National ACAP Conference 2010 19-20 May 2010 Barbara Anderson Manager, Aged Care Integration Unit

1. CAPTURING THE PERSPECTIVE OF KEY ACAT STAKEHOLDERS IN NSW National ACAP Conference 2010 19-20 May 2010 Barbara Anderson Manager, Aged Care Integration Unit Donald Woo Manager, Dubbo Aged Care Assessment Team NSW Department of Health

2. ACAP COAG REFORM AGENDA 2006-2010 • Ambitious set of ACAP COAG structural reform activities in NSW • ACAP MDS data used for quantitative measurement of improved performance • Decision to undertake key ACAT Stakeholder Consultations to provide qualitative data from consumer perspective - ACAP COAG funded project

3. NSW Key ACAT Stakeholder Consultations • Elton Consulting appointed for 3-year project • ACAP COAG Advisory Group established • Round 1 -2008 & Round 3 – 2010: • Statewide surveys of clients, including families and carers, and service providers. • Round 2 – 2009: • To gain more indepth understanding of hard-to-reach groups, particularly Aboriginal and Torres Strait Islander population and Culturally and Linguistically Diverse community.

4. Round 1 What did we set out to do in Year 1 ? • Establish baseline data to inform ongoing quality improvement of ACAT services in NSW • Examine stakeholder perspectives in relation to three ‘indices of satisfaction’: service standards, service values and results. • Take into account variables of interest including assessment setting, geographic location and client Priority Category. • Examine client values to find out ‘what aspect of ACAT service is most important/ least important to clients?’

5. Client feedback: ‘What aspect of service delivery is most important to me?’

6. Round 1 results What did we find? • Very high overall level of satisfaction with ACAT assessment process from clients – 95% • More moderate level of satisfaction expressed by service providers – 66% • Both stakeholder groups had very high level of satisfaction with clinicians’ levels of ‘courtesy’ and ‘respect’ • Contrasting views on ‘timeliness’ reflecting different perspective of clients and service providers

7. Round 2 What did we do? • Explored perspectives of frontline health professionals and community workers working specifically with Aboriginal and CALD communities. What did we find? • Common suggestions from both groups included: • Wider promotion of ACAT service and role needed • More partnerships with ethno-specific service providers needed • Minimisation of existing duplication of assessments needed • Better use of simple English language in assessment process and promotional materials

8. Round 2: CALD-specific observations CALD – Specific Findings: • Greater use of interpreters during ACAT assessments needed • Access to interpreters a complementary concern • Greater sensitivity to anxieties of CALD clients and families around ‘failing’ the assessment needed • ACAT assessment process can seem overwhelming • Many clients see assessment as a test • General distrust of government-based services • May relate to past experience in country of origin

9. Round 2: Dubbo ACAT experience Key issues from Round 1 in Dubbo: • Need to address specific needs of Aboriginal clients and their carers/families and issues of relevance to ACAT Assessment process for this stakeholder group. • Low response rate from service providers working specifically with clients from Aboriginal and Torres Strait Islander Communities noted

10. Dubbo ACAT experience cont. Why was Dubbo targeted in Round 2? • Dubbo ACAT identified as being in a rural location with a large Aboriginal population aged 50+.

11. Round 2: Dubbo ACAT involvement What happened in Round 2? • Elton Consulting contacted team about participating in Round 2 • Workshop arranged to target frontline and community support workers working specifically with Aboriginal client groups within region serviced by Dubbo ACAT • Aboriginal Service Providers Workshop in Dubbo 27 May 2009 - facilitated by representatives from Elton Consulting NB: Whilst Dubbo ACAT instrumental in organising the Workshop, they did not participate to avoid influencing feedback

12. 2009 workshop participants Who participated in the Workshop? • HACC • COPS - Aboriginal • COPS – Mainstream • Aboriginal Home Care • ComPacks Providers • AMS • GP from Thubbo • Aboriginal Health Workers

13. Workshop participants cont. Who participated in the workshop? (cont): • Outback Division of General Practitioners • Representative from Bourke • Commonwealth • Respite and Carelink Centre • Allira – Aboriginal CACP Provider • Jack Towney Hostel – CACP & RACF for Aboriginal People • Acute Settings • Acute to Aged-Related Care Service (AARCS), Dubbo Base Hospital

14. Key workshop findings specific to ACAT service delivery to Aboriginal Communities What did we find out at the workshop? • To ensure ACAT assessments completed in a more culturally appropriate manner, there should be ongoing involvement of Aboriginal Service Providers and Aboriginal ACAT workers wherever possible • Need to address existing lack of awareness and understanding of the ACAT service and role of ACAT teams among Aboriginal Services, clients and families • Need to note that the role of ‘carer’ may be assumed by different people in the Aboriginal community and may change over time.

15. DUBBO ACAT’S RESPONSE TO KEY FINDINGS IN ROUND 2 What did we do about the findings? Explored avenues for funding a specialist Aboriginal Health Worker to be part of Dubbo ACAT. Aboriginal Health Programs agreed to support this position and allocated $70,000.00 for one year’s funding • Job description developed • Recruitment successful • Commenced 28 September 2009 • National ACAT Generic and Assessor training packages completed • Skills continually being developed

16. Achievements to date What else did we do? • Met with Local Lands Council and elders from the six “mobs” of Aborigines Dubbo ACAT region. Main purpose: to promote our service, educate on role of ACATs and availability of services to Aboriginal people. • Made contact and worked with Aboriginal service providers • Participated with other team clinicians during assessments to achieve good outcomes for complex Aboriginal referrals What did we achieve? • Approximately 110 occasions of service since commencement in position • 200% increase in completed assessments for Aboriginal clients compared to same period in previous 12 months.

17. Learnings What did we learn in Dubbo? • Large increase in requests for the ACAT Aboriginal Health Worker to become involved in issues not relevant to her role. This has required active management • Not enough culturally appropriate services to meet the assessed needs of individuals for the Aboriginal Health Worker to refer to; eg. Negotiate for family members to provide CACP • Males prefer to communicate with a male health worker

18. Comparing Round 1 to Preliminary Round 3 findings: Participation in Round 1 and Round 3: • Participation in the Client Feedback Survey rose from 892 in Round 1 to 1,044 in Round 3 • higher participation from all target groups: clients assessed in hospital, Aboriginal clients, CALD clients • Participation by service providers also rose - from 370 to 590

19. Which clients did we hear from in Round 3? Client Feedback Survey (n=1,044)

20. Who did we hear from? • Special Needs Groups: • Clients assessed in hospital: • Round 1 = 60 Round 3 = 158 • Culturally and Linguistically Diverse clients (ie born overseas and speak language other than English at home) • Round 1 = 226 Round 3 = 235 • Aboriginal clients • Round 1 = 5 Round 3 = 14 • GPs • Round 1 = 4 Round 2 = 12

21. Client feedback Overall Client satisfaction remains high: Round 1 95% Round 3 95%

22. Client feedback Round 3 • ‘As the family member who has dealt with the process of achieving the aged care assessment, I am quite satisfied. Although there is a wait for response, it is acceptable and the assessor could not have been more kindly, professional or helpful in manner.’ • ‘The assessor was absolutely wonderful. She listened and understood where no one else did. She also offered solutions that were extremely helpful.’ • ‘Since having the assessment I feel more secure and I know where to go for services.’ Indicative qualitative responses

23. Which service providers did we hear from in Round 3 Service Provider Survey (n=590)

24. Service Provider feedback Overall Service Provider satisfaction has significantly improved. It remains in the moderate range: Round 1 66%Round 3 75%

25. Service Provider feedback Round 3 • ‘ACAT staff are very professional/responsive and always willing to help.’ • ‘Variability across the region in the timeliness of ACAT assessments.’ • ‘I feel that their resources are stretched on many occasions, therefore assessment times are a lot slower.’ • ‘ACAT is such an important service they should never be understaffed... Marvellous service - extremely appropriate for the community, but demand hugely exceeds provision.’ Indicative qualitative responses

26. Where to from here? • ACATs in NSW now have access to a set of survey tools to enable continued trending of stakeholder satisfaction in NSW • Careful analysis of findings and recommendations in final report • Follow-up action appropriate to the ‘big picture’ context of national health, hospital and aged care reform

27. Thank you • A big thank you to all ACATs across NSW for their efforts to contribute to the success of this 3-year project. • A big vote of appreciation to all our dedicated and hard working ACATs – the clients and their families and carers clearly love you!