core activity restriction (as reported in the ABS 2003 Survey of Disability, Ageing and Carers) to population estimates for the period of 2006–2026.

The HACC target population calculation is used by the Australian Government to determine the allocation of HACC funding between states and territories.

The national HACC target population for 2008–09 was determined as being 1,938,805 people. The 862,488 HACC clients who received assistance during 2008–09 equated to 44.5% of the target population.


Table 1. HACC target population and clients, by state/territory, 2008-09

nsW VIC Qld sA WA tAs nt ACt Australia

Number of people

Target population

570,913 468,410 438,546 165,269 197,891 56,555 12,566 28,654 1,938,805

HACC clients

233,069 264,783 163,534 93,174 66,422 26,607 3,607 11,292 862,488

HACC clients (% of target population)

total 40.8% 56.5% 37.3% 56.4% 33.6% 47.0% 28.7% 39.4% 44.5%

Notes

1. The proportion of HACC funded agencies that submitted HACC MDS data for 2008–09 differed across jurisdictions, and ranged from 89% to 100%.

2. State/territory refers to the location of service providers.

HaCC clients

Clients of the program include not only those people in the community who are experiencing a level of difficulty with the tasks of daily living, but also the carers of those clients. They include Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, people suffering from dementia, financially disadvantaged people, and those living in remote or isolated areas of Australia.

Victoria had the largest portion of reported HACC clients with 264,783 Victorians receiving HACC services (Table 1). The greatest proportion of the target population reported as receiving HACC services was in Victoria (56.5%), the Northern Territory reported as having the lowest proportion (28.7%).

Reporting on the number of clients as a percentage on the HACC target population is a program performance indicator. It is an important measure of equity of access, and Figure 1 demonstrates the extent to which the HACC target population was reached by states and territories in 2008–09.

Figure 1 – KPI 1: Number of HACC clients as a percentage of the HACC target population, 2008–09

0

10

20

30

40

50

60

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Perc

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Notes

1. Results are supplied by states and territories in annual business reports and may not be directly comparable.


3

Program

Perform

ance in 2008–09

It must be noted, however, that the agency participation rate, structure and content of the aged care programs, including interfaces between HACC and other programs, will affect the number of clients in each state and territory. It should also be noted that data was not calculated using the same method for all jurisdictions for 2008–09 and performance information may not be comparable.

The distribution of HACC clients across the nation tends to roughly reflect the overall population distribution of the states and territories, although on this basis there is slight under-representation of HACC clients in major cities and an over-representation in regional areas.

Nationally, the majority of clients, 61%, lived in major cities and 36% in regional areas. Inner regional HACC clients accounted for 24.4% of all HACC clients followed by 11.5% for outer regional clients, 1.5% for remote clients and 0.6% for very remote clients.

In the Northern Territory, 51% of HACC clients lived in outer regional areas, which includes Darwin, and 27% in very remote areas. Comparatively high proportions of HACC clients in Tasmania (35%), South Australia (19%) and Queensland (17%) lived in outer regional, remote or very remote locations.

Carers

Carers who provide the majority of care for frail older people and younger people with a disability play an important role in the community and contribute enormously to the quality of life of the person receiving care. Services specifically designed for carers, such as respite and counselling, are provided through the HACC Program to assist them in their caring role.

Where carer status was recorded, approximately a third (32%) of HACC clients nationally reported that they received assistance from a carer (Table 2).

Table 2. HACC clients, carer status by state/territory, 2008–09


Carer Availability Number of clients

Has a Carer 60,833 77,165 53,153 21,476 19,043 6,319 1,480 2,874 242,343

Has no Carer 146,605 148,788 83,482 57,746 43,263 17,916 1,768 6,384 505,952

Total (excluding not stated)

207,438 225,953 136,635 79,222 62,306 24,235 3,248 9,258 748,295

Not Stated 25,631 38,830 26,899 13,952 4,116 2,372 359 2,034 114,193

Per cent (excluding not stated)

Has a Carer 29.3% 34.2% 38.9% 27.1% 30.6% 26.1% 45.6% 31.0% 32.4%

Has no Carer 70.7% 65.8% 61.1% 72.9% 69.4% 73.9% 54.4% 69.0% 67.6%

Notes



3. If a client has a paid carer or a formally arranged volunteer carer, the carer status is recorded as ‘has no carer’ because the focus of the item is on the existence of informal arrangements with family members, friends and neighbours.


For those HACC clients who reported having a carer, about three-quarters (77%) had the carer living with them. This ranged from 73% in the Australian Capital Territory through to 81% in New South Wales. Just under half (45%) of the carers were the spouse or partner of the HACC client, 29% were a son or daughter, 16% were a parent, and 3% were a friend or neighbour.

HACC clients aged 85 years and over were more likely to have a carer than those aged less than 85 (Figure 2). Men (40%) were more likely to receive the assistance of a carer than women (29%). HACC clients whose country of birth was recorded as Australia (32%) were less likely to have a carer than those born in Asia (37%), Southern and Eastern Europe (36%), and North Africa and the Middle East (34%), but slightly more likely than those born in North West Europe (29%).

Figure 2. Prevalence of unpaid carer by age, 2008–09

age and gender of HaCC clients

Generally in Australia, women outnumber men in all groups over the age of 30. In 2008–09 this pattern is also evident in the HACC client population, women comprising approximately two-thirds (64%) of the HACC client population (Table A3). There were more women than men for all but the youngest categories (under 30 years), and the sex imbalance increases with increasing age (Figure 3). The largest age cohort of HACC clients is the 80-84 age group, and this is the case for both male and female clients.

Has carerNo carer

120 100 80 60 40 20 0 20 40 60 80

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75–79

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Age

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Figure 3. Distribution of HACC clients by age and sex, 2008–09

People aged 65 years or over accounted for 77.0% of all HACC clients in 2008–09, while those 75 years or over accounted for 57.6%.

Figure 4. HACC clients by age, 2008–09

Males Females

80 60 40 20 0 20 40 60 80 100 120

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90–94

85–89

80–84

75–79

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During the 2008–09 reporting period, 197,801 people aged less than 65 years received HACC services, accounting for 23.1% of all HACC clients. The average age of these clients was 44.9 years. As demonstrated in Figure 5, the distribution of younger HACC clients varied between states and territories, the highest ratio of younger clients being in the Northern Territory (44.0%). This is, in part, related to the high proportion of Aboriginal and Torres Strait Islander HACC clients in the Northern Territory. New South Wales had the lowest percentage of younger clients with 20.4% of clients being aged 64 or less.

Figure 5. Distribution of younger and older HACC clients by state/territory, 2008–09

aboriginal and torres Strait islander people – KPi 2

In 2008–09, approximately 2.7% (21,000 people) of all HACC clients, where Indigenous status was recorded, were identified as being of Aboriginal or Torres Strait Islander origin (Table 3). This proportion ranged from less than 1% in Victoria to 46% in the Northern Territory. Indigenous status was not recorded for 10% of HACC clients.

Table 3. HACC clients, Indigenous status, by state/territory, 2008–09


Indigenous status Number of clients

Indigenous 7,959 2,223 4,020 2,333 2,348 475 1,570 104 21,032

Non-Indigenous 208,078 234,880 137,625 82,182 59,880 23,712 1,810 9,518 757,685


216,037 237,103 141,645 84,515 62,228 24,187 3,380 9,622 778,717

Not Stated 17,032 27,680 21,889 8,659 4,194 2,420 227 1,670 83,771


Indigenous 3.7% 0.9% 2.8% 2.8% 3.8% 2.0% 46.4% 1.1% 2.7%

Non-Indigenous 96.3% 99.1% 97.2% 97.2% 96.2% 98.0% 53.6% 98.9% 97.3%

Notes



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%)

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Within the HACC KPI framework, KPI 2 was introduced to measure the extent to which Aboriginal and Torres Strait Islander people accessed HACC services. In 2008–09, states and territories reported on the percentage of Aboriginal and Torres Strait Islander clients as a proportion of this group in the total population. Figure 6 demonstrates the percentage of clients reached by states and territories in 2008–09.

Aboriginal and Torres Strait Islander people have higher rates of disability and illness reported than the overall Australian population. As such, Aboriginal and Torres Strait Islander people have been identified as a special needs group within the HACC Program. One indication of success in targeting a special needs group is whether that group is over-represented in the HACC client population when compared to their overall population prevalence. For this KPI, results greater than 100% indicate that Aboriginal and Torres Strait Islander people are accessing HACC services at a rate higher than expected from their population prevalence.

Figure 6. KPI 2: Percentage of Aboriginal and Torres Strait Islander clients as a proportion of this group in the total population, by state/territory, 2008–09.

Notes

1. The proportion of HACC funded agencies that submitted HACC MDS data 2008–09 differed across jurisdictions and ranged from 89% to 100%.


3. Nationally, the data item Indigenous status has a combined null and not stated response of 9.7%.

4. Percentages have been adjusted, distributing null and not stated responses on a pro rata basis.

As can be seen in Figure 6, New South Wales has the highest proportion of Aboriginal and Torres Strait Islander clients when compared to their overall population prevalence, and Tasmania the lowest. The proportion of all HACC clients who are of Aboriginal or Torres Strait Islander background in New South Wales is 1.68 times higher (i.e. 168%) than would be expected by population prevalence. By contrast, the proportion of Aboriginal and Torres Strait HACC clients in Tasmania is about half (53%) that expected from the population prevalence of this client group.

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A comparison of the proportion of the population from an Aboriginal or Torres Strait Islander background and the proportion of HACC clients who are from an Aboriginal or Torres Strait Islander background shows a strong representation of Indigenous clients within the HACC client group. Some 2.5% of the Australian population is identified as coming from an Indigenous background, while 2.7% of HACC clients are reported as such. Figure 7 shows this data by state and territory and nationally.

Figure 7. Comparison of Indigenous HACC clients and the Australian Indigenous population, 2008–09

Notes



3. Nationally, the data item Indigenous status has a combined null and not-stated response of 9.7%.

4. Percentages have been adjusted, distributing null and not-stated responses on a pro rata basis.

The most significant issue affecting the reporting of Aboriginal and Torres Strait Islander HACC client numbers is the reporting of Indigenous status during the initial HACC assessment. Assessments either do not collect or are not given a response to this data item for reporting in the MDS. Appendix A3 contains further information on areas of differences with data items.

The HACC Program is also committed through the Review Agreement to adhering to the principles of the National Framework of Principles for Delivering Services to Indigenous Australians when delivering services.

The following case study, Galiwin’ku HACC Service Medication Supervision Program, supplied by the Northern Territory Government, is an example of service delivery that supports both the principles of the program and the National Framework in providing services to Aboriginal and Torres Strait Islander clients.

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State/Territory

Perc

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of

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Australian Indigenous Population

Indigenous HACC Clients


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Galiwin’ku HACC service Medication supervision program

east arnhem Shire Council (eaSC) provides HaCC services to frail aged and people with a disability within the east arnhem Shire communities of angurugu, galiwin’ku, gapuwiyak, gunyangara, millingimbi, ramingining, umbakumba, yirrkala and milyakburra.

galiwin’ku is a large indigenous community situated on elcho island. the local HaCC service (the service) provides eligible clients with meals on wheels, personal care, respite care, domestic assistance, transport, home maintenance and social support and has expanded this to include a Breakfast Program, medication Support and medication Supervision Program. the Breakfast Program allows people who are considered to be at risk of malnutrition or who require medication to be taken with food to have a healthy breakfast up to five days a week. the medication Supervision Program is for people who are at risk of requiring urgent medical attention if medications are not taken regularly. it was identified that clients could benefit from assistance with medication monitoring and supervision.

in november 2009, as a result of the development of a strong working relationship with ngalkanbuy Health (the local health clinic), the service introduced medication Support and medication Supervision as ongoing programs. ngalkanbuy Health orders all medications for both programs. Clients receiving medication support have their medications delivered to their homes by the service. the supervision of medications is a partnership program: the service supervises clients taking their morning medications monday to Fridays; and ngalkanbuy Health supervises clients taking their evening medications monday to Friday and all medications during weekends and public holidays. in line with organisational best practice, these programs were conceptualised and piloted.

after consultation with clients, carers, ngalkanbuy Health, and with the assistance of yolngu staff, the service began delivering medications in blister or multi-dose packs to 15 clients a week. the success of the medication Support Program required the participation of the client, family and carers who returned medication packages to yolngu staff on a regular basis. any issues were reported to ngalkanbuy Health, allowing for early intervention.

the introduction of the HaCC medication Supervision Program has reduced avoidable medical evacuations due to non-compliance with medical regimes and the impact on clinic staff has been lessened. most noticeable, however, is the positive difference this program has made to the lives of HaCC clients and their carers in the galiwin’ku community.


Culturally and linguistically diverse clients – KPi 3

The HACC Program reflects the fact that Australia is a culturally diverse nation. Just over one-quarter of clients (28%) were born outside Australia (Table A5). Diversity in country of birth and language spoken at home are two ways that this group is reported on in the program.

Information relating to both measures is provided below.

Main language spoken at home

In 2008–09, a language other than English was the main language spoken at home for approximately 10% of HACC clients for whom language status was recorded. This ranged widely from 3% in Tasmania to 41% in the Northern Territory (Table 4).The main language spoken at home was not recorded for 7% of HACC clients nationally.

Table 4. HACC clients, non-English speaking background status, by state/territory, 2008–09


Main language spoken at Home

Number of Clients

English 195,291 215,188 140,922 76,852 57,073 24,327 1,950 8,898 720,501

Other 23,712 31,792 5,876 10,031 5,626 757 1,374 1,041 80,209


219,003 246,980 146,798 86,883 62,699 25,084 3,324 9,939 800,710

Not Stated 14,066 17,803 16,736 6,291 3,723 1,523 283 1,353 61,778


English 89.2% 87.1% 96.0% 88.5% 91.0% 97.0% 58.7% 89.5% 90.0%

Other 10.8% 12.9% 4.0% 11.5% 9.0% 3.0% 41.3% 10.5% 10.0%


100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Notes




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There were 122 individual languages reported in the 2008–09 dataset. While about 90% of clients reported English as their main language, Greek and Italian were the most common of the other languages spoken by HACC clients (representing 27% and 14% respectively of clients who spoke a language other than English). Australian Indigenous languages were the most common languages other than English in the Northern Territory and the second most common in Western Australia. Other languages that were significant in individual states and territories included Polish in Tasmania, South Australia and Western Australia, Spanish and Croatian in the Australian Capital Territory and Arabic in New South Wales. The frequency of use of the top 20 most spoken languages other than English is provided in Table A4. Figure 8 demonstrates the frequencies of these languages on a national basis.

Figure 8. HACC clients, languages other than English spoken at home, 2008–09

Notes



3. Null and not-stated responses have been excluded.

4. Non-verbal languages have been included in the ‘Other languages, nec’ section due to unreliable data.

5. Netherlandic refers to Dutch and related languages. These may include Flemish, Vlaams and Frisian, but does not include other Dutch related languages such as Afrikaans.

0 5 10 15 20 25 30

Other languages, nec

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Greek

Arabic (including Lebanese)

Cantonese

Polish

Vietnamese

Aboriginal Languages

Spanish

Croatian

Russian

German

Macedonian

Mandarin

Maltese

Netherlandic

Serbian

Turkish

Hungarian

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Number of HACC clients (’000)

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Country of birth

In 2008–09 approximately 28% of HACC clients indicated that they were born in a country other than Australia (Table 5). About 11% were born in North West Europe (including the United Kingdom), 10% in Southern and Eastern Europe, and 3% in Asia. The Northern Territory had the lowest percentage of HACC clients with a birthplace outside Australia (17%), and Western Australia reported the highest percentage of HACC clients with a birthplace outside Australia (39%). Country of birth was not recorded for 6.3% of HACC clients.

Table 5. HACC clients, place of birth, by state/territory, 2008–09


Country of Birth Number of clients

Australia 168,134 170,333 115,406 59,275 38,109 21,296 2,817 6,680 582,050

Outside Australia 56,662 77,919 30,300 28,481 24,323 4,353 568 3,806 226,412


224,796 248,252 145,706 87,756 62,432 25,649 3,385 10,486 808,462

Not stated 8,273 16,531 17,828 5,418 3,990 958 222 806 54,026


Australia 74.8% 68.6% 79.2% 67.5% 61.0% 83.0% 83.2% 63.7% 72.0%

Outside Australia 25.2% 31.4% 20.8% 32.5% 39.0% 17.0% 16.8% 36.3% 28.0%

Notes





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Figure 9 demonstrates the distribution of countries of birth on a regional basis.

Figure 9. HACC clients, place of birth by major region, 2008–09

Notes




Reporting on numbers of culturally and linguistically diverse (CALD) clients not only occurs within the data collected in the MDS, but is also reported in state and territory business reports as a measure of equity of access under the program’s KPI framework. KPI 3 is the number of CALD people as a proportion of this group within the target population.

The purpose of reporting on this KPI is to measure the current effectiveness of the program in meeting the needs of the CALD population, aiming to improve access for this group to HACC services. As with the other KPIs, comparative information will verify good performance, best practice and foster more culturally appropriate services to those clients already receiving services.

Figure 10 reports on KPI 3 and shows the percentage of CALD clients as a proportion of this group in the HACC target population. In South Australia, 78% of all CALD people within the HACC target population accessed HACC services. In the Australian Capital Territory this figure was 33%.

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Figure 10. KPI 3: Number of culturally and linguistically diverse (CALD) clients as a proportion of this group within the target population where CALD is defined as country of birth other than Australia that is mainly non-English speaking, by state/territory, 2008–09

Notes



3. People speaking Aboriginal languages are not considered from a CALD background in this data.


5. CALD HACC target population is based on numbers of people from countries other than Australia that are mainly non-English speaking.

Primary language spoken at home has been used as the method to identify CALD status for the purposes of KPI 3 for 2007–08 by states and territories, except for New South Wales. For the 2007–08 reporting period, there was not an agreed methodology for calculating KPI 3 and, as such, states and territories reported on KPI 3 using a basic level of information that was collected by state and territory governments in the HACC MDS.

For 2008–09, KPI 3 is reported as the number of CALD clients as a proportion of this group within the target population, where CALD is defined as country of birth other than Australia that is mainly non-English speaking.

Nationally, the proportion of HACC clients from a CALD background is lower than would be expected based on the proportion of people in the HACC target population from a CALD background. This pattern holds for all jurisdictions other than South Australia, Western Australia and Tasmania (Table 6).

Of the Australian HACC target population, 17% are identified as coming from a CALD background, and 17% of the HACC client group is reported as coming from a CALD background. Victoria and the ACT have the highest representation of CALD clients (22% of all clients). Tasmania contains the lowest proportion of CALD clients (8%).

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Table 6. Proportion of culturally and linguistically diverse (CALD) clients within the HACC target population and the HACC client group, by state/territory, 2008-09


population Group Per cent

% of target population identified as CALD

18.7% 24.2% 9.5% 12.7% 12.9% 7.4% 25.1% 26.8% 16.7%

% of HACC Clients identified as CALD

17.1% 21.9% 9.0% 17.4% 17.4% 8.1% 10.3% 22.3% 16.9%

Note




5. CALD HACC target population is defined as people with a country of birth other than Australia that is mainly non-English speaking.

HaCC service types

HACC agencies provide a wide range of types of assistance, as described in Appendix 2. The most common types of assistance nationally are an initial assessment for services (323,000 clients) and domestic assistance, which was provided to 272,000 clients in 2008–09.

There are some notable differences between states and territories in the proportion of clients receiving different types of assistance, some of which may be related to state differences in reporting.

Nationally, 18% of all clients received transport services (26% if Victorian clients are excluded where transport services are not reported separately). More than 26% of clients received this service in the Northern Territory (40%), Western Australia (33%) and New South Wales (29%) (Table A6).

HACC clients in the Northern Territory were more likely to receive social and instrumental support services (such as counselling, case management, domestic assistance, meal assistance) and less likely to receive nursing services at home and allied health than the overall HACC population. Agencies in Queensland, Tasmania and Victoria provided nursing care at home to higher proportions of clients (27%, 24% and 22% respectively) than the national average. Nationally just over one in five HACC clients (21%) received nursing care at home. Nursing care and allied health care can be provided both in the client’s home and at a community centre.

The highest average hours of service, by assistance type, during the 2008–09 collection period was for centre-based day care. HACC clients who received centre-based day care for one or more quarters received on average 132 hours over the year – an increase of 2 hours per client over the previous year. The next highest averages were: 85 hours for respite care, 53 hours for personal care, and 38 hours for social support (Table A7).

It must be noted that average hours of care are a rough measure of service provision and do not reflect the experiences of all individuals. Differences in average hours per instance of assistance between assistance type reflects differences in the nature of the assistance provided, the varying intensity of service provided, the differing lengths of time clients receive services throughout the year, and some clients receiving services throughout the entire year and others for only short periods. Figure 11 shows the different types of assistance provided to HACC clients nationally. Figures 12 through to 19 provide this information for each state and territory.


Figure 11. HACC services provided nationally, type of assistance received (,000 clients), 2008–09

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Allied Health Care (Centre)

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Carer Counselling Support

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Figure 12. NSW HACC services, type of assistance received (,000 clients), 2008–09

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Domestic Assistance


Aids for Reading

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Figure 13. Victorian HACC services, type of assistance received (,000 clients), 2008–09

Notes

1. Victoria’s data collection does not distinguish between Home Maintenance and Home Modification, and does not collect for Transport or Other Food Services.

2. Validation processes for the Victorian Data Repository and the HACC MDS differ, and actual service levels may be up to 5% higher or lower than stated. In the case of Respite Care, the Victorian Data Repository recorded service levels 50% higher than stated.

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Figure 14. Queensland HACC services, type of assistance received (,000 clients), 2008–09

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Domestic Assistance


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Figure 15. South Australian HACC services, type of assistance received (,000 clients), 2008–09

Note

1. Validation processes for South Australian data differ from HACC MDS. As a result actual services may be up to 5% higher than shown in this table.

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Figure 16. Western Australian HACC services, type of assistance received (,000 clients), 2008–09

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Figure 17. Tasmanian HACC services, type of assistance received (,000 clients), 2008–09

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Figure 18. Northern Territory HACC services, type of assistance received (,000 clients), 2008–09

Note

1. Data not collected separately on home modifications.

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Figure 19. Australian Capital Territory HACC services, type of assistance received (,000 clients), 2008–09

Note

1. Nursing hours in the ACT are under-reported for 2008/09.

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Client stories

While services delivered under the HACC Program are easy to describe statistically, a harder concept to capture and report on is how services make a daily difference to the lives of HACC clients.

Over the years, innovation and flexibility in delivering services is a widely acknowledged strength of the program. The Wellness Approach from Western Australia describes an emerging approach to the delivery of services that is delivering significant benefits to the clients whose stories are below.

In March 2006, the WA HACC Program adopted a Wellness Approach for the future delivery of HACC services across the state. A Wellness Approach to service delivery involves redesigning the model of service delivery in community care, starting from the premise that people who are frail or disabled as a result of chronic disease or injury have the capacity to make gains in their physical, social and emotional wellbeing and can continue to live autonomously and independently in the community if positively supported to do so. The Western Australian Government has provided the following case studies. They have been collected from HACC agencies in Western Australia who are implementing the Wellness Approach to service delivery.


the Wellness Approach in HACC

praise and encouragement works wonders with Helen.

Helen was referred for shower assistance three times a week and in-home respite for her husband Bob. Helen has dementia. Though she mobilised well, she rarely spoke – Bob spoke on her behalf during the Wellness Assessment.

Bob explained that he would choose his wife’s clothes, undress her, assist with 90% of her personal care and then fully assist with dressing Helen. Bob was finding the process increasingly stressful.

As part of the assessment and support agreed upon, Helen was encouraged to complete more personal care tasks. She is now choosing her own clothing. She also showers herself while being verbally prompted by her husband. Helen has continued to improve and has found a new sense of dignity in her presentation. Verbal prompts, praise and encouragement have replaced physical assistance.

Wellness Assessment identifies Anna’s real needs

82-year-old Anna lives alone and has been receiving two hours domestic assistance every fortnight for many years.

The Wellness Assessment revealed that Anna was able to care for her dogs and maintain a veggie patch in the garden. She also cleaned the house before the support worker arrived. The assessment determined that Anna could clean her own home independently.

It also became clear in the assessment that Anna was cleaning the house so the support worker would have time to talk to her. She was socially isolated.

An alternative service has been provided that links Anna back into the Italian Club and community. Anna no longer receives an unneeded service and is much happier to be getting back to the club.

“At the club, I saw Isabella, an old friend from church.”

dan is supported back into the community.

As a result of mental health issues, Dan had isolated himself to the point where he would shut himself in his room when Julie, his support worker, visited. As his isolation persisted, he was in danger of losing his independence in other areas. Dan showed no interest in his personal care, diet or managing his diabetes.

Using a Wellness Approach, Dan could see the benefit of setting small goals. Over time these goals have led Dan to a more active role in his own care. He now works with Julie to maintain the house as well as plan, prepare and freeze his own meals.


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They even have a laugh about some of the meals he chooses to cook. These steps have improved both his psychological wellbeing and diabetes.

Dan has expressed a desire to reconnect with his local support group.

Meal preparation, from a Wellness perspective

A HACC Wellness Assessment identified a client who was receiving Meals on Wheels – simply because he had never learned to cook.

Stan’s oven had not been used since his wife died. During an assessment, it was determined that Stan could get to the shops and operate the oven and stovetop; he just needed help to learn the basics of cooking and create a list of ingredients. After four sessions with a support worker, Stan has learned to make several types of soup, roast chicken with veggies and custard. He has now set his sights on casseroles and stews for winter. The one-on-one lessons provided Stan with an opportunity to learn something new while ensuring that safety and hygiene issues were clearly understood.

Stan has gone from sitting at home waiting for Meals on Wheels to engaging in a series of beneficial and motivating activities. Stan now assesses his pantry, chooses meals, commutes to the shops, buys and unpacks the food, prepares the meal and cleans up the kitchen. Each activity in Stan’s new cooking regime contributes to his physical and mental wellbeing, and gives him a sense of purpose, control and independence in his daily life.

practical strategies give Mavis a new outlook on her abilities

Mavis has been blind for some years and had been receiving assistance to prepare her meals.

Since the Wellness Approach has been introduced, the support worker works with Mavis who now does all the veggie chopping. They have also worked out a system (using Velcro) that allows Mavis to identify the containers in her pantry. These strategies have given Mavis growing independence in the kitchen. The focus was then placed on organising social support for Mavis and to assist her with going to the shops, which had been beyond her.

The Wellness Approach has given Mavis the tools to build her own capacity and self-belief. Mavis is now ready to take on more.


Another example of the program meeting the needs of its clients in a flexible and responsive way has been provided by the New South Wales Government. The client story below follows one lady’s journey through HACC from accessing a simple service, transport, to receiving additional services as her needs have changed over the years. This support is proving to be vital to enable her to remain living where she desires – living in the community still in her own home.

Help to stay at Home

the HaCC Program has been providing services to a 91-year-old lady over the past 15 years that have enabled her to remain independent and living at home. the lady who lives alone, and whose two sons don’t live locally, has been a client of great Community transport (gCt) since July 1995.

initially, she only requested occasional transport assistance from gCt to the medical specialists in Penrith and to nepean Hospital as her vision was a problem and she didn’t drive. She loved gardening and making home-made jams and pickles and was always helping with fundraising efforts, with her preserves being in great demand. She has since become a regular on the gCt shopping buses, shopping independently and then needing a volunteer carer to help her shop and carry her groceries. For many years she travelled on the gCt Social outings, making friends and expanding her social network.

Stubbornly independent, this lady has accepted additional HaCC services as her eyesight deteriorated and her mobility has declined. She has high blood pressure, has had a knee replaced, suffers from osteoporosis and is now legally blind and has a white cane. She has had several falls in her garden and on several occasions has been unable to get herself up. She agreed to be referred to telecross, a social support service, also funded by the HaCC program. this ensures daily contact. She has also agreed to have a Vitalcall alarm installed rather than consider alternative accommodation such as a hostel.

She has become very reliant on having a volunteer carer accompanying her when she shops but will not allow others to do it for her. She has regular personal care and cleaning, and attends community restaurants, for cooked meals and companionship weekly, all funded through the HaCC program. over the years she has had visits from a HaCC-funded community nurse when her knee was replaced, as well as support from a continence advisor.

these services funded through the HaCC Program have supported her to remain living in the community, in her own home, and – as she often tells the gCt manager – where she intends to stay.


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Effectiveness

Quality of service provision – KPi 4

The Australian Government and state and territory governments are committed to providing quality services to HACC clients. To facilitate this, the program has a quality assurance framework, which has the primary objectives of ensuring high-quality outcomes for clients and ensuring responsiveness on the part of agencies to meet the needs of clients. At the heart of this framework are the HACC National Service Standards (the Standards).

The Standards were designed to ensure that clients receive the services they require, and that those services are delivered in a way that ensures funding is used appropriately and the rights of clients are maintained.

The Standards were introduced to provide agencies with a common reference point for internal quality controls, to help service providers comply with the principles and goals of the program as outlined in the Home and Community Care Act 1985, and to assist in improving the quality of HACC services. Further information relating to the objectives of the standards is at Appendix 6.

Following on from the Standards, the National Service Standards Instrument (NSSI) was developed to provide a consistent method for evaluating and monitoring the quality of service provision, as well as assisting the planning aspects of the service-delivery system on a regional, state, territory and national level.

Monitoring of compliance with the Standards is currently a major part of service reviews completed by state and territory governments, and is the basis for reporting on KPI 4 as a quality indicator within annual business reports.

This KPI reports the outcomes of the assessments completed by state and territory governments on the performance of agencies against the Standards. Figure 20 demonstrates the percentage of service providers that have received a rating of ‘good’ or higher during the annual reporting cycle.

It is important to note that this KPI is reported each year but service appraisals are conducted over an agreed three year cycle so that all eligible agencies are appraised once every three years. Within the cycle, states and territories have flexibility in how and when they conduct the appraisals. Some states and territories undertake their appraisals evenly across the three years while other jurisdictions conduct all appraisals within the one financial year. This is the first year of the current three-year cycle (2008–09 to 2010–11).


Figure 20. KPI 4: The percentage of eligible HACC ‘agencies’ which received a rating of ‘good’ or higher, by state/territory, 2008–09

Notes

1. Data was provided through state and territory business reports and the results of the appraisals will reflect the individual approaches adopted by each state and territory.

HACC agencies

Eligibility for agencies to be funded to provide services under the HACC Program is determined by individual state and territory governments, whose responsibilities include assessing the need for service types across regions and selecting appropriate organisations to provide those services.

All agencies funded under the HACC Program must provide services in accordance with the HACC National Service Standards and according to the National HACC Program Guidelines 2007.

Distance is no Barrier to Care is a client story from Blue Care, an agency in Queensland, which reflects the quality service principles for agencies under the HACC National Service Standards.

distance is no Barrier

every week the Blue Care vehicles belonging to a Community Services team located in regional Queensland easily clock up more than 5,000 kilometres. registered nurses and Personal Carers travel vast distances to visit clients who live in rural and remote parts of a shire on the Queensland–new South Wales border.

Service manager Cheryl said a flexible approach to service delivery has allowed Blue Care to overcome the tyranny of distance in many cases.

“We pride ourselves in tailoring clients’ care to meet their needs regardless of their distance from town.”

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one client who benefits from Blue Care’s positive attitude to long distance travel is Betty, who has dementia, mobility difficulties and continence issues. Betty lives 50 kilometres away from the community services team in a regional town, with her son matthew.

matthew is a busy man working seven days a week and over twelve hours a day as well as having to care for his mother.

Betty was living in Sydney with no family close at hand and facing full-time care in a residential facility. matthew stepped in and brought her to live with him and had the foresight to contact Blue Care requesting help for himself and his mum.

Blue Care was able to step in and provide a range of support services, including nursing and personal care, social support, in-home respite and centre-based day care.

“We are extremely happy with the Blue Care service and mum likes the company and it gives me a break from the caring role as well as the peace of mind to do other things around work.”

Personal carer, Belinda, (pictured below) thoroughly enjoys her days with Betty. “We’ve been able to help Betty socialise again by taking her to centre-based day care. She enjoys her day chatting with the other ladies and joining in on the activities”, Belinda said.

“it also gives matthew a chance to get away and do other jobs he needs to do, like shopping. other simple things like helping Betty shower, taking her for drives and helping her with her daily exercises makes a big difference to their day,” she said.

“usually it’s an hour and a half round trip to the client. However, if we are supporting Betty to attend centre-based respite, it is a three hour journey with two round trips, so we certainly clock up the miles.

“We focus on finding ways to give clients in every community, regardless of its isolation, the choice of independence.”


HACC agencies vary significantly in size, ranging from small community-based groups to large for-profit organisations. They also vary in location, and these variables impact on the range of services provided and numbers of clients receiving services. Nationally, the average agency provided 653 instances of care during 2008–09, averaging 12,400 hours of service, 5,500 instances of meals, transport, aids and modifications, and spent $5,500 on home modifications (Table 7).

Figures for instances of service will differ to the HACC clients’ figures as a client may receive more than one service from an agency. A simple example is that Agency X provided assistance to John, Mary and Olive during 2008–09. John received Delivered Meals and a Hearing Aid. Mary received Delivered Meals and Personal Care. Olive received Delivered Meals, Personal Care and Home Maintenance. Each assistance type received by each person is an instance of agency assistance, so for Agency X there were seven instances of assistance. These can be broken down as:

2 for John, 2 for Mary and 3 for Olive (2 + 2 + 3 = 7)

OR

3 instances of Delivered Meals, 2 instances of Personal Care, 1 instance of Communication Aids (John’s hearing aid) and 1 instance of Home Maintenance (3 + 2 + 1 + 1 = 7). In this example, 7 instances of assistance were for 3 distinct clients.

South Australian agencies had the highest average instances of assistance per service (1,600) and Victorian agencies had the highest average hours of care provided, having an average of 27,800 hours provided per agency.

Table 7. HACC agencies, instances of service delivery, by state/territory, 2008–09


Instances of Agency Assistance1

Minimum 1 5 1 3 8 1 5 24 1

Maximum 6,945 49,595 9,154 42,063 10,879 7,084 923 4,483 49,595

Average 357 1,298 619 1,631 993 1,043 144 812 653

Hours of service2

Minimum 0 0 0 0 0 0 0 887 0

Maximum 576,626 744,055 200,284 569,891 208,925 106,280 35,449 106,498 744,055

Average 7,056 27,787 11,782 23,202 19,511 14,072 2,426 16,397 12,469

Quantity3

Minimum 0 0 0 0 0 0 0 0 0

Maximum 144,569 196,238 81,387 1,061,265 146,121 206,706 26,688 102,282 1,061,265

Average 3,475 8,011 5,857 11,840 9,303 7,190 4,073 6,904 5,509

dollars4

Minimum 0 $0 $0 $0 $0 $0 $0 $0 $0

Maximum $2,199,779 $0 $490,787 $578,189 $107,805 $152,172 $0 $427,902 $2,199,779

Average $7,311 $0 $6,620 $7,344 $473 $3,779 $0 $14,272 $5,554


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Notes:

1. Instances of agency assistance refer to the numbers of clients who received assistance during 2008–09, by assistance type. In many cases, a client will receive more than one type of assistance from an agency. Each client will be represented once for each assistance type for each agency.

2. Service types include Allied Health Care, Assessment, Care Recipient Counselling Support, Carer Counselling Support, Case Management, Centre-Based Day Care, Client Care Coordination, Domestic Assistance, Home Maintenance, Nursing Care, Other Food Services, Personal Care, Respite Care and Social Support.

3. Service types include Aids for Reading, Car Modifications, Communication Aids, Medical Care Aids, Other Goods and Equipment, Self Care Aids, Support and Mobility Aids, Meals, Formal Linen Service and Transport.

4. Service type includes Home Modifications.

5. The proportion of HACC funded agencies that submitted HACC MDS data 2008–09 differed across jurisdictions and ranged from 89% to100%.


data reporting by agencies – KPi 5

As at 30 June 2009, there were 3,334 active HACC agencies funded to deliver HACC services within Australia.

The KPI framework uses KPI 5 to measure the performance of agencies complying with the program’s management requirements by providing data to the HACC MDS. Figure 21 demonstrates that there is a high participation rate among agencies from each state and territory.

Figure 21. KPI 5: The percentage of active agencies in the National Data Repository providing data to the HACC MDS, by state/territory, 2008–09

Notes

1. Data are sourced from the 2008–09 HACC MDS Annual Bulletin.

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Financial acquittal – KPi 6

KPI 6 (Figure 22) aims to measure the performance of states and territories in managing HACC funds. According to the HACC Program Management Manual (p. 56), all HACC funded agencies are required to provide acquittals to their state and territory departments for the funds they receive. An acquittal is defined as an annual financial reconciliation of allocated HACC funds by HACC funded organisations to state and territory governments. Information agreed to be included in the annual acquittals is:

• HACC funds received by the organisation;

• HACC funds spent; and

• whether the funds have been fully expended.

Figure 22. KPI 6: The percentage of HACC funded organisations that have supplied acquittals, by state and territory, 2008–09.

Notes

1. Data are sourced from the 2008–09 state and territory business reports.

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unit cost for key service types – KPi 7

Under the HACC Review Agreement, all states and territories agreed to report an average unit cost for key service types. This builds on earlier work done in 1993 in regard to determining a unit cost for HACC services titled the HACC Unit Cost Framework.

This reporting year, 2008–09, sees the first reporting on this performance measure (Figure 23). Since 2007, HACC Officials have made progress towards refining an acceptable methodology for calculating a unit cost that reflects the average cost of delivering a service. The reporting below reflects an interim methodology agreed in May 2009 that reports on basic calculation to determine a simple unit cost.

Of the 19 principle service types, reflecting the wide range of HACC services, state and territory governments through their HACC Officials agreed to report on two key service types, Personal Care and Domestic Assistance, in 2008–09.

Figure 23. KPI 7: Unit cost for key service types, by state and territory, 2008–09

Notes

1. Data are sourced from the 2008–09 state and territory business reports.

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4 Funding for the HACC program

Governments’ funding contributions for the HACC Program are agreed annually between the Australian Government Minister responsible for Ageing and the relevant state or territory minister. These contributions include an indexation factor applied to funding provided in the previous financial years, as determined by each government.

In addition, both levels of government contribute a real growth component to the HACC Program funding. Australian Government growth funding for the program is distributed among the states and territories using an equalisation strategy, to ensure that all per capita funding for the program is the same across all jurisdictions by 2010-11.

Table 8. HACC funding for 2008–09

state

Australian Government funding

$m

state and territory funding

$m

total program funding

$m

% Increase (including

indexation 2.3%)

NSW 326.962 219.340 546.302 7.13%

VIC 264.094 176.356 440.450 6.99%

QLD 248.436 135.902 384.338 11.37%

SA 92.276 57.450 149.726 8.04%

WA 109.640 71.016 180.656 8.58%

TAS 28.662 21.150 49.812 8.95%

NT 7.592 3.457 11.049 8.47%

ACT 12.957 13.551 26.508 8.52%

Australia 1,090.619 698.222 1,788.841 8.28%

Total combined Australian Government and state and territory government funding for 2008–09 for the HACC Program was $1.788 billion, an increase of $136.8 million over 2007–08.


5 Building the evidence Base

Much of the current evidence base for decision making and future planning in the HACC Program is based on projects and research conducted by the states and territories. While the largest majority of HACC funding is used in providing services directly to clients, the program may also fund research and activities to support the development of national policy initiatives or reforms.

States and territories report annually on their research and development activities, pilots or trials in the HACC Annual Business Reports. This activity may vary from year to year and from state or territory depending on the funding available on a local level. The decision to fund research and projects is undertaken by individual states and territories.

In 2008–09, states and territories undertook a significant amount of research and projects. A brief snapshot is provided below.

In Tasmania, the HACC Program provided funding to the Department of Rural Health at the University of Tasmania to explore social eating opportunities in a rural community. The final report was received in January 2009 – Healthy Eating, Healthy Ageing – Perspectives from a Rural Community Study. The report recommendations note that more attention needs to be given to educating health professionals and the community about geriatric nutritional risk, and that resources should be allocated to the development and support of a range of social eating approaches aimed at addressing this identified risk. The outcome for the HACC Program in Tasmania was that a project officer position was funded to develop and expand the Eating With Friends Program which provides a social eating model with nutritional benefits as well.

The CALD Emerging Need Scoping Study was funded by the Office for the Ageing in South Australia. The project, over three stages, is to undertake a scoping study of the ageing-related needs of new and emerging communities to identify population numbers of ageing people, the relative needs of ethnic groups, the current availability of culturally appropriate aged care services, and gaps within the service system. The initial stages of this project were undertaken in 2008–09.

New South Wales reported funding several research projects including funding to the Men’s Health Information and Resource Centre to continue research to investigate HACC services usage by older men. This research is based on consultations with men, carers and service providers to identify barriers and best practice for providing HACC services for men. Results from this research will identify service gaps in the program and assist in better planning of services to target frail older men more effectively.

During 2008–09, Victoria undertook an analysis of the HACC Minimum Data Set in order to see the extent to which older people from non-English speaking backgrounds were using HACC services in 2006-07. The report described each local government area (LGA) with summaries for the eight Department of Human Services regions and the state. It looked at the population of people aged 70-plus in each LGA and divided them into three groups according to birthplace. The publication provided detail on how the relative size of a particular birthplace group compares to its proportion of HACC clients for that LGA. This will be useful for future planning of HACC services.


Appendix 1: HACC Mds Bulletin data tables

Table A1. HACC clients, remoteness by state/territory, 2008–09


Remoteness5 Number of clients

Major City 141,518 173,163 94,598 62,923 45,368 . . . . 11,198 528,766

Inner Regional 60,759 67,910 41,566 12,656 10,238 17,410 . . 46 210,585

Outer Regional 24,107 22,606 21,640 13,333 7,244 8,561 1,844 . . 99,335

Remote 2,440 781 3,306 3,342 2,098 451 791 . . 13,208

Very Remote 375 . . 2,084 808 1,178 149 969 . . 5,562

Not stated 3,870 323 341 112 297 36 4 49 5,032

totAl 233,069 264,783 163,534 93,174 66,422 26,607 3,607 11,292 862,488

Per cent

Major City 60.7% 65.4% 57.8% 67.5% 68.3% . . . . 99.2% 61.3%

Inner Regional 26.1% 25.6% 25.4% 13.6% 15.4% 65.4% . . 0.4% 24.4%

Outer Regional 10.3% 8.5% 13.2% 14.3% 10.9% 32.2% 51.1% . . 11.5%

Remote 1.0% 0.3% 2.0% 3.6% 3.2% 1.7% 21.9% . . 1.5%

Very Remote 0.2% . . 1.3% 0.9% 1.8% 0.6% 26.9% . . 0.6%

Not stated 1.7% . . 0.2% 0.1% 0.4% 0.1% 0.1% . . 0.6%

totAl 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Distribution of Australian population across remoteness areas, ABS 2006 Census (per cent)

Major City 72.8% 75.0% 59.9% 72.7% 71.3% . . . . 99.9% 68.6%

Inner Regional 20.3% 20.1% 21.9% 12.3% 12.9% 64.8% . . 0.1% 19.7%

Outer Regional 6.3% 4.8% 15.0% 11.4% 9.0% 33.1% 55.7% . . 9.4%

Remote 0.5% 0.1% 2.1% 2.9% 4.3% 1.6% 21.4% . . 1.5%

Very Remote 0.1% . . 1.2% 0.8% 2.4% 0.5% 22.9% . . 0.8%

totAl 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Notes

1. The proportion of HACC funded agencies that submitted HACC MDS data for 2008–09 differed across jurisdictions, and ranged from 89% to 100%. Actual client numbers will be higher than those reported here.

2. Remoteness indicator source: ABS Australian Standard Geographical Classification Remoteness Structure (ABS catalogue number 1216.0). Data are classified according to an index of remoteness which rates each Census District based on the number and size of towns, and the distance from major towns and urban centres.

3. Population data source: ABS Preliminary Population Projections by SLA 2007-2027 based on the 2006 census (unpublished). Based on Series B (medium scenario), for year 2009.


5. Remoteness Category is determined using the client’s postcode. In cases where the client’s postcode is invalid or unknown, Remoteness Category cannot be reported.

. . Not applicable


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Table A2. HACC clients, age, by state/territory 2008–09


Age in YearsNumber of clients

Younger people with a disability

0-49 22,370 34,221 16,614 10,868 6,535 2,573 777 1,853 95,811

50-54 5,885 8,291 4,336 2,689 1,841 806 214 376 24,438

55-59 8,061 10,483 6,348 3,593 2,493 1,163 278 511 32,930

60-64 11,560 15,742 8,900 5,098 3,316 1,616 362 571 47,165

Total Younger People

47,876 68,737 36,198 22,248 14,185 6,158 1,631 3,311 200,344

Older people

65-69 16,629 22,262 12,695 7,451 4,891 2,227 429 827 67,411

70-74 25,807 31,848 18,354 10,855 7,340 3,020 466 1,200 98,890

75-79 37,961 42,723 26,842 14,753 11,236 4,604 461 1,852 140,432

80-84 47,264 47,467 31,997 17,689 13,457 5,022 346 1,927 165,169

85-89 37,018 34,256 25,079 12,970 10,188 3,564 183 1,487 124,745

90-94 15,890 13,359 9,591 4,930 4,071 1,589 69 566 50,065

95+ 4,623 4,131 2,774 2,226 1,051 423 20 121 15,369

Total Older People 185,192 196,046 127,332 70,874 52,234 20,449 1,974 7,980 662,081

invalid/unknown 1 .. 4 52 3 .. 2 1 63

totAl 233,069 264,783 163,534 93,174 66,422 26,607 3,607 11,292 862,488

Per cent

Younger people with a disability

0-49 9.6% 12.9% 10.2% 11.7% 9.8% 9.7% 21.5% 16.4% 11.1%

50-54 2.5% 3.1% 2.7% 2.9% 2.8% 3.0% 5.9% 3.3% 2.8%

55-59 3.5% 4.0% 3.9% 3.9% 3.8% 4.4% 7.7% 4.5% 3.8%

60-64 5.0% 5.9% 5.4% 5.5% 5.0% 6.1% 10.0% 5.1% 5.5%

Total Younger People 20.5% 26.0% 22.1% 23.9% 21.4% 23.1% 45.2% 29.3% 23.2%

Older people

65-69 7.1% 8.4% 7.8% 8.0% 7.4% 8.4% 11.9% 7.3% 7.8%

70-74 11.1% 12.0% 11.2% 11.7% 11.1% 11.4% 12.9% 10.6% 11.5%

75-79 16.3% 16.1% 16.4% 15.8% 16.9% 17.3% 12.8% 16.4% 16.3%

80-84 20.3% 17.9% 19.6% 19.0% 20.3% 18.9% 9.6% 17.1% 19.2%

85-89 15.9% 12.9% 15.3% 13.9% 15.3% 13.4% 5.1% 13.2% 14.5%

90-94 6.8% 5.0% 5.9% 5.3% 6.1% 6.0% 1.9% 5.0% 5.8%

95+ 2.0% 1.6% 1.7% 2.4% 1.6% 1.6% 0.6% 1.1% 1.8%

Total Older People 79.5% 74.0% 77.9% 76.1% 78.6% 76.9% 54.7% 70.7% 76.8%

invalid/unknown 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.1% 0.0% 0.0%

totAl 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Notes


2. Population data source: ABS Preliminary Population Projections by SLA 2007-2027 based on the 2006 census (unpublished). Based on Series B (medium scenario), for the year 2009.


4. The 95+ age group is over-estimated. See A3.5.4.


A3. HACC clients, sex, by state/territory, 2008-09


Number of clients

Male 82,537 94,595 61,187 34,754 22,287 9,118 1,523 3,739 309,740

Female 148,844 165,302 101,152 58,065 44,061 17,406 2,078 7,420 544,328

Not stated 1688 4886 1195 355 74 83 6 133 8420

totAl 233,069 264,783 163,534 93,174 66,422 26,607 3,607 11,292 862,488


Male 35.7% 36.4% 37.7% 37.4% 33.6% 34.4% 42.3% 33.5% 36.3%

Female 64.3% 63.6% 62.3% 62.6% 66.4% 65.6% 57.7% 66.5% 63.7%

totAl 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Notes

1. The proportion of HACC funded agencies that submitted HACC MDS data 2008–09 differed across jurisdictions and ranged from 89% to 100%. Actual client numbers will be higher than those reported here.


Table A4. HACC clients, main language spoken at home, by state/territory, 2008-09


Main language spoken at Home

Number of clients

English 195,291 215,188 140,922 76,852 57,073 24,327 1,950 8,898 720,501

Italian 4,163 10,131 1,603 3,205 1,971 176 28 130 21,407

Greek 3,042 5,421 450 1,540 185 104 19 74 10,835


2,448 1,169 81 174 87 1 0 23 3,983

Cantonese 1,715 1,085 338 217 280 43 16 61 3,755

Polish 572 1,234 238 656 361 205 1 60 3,327

Vietnamese 890 1,247 151 287 135 0 3 77 2,790

Aboriginal Languages 65 55 180 332 732 4 1,172 0 2,540

Spanish 1,077 758 324 159 87 15 2 97 2,519

Croatian 470 1,085 176 380 217 10 3 92 2,433

Russian 721 1,133 84 131 31 4 2 9 2,115

German 495 547 211 403 195 48 5 40 1,944

Macedonian 596 985 21 41 120 0 0 2 1,765

Mandarin 714 683 91 84 93 8 2 58 1,733

Maltese 503 771 37 192 16 0 0 3 1,522

Netherlandic 156 469 119 320 162 16 2 14 1,258

Serbian 309 502 105 222 39 6 0 26 1,209

Turkish 250 836 12 24 11 0 0 0 1,133

Hungarian 194 415 133 217 37 8 3 27 1,034

Ukrainian 148 303 66 345 63 14 1 15 955


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French 207 351 96 67 92 6 4 4 827

Other languages, nec 2,813 2,195 1,157 1,005 710 60 111 196 8,247

Not Stated 16,230 18,220 16,939 6,321 3,725 1,552 283 1,386 64,656

TOTAL 233,069 264,783 163,534 93,174 66,422 26,607 3,607 11,292 862,488


English 90.1% 87.3% 96.1% 88.5% 91.0% 97.1% 58.7% 89.8% 90.3%

Italian 1.9% 4.1% 1.1% 3.7% 3.1% 0.7% 0.8% 1.3% 2.7%

Greek 1.4% 2.2% 0.3% 1.8% 0.3% 0.4% 0.6% 0.7% 1.4%


1.1% 0.5% 0.1% 0.2% 0.1% 0.0% 0.0% 0.2% 0.5%

Cantonese 0.8% 0.4% 0.2% 0.2% 0.4% 0.2% 0.5% 0.6% 0.5%

Polish 0.3% 0.5% 0.2% 0.8% 0.6% 0.8% 0.0% 0.6% 0.4%

Vietnamese 0.4% 0.5% 0.1% 0.3% 0.2% 0.0% 0.1% 0.8% 0.3%

Aboriginal Languages 0.0% 0.0% 0.1% 0.4% 1.2% 0.0% 35.3% 0.0% 0.3%

Spanish 0.5% 0.3% 0.2% 0.2% 0.1% 0.1% 0.1% 1.0% 0.3%

Croatian 0.2% 0.4% 0.1% 0.4% 0.3% 0.0% 0.1% 0.9% 0.3%

Russian 0.3% 0.5% 0.1% 0.2% 0.0% 0.0% 0.1% 0.1% 0.3%

German 0.2% 0.2% 0.1% 0.5% 0.3% 0.2% 0.2% 0.4% 0.2%

Macedonian 0.3% 0.4% 0.0% 0.0% 0.2% 0.0% 0.0% 0.0% 0.2%

Mandarin 0.3% 0.3% 0.1% 0.1% 0.1% 0.0% 0.1% 0.6% 0.2%

Maltese 0.2% 0.3% 0.0% 0.2% 0.0% 0.0% 0.0% 0.0% 0.2%

Netherlandic 0.1% 0.2% 0.1% 0.4% 0.3% 0.1% 0.1% 0.1% 0.2%

Serbian 0.1% 0.2% 0.1% 0.3% 0.1% 0.0% 0.0% 0.3% 0.2%

Turkish 0.1% 0.3% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1%

Hungarian 0.1% 0.2% 0.1% 0.2% 0.1% 0.0% 0.1% 0.3% 0.1%

Ukrainian 0.1% 0.1% 0.0% 0.4% 0.1% 0.1% 0.0% 0.2% 0.1%

French 0.1% 0.1% 0.1% 0.1% 0.1% 0.0% 0.1% 0.0% 0.1%

Other languages, nec 1.3% 0.9% 0.8% 1.2% 1.1% 0.2% 3.3% 2.0% 1.0%

totAl 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Notes



3. Language classification is based on the ABS Australian Standard Classification of Languages (ABS catalogue number 1267.0).

5. Non-verbal languages have been included in ‘Other languages,nec’ due to unreliable data.

6. Null and not-stated responses have been excluded from the calculation of percentages in this table.

Table A4. HACC clients, main language spoken at home, by state/territory, 2008-09 (cont)


Table A5. HACC clients, country of birth by state/territory, 2008–09


Country of Birth Number of clients

Australia (includes External Territories)

168,134 170,333 115,406 59,275 38,109 21,296 2,817 6,680 582,050

New Zealand 1,580 1,295 2,964 363 684 135 33 103 7,157


983 453 777 77 54 17 6 46 2,413

North-West Europe 18,338 23,559 15,424 14,492 13,367 2,727 211 1,568 89,686


19,473 35,664 6,688 10,752 5,352 1,079 111 1,184 80,303

North Africa and the Middle East

5,427 4,096 473 556 449 36 8 90 11,135

South-East Asia 2,678 3,312 991 769 1,402 77 120 225 9,574

North-East Asia 3,040 2,124 683 348 351 70 26 163 6,805


2,198 3,383 685 429 1,529 51 30 207 8,512

Americas 1,691 1,288 865 312 358 84 13 140 4,751

Sub-Saharan Africa 930 1,530 615 229 720 72 10 51 4,157

Not stated 8,597 17,746 17,963 5,572 4,047 963 222 835 55,945

totAl 233,069 264,783 163,534 93,174 66,422 26,607 3,607 11,292 862,488

Country of Birth Per cent (excluding not stated)

Australia (includes External Territories)

74.9% 69.0% 79.3% 67.7% 61.1% 83.0% 83.2% 63.9% 72.2%

New Zealand 0.7% 0.5% 2.0% 0.4% 1.1% 0.5% 1.0% 1.0% 0.9%


0.4% 0.2% 0.5% 0.1% 0.1% 0.1% 0.2% 0.4% 0.3%

North-West Europe 8.2% 9.5% 10.6% 16.5% 21.4% 10.6% 6.2% 15.0% 11.1%


8.7% 14.4% 4.6% 12.3% 8.6% 4.2% 3.3% 11.3% 10.0%

North Africa and the Middle East

2.4% 1.7% 0.3% 0.6% 0.7% 0.1% 0.2% 0.9% 1.4%

South-East Asia 1.2% 1.3% 0.7% 0.9% 2.2% 0.3% 3.5% 2.2% 1.2%

North-East Asia 1.4% 0.9% 0.5% 0.4% 0.6% 0.3% 0.8% 1.6% 0.8%


1.0% 1.4% 0.5% 0.5% 2.5% 0.2% 0.9% 2.0% 1.1%

Americas 0.8% 0.5% 0.6% 0.4% 0.6% 0.3% 0.4% 1.3% 0.6%

Sub-Saharan Africa 0.4% 0.6% 0.4% 0.3% 1.2% 0.3% 0.3% 0.5% 0.5%

totAl 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Notes


2. Country of birth classification is based on the ABS Standard Australian Classification of Countries (ABS catalogue number 1269.0).


5. Null and not-stated responses have been excluded from the calculation of percentages in this table.


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Table A6. HACC clients, assistance type by state/territory, 2008–09


Assistance type Number of clients1

Allied Health Care (Centre) 20,852 70,959 14,176 6,294 792 1,884 21 1,591 116,569

Allied Health Care (Home) 10,645 26,205 39,921 7,597 3,325 897 9 363 88,962

Assessment 91,594 87,540 28,018 42,500 55,647 15,892 1,196 357 322,744

Care Counselling Support 10,372 5,582 12,085 13,365 13,023 3,399 960 861 59,647

Carer Counselling Support 2,378 5,594 4,030 6,571 2,463 787 505 377 22,705

Case Management 22,065 8,699 8,156 9,883 975 2,084 753 3,541 56,156

Centre-Based Day Care 19,802 34,037 18,998 9,709 12,854 1,831 631 942 98,804

Client Care Coordination 47,562 2,033 13,101 35,118 23,697 8,238 1,181 1,122 132,052

Domestic Assistance 56,707 86,404 59,560 25,414 27,474 10,987 1,642 4,271 272,459

Formal Linen Service 981 - 668 180 51 157 46 84 2,167

Aids for Reading 60 - - 4 1 - - - 65

Car Modifications 88 - 1 4 1 - - 4 98

Communication Aids 665 - 1,128 30 403 - - - 2,226

Medical Care Aids 2,988 - 24 114 1 - - 3 3,130


3,386 - 45 763 2 346 - 4 4,546

Self-Care Aids 3,796 - 130 5,924 1,265 - - - 11,115

Support and Mobility Aids 1,951 - 220 6,127 2,116 - - 30 10,444

Home Maintenance 22,066 46,338 35,507 16,162 15,532 3,916 268 2,225 142,014

Home Modification 14,966 - 11,854 6,865 151 705 0 129 34,670

Meals (Centre) 14,687 6,410 12,567 7,910 5,172 1,618 477 213 49,054

Meals (Home) 30,158 28,315 21,691 11,430 8,947 2,905 1,512 811 105,769

Nursing Care (Centre) 19,263 20,706 2,267 2,833 205 484 139 342 46,239

Nursing Care (Home) 42,547 59,295 44,655 15,380 8,078 6,462 46 399 176,862

Other Food Services 4,079 - 495 442 177 22 207 - 5,422

Personal Care 16,778 30,920 22,394 7,070 7,447 3,626 585 1,174 89,994

Respite Care 9,257 6,485 9,772 3,517 2,848 529 174 427 33,009

Social Support 34,688 17,154 30,648 17,282 12,085 2,964 1,281 2,273 118,375

Transport 66,896 - 36,766 17,081 21,774 6,371 1,440 2,825 153,153

Number of distinct clients

233,069 264,783 163,534 93,174 66,422 26,607 3,607 11,292 862,488

Assistance type Per cent6

Allied Health Care (Centre) 8.9 26.8 8.7 6.8 1.2 7.1 0.6 14.1 13.5

Allied Health Care (Home) 4.6 9.9 24.4 8.2 5.0 3.4 0.2 3.2 10.3

Assessment 39.3 33.1 17.1 45.6 83.8 59.7 33.2 3.2 37.4

Care Counselling Support 4.5 2.1 7.4 14.3 19.6 12.8 26.6 7.6 6.9

Carer Counselling Support 1.0 2.1 2.5 7.1 3.7 3.0 14.0 3.3 2.6



Case Management 9.5 3.3 5.0 10.6 1.5 7.8 20.9 31.4 6.5

Centre-Based Day Care 8.5 12.9 11.6 10.4 19.4 6.9 17.5 8.3 11.5

Client Care Coordination 20.4 0.8 8.0 37.7 35.7 31.0 32.7 9.9 15.3

Domestic Assistance 24.3 32.6 36.4 27.3 41.4 41.3 45.5 37.8 31.6

Formal Linen Service 0.4 - 0.4 0.2 0.1 0.6 1.3 0.7 0.3

Aids for Reading - - - - - - - - -

Car Modifications - - - - - - - - -

Communication Aids 0.3 - 0.7 - 0.6 - - - 0.3

Medical Care Aids 1.3 - - 0.1 - - - - 0.4


1.5 - - 0.8 - 1.3 - - 0.5

Self-Care Aids 1.6 - 0.1 6.4 1.9 - - - 1.3

Support and Mobility Aids 0.8 - 0.1 6.6 3.2 - - 0.3 1.2

Home Maintenance 9.5 17.5 21.7 17.3 23.4 14.7 7.4 19.7 16.5

Home Modification 6.4 - 7.2 7.4 0.2 2.6 - 1.1 4.0

Meals (Centre) 6.3 2.4 7.7 8.5 7.8 6.1 13.2 1.9 5.7

Meals (Home) 12.9 10.7 13.3 12.3 13.5 10.9 41.9 7.2 12.3

Nursing Care (Centre) 8.3 7.8 1.4 3.0 0.3 1.8 3.9 3.0 5.4

Nursing Care (Home) 18.3 22.4 27.3 16.5 12.2 24.3 1.3 3.5 20.5

Other Food Services 1.8 - 0.3 0.5 0.3 0.1 5.7 - 0.6

Personal Care 7.2 11.7 13.7 7.6 11.2 13.6 16.2 10.4 10.4

Respite Care 4.0 2.4 6.0 3.8 4.3 2.0 4.8 3.8 3.8

Social Support 14.9 6.5 18.7 18.5 18.2 11.1 35.5 20.1 13.7

Transport 28.7 - 22.5 18.3 32.8 23.9 39.9 25.0 17.8

Notes

1. Instances of agency assistance represent the number of distinct clients that received each assistance type on an agency by agency basis. This results in some duplication in cases where a client received the same type of assistance from more than one agency. Also, clients often receive more than one type of assistance, consequently the sum of the columns does not equal the number of distinct clients, and the sum of the percentages of clients receiving different types of assistance adds up to more than 100.

2. The proportion of HACC funded agencies that submitted HACC MDS data for 2008–09 differed across jurisdictions, and ranged from 89% to 100%. Actual client numbers will be higher than those reported here.


4. Refer to Appendix 2 for definitions of HACC assistance types.

5. Note that exact definitions and counting rules for case management, care coordination, assessment and counselling tend to vary with agency practice in different jurisdictions. Aggregate data on number of hours and number of clients for these activities should be interpreted in this light, and attempts at cross-jurisdiction comparison should be treated cautiously at this stage.

6. Represents the number of distinct clients that received each assistance type as a proportion of the total number of distinct clients.

- Nil or rounded to zero.

Table A6. HACC clients, assistance type, by state/territory, 2008-09 (cont)


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Table A7. Average HACC services received per client, assistance type by state/territory, 2008–09


Assistance type Services received per client1


Hours 5.2 5.4 5.8 4.2 4.7 3.2 3.7 2.2 5.2


Hours 3.8 6.0 6.4 3.3 5.9 3.2 2.4 2.3 5.6

Assessment Hours 3.4 3.0 2.5 1.9 2.1 1.6 4.5 2.1 2.7

Care Counselling Support Hours 7.3 4.3 5.2 6.1 3.6 7.0 8.3 8.7 5.5


Hours 9.8 4.0 7.5 10.3 8.0 3.8 7.0 6.2 7.6

Case Management Hours 10.3 20.9 5.3 7.0 6.4 5.4 6.5 10.9 10.3

Centre-Based Day Care Hours 144.5 110.8 163.1 107.5 147.2 131.3 55.6 114.2 132.1

Client Care Coordination Hours 4.4 25.3 5.7 3.6 3.3 4.6 5.8 4.9 4.5

Domestic Assistance Hours 37.1 31.3 26.1 23.9 29.6 18.7 38.9 23.6 29.9

Formal Linen Service Deliveries 29.9 - 5.7 14.5 28.7 6.4 39.2 43.1 20.1

Aids for Reading Quantity 5.0 - - 1.8 1.0 - - - 4.7

Car Modifications Quantity 3.0 - 4.0 2.3 1.0 - - 30.0 4.1

Communication Aids Quantity 4.4 - 4.7 1.1 1.4 - - - 4.0

Medical Care Aids Quantity 15.6 - 2.2 1.1 1.0 - - 50.0 15.0


Quantity 4.1 - 2.8 33.9 1.0 2.1 - 32.8 9.0

Self-Care Aids Quantity 4.3 - 1.8 2.3 1.3 - - - 2.9

Support and Mobility Aids Quantity 4.7 - 1.7 2.3 1.3 - - 21.5 2.6

Home Maintenance Hours 13.9 6.5 6.7 5.4 12.9 7.6 13.7 7.3 8.3

Home Modification Dollars 782.1 - 387.0 180.8 714.5 391.3 - 3319.0 529.1

Meals (Centre) Quantity 26.6 29.2 34.8 27.6 34.9 25.2 55.6 24.0 30.3

Meals (Home) Quantity 102.0 111.6 95.1 107.2 105.8 103.1 169.7 121.7 105.2

Nursing Care (Centre) Hours 6.4 4.6 7.0 7.0 7.8 3.1 2.2 6.9 5.6

Nursing Care (Home) Hours 11.9 19.9 12.2 15.3 16.6 16.1 2.0 8.8 15.3

Other Food Services Hours 22.5 - 19.5 30.3 29.5 13.6 24.0 - 23.1

Personal Care Hours 108.4 40.9 22.3 67.6 52.6 51.1 41.4 58.8 52.6

Respite Care Hours 98.2 78.4 65.2 110.5 77.7 106.8 106.2 123.0 84.6

Social Support Hours 45.7 41.6 31.0 33.1 41.3 32.1 32.3 35.6 38.3

Transport Single Trips 29.6 - 42.1 29.4 45.4 28.7 59.6 34.9 35.2

Notes

1. Calculated by dividing the total amount of assistance by instances of agency assistance. Instances of agency assistance represent the number of distinct clients that received each assistance type on an agency by agency basis.



4. Refer to Appendix 2 for definitions of HACC service types.

- Not applicable as no clients were reported as having received this assistance type.


Appendix 2: HACC service types

service type definition

Domestic Assistance This type of assistance refers to domestic chores, including:

– assistance with cleaning

– dishwashing

– clothes washing and ironing

– shopping (unaccompanied)

– bill paying.

Social Support This refers to assistance provided by a companion (paid worker or volunteer), either within the home environment or while accessing community services. The assistance is primarily directed towards meeting the person’s need for social contact and/or accompaniment in order to participate in community life. Social support includes:

– friendly visiting services

– letter writing for the person

– shopping and bill paying

– banking

– telephone-based monitoring services.

Nursing Care This refers to professional care from a registered or enrolled nurse. It includes time spent recording observations of a client, where this is considered to be part of the nurse’s duty of care.

Allied health Care This service is also known as paramedical care and refers to professional allied health care services, and includes a wide range of specialist services, such as:

– podiatry

– occupational therapy

– physiotherapy

– social work; speech pathology

– advice from dietician or nutritionist.

Personal Care This refers to assistance with daily self-care tasks, such as:

– eating

– bathing

– toileting

– dressing

– grooming

– getting in and out of bed

– moving about the house.

Centre-based Day Care This refers to attendance/participation in structured group activities designed to develop, maintain or support the capacity for independent living and social interaction which are conducted in, or at, a centre-based setting.


Appendix 2: H

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service type definition

Meals This refers to those meals which are prepared and delivered to the client. It does not include meals prepared in the client’s home.

Other Food Services This refers to assistance with the preparation and cooking of a meal in the client’s home and the provision of advice on nutrition, storage or food preparation.

Respite Care This refers to assistance received by a carer from a substitute carer who provides supervision and assistance to their care recipient (even though the carer may still be present).

Assessment This refers to assessment and re-assessment activities that are directly attributable to individual care recipients. This includes assessment activities associated with client intake procedures and the determination of eligibility for service provision. It also includes more comprehensive assessments of a person’s need for assistance and capacity to undertake tasks of daily living, as well as Occupational Health and Safety assessments undertaken by the agency in relation to service delivery.

Client care Coordination This service focuses on coordination activities undertaken to facilitate access to HACC services for clients who need help to gain access to more than one service; for example, HACC special-needs group clients.

Case Management This service comprises active assistance received by a client from a formally identified agency worker who coordinates the planning and delivery of a suite of services to the individual client.

Home Maintenance Refers to the assistance with the maintenance and repair of the person’s home, garden or yard to keep their home in a safe and habitable condition. Home maintenance includes minor dwelling repairs and maintenance, such as changing light bulbs, carpentry and painting, or replacing tap washers, as well as some major dwelling repairs such as replacing guttering or other roof repairs. It also includes garden maintenance, such as lawn mowing and the removal of rubbish.

Home Modification Refers to structural changes to the person’s home so he or she can continue to live and move safely about the house. These include modifications such as grab rails, hand rails, ramps, shower rails, appropriate tap sets, installation of emergency alarms, other safety and mobility aids, and other minor renovations.

Provision of Goods and Equipment

Refers to the loan or purchase of goods and equipment to assist the person to cope with a disabling condition and/or maintain independence. Goods and equipment are items that can assist the client’s mobility, communication, reading, personal care or health care. It includes a wide range of items such as incontinence pads, dressing aids and wheelchairs.

Formal Linen Service Refers to the provision and laundering of linen, usually by a separate laundry facility or hospital.

Transport Refers to assistance with transportation either directly (e.g. a ride in a vehicle provided or driven by an agency worker or volunteer) or indirectly (e.g. taxi vouchers or subsidies).

Counselling/Support, Information and Advocacy (care recipient)

Refers to assistance with understanding and managing situations, behaviours and relationships associated with the person’s need for care, including advocacy and the provision of advice, information and training.

Counselling/Support, Information and Advocacy (carer)

Refers to assistance with understanding and managing situations, behaviours and relationships associated with the caring role, including advocacy and the provision of advice, information and training.


Appendix 3: data Issues and Quality Considerations

a3.1 Participation rates

The HACC MDS does not cover all HACC services provided. For example:

• clients can ‘opt out’ of having their data provided;

• only services to individuals are recorded (i.e. excludes group assistance, other than where a HACC client has been transported within a group); and

• some clients may be assisted anonymously (e.g. by telephone where a name is not provided).

One other consideration occurs around agency participation rates. Although all agencies are required to report HACC MDS data, this is not achieved in practice. The proportion of HACC agencies that submit data for the year varies between jurisdictions and actual service levels may be higher than stated. There is no evidence to support the assumption that non-reporting agencies are statistically similar to those that do report.

a3.2 Statistical Linkage Key (SLK)

While the HACC MDS data are de-identified before transmission outside the HACC agency, the records retain sufficient identifying information to allow quarterly records to be linked using a deterministic statistical linkage key (SLK). This method protects the privacy of the individual while allowing individuals’ records to be combined within the HACC MDS.

The HACC MDS SLK is derived by joining the ‘letters of name’ (2nd, 3rd and 5th letters of the family name/surname, and 2nd and 3rd letters of the first given name), ‘date of birth’, and ‘sex’ to create a 14 character identifier. There are also some instances where the SLK information may be unknown, and substitute characters are used instead. Records with the same SLK are considered to be the same client.

The linkage key is not a unique identifier and is designed for statistical purposes only. For the purposes of record linkage there are three key sources of error with this type of linkage key:

• the linking of records of different individuals together;

• not linking records of the same individual together; that is, an individual has multiple SLKs. This is caused through one or more of the components of the SLK being recorded differently in separate records (e.g. ‘Joseph’ cf. ‘Joe’ or the use of an estimated date of birth by one agency and an exact date of birth by another); and

• linking records containing substitute characters in the SLK.


Appendix 3: D

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a3.3 multiple Client records

Client records are collected in the HACC MDS for each type of assistance a client receives from an agency. Demographic data (e.g. country of birth, main language spoken, Indigenous status) on the client are reported against each of these records. In a number of instances the demographic information for a client can differ between records. In collapsing multiple records down into an individual’s record, the current method uses the demographic information from the client’s most recent assessment. This may cause demographic data to be lost, in cases where the last client record contains information of a poorer quality than from an earlier record.

a3.4 State/territory and regional Variations

Business processes vary across jurisdictions and can impact on the MDS. Variations in state and territory service and data provision can be the result of several factors:

• the structure and content of aged care programs, including the interfaces between HACC and other programs;

• program funding levels;

• profiles of HACC client groups, e.g. differences in age, geographic distribution and need for assistance profiles;

• differences in HACC MDS reporting; and

• local business rules for data acceptance in State Data Repositories and the Commonwealth’s data warehouse.

In particular, Victorian figures are not available for transport, home modification, other food services, or formal linen service. In that state, transport is reported as part of their volunteer social support assistance type, and would be classed as social support for the national data collection; home modification is part of property maintenance (home maintenance); and the preparation of meals in the home is included in domestic assistance rather than other food services. Formal linen service is not included in the Victorian list of assistance types (see the Victorian HACC web-site). Similarly, the availability of services in particular regions, the level of access to those services, and the extent of HACC MDS participation in reporting are factors to be considered when comparing regional service provision.

It is also noted that the ways jurisdictions define what constitutes an agency can differ, and thus impact on the scope of the collection.

There are some discrepancies between NSW statistics reported in this publication and elsewhere due to different processes in use in data warehouses. These discrepancies are the subject of ongoing investigation with the aim of ensuring consistent reporting in future.


a3.5 data item-specific Considerations

There are also a number of data item-specific issues that have been identified which should be considered when using these data items.

A3.5.1 distinct Counts of Clients

For the purposes of this report, ‘clients’ refers to the number(s) of distinct client statistical linkage keys (SLKs).

When reporting by Assistance Type, clients (SLKs) can be counted more than once in those cases where a client received more than one type of assistance and/or where a client received the same assistance type from more than one agency.

A3.5.2 Assistance Groups

Victoria does not collect data separately on transport, goods and equipment, formal linen services and home modifications.

Northern Territory does not collect data separately on home modifications.

A3.5.3 location data

Location information is reported based on the agency location, not the client residential location. In a small number of cases, a client may receive services in more than one jurisdiction. In such cases, service provision will be reported against one jurisdiction only.

A3.5.4 Age

Age is calculated based on the date of birth as at 30 June 2009. Agencies may estimate the date of birth to the nearest month, year or decade, or use either 1/1/1900 or 1/1/1901 where the date of birth is unknown. During the 2008–09 period, 63,000 clients (7.4%) were reported as having an estimated date of birth.

The 95+ age group is over-represented and likely to reflect poor data quality at data collection or entry. There are over 1,700 records with the date of birth recorded as 1/1/1900 or 1/1/1901, of which only 770 of these are flagged as being estimated. The expected number of clients born on these dates, based on the number of clients born in 1900 or 1901, is small (just under 80 clients were born on days other than the 1st of January in these two years). Also, in a small number of cases (0.5%), where it was not possible to obtain the care recipient’s date of birth and where the care recipient has a carer, the care recipient’s date of birth has been replaced by the carer’s date of birth.

A3.5.5 Country of Birth

Country of birth classification is based on the ABS Standard Australian Classification of Countries (ABS catalogue number 1269.0).

A3.5.6 Main language spoken at Home

The main language spoken at home is the language spoken by the care recipient to communicate with family and friends. Language classification is based on the ABS Australian Standard Classification of Languages (ABS catalogue number 1267.0).


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a3.6 Population data

A3.6.1 population projections

Population data is sourced from the ABS Preliminary Population Projections by SLA 2007-2027, based on the 2006 census (unpublished) and based on Series B (medium scenario) for year 2009.

A3.6.2 HACC target population

The HACC target population is people in the Australian community who, without basic maintenance and support services provided under the scope of the HACC Program, would be at risk of premature or inappropriate long-term residential care, including older and frail people with moderate, severe or profound disabilities and younger people with moderate, severe or profound disabilities. The HACC target population is estimated by applying the proportion of people in households with moderate, severe or profound disability as reported in the ABS 2003 Survey of Disability, Ageing and Carers to the ABS Preliminary Population Projections 2006-2026 (unpublished).

A3.6.3 Indigenous population

Indigenous data for June 2009 are determined as follows: observed average annual growth at state level in ABS Experimental Indigenous Estimated Residential Populations (ERPS) between 2001 and 2006 for total Indigenous people of all ages was applied to project 2006 ERPs forward to 2009.

a3.7 HaCC mdS data Storage rules

HACC data are submitted to the HACC National Data Repository (HACC NDR) on a quarterly basis. These data are subjected to a number of business rules to ensure an agreed level of data quality before being stored in the HACC NDR. Data are then aggregated into extracts and supplied to DoHA, at a national level, and to state and territory governments as extracts relevant to their jurisdiction.

Some additional data storage rules are applied when the national extracts are loaded into the HACC MDS. These additional storage rules further improve the quality of the data to be held in the HACC MDS, which is then used for reporting, such as in this publication, the HACC MDS Annual Bulletin, and the Productivity Commission’s Annual Report on Government Services. As these additional storage rules are applied during the load process into the HACC MDS, state and territory reporting may vary from HACC MDS reporting to some small degree. These discrepancies are the subject of ongoing discussions with the aim of ensuring consistent reporting.


Appendix 4: Main languages spoken at Home

The following languages have been reported in the 2008–09 dataset:

Aboriginal Languages

Afrikaans

Albanian

Amharic


Armenian

Assyrian (including Aramaic)

Basque

Belorussian

Bengali

Bisaya

Bosnian

Bulgarian

Burmese

Cantonese

Catalan

Cebuano

Croatian

Czech

Danish

English

Estonian

Fijian

Finnish

French

Gaelic (Scotland)

German

Gilbertese

Greek

Gujarati

Hakka

Hebrew

Hindi

Hmong

Hokkien

Hungarian

Ilokano

Indonesian

Irish

Italian

Japanese

Kannada

Khmer

Konkani

Korean

Kurdish

Lao

Latvian

Lithuanian

Macedonian

Malay

Malayalam

Maltese

Mandarin

Maori (Cook Island)

Maori (New Zealand)

Marathi

Mauritian Creole

Nauruan

Nepali

Netherlandic

Non Verbal (incl. sign languages, e.g. Auslan, Makaton)

Norwegian

Other Languages, nec

Papuan Languages

Pashto

Persian

Polish

Portuguese

Punjabi

Romanian

Russian

Samoan

Serbian

Sindhi

Sinhalese

Slovak

Slovene

Somali

Spanish

Swahili

Swedish

Tagalog (Filipino)

Tamil

Telugu

Teochew

Tetum

Thai

Timorese

Tongan

Torres Strait Islander Languages

Turkish

Ukrainian

Urdu

Vietnamese

Welsh

Wu

Yiddish


Appendix 5: Abbreviations

ABS Australian Bureau of Statistics

CALD culturally and linguistically diverse

COAG Council of Australian Governments

DoHA Department of Health and Ageing

ERPS estimated residential populations

HACC Home and Community Care program

KPI key performance indicator

MDS Minimum Data Set

NDR National Data Repository

NSSI National Service Standard Instrument

SLA Statistical Local Area (ABS Australian Standard Classification)

SDAC Survey of Disability, Ageing and Carers


Appendix 6: HACC national service standards objectives

Objective 1: Access to services

To ensure that each consumer’s access to a service is decided only on the basis of relative need.

Objective 2: Information and consultation

To ensure that each consumer is informed about his or her rights and responsibilities and the services available, and consulted about any changes required.

Objective 3: Efficiency and effective management

To ensure that consumers receive the benefit of well-planned, efficient and accountable service management.

Objective 4: Coordinated, planned and reliable service delivery

To ensure that each consumer receives coordinated services that are planned, reliable and meet his or her specific ongoing needs.

Objective 5: Privacy, confidentiality and access to personal information

To ensure that each consumer’s rights to privacy and confidentiality are respected, and he or she has access to personal information held by the agency.

Objective 6: Complaints and disputes

To ensure that each consumer has access to fair and equitable procedures for dealing with complaints and disputes.

Objective 7: Advocacy

To ensure that each consumer has access to an advocate of his or her choice.


Appendix 7: Refined Key performance Indicators 1–7

KPI 1 The number of clients as a percentage of the HACC target population

KPI 1 is calculated as: Numerator: number of HACC clients/carer dyad as defined in the Minimum Data Set (MDS) National Data Repository (NDR) Extract 2; and Denominator: number of people living with a profound disability or severe disability or moderate disability for at least six months, living in private households as defined in 2003 Survey of Disability, Ageing and Carers (SDAC).

Data collection: Numerator: data available from annual records taken from the MDS and provided by the Australian Government. No adjustment will be made for under-reporting or lack of reporting by service providers in the MDS; and Denominator: the Australian Government will undertake this calculation from the SDAC and provide updated yearly estimates to each jurisdiction.

KPI 2 The percentage of Aboriginal and Torres Strait Islander clients as a proportion of this group in the total population

This KPI is measured by Fraction 1 divided by Fraction 2 where: Fraction 1: Aboriginal and Torres Strait Islander identified HACC clients/carer dyad as defined in the MDS NDR Extract 2 as a percentage of all HACC clients; and Fraction 2: Aboriginal and Torres Strait Islander identified people as a percentage of the total (Aboriginal and Torres Strait Islander and non-Indigenous) population.

Data collection: Fraction 1: data available from annual records taken from the MDS and provided by the Australian Government. Not-stated responses should not be incorporated into measuring the number of Aboriginal and Torres Strait Islander HACC clients for calculating the numerator. No adjustment will be made for under-reporting or lack of reporting by service providers in the MDS; and Fraction 2: estimated resident (Aboriginal and Torres Strait Islander and non-Indigenous) population data provided by the Australian Government and sourced from the ABS.

KPI 3 The number of culturally and linguistically diverse (CALD) clients as a proportion of this group within the target population where CALD is defined as country of birth other than Australia that is non-English speaking

KPI 3 is calculated as Numerator: number of HACC clients/carer dyad with a country of birth other than Australia that is non-English speaking as recorded in the Minimum Data Set (MDS) National Data Repository (NDR) Extract 2; and Denominator: HACC target population with a country of birth other than Australia that is non-English speaking.

Data collection: Numerator: data available from annual records taken from the MDS and provided by the Australian Government. Not-stated responses should not be incorporated into measuring the number of CALD HACC clients. No adjustment will be made for under-reporting or lack of reporting by service providers in the MDS; and Denominator: CALD HACC target population calculated from the ABS SDAC and yearly records provided to each jurisdiction by the Australian Government.


KPI 4 The percentage of eligible HACC ‘agencies’ which received a rating of ‘good’ or higher over the three-year reporting cycle [next cycle 2008–09 to 2010-11]

KPI 4 will be reported each year and published every three years where the Numerator: number of HACC agencies that received a rating of ‘good’ plus the number of HACC agencies that received a rating of ‘high’; and the Denominator: total number of HACC agencies that were appraised in the year. This KPI should also report the percentage of agencies that were appraised in that year.

Data collection: data on appraisal results should continue to be collected by states and territories in line with current practices. The Australian Government will include a caveat relating to the definition of an agency when publishing this information.

KPI 5 The percentage of active agencies in the NDR providing data to the HACC MDS

KPI 5 will be reported as the Numerator: sum of the number of active agencies that submitted data to the MDS in each quarter plus any additional agencies that made entries (for each quarter that they submitted data including the annual revision period); and the Denominator: sum of the number of active agencies in each quarter.

Data collection: an inter-jurisdictional data working group proposed that the data for measuring the KPI (numerator and denominator) be made available by the Australian Government by 1 October each year. This would include the quarterly participation rates and any additional entries provided in the annual revision period. These rates would be incorporated into each jurisdiction’s business report. The Australian Government will include a caveat relating to the definition of an active agency when publishing this information.

KPI 6 The percentage of HACC funded organisations that have supplied acquittals

KPI 6 will be reported for the last two financial years. The most recent financial year with the numerator as the number of HACC funded organisations that are required by the states and territories to provide acquittals, that have supplied acquittals for the most recent financial year. The denominator being reported as the total number of unique HACC funded organisations that are required by the states and territories to provide acquittals in the most recent financial year. The previous financial year is reported using the same methodology as above applied to the previous year’s acquittal.

States should receive acquittals in time to be included in the business reports. An acquittal is defined as an annual financial reconciliation of allocated HACC funds by HACC funded organisations to state and territory governments providing information on HACC funding, including funds received, funds spent and whether funds have been fully expended.

KPI 7 Unit cost for key service types

KPI 7 will be reported using a base calculation with the numerator being the actual base funding expenditure reported in annual business reports and the denominator as the outputs taken form the MDS and or service provider data. Key service types agreed for reporting in 2008-09 were Personal Care and Domestic Assistance with two additional service types, Allied Health and Nursing added for reporting in 2009-10.


Appendix 8: H

AC

C P

lanning Regions

number of clients with region not reported

HACC clients by Age and HACC Planning Region – 2008–09

0–49 50–64 65–69 70–79 80 + unknown total

number of clients

Unknown 552 548 387 1,023 2,152 345 5,007

1. Planning Region is determined using the client’s postcode. In cases where the client’s postcode is invalid or unknown, Planning Region cannot be reported.

Documents

HACC-anuual-report-210111