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Section A - Policy

16. Specific Programs & Technical Details

Appendix 6-Post Acute Care

1. Background

The Post Acute Care (PAC) Program is a joint initiative of the Acute Health and Aged, Community and Mental Health (ACMH) Divisions of the Department of Human Services.

The PAC Program commenced in 1996-97 with a $3 million commitment resulting in the establishment of six pilot projects. The PAC Program now has a total operating budget of $8.2 million and in 1998-99, the PAC Program was expanded to further extend coverage in metropolitan areas and rural Regions. There are now a total of 16 PAC projects operating across the State as listed below.

* denotes new projects funded in 1998-99

In addition to the establishment of new projects, some projects have significantly expanded their geographical coverage, accepting PAC clients from an increased number of acute care facilities.

The PAC Program is now well established and well supported by both the acute health, aged care and community sectors and is increasingly seen as integral to the care of patients. The Program has now moved beyond the pilot phase and program objectives have been adjusted to reflect this. In particular, reinforced by the Effective Discharge Strategy, it remains the responsibility of hospitals to engage in appropriate and active discharge planning with the resources allocated to PAC projects being dedicated to coordination and service provision following discharge.

2. Definition

For the purposes of the PAC program, post acute care is a time limited short term intervention designed to assist patients to recuperate following an acute hospital admission and to facilitate their independence or transition to continuing care where required.

Post acute care funding enables the purchase of individually tailored packages of health and community care services such as home nursing, personal care, child care, allied health services and home help following discharge from hospital.

The PAC Program provides funding for the provision of additional post acute care services as required, and in so doing, acts to augment the current service system, not substitute existing services.

3. Program Objectives

The objectives of the Program are:

• To improve the co-ordination of care for patients discharged from hospital;
• To provide additional post acute care services based on individual need;
• To improve the links between hospitals and other health and community care providers; and
• For newly established PAC projects, to assist hospitals and other health and community care providers to develop innovative models for the delivery of post acute care, by identifying and assisting those patients needing extra help to recover and regain independence in the community and to facilitate the transition to continuing care where required.

4. Client identification and services purchasing model

Participating hospitals are encouraged to screen patients as soon as possible during the acute episode to identify potential risk for poor health outcomes, using the risk screening tool trialed and validated by Thomas and Associates, and for patients identified as being at risk, to assess their need for post acute care.

If patients are assessed as requiring additional post acute care services and are eligible for PAC, the PAC project should:

• Develop, coordinate and implement a post discharge care plan;
• Purchase an individually tailored package of health and community care services in accordance with the post discharge care plan developed above;
• Review client needs and adjust services accordingly; and
• Facilitate transition to continuing care where required by referring PAC clients to appropriate health and community care agencies, prior to their exit from the PAC program.

Hospitals are responsible for implementing and providing effective discharge procedures for their patients. As such, PAC projects are encouraged not to take on those tasks within the discharge process which are the responsibility of the hospital, including risk screening and assessment processes.

5. Eligibility

To receive additional post acute care services through the PAC program, clients must:

• Be a patient of a public hospital;
• Be assessed as requiring additional services to assist with recuperation or transition to continuing care following an acute episode;
• Consent to receive additional post acute care services under the PAC program; and
• Agree to the forwarding of individual de-identified client level data to the Department for the purposes of program monitoring and evaluation.

6. Provider Arrangements

Health and community support services should be purchased from providers through service contracts which emphasise:

• Quality, including responsive and timely service delivery;
• Price;
• Maintenance of effort;
• Preparedness to participate in project evaluation and review; and
• Other relevant items deemed to be appropriate by individual projects.

7. Funding

Budgets for PAC projects will comprise three components:

• Project management;
• Care coordination; and
• Service provision.

The service provision component will comprise a minimum of 50% of the overall budget to ensure that the program continues to focus on the provision of additional post acute care services.

8. Department of Veterans Affairs Clients

Additional funds will be available for PAC projects for service provision to Department of Veterans Affairs (DVA) clients. An average case cost, covering the cost of purchase of services, care coordination, and a small administration component, is currently being negotiated with DVA. These funds are likely to be paid quarterly on the basis of numbers of DVA clients serviced. Details of the arrangements will be provided to PAC projects prior to the end of June 1999.

9. New Resource Allocation Model

Work has commenced on developing a new resource allocation model for the PAC Program to ensure the equitable distribution of available funds. A Working Group has been established with representation from key stakeholders, and consultation will occur during the development of the model. The model should be completed by the end of October 1999 and all projects will be given adequate notice of any changes that may result. It is intended that the new resource allocation model will be implemented from July 2000.

10. Reporting and Accountability Requirements

Projects are required to comply with the following reporting arrangements:

• Participating hospitals to record on the Victorian Admitted Episodes Dataset (VAED), all patients discharged from hospital and admitted to the PAC program, by the use of formal separation code P in accordance with the PRS/2 Manual, Version 9;
• No later than ten working days following the end of each quarter, provide hard copy quarterly and year-to-date reports, containing information at least equivalent to that provided by the Project Service Accountability Report and Project Financial Accountability Report generated by the PAC Manager software or its subsequent upgrade;
• No later than ten working days following the end of each quarter, provide year-to-date electronic reports in a format compatible with the Department's consolidation module, such as those generated by the Report Export function of the PAC Manager software or its subsequent upgrade;
• By 31 July, 2000 submit a certified statement of income and expenditure on an accrual basis for the 1999-2000 financial year in a format to be specified by the Department;
• By 30 September, 2000 submit an independent auditor's report regarding the above statement;
• No later that ten working days following the end of the financial year, or as required by the Department for monitoring and evaluation purposes, provide de-identified client data, as provided by the Encrypted Backup function of the PAC Manager software or its subsequent upgrade;
• Advise the Department of intention to change the auspice, management structure or hospitals to be serviced by the PAC project; and
• Provide other information as required by the Department.

11. Other Requirements

PAC projects are required to comply with the following program policies:

• Maintenance of Effort policy; and
• Inter-project referral protocols (under development and to be implemented during 1999).

12. Monitoring and Evaluation

The Department will monitor project activity and expenditure on a quarterly basis and provide quarterly reports to projects for feedback and comparison.

A consultancy to examine health outcomes and cost benefits in relation to the PAC program began in September, 1998. The Centre for Applied Gerontology at the Bundoora Extended Care Centre is conducting the study, using a randomised controlled trial methodology. The study is expected to be completed by June, 2000 and the outcomes of the study will inform future policy directions.

13. Future Challenges

Key directions for the Department's purchasing of Post Acute Care services in the future include:

• Development of an equitable model for the allocation of resources;
• Development of purchasing models; and
• Exploration of the interface of the PAC Program with the Department's Effective Discharge Strategy and the Primary Health and Community Support Sector reforms.

14. Contact Persons

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