Residential Care Manual
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The Residential
Care Manual
www.health.gov.au
Residential Care Manual
ISBN: 978-1-74241-010-4
Online ISBN: 978-1-74241-011-1
Publications Approval Number: 6039
(c) Commonwealth of Australia 2009
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 Oces, National Circuit, Barton ACT 2600
or posted at http://www.ag.gov.au/cca
I
TABLE OF CONTENTS
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
TABLE OF CONTENTS
EXECUTIVE SUMMARY 01
Welcome to the Residential Care Manual 2009, Edition 1. 01
Diagram A—Structure of the Aged Care Act 1997 03
Revised structure 04
References 07
Guide to terms 09
Update your details online 10
References—links, guides and forms referred to in this chapter 10
BECOMING AN APPROVED PROVIDER 11
Relevant legislation 11
Overview 11
Additional information 11
Becoming an approved provider 11
How to apply for approval as a provider of aged care 12
Assessing an application to become an approved provider of aged care 12
When does an approval come into force? 12
When does an approval lapse? 12
Can an approval be revoked? 13
Suitability to provide aged care 13
Circumstances aecting suitability 14
Definition of key personnel 14
Notifying the Department about changes to key personnel 14
Definition of disqualified individual 14
Ongoing suitability 15
Review rights 15
References—links, guides and forms referred to in this chapter 16
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THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
II
ALLOCATED PLACES 17
Relevant legislation 17
Overview 17
Additional information 17
Planning the provision of residential aged care services 17
Allocating places 18
Level 1 decision: Number of places made available nationally 18
Level 2 decision: Regional distribution of places 18
Level 3 decision: Allocation of places 19
Notification process 19
Provisional allocations 19
How allocated places take eect 20
Conditions of allocation 20
Conditions applying to particular allocations 20
Conditions applying to allocations generally 21
Applying to vary conditions for operational places 21
Applying to vary conditions for provisionally allocated places 23
Transferring operational places to another provider 23
Applying to transfer places 23
Transferring provisionally allocated places to another provider 27
Relinquishing operational places 28
Revoking places 28
Exchange of care type 28
Applying for exchange of care type 29
About special needs groups 29
About supported, concessional and assisted residents 29
References—links, guides and forms referred to in this chapter 30
EXTRA SERVICE PLACES 31
Relevant legislation 31
Overview 31
Additional information 31
What is an extra service place? 31
How is extra service status granted? 32
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THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
Criteria for approval 32
Access to residential aged care 33
Accommodation, food and services 33
Record of the applicant 34
Certification and accreditation 34
Competitive assessment 34
Notification of extra service status 35
Conditions of extra service status 35
When does extra service status cease? 36
Lapsing of extra service status 36
Revoking or suspending extra service status as a sanction 36
Revoking or suspending extra service status on request 36
Fees and payments 37
Extra service fee 37
Extra service amount and extra service reduction 37
Respite supplement 38
Changes in the levels of the extra service fee 38
Claiming arrangements 39
Extra service agreement 40
New residents 40
Existing residents 40
Eligibility for subsidies and additional funding 40
Extra service status and capital repayment 41
Extra service status and supported resident requirements 42
Allocations, transfers and variations 42
Transitional arrangements—existing approvals 43
Fees and subsidies 43
References—links, guides and forms referred to in this chapter 43
ACCREDITATION AND QUALITY OF CARE 45
Relevant legislation 45
Overview 45
Additional information 46
About the Aged Care Standards and Accreditation Agency 46
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THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
IV
Accreditation 46
Who audits aged care services? 46
Accreditation fees 46
Accreditation—commencing services 47
Accreditation—existing services 47
The accreditation decision 48
What happens once an aged care service is accredited? 49
Monitoring after accreditation 49
Exceptional circumstances 50
Non-compliance with the Accreditation Standards 50
Appealing, reconsiderations and reviewable decisions 51
Review audits 51
Referral to the Department 53
Nursing and related stang requirements 53
The Accreditation Standards 53
Standard 1: Management systems, stang and organisational development 54
Standard 2: Health and personal care 54
Standard 3: Resident lifestyle 55
Standard 4: Physical environment and safe systems 56
References—links, guides and forms referred to in this chapter 56
CERTIFICATION 59
Relevant legislation 59
Overview 59
Additional information 60
The Certification Assessment Instrument 60
Fire and safety 60
Privacy and space 60
Privacy and space requirements for buildings constructed post-July 1999 61
Privacy and space requirements for buildings constructed pre-July 1999 61
Certification assessments 61
The entire service is certified 61
Applying for certification 62
Preparing for an inspection 62
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The inspection process 63
Serious hazards 64
After the inspection 64
Suitability of residential care service for certification 64
Accommodation bonds 65
Reviewing, revoking or suspending certification 65
Reviewing certification 65
Lapse of certification 65
Revoking certification 65
Suspension 66
Accommodation payments and the revocation or suspension of certification 66
Appeals 66
Fire safety declaration 66
References—links, guides and forms referred to in this chapter 67
APPROVAL OF RESIDENTS 69
Relevant legislation 69
Overview 69
Additional information 69
Approval for Government-subsidised residential aged care 70
Who can be approved for residential care? 70
What limits can be placed on approval to receive care? 71
Approval for high level residential care 71
Payment of subsidy 71
When does an approval cease to have eect? 72
When should an aged care service request an ACAT reassessment? 72
Emergency approvals 73
Approval form 74
Reviewable decisions 74
References—links, guides and forms referred to in this chapter 75
CLASSIFICATION OF RESIDENTS 77
Relevant legislation 77
Overview 77
Additional information 77
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VI
About the Aged Care Funding Instrument (ACFI) 77
Applications for classification 78
Classification of residents 78
Figure 1—Weightings and range of points for each category 79
High and low care classifications 80
Classification expiry 80
ACFI appraisals—when must an appraisal be undertaken 81
New residents 81
Reappraisals for existing residents 81
Existing resident—significant change in care needs 82
Existing resident—reappraisal of lowest applicable classification 82
Existing resident—transfer from another aged care service 82
Existing resident—ageing in place 83
Reappraisal period 83
Late applications for reappraisal 84
Review of ACFI appraisals 84
Notice of a review visit 86
Roles and responsibilities 86
Exit meetings 87
Notifying the approved provider of the review outcome 87
Inaccurate assessments 87
Complaints and concerns 88
Risk assessment approach 88
Appeals to the Department for the reconsideration of decision 88
Notification of the reconsideration decision 89
Date of eect 90
Administrative Appeals Tribunal 90
Subsidy rate 90
Grandparenting of Resident Classification Scale (RCS) subsidies 90
References—links, guides and forms referred to in this chapter 91
FUNDING FOR PERMANENT RESIDENTIAL AGED CARE 93
Overview 93
A. ACCOMMODATION AND HOTEL SERVICES 95
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THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
Relevant legislation—resident fees (including the standard resident contribution) 95
Relevant legislation—accommodation payments 95
Overview 95
Rates and additional information 95
How to calculate fees payable by a resident 96
Standard resident contribution (basic daily fee) 96
Protected resident contribution 96
Phased resident contribution 97
Resident contribution top-up supplement 97
Non-standard resident contribution 97
Accommodation payments 98
Accommodation payments and assets testing 98
The value of a resident’s assets 99
Accommodation charge 100
How much is the accommodation charge? 101
Charge exempt residents—residents who entered care prior to 1 October 1997 101
Residents who entered care 1 October 1997–30 June 2004 102
Concessional residents 102
Assisted residents 103
Insucient assets to pay an accommodation charge but not
concessional 103
Charge-paying residents 103
Residents who entered care 1 July 2004–19 March 2008 (inclusive) 104
Concessional residents 104
Assisted residents 104
Charge-paying residents 104
Insucient assets to pay an accommodation charge but not
concessional 104
Residents who entered from 20 March 2008; or entered 1 July 2004–
20 March 2008 with break in care and re-entered on/after 20 March 2008 105
Accommodation supplement 105
Calculating a resident’s supplement 106
Accommodation supplement—assets test 106
Encouraging quality 106
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Supported resident ratios 106
Accommodation charge top-up supplement 107
Residents who move to another aged care service 108
Interest on delayed payments 108
Accommodation charge and hardship arrangements 108
Accommodation bonds 108
Which residents can be charged an accommodation bond? 109
Varying amount of accommodation bond with existing resident 110
Amount of accommodation bond 110
Types of accommodation bond payments 111
Retention amounts 111
Interest charges 112
Periodic payments 113
Retention component of a periodic payment 114
Calculating periodic payments 114
Refunding the accommodation bond balance 115
Residents who move to another aged care service 115
What if the resident’s care needs increase after entry? 116
Transitional accommodation supplement 116
Accommodation bonds and hardship 116
Accommodation payments—information provided to residents and resident
agreements 116
Essential information in accommodation charge agreements 116
Essential information in accommodation bond agreements 117
Accommodation bond agreements 118
Extra service fee 119
Fees for additional services 119
Grandparenting arrangements 120
Concessional resident supplement 120
Concessional resident—eligibility 120
Structure of the concessional resident supplement 121
Assisted residents 121
Charge exempt resident supplement 121
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Charge exempt residents and supported resident ratios 122
Pensioner supplement 122
Transitional supplement 122
Grandparenting of hostel variable fees 122
Transitional arrangements for entry contributions 123
B. FUNDING AND INCOME FOR CARE SERVICES 124
Relevant legislation 124
Overview 124
Rates and additional information 124
How to calculate fees payable by a resident 124
Residential care subsidy 125
How residential care subsidy is paid 125
Claims for residential care subsidy 126
Working out the amount of residential care subsidy 127
Basic subsidy amount 127
Transitional measures 127
Conditional adjustment payment 128
Eligible oxygen treatment and enteral feeding supplement 128
Oxygen supplement 128
Enteral feeding supplement 129
Payroll tax supplement 129
Who can claim the payroll tax supplement? 130
How the supplement is calculated 130
Income-tested fee 130
Which residents cannot pay an income tested fee? 131
Maximum income tested fee 131
Working out the amount of income tested fee 131
Income testing process 132
Reviews of income tested fees 133
Refunds of overcharged income tested fees 134
Remote area allowance 135
C. GOVERNMENT-FUNDED SUPPLEMENTS AND SUBSIDY REDUCTIONS 136
Relevant legislation 136
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Overview 136
Rates and additional information 136
How to calculate fees payable by a resident 136
Viability supplement 137
Viability supplement—current 2005 scheme 137
Viability supplement—previous schemes 137
Respite supplement 138
Reductions in subsidy 138
Compensable residents 138
Claim not settled yet 138
Extra service reduction 138
Adjusted subsidy reduction 138
D. HARDSHIP 140
Relevant legislation 140
Overview 140
Rates and additional information 140
Class hardship determinations 140
Individual hardship determinations 141
How are hardship assessments conducted? 141
How do hardship determinations end? 142
Revoking financial hardship 142
Reviewable decisions 142
Hardship, standard resident contribution and care payments (income tested fee) 143
How is a hardship supplement paid where financial assistance is given for the
basic daily fee? 143
How is subsidy paid where financial assistance is given for income tested fees? 143
Hardship and accommodation payments 143
Financial hardship—circumstances 144
E. LEAVE 145
Fees during periods of leave 145
Hospital leave 145
Extended hospital leave 145
Social leave 145
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Pre-entry leave 145
High-dependency care leave 146
References—links, guides and forms referred to in this chapter 147
RESIDENTIAL RESPITE CARE 151
Relevant legislation 151
Overview 151
Additional information 152
Conditions of allocation relating to the provision of respite care 152
What proportion of residential aged care should be provided as respite care? 152
What proportion of a service’s care can be provided as respite? 152
How are respite conditions of an individual aged care service varied? 153
How are places which can be used for respite allocated to new and existing
services? 153
Conditions of allocation of respite places—transferring places 153
Approval of respite care recipients 153
How does a person become approved as a respite care recipient? 154
Who is eligible for approval as a respite care recipient? 154
What are the limits on approval to receive respite care? 154
When does an approval cease to have eect? 154
Classification appraisal 155
When do classifications cease to take eect? 155
Approved period of respite care 156
Approving an extra 21 days of respite 156
Respite care for veterans and war widows and widowers 157
Extra service places 157
Residential care subsidies 157
Rules about the payment of subsidies and supplements 158
Additional amount for high care respite 158
Transfers from respite to permanent care 159
Date of entry into permanent care 159
Notification of entry into respite care 159
Monthly claim forms 159
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Care fees 159
What fees can be charged for respite care? 159
Respite booking fees 160
Reasons for not taking up a respite admission 160
Leaving a service before the end of a booked period 161
Resident’s agreement 161
Accommodation payments 161
Residents’ rights 161
References—links, guides and forms referred to in this chapter 162
CAPITAL GRANTS FOR RESIDENTIAL AGED CARE 165
Relevant legislation 165
Overview 165
Additional information 165
Eligible capital works 165
Eligibility 166
Residential Care (Capital) Grant 166
Rural and Regional Building Fund grants 166
Services not eligible for a grant 166
Assessment of capital funding proposals 167
The grant amount 167
Deed of Agreement 168
Payment arrangements and reporting requirements 168
Ceasing to provide residential aged care 168
Revoking or decreasing an allocation 169
Varying conditions of an allocation 169
Capital funding and extra service status 170
References—links, guides and forms referred to in this chapter 170
RESIDENTS’ RIGHTS 171
Relevant legislation 171
Overview 171
Additional information 171
Charter of Residents’ Rights and Responsibilities 171
Information for residents 173
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Resident agreements 173
Signing agreements 174
Resident agreement for respite residents 174
Transitional arrangements for agreements 175
Information for residents who do not sign agreements 175
Disclosure of financial information to residents 175
Protecting residents’ information 175
Security of tenure 176
Four steps—asking a resident to leave 176
Step 1—providing written notice 176
Step 2—considering suitable alternate accommodation 177
Step 3—assessing the resident’s long-term needs 177
Step 4—when the resident is no longer required to leave 177
Security of place within the residential service—moving residents 178
Respite booking fees 178
Resolving complaints 178
Internal complaint resolution 178
Aged Care Complaints Investigation Scheme 178
The Oce of the Aged Care Commissioner 179
Advocacy services 179
Community Visitors’ Scheme 180
References—links, guides and forms referred to in this chapter 180
PROTECTION AND RESPONSIBILITIES RELATING TO ACCOMMODATION BONDS 187
Relevant legislation 187
Overview 187
Additional information 187
Use of accommodation bond funds 187
Income derived from accommodation bond balances 188
Deductions from accommodation bond balances 188
Refunding accommodation bond balances 188
Recipient of the refund 188
Refunding accommodation bond balances—resident transfers from one
service to another 189
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THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
XIV
Refunding accommodation bond balances—resident leaves a service to move
back to their home or carer’s home 189
Refunding accommodation bond balances—resident dies 190
Refunding entry contribution balances 190
Delaying refunds to secure re-entry 190
Record keeping requirements in relation to accommodation bond balance
refunds 190
Former approved providers must refund accommodation bonds 191
Paying interest 191
Base interest 192
Maximum permissible interest rate 192
Period during which interest accrues and how to calculate interest 192
Accrual of interest—resident gives approved provider more than 14 days
notice of moving to another service (applicable since 1 July 2006) 193
Accrual of interest—resident gives less than 14 days notice of moving
to another service (applicable since 1 July 2006) 193
Accrual of interest—resident leaves service to move to another service
without giving any notice (applicable since 1 July 2006) 194
Accrual of interest—resident dies (applicable since 1 July 2006) 194
Resident paid entry contribution for entry into hostel before
1 October 1997 under formal agreement 195
Record keeping requirements in relation to interest 195
Pre-allocation lump sums of new approved providers 195
Pre-allocation lump sum paid to organisation not yet approved
as a provider 196
Protection of unregulated lump sums held by existing approved providers 196
The three prudential standards 197
The Liquidity Standard 197
Requirements of the Liquidity Standard 197
Determining the minimum level of liquidity 198
Identifying forms in which the minimum level of liquidity is maintained 199
Review of Liquidity Management Strategy 199
Other issues 200
The Records Standard—bond register 200
Information included in the bond register 201
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Deductions 201
Refund of accommodation bond 202
Entry contributions 202
Additional information 202
The Disclosure Standard 203
Disclosure to residents 203
Copy of accommodation bond agreement and guarantee 203
Routine provision of information at the end of the financial year 203
Provision of information on request at any other time 203
Keeping records of disclosures to residents 204
Disclosure to prospective residents 204
Disclosure to the Secretary of the Department 204
Annual disclosure requirements 205
Information about accommodation bonds held 205
Information about compliance with accommodation bond agreement
and written guarantee requirements 205
Information about the repayment of accommodation bond balances 205
Information about compliance with the prudential standards 205
Approved provider declaration 205
Audit opinion 205
Monitoring compliance of the prudential requirements 206
Responsibilities of approved providers 206
Mechanisms used to monitor compliance 206
Annual Prudential Compliance Statements (APCS) 206
Information obtained from an approved provider 207
Aged Care Standards and Accreditation Agency 207
Aged Care Complaints Investigation Scheme 207
Other reporting by approved providers or the public 207
Actions the Department can take in the event of non-compliance 207
No action 208
Education 208
Issue a non-compliance notice 208
Impose sanctions 208
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Accommodation Bond Guarantee Scheme 208
Aged Care (Bond Security) Act 2006 (the Bond Security Act) 208
Aged Care (Bond Security) Levy Act 2006 (the Bond Levy Act) 209
References—links, guides and forms referred to in this chapter 209
SPECIFIED CARE AND SERVICES 211
Relevant legislation 211
Overview 211
Additional information 212
Schedule 1 Specified care and services for residential care services 212
Part 1, Hotel Services—to be provided for all residents who need them 212
Part 2, Care and services—to be provided for all residents who need them 217
Part 3, Care and Services—to be provided for residents receiving a high
level of residential care 221
References—links, guides and forms referred to in this chapter 227
PROVIDERS’ RESPONSIBILITIES AND NONCOMPLIANCE 229
Relevant legislation 229
Overview 229
Additional information 229
Quality of care 229
User rights 230
Accountability requirements 230
Police checks 231
What is a national criminal history record check? 232
Who is required to have a police check? 232
What are the consequences for sta and volunteers whose police checks
reveal a criminal oence? 233
When should a statutory declaration be made? 233
Maintaining and renewing police checks 233
Keeping sta and volunteers’ police checks on file 234
Missing residents 234
Monitoring compliance 234
Role of the Department of Health and Ageing 235
Role of the Aged Care Standards and Accreditation Agency 235
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Compliance action 236
When can sanctions be imposed? 236
What sanctions can be imposed? 236
Agreeing to certain matters in lieu of revoking approved provider status 237
Duration of sanctions 237
Notice of non-compliance 238
Notice to remedy non-compliance 238
Notice of intention to impose sanctions 239
Notice of decision on whether to impose sanctions 239
Review rights 240
Publishing sanctions and notices of non-compliance 240
Case management and consumer information 240
Notices of non-compliance 241
References—links, guides and forms referred to in this chapter 241
COMPULSORY REPORTING 245
Relevant legislation 245
Overview 245
Additional information 245
The 5 key elements to compulsory reporting requirements 246
Reportable assaults 246
Unlawful sexual contact 247
Unreasonable use of force 247
Making a report to the Department 247
Approved provider responsibilities regarding compulsory reporting of assault
on a resident 248
Reporting reportable assaults 248
Requiring sta members to report reportable assaults 248
Specified circumstances in which the responsibility to report does not apply 249
Assaults perpetrated by a resident with cognitive or mental impairment 249
Health professionals who can assess cognitive and mental impairment 250
Similar or previously reported incidents 250
Responding to allegations of assault on a resident 250
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Role of the Department 250
Role of the Agency 251
Protecting an informant’s identity 251
Record keeping and privacy 253
References—links, guides and forms referred to in this chapter 254
RECORD KEEPING 257
Relevant legislation 257
Overview 257
Additional information 257
Kinds of records 257
False or misleading records 258
References—links, guides and forms referred to in this chapter 259
INDEX 261
I
Welcome to the Residential Care Manual 2009, Edition 1. 01
Diagram A—Structure of the Aged Care Act 1997 03
Revised structure 04
References 07
Guide to terms 09
Update your details online 10
References—links, guides and forms referred to in this chapter 10
EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
II
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
1
EXECUTIVE SUMMARY
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
Welcome to the Residential Care Manual 2009, Edition 1.
This Manual has been updated and revised to help approved providers comply with
their responsibilities under the Aged Care Act 1997 (the Act); and to assist sta of
aged care services understand the regulation of residential aged care. Additional
information can also be accessed through the Aged Care Information Line
1800 500 853.
Australian Government-subsidised residential aged care is governed by the Act and
the Aged Care Principles and is administered by the Department of Health and
Ageing. The Act covers a number of types of aged care including residential care,
community care (Community Aged Care Packages) and flexible care (Extended Aged
Care at Home and Extended Aged Care at Home—Dementia packages, multi-
purpose services, innovative care and transition care).
However, the purpose of this Manual is to provide a plain English guide
to Government-subsidised residential aged care only.
Government-subsidised residential aged care provides a range of supported
accommodation services for older people who are unable to continue living
independently in their own homes; and is based on a set of objectives outlined
in the Act. See legislative reference. These are to:
promote a high quality of care and accommodation
protect the health and wellbeing of residents
help residents enjoy the same rights as all other people in Australia
ensure that care is accessible and aordable for all residents
plan eectively for the delivery of aged care services
ensure that aged care services and funding are targeted towards people and
areas with the greatest needs
encourage services that are diverse, flexible and responsive to individual needs
provide funding that takes account of the quality, type and level of care
provide respite for families and others who care for older people
promote ‘ageing in place’—that is, help older people stay where they want
to live, by linking care and support services.
Approximately 70 per cent of the total funding for residential aged care is provided
by the Australian Government, paid directly to providers of aged care services on
behalf of the residents in those services.
l e g i s l a t i v e r e f e r e n c e s
Division 2
(Objects), Aged
Care Act 1997
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXECUTIVE SUMMARY
2
Australian Government subsidies can only be paid for a resident:
when the resident has been approved by an Aged Care Assessment Team (ACAT)
the resident’s care is provided by a Government-approved aged care provider
that care is provided in a Government-subsidised aged care place
and the standard of care in that service meets the accreditation requirements.
While most of the funding comes via the Department of Health and Ageing,
residential aged care for veterans is also funded by the Department of Veterans’ Aairs.
Although the Government funds the majority of approved residential aged care
services, residents are asked to make a contribution to the cost of their care and
accommodation where they can, by paying fees direct to an approved provider. The
legislation regulates the maximum fees an approved provider can ask a resident to pay.
All residents in Government-subsidised residential aged care can be asked to pay
a basic daily fee as a contribution towards accommodation costs and living expenses,
such as meals, cleaning, laundry, heating and cooling in the service.
Residents with sucient assets may be asked to pay an accommodation payment.
Accommodation payments include accommodation bonds for low-care residents
or residents who receive high-care on an extra service basis; and accommodation
charges for residents with high-care needs. Residents can only be asked for an
accommodation payment if the aged care service is certified.
Residents who have the means will also make a contribution towards their costs
of care, through an income tested fee.
The Government can assist older people experiencing genuine financial hardship
through hardship provisions, whereby the Government steps in and makes up for any
shortfall in fees these residents pay an approved provider. Hardship provisions also
ensure that these residents have equal access to residential aged care and are not
discriminated against in favour or residents who can aord to pay fees themselves.
In addition to regulating funding and income for residential aged care, the legislation
sets out the planning and distribution of Government-subsidised aged care places,
approval and classification of care recipients, approved providers’ responsibilities and
residents’ rights.
In order to meet the objectives of the Act, approved aged care providers must meet
building requirements for certification and for accreditation, as overseen by the Aged
Care Standards and Accreditation Agency. They must also adhere to prudential
regulation requirements. Under Government-subsidised residential aged care,
protections are also aorded to residents by the Aged Care Commissioner and
the Aged Care Complaints Investigation Scheme.
The structure of the Act is outlined in the Diagram A.
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXECUTIVE SUMMARY
3
Diagram A—Structure of the Aged Care Act 1997
CHAPTER 2PRELIMINARY MATTERS
RELATING TO SUBSIDIES
Part 2.1 Approval of providers
Part 2.2 Allocation of places
Part 2.3 Approval of care recipients
Part 2.4 Classification of care recipients
Part 2.5 Extra service places
Part 2.6 Certification of residential care
services
CHAPTER 3SUBSIDIES
Part 3.1 Residential care subsidies
Part 3.2 Community care subsidies
Part 3.3 Flexible care subsidies
CHAPTER 4RESPONSIBILITIES OF
APPROVED PROVIDERS CHAPTER 5GRANTS
Part 4.1 Quality of care Part 5.1 Residential care grants
Part 4.2 User rights Part 5.2 Community care grants
Part 4.3 Accountability Part 5.2A Flexible care grants
Part 4.4 Consequences of non-compliance Part 5.3 Assessment grants
Part 5.4 Accreditation grants
Part 5.5 Advocacy grants
Part 5.6 Community visitors grants
Part 5.7 Other grants
CHAPTER 6ADMINISTRATION
Part 6.1 Reconsideration and review of decisions
Part 6.2 Protection of information
Part 6.3 Record keeping
Part 6.4 Powers of ocers
Part 6.5 Recovery of overpayments
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXECUTIVE SUMMARY
4
REVISED STRUCTURE
The Residential Care Manual 2009, Edition 1 is structured as per below.
Table of contents
Section 1 Executive summary
Executive summary
Section 2 Approved provider, allocations, accreditation and certification
Becoming an approved provider
Allocated places
Extra service places
Accreditation and quality of care
Certification
Section 3 Approval and classification of residents
Approval of residents
Classification of residents
Section 4 Funding for residential aged care, residential respite and capital grants
Funding for permanent residential aged care
Residential respite care
Capital grants for residential aged care
Section 5 Caring for residents and providers’ responsibilities
Residents’ rights
Protection and responsibilities relating to accommodation bonds
Specified care and services
Providers’ responsibilities and non-compliance
Compulsory reporting
Record keeping
Index (will be provided on the Department’s website shortly)
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXECUTIVE SUMMARY
5
FUNDING F O R RESI DENTIAL
A G ED CARE, RESIDENTIAL RE SPITE
AND CAPIT A L G R ANTS
F u nding for permanent re sid ential aged car e
Res iden ti al r e spi te car e
Capital g rants f o r re si dentia l aged car e
4 Funding for residential
aged care, residential respite
and capital grants
APPRO V ED PRO V IDER, A L L OCA T IONS,
A C CRE DITA T I O N AND CERTIFICA T I O N
Bec o ming an approv ed pro vide r
Allocat e d places
Extra se rvi ce places
Acc redit at ion and qual ity o f care
C ertifi cation
2 Approved provider,
allocations, accreditation
and certifi cation
For this update, chapters of the Manual have been re-organised, with similarly-themed
chapters grouped together into five coloured main sections as outlined below.
To help approved providers find the information they need:
There is a table of contents at the beginning of the Manual
I
T A BLE OF CONTENTS
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
TABLE OF CONTENTS
EXECUTIVE SUMMARY 01
We lcome to the Residential Care Manual 2009, Edition 1. 01
Diagram A—Structure of the Aged Care Act 1997 0 3
Revised structure 04
Refer ences 07
Guide to te rms 09
Update your details online 10
References—links, g uides and forms referred to in th is chapter 10
BECOMING AN APPROV ED PROV IDER 11
Relevant legislation 11
Overview 11
Additional information 11
Becoming an approved provider 11
How to apply fo r approval as a provider of aged care 12
Assessing an application to beco me an approved provider of aged care 12
When does an approval come into forc e ? 12
When does an approval lapse? 12
Can an approval be revoke d? 13
Suitability t o provide aged care 13
Circ umstances aecting suitability 14
Definition of key personnel 14
Notifying the Department about changes t o key personnel 14
Definition of disqualified individual 14
Ongoing suitability 15
Review rights 15
References—links, g uides and forms referred to in th is chapter 16
Each of the five colour-coded sections list the chapters
in that section
table of contents
major section tabs
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXECUTIVE SUMMARY
6
Each chapter also has a contents page
There is extensive cross-referencing in each chapter.
cross-referencing of
legislative references
contents page
for each chapter
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXECUTIVE SUMMARY
7
References
A two-colour system has been used for references within this Manual. In the online
version, all these references are hyperlinked.
GREEN REFERENCES
All references to links, guides, forms and information available on the Department’s
website or other sites are marked in green, like this:
EXAMPLE:
Notifying the Department about changes to key personnel
Approved providers must inform the Secretary of any change to key personnel within
28 days after the change occurs, by completing the notification of key personnel
changes form. See References at the end of this chapter for a link to this form.
All these references can be found in the References section at the end of each chapter.
cross-referencing
of green references
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXECUTIVE SUMMARY
8
Green references are also used to refer to other sections within the same chapter;
or to other sections in dierent chapters of the manual, like this:
EXAMPLE:
Extra service agreement
In entering an agreement, the resident must not be subject to duress, misrepresentation
or threat of disadvantage or detriment. See also section on Accommodation payments
—information provided to residents and resident agreements in chapter on Funding
for permanent residential aged care; and section on Resident agreements in chapter
on Residents’ rights.
Sections in dierent chapters can be found using the table of contents at the beginning
of each chapter; or the overall table of contents at the beginning of the Manual.
DARK BLUE REFERENCES
All references to the Aged Care Act 1997 or the Aged Care Principles will be marked
in dark blue. Legislative references will sit beside the sentence to which they relate,
like this:
cross-referencing of
dark blue references
cross-referencing
of green references
EXECUTIVE SUMMARY
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXECUTIVE SUMMARY
9
EXAMPLE:
Accreditation—commencing services
An aged care service is considered a commencing service if an approved provider
has been allocated places for that service, residential aged care has not previously
been provided for those places and the service is not currently accredited by
the Agency. See legislative reference.
Guide to terms
The following list includes some of the terms used throughout the Manual; and
explains the way in which they are used. Where terms used in the Manual are not
defined, they have their plain English meaning. A list of definitions is also included
in the Dictionary at the end of the Act. See legislative reference.
Aged care service
This is the term used to describe a residential aged care service operated by
an approved provider. It replaces the older terms “nursing home” and “hostel”.
Approved provider
An approved provider is a person or body who is approved by the Department
to provide Government-subsidised residential aged care. This may be residential,
community or flexible care or a combination of these care types. In this Manual,
it is assumed that an approved provider has been approved to provide residential
aged care. An approved provider is referred to either in full, as an approved provider;
or in some instances as a provider.
Care recipient
A care recipient is a person who is receiving aged care provided by an approved
provider. The terms care recipient, resident and person are used interchangeably
throughout the Manual.
Department
All references to the Department mean the Department of Health and Ageing.
Health professional
The term health professional used in the Manual means a person who has
qualifications acceptable to the relevant state or territory regulatory board
or authority and who is currently registered with, or accredited by, that board
or authority.
Minister
All references to the Minister mean the Minister for Ageing.
Resident
A resident is someone living in a residential aged care service. All references to
resident also cover resident and/or their representative as appropriate. A resident’s
representative may be:
a guardian appointed by a tribunal
a person to whom the resident has formally delegated decision-making power
(“power of attorney”)
a person nominated by the care recipient as his or her representative.
l e g i s l a t i v e r e f e r e n c e s
Schedule 1—
Dictionary, Aged
Care Act, 1997
Division 14, Aged
Care Act 1997
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10
In some circumstances, a person may nominate himself or herself as a resident’s
representative. If the approved provider is satisfied that the person has a connection
with the resident, and is concerned for the safety, health and well-being of the
resident, the person may be regarded as the resident’s representative for some
purposes. Such a person may be, for example, a family member or carer.
Secretary
All references to the Secretary mean the Secretary of the Department of Health and
Ageing. References to the Secretary may include an ocer of the Department
holding, or performing powers of the Secretary as a delegate under the Act.
UPDATE YOUR DETAILS ONLINE
The Residential Care Manual will be updated in line with any changes in
legislation, policy or regulatory arrangements. Let us know of any changes
to your organisation’s contact details, so we can send you updates and
other important information.
To update your details go to
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-
contacts-subscribe.htm
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Aged Care Act 1997, Aged Care Principles
The Act and the Principles can be accessed via the Department’s website
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-legislat-aca1997-
acaindex.htm
Aged Care Information Line
Ph 1800 500 853
Dictionary—Aged Care 1997
A complete list of definitions is included in the Dictionary at the end of the Act,
which can be accessed via ComLaw or via the Department’s website.
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Legislation
Go to ComLaw to access all Commonwealth legislation, including the Act and the
Principles and any other legislation mentioned in this Manual
www.comlaw.gov.au
I
Relevant legislation 11
Overview 11
Additional information 11
Becoming an approved provider 11
How to apply for approval as a provider of aged care 12
Assessing an application to become an approved provider of aged care 12
When does an approval come into force? 12
When does an approval lapse? 12
Can an approval be revoked? 13
Suitability to provide aged care 13
Circumstances aecting suitability 14
Definition of key personnel 14
Notifying the Department about changes to key personnel 14
Definition of disqualified individual 14
Ongoing suitability 15
Review rights 15
References—links, guides and forms referred to in this chapter 16
BECOMING AN APPROVED PROVIDER
BECOMING AN APPROVED PROVIDER
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BECOMING AN APPROVED PROVIDER
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
II
BECOMING AN APPROVED PROVIDER
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11
l e g i s l a t i v e r e f e r e n c e s
BECOMING AN APPROVED PROVIDER
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 2.1, Divisions 6 to 10A,
Aged Care Act 1997 (the Act)
Approved Provider Principles 1997
(the Approved Provider Principles)
OVERVIEW
To receive Australian Government subsidies for providing aged care, an aged care
service must be operated by an organisation that has been approved by the Australian
Government—ie, an approved provider—and has an allocation of places in respect of
care recipients occupying those places in a service. If providing residential care, the
facilities must also be accredited by the Aged Care Standards and Accreditation Agency.
For the approved provider to be eligible to receive subsidies, the care recipient must be
assessed by an Aged Care Assessment Team as eligible to receive that type of care.
An applicant only needs to submit one application, even if they plan to operate in more
than one state or territory. Approval can be for one or more types of care—ie,
residential, community or flexible care. See legislative reference.
Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can
also be accessed through the Aged Care Information Line on 1800 500 853; and
questions about approval can be sent to: ApprovedProviderProgram@health.gov.au
BECOMING AN APPROVED PROVIDER
To gain approval as a provider of aged care an applicant and its associated key
personnel such as directors, board members and service managers must be
assessed by the Department as suitable to provide aged care.
In order to become an approved provider:
the applicant must make an application by completing the approved form
See legislative reference.
the applicant must be a corporation as defined in the Act
See legislative reference.
the applicant must be suitable to provide aged care
See legislative reference.
none of the applicant’s key personnel can be a disqualified individual as defined
in s10A-1 of the Act. See legislative reference.
State, territory and local government authorities are taken to be approved providers
unless the approval has lapsed or been revoked. See legislative reference.
s 8-1(2)(a), Aged
Care Act 1997
s 8-1(1)(a), Aged
Care Act 1997
s 8-1(1)(b), Aged
Care Act 1997
s 8-1(1)(c), Aged
Care Act 1997
s 8-1(1)(d), Aged
Care Act 1997
s 8.6, Aged Care
Act 1997
BECOMING AN APPROVED PROVIDER
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
BECOMING AN APPROVED PROVIDER
12
How to apply for approval as a provider of aged care
Applications can be made at any time during the year. Prospective applicants should:
read the Approved Provider Status Application: Guidelines
read the relevant sections of the Act and Aged Care Principles
make an application on the approved form, including the required documents
obtain a National Criminal History Check from the Australian Federal Police or
another agency accredited by Crimtrac, for the applicant organisation and each
of their associated key personnel. Original documents must be included with
the application. See also section on Police checks in chapter on Providers’
responsibilities and non-compliance.
See References at the end of this chapter for these links.
Assessing an application to become an approved provider
of aged care
The Secretary has 90 days to consider an application. If further information is
required in order to properly assess the application, the Secretary may send a
request for information, and the applicant then has 28 days to respond. If this additional
information is not provided, the application is considered to be withdrawn. Once the
information is received, the Secretary then has a further 90 days, to finalise the
application.
In assessing an application, the Secretary will consider all relevant information
available to the Department including:
the application
information from:
the Aged Care Standards and Accreditation Agency
the Australian Federal Police
the Aged Care Complaints Investigation Scheme
organisations which can independently investigate the financial probity and
credit/debt of an applicant.
When does an approval come into force?
An approval comes into eect when a provider obtains an allocation of places. An
approval is only in respect of each service for which an allocation of places is held.
Places can be allocated by the Secretary, through the Aged Care Allocations Round;
or by transfer from another approved provider with the approval of the Secretary.
When does an approval lapse?
For a provider approved on or after 1 January 2009, an approval will cease if the
provider does not receive an allocation of places within two years from the day the
approval is made. See legislative reference.
s 8-1(4), Aged
Care Act 1997
l e g i s l a t i v e r e f e r e n c e s
BECOMING AN APPROVED PROVIDER
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
BECOMING AN APPROVED PROVIDER
13
l e g i s l a t i v e r e f e r e n c e s
For a provider approved before 1 January 2009, approval would have lapsed on 1 July
2009, if:
no allocation of places is in eect
no provisional allocation of a place is in force
and a transfer of places has not occurred.
An approval which is in force will also lapse if the approved provider has no allocated
places. See legislative reference.
Can an approval be revoked?
Approval as a provider can be revoked under s10-3 of the Act if:
See legislative reference.
the approved provider has ceased to be a corporation
or the approved provider has ceased to be suitable to provide aged care (this
includes suitability of the provider’s key personnel)
or the approved provider’s application for approval contained false or
misleading information.
Approval as a provider can also be revoked as a sanction under Part 4.4 of the Act
where an approved provider has not met its responsibilities. See legislative reference.
SUITABILITY TO PROVIDE AGED CARE
The Secretary must consider a range of issues when assessing an applicant’s
suitability to provide aged care, including:
the suitability and experience of the applicant’s key personnel
ability to provide, and any experience, in providing aged care
ability to meet relevant standards for providing aged care
commitment to the rights of residents
record of financial management and methods for ensuring sound financial
management
if the applicant has been a provider of aged care, its conduct as a provider; and
its compliance with its responsibilities and obligations arising from receiving any
Commonwealth payments for providing aged care
if key personnel are also relevant key personnel in common with a current or
former approved provider, the record and suitability of that approved provider
will be considered
the conduct and experience of the applicant other than as a provider
of aged care
any other matters specified in the Approved Provider Principles.
s 10-2, Aged Care
Act 1997
s 10-3, Aged Care
Act 1997
Part 4.4, Aged
Care Act 1997
BECOMING AN APPROVED PROVIDER
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
BECOMING AN APPROVED PROVIDER
14
Circumstances aecting suitability
If an applicant was granted approved provider status after 1 January 2009, the
Secretary can specify any circumstance that would materially aect the applicant’s
suitability to provide aged care. The approved provider must get the Secretary’s
agreement before there is any change to the specified circumstance. See legislative
reference. For example, if an approved provider has an ongoing arrangement to
provide care through a management company and the Secretary specified that this
is a circumstance that materially aects the provider’s suitability, then the provider
must get the Secretary’s agreement before changing its management company
or ceasing to engage a management company. An approved provider can be
sanctioned if it does not comply with this responsibility.
Definition of key personnel
In the Act, the definition of provider’s key personnel includes any person exercising
one or more of the functions specified below:
See legislative reference.
a member of a group of persons responsible for the executive decisions of the
entity, including directors and board members
a person who has authority or responsibility for, or significant influence over,
planning, directing or controlling the activities of the entity
any person who is, or is likely to be responsible for, the nursing services
provided by the service
any person who is, or is likely to be responsible for, the day-to-day operations
of the service.
If a person performs one or more of these specified functions, they are one of the
key personnel of the approved provider whatever their job title is and whether or not
they are employed by the provider or applicant.
The definition of key personnel now includes an explicit statement that key personnel
include any person having authority or responsibility for (or significant influence over)
planning, directing or controlling the activities of the applicant/approved provider.
Notifying the Department about changes to key personnel
Approved providers must inform the Secretary of any change to key personnel within
28 days after the change occurs, by completing the notification of key personnel
changes form. See legislative reference. See References at the end of this chapter
for a link to this form.
An approved provider who does not inform the Secretary about changes to key
personnel within 28 days can be sanctioned under Part 4.4 of the Act, and is guilty
of a strict liability oence of 30 penalty units (where 1 penalty unit is $110).
Definition of disqualified individual
A disqualified individual is anyone who:
has been convicted of an indictable oence and the conviction is not a ‘spent
conviction’
is an insolvent under administration—ie, an undischarged bankrupt
or is of unsound mind.
s 63-1C, Aged
Care Act 1997
s 8-3A, Aged Care
Act 1997
s 9-1(1)(b), Aged
Care Act 1997
l e g i s l a t i v e r e f e r e n c e s
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BECOMING AN APPROVED PROVIDER
15
l e g i s l a t i v e r e f e r e n c e s
An approved provider must take all reasonable steps to ensure that none of its key
personnel is a disqualified individual. Failure to do so may result in sanctions being
imposed, and an oence of 300 penalty units may apply. See legislative reference.
Ongoing suitability
An approved provider must inform the Secretary of any change of circumstances
that significantly aects their suitability to be a provider of aged care, including:
suspending trading in shares
appointing an administrator
appointing a receiver or manager
entering into voluntary liquidation
an application for winding up.
See legislative reference.
An approved provider who does not inform the Secretary about a change in
circumstances that materially aects their suitability to be a provider of aged care
within 28 days can be sanctioned under Part 4.4 of the Act, and is guilty of a strict
liability oence of 30 penalty units (where 1 penalty unit is $110).
At any time, the Secretary can ask an approved provider for information relevant
to the provider’s suitability to be an approved provider of aged care. See legislative
reference. An approved provider who does not comply with such a request within
the time specified in the notice can be sanctioned under Part 4.4 of the Act, and
is guilty of a strict liability oence of 30 penalty units (where 1 penalty unit is $110).
See legislative reference.
REVIEW RIGHTS
If an applicant’s application for approval as an approved provider is rejected, they can
write to the Secretary within 28 days of receiving the rejection, asking the Secretary
to reconsider the decision. See legislative reference. The applicant should provide
reasons for the request and any relevant supporting material. See References at the
end of this chapter for mailing address.
The Secretary must then reconsider the decision, and either confirm, vary or set the
decision aside and substitute a new decision. If the Secretary does not give notice of
a decision within 90 days after receiving the request, the Secretary is taken to have
confirmed the decision—ie, the application is rejected. If an applicant wants to
appeal against a decision after review by the Secretary, they can apply to the
Administrative Appeal Tribunal for external review.
If an application is rejected, an applicant can reapply, at any time, on the
approved form.
Part 1A, Sanctions
Principles 1997
s 9-1(1)(a), Aged
Care Act 1997
s 9-2(1), Aged
Care Act 1997
ss 9-2(2) and
(3), Aged Care
Act 1997
s 85-5, Aged
Care Act 1997
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BECOMING AN APPROVED PROVIDER
16
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Aged Care Information Line
Ph 1800 500 853
Approved Provider Status Application—form, guidelines and postal address
Send applications to:
Approved Provider Section
Oce of Aged Care Quality and Compliance
Department of Health and Ageing
MDP 12
GPO Box 9848
Canberra ACT 2601
Crimtrac accredited agencies—for more information go to
www.crimtrac.gov.au/criminal_history_checks/index.html
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Form—notification of changes to key personnel
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-approvedp-index.htm
National Criminal History Check—consent, fees, form and guidelines
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-approvedp-index.htm
National Criminal History Checks—for more information on national police checks
www.afp.gov.au/business/national_police_checks
Questions and queries—about approval, email
ApprovedProviderProgram@health.gov.au
Reviews—requesting reconsideration of a decision not to grant approved
provider status
Send requests in writing to:
Approved Provider Section
Oce of Aged Care Quality and Compliance
Department of Health and Ageing
MDP 12
GPO Box 9848
Canberra ACT 2601
I
Relevant legislation 17
Overview 17
Additional information 17
Planning the provision of residential aged care services 17
Allocating places 18
Level 1 decision: Number of places made available nationally 18
Level 2 decision: Regional distribution of places 18
Level 3 decision: Allocation of places 19
Notification process 19
Provisional allocations 19
How allocated places take eect 20
Conditions of allocation 20
Conditions applying to particular allocations 20
Conditions applying to allocations generally 21
Applying to vary conditions for operational places 21
Applying to vary conditions for provisionally allocated places 23
Transferring operational places to another provider 23
Applying to transfer places 23
Transferring provisionally allocated places to another provider 27
Relinquishing operational places 28
Revoking places 28
Exchange of care type 28
Applying for exchange of care type 29
About special needs groups 29
About supported, concessional and assisted residents 29
References—links, guides and forms referred to in this chapter 30
ALLOCATED PLACES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
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ALLOCATED PLACES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
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ALLOCATED PLACES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
17
ALLOCATED PLACES
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 2.2,
Aged Care Act 1997 (the Act)
Allocation Principles 1997
(the Allocation Principles)
OVERVIEW
This chapter explains how the Government allocates new aged care places
to approved providers, and includes information about:
planning the provision of residential aged care places
the allocation of residential aged care places
conditions of allocation
varying the conditions of allocated places
transferring places between approved providers
how the allocation of places may cease
the exchange of care type mechanism.
Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can also
be accessed through the Aged Care Information Line on 1800 500 853.
PLANNING THE PROVISION OF RESIDENTIAL
AGED CARE SERVICES
In planning the allocation of residential care services across Australia, the
Government seeks to:
provide an open and clear planning process
identify community needs, particularly in relation to people with special needs
allocate places in a way that best meets the identified needs in the community.
To meet these objectives, the Government aims to:
have a national provision of 113 residential and community aged care operational
places per 1,000 people aged over 70 years, to be achieved by June 2011
these 113 places comprise a ratio of 88 places in a residential setting, (44
high care and 44 low care); and 25 in a community setting (4 high care and
21 low care)
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ALLOCATED PLACES
18
ensure an equitable balance in the provision of services between metropolitan,
regional, rural and remote areas, as well as between people needing diering
levels of care
ensure that people with special needs have access to culturally appropriate,
quality care
provide an appropriate level of respite places
increase the capacity for care recipients to age in place—ie, to stay where they
are most comfortable, as they age.
Aged care services with places approved before October 1997 can oer low level and
high level care. Places allocated after October 1997 may have conditions attached to
them, including if the place can be used to provide high or low level care
ALLOCATING PLACES
Decisions about where and how many places are to be allocated in any planning year
are made in three stages or levels.
Level 1 decision: Number of places made available nationally
The Minister decides the number of new residential and community and flexible aged
care places to be made available to each state and territory for the financial year.
These numbers are calculated according to the national planning benchmark—
currently 113 residential, community and flexible operational places per 1,000 people
over 70 years (to be achieved by June 2011). The decision also takes into account
state and territory population projections, current service provision levels, and the
total number of places which have already been allocated, including operational
and provisional allocations—ie, those which are yet to take eect.
Level 2 decision: Regional distribution of places
The Secretary decides how places should be distributed across the aged care
planning regions in each state and territory. This distribution is based on the national
planning benchmark and advice from individual state or territory Aged Care Planning
Advisory Committees. The committees provide recommendations to the Secretary on
the distribution of new aged care places across planning regions. The
recommendations are based on data on current and future supply and demand and
information provided by federal, state/territory and local governments, community
groups, individuals and organisations.
The distribution of new places across aged care planning regions aims to achieve
a balance in providing services between:
metropolitan, regional, rural and remote areas
people needing diering levels of care, including people with special needs.
Details of the distribution of places to regions are contained in the Regional
Distribution of Aged Care Places which is incorporated in the Aged Care Approvals
Round Essential Guide. See References at the end of this chapter for a link.
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ALLOCATED PLACES
19
l e g i s l a t i v e r e f e r e n c e s
Level 3 decision: Allocation of places
After deciding on the regional distribution of aged care places, the Secretary asks for
applications from organisations interested in providing aged care services, through
the Aged Care Approvals Round process.
Advertisements about the places made available and the application process are
published in major national, regional and selected ethnic newspapers in each state
and territory.
All applications are competitively assessed by the Department against the criteria set
out in the Act and the Allocation Principles. See legislative reference.
The allocation of places to successful applicants takes into account the number of
places made available for the Aged Care Approvals Round, the identified needs of
an aged care planning region and the merits of each proposal. Places can only be
allocated to an applicant who has been approved, or will be approved, to provide
the type of aged care the places are for, once the allocation takes eect
or is in force.
NOTIFICATION PROCESS
Applicants are advised in writing whether or not they have been successful in being
allocated places. As part of this notification process, successful applicants are
advised of:
the number and care type of the places to be allocated—for example,
10 residential high-care places
the aged care planning region in which the service is located
whether or not the places are allocated provisionally or take eect immediately
conditions related to the allocation.
PROVISIONAL ALLOCATIONS
An allocation of places to a provider will be a provisional allocation if the provider
is not ready to provide care immediately—if for example, the building subject to the
allocation is not yet completed.
A provisional allocation remains in force until the end of the provisional allocation
period, which is two years unless the Department approves a request made by the
provider to extend the period. The provider is expected to commence the service
within the provisional allocation period, in accordance with the conditions of
allocation, otherwise the allocation will cease.
A provider cannot receive a subsidy for a provisional allocation.
Allocation
Principles 1997,
4.36–4.40
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ALLOCATED PLACES
20
HOW ALLOCATED PLACES TAKE EFFECT
An allocation takes eect when the Secretary determines that the provider is ready
to provide care. There are a number of matters that the Secretary will consider in
deciding when a provider is ready to provide care: See legislative reference.
in relation to all types of aged care, whether the provider has met all of the
conditions that must be met before the determination is made
in relation to community care, whether the provider has entered into any
required agreement with the Department
in relation to residential care, the results of any inspection by the Department
and, in addition, whether:
certificates to occupy the facility have been received from relevant
government authorities
accreditation has been applied for and associated fees paid
the provider has registered in accordance with aged care prudential
requirements
administrative and operational arrangements have been put in place.
Once it has taken eect, the approved provider can begin to receive subsidies for
care recipients in those places. Places for which an allocation has taken eect are
usually referred to as operational aged care places.
CONDITIONS OF ALLOCATION
The Secretary places conditions on all allocations of places, including:
conditions relating to particular allocations
See legislative reference.
conditions that apply to all allocations in general, or of a particular kind.
See legislative reference.
Providers are not required to accept places which they are allocated, that have
conditions attached. However if they do accept the places, they may face sanctions
if they fail to comply with any of the conditions and this could lead to the allocated
places being revoked.
Conditions applying to particular allocations
See legislative reference.
It is a condition of every allocation that the place is allocated for a specified location
and a particular aged care service. Any care provided for that place must be at that
location and service. Some conditions may relate to the allocation while it is
provisional, for example, planning or timeline factors in the construction of an aged
care service, while others may relate to the ongoing operation of the service.
Examples of matters with which conditions may deal include:
the proportion of care to be provided to:
people with special needs
supported, concessional and assisted residents
respite care recipients
residents needing a particular level of care
l e g i s l a t i v e r e f e r e n c e s
s 14-5, Aged Care
Act 1997
s 14-6, Aged Care
Act 1997
s 14-5, Aged Care
Act 1997
s 15-1, Aged Care
Act 1997, 4.49,
Allocation
Principles 1997
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THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
ALLOCATED PLACES
21
l e g i s l a t i v e r e f e r e n c e s
the period within which
the service is to start providing care
the premises to be used to provide care must be built
professional planning of the aged care service
the treatment of any lump sums paid for entry to the service before the
provider received an allocation of Government-subsidised places
the terms of accommodation bond agreements entered into after a refund
of such lump sums.
Conditions applying to allocations generally
A number of conditions apply to all allocations, including: See legislative reference.
that an approved provider cannot discharge and re-admit a resident to attract
concessional resident supplement or to charge the resident an accommodation
bond
that an aged care service which relocates will only be recognised as a new
service if the relocation is
to a new purpose-built facility for providing aged care
or to a totally dierent catchment area.
In relation to provisionally allocated places, an approved provider must:
provide quarterly reports on its progress towards satisfying the Secretary
that the allocation of places should take eect
ensure its reports are in a format approved by the Department and received
by the Department by the due dates
bring its allocated places on line in a timely manner
Applying to vary conditions for operational places
An approved provider may apply to the Secretary to vary any of the specific
conditions which apply to particular allocations of its operational places. See
legislative reference. However, approved providers cannot apply to vary conditions
which apply to allocations in general and which apply to all providers equally.
See legislative reference.
In deciding whether a variation is justified, the Secretary will consider:
whether the variation will meet community needs and is consistent with other
objectives of the allocation planning process
the financial viability of the service where the places are located
whether care needs will continue to be met
the suitability of any dierent premises proposed to be used
the eect of any change in location on current and future care recipients,
including access to respite care, diversity of care and continuity of care.
s 14-5, Aged Care
Act, 1997
s 17-1 Aged Care
Act 1997
Division 17, Aged
Care Act 1997,
Part 8, Allocation
Principles 1997
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ALLOCATED PLACES
22
Applications to vary conditions must be made at least 60 days before the proposed
day of variation, unless the Secretary agrees to a shorter period. Approvals cannot
be backdated. Applications must be made on either:
the standard application form for a variation of conditions of allocation, for all
conditions except respite
or the standard application form for a variation of conditions of allocation for
residential respite
See References at the end of this chapter for a link to these forms.
The Department will take the date proposed in the application as the variation day;
and the Department will not recognise the approved changes as having taken eect
before the variation day. The Secretary must approve or reject the application at least
14 days before the proposed variation day.
However, it can be dicult for an approved provider to work out a precise date in
advance, or circumstances may change which prevent the variation occurring on the
nominated day.
If an application to vary conditions has not yet been approved by the Secretary and
either a later or an earlier variation day is required—ie, a date earlier or later than the
date nominated in the application to vary conditions:
then the approved provider should write to the Secretary about the proposed
change. See legislative reference.
If an application to vary conditions has been approved by the Secretary:
and an earlier variation day is required—ie, a date earlier than the date
nominated in the application to vary conditions
then a new application is required. The approved provider should write to
the Secretary about the proposed new variation day, stating that this letter,
together with the information in the original application, be treated as a new
application See legislative reference.
and a later variation day is required—ie, a date later than the date nominated
in the application to vary conditions
then the approved provider should apply to the Secretary for a new variation
day. See legislative reference.
The Secretary cannot approve a variation of conditions which would mean that the
care to which the place relates would be provided in a dierent state or territory.
See legislative reference. s 17-1(1)(d) Aged Care Act 1997
If further information is needed to decide whether a variation of conditions should
be approved, the Secretary may ask for further information to be provided within 28
days. See legislative reference. s 17-3, Aged Care Act 1997
Special conditions apply to a change of location of places which aect extra service
status. See also the section on Allocations, transfers and variations in chapter on
Extra service places in this Manual.
l e g i s l a t i v e r e f e r e n c e s
s 17-2(8), Aged
Care Act, 1997
s 17-2(5) Aged
Care Act 1997 s
s 17-7(2), Aged
Care Act, 1997
s 17-1(1)(d) Aged
Care Act 1997
s 17-3, Aged Care
Act 1997
ALLOCATED PLACES
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ALLOCATED PLACES
23
l e g i s l a t i v e r e f e r e n c e s
Applying to vary conditions for provisionally allocated places
An approved provider may also apply to vary its provisionally allocated places.
See legislative reference.
The variation may be a reduction in the number of places to which the provisional
allocation relates; or a variation of the conditions to which the provisional allocation
is subject. See legislative reference.
The application must be lodged before the end of the provisional allocation period—
ie, two years after the day on which the allocation was made, unless an extension
to the provisional allocation period is approved or an application for an extension
is pending.
If the proposed variation means that provisional allocation period needs to be
extended, the approved provider must lodge an application for an extension using
the required form. See legislative reference.
TRANSFERRING OPERATIONAL PLACES TO ANOTHER PROVIDER
Under the Act, a transfer occurs when operational places previously allocated to one
approved provider become allocated to another approved provider. See legislative
reference.
As a result of a transfer of places:
any entitlement to unpaid aged care subsidy passes to the transferee
the transferee inherits any responsibilities for accommodation bond balances
that the transferor had before the transfer day
the transferee inherits any obligations that the transferor had before the transfer
day under a resident agreement or community care agreement. See legislative
reference.
The transferor must give the following records or copies of records to the transferee
for each resident whose place is being transferred:
assessment and classification records
individual care plans, medical care plans, progress notes and other clinical
details of fees and charges, including accommodation payments
any agreements between those residents and the transferor
the accounts of those residents
name and contact details for each representative of those residents.
In addition, where applicable the transferor must provide records of the prudential
requirements for accommodation bonds relating to the tranferor’s service.
Applying to transfer places
The Secretary must approve all transfers of places between approved providers.
Before applying for a transfer of places, it is a good idea for the transferor and/or
transferee to contact their state or territory oce of the Department to discuss their
proposal. The Department may ask both the transferor and the transferee to discuss
specific aspects of their application.
s 15-5, Aged
Care Act 1997
s 15-5, Aged
Care Act 1997
s 15-7(4), Aged
Care Act 1997
s 16-1, Aged
Care Act 1997
s16-1A, Aged
Care Act 1997,
Part 7, Allocation
Principles 1997
ALLOCATED PLACES
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ALLOCATED PLACES
24
When applying for transfer, an approved provider should use the standard form,
providing the following information:
details of any conditions that the transferor wants to have varied as part of the
transfer, such as the location or the service
the names of the transferor and transferee
the number of places to be transferred
the proposed day of transfer
the aged care service where the places currently are and its location
if the places are being transferred to a dierent service, the name of that
service and its location, whether the service or part of it has extra service status
and proposals for ensuring that care needs of the residents whose places are
being transferred will be appropriately met
if the places are being transferred to more than one other service, the
application will need to address these issues in relation to each service
whether any of the places:
have extra service status
are adjusted subsidy places
in respect of which residential care grants have been paid
in respect of which grants under the
Aged or Disabled Persons Care Act
1954 have been paid.
See References at the end of this chapter for a link to this form. Providers should
also note the further information listed in s 4.61 of the Allocation Principles that
the transferor and transferee must provide with an application. See legislative
reference.
Both the approved provider holding the allocation of places (the transferor) and the
provider seeking the places (the transferee) must complete this form.
The application must be made:
at least 60 days before the proposed transfer day, if the transferee is already
an approved provider
at least 90 days before the proposed transfer day, if the transferee has not yet
been approved as an approved provider.
The proposed transfer day is the day specified in the application for the transfer of
places and is the date from which the Department will recognise the transferee as
being responsible for the places. In special circumstances, at the request of both the
transferor and the transferee, the Secretary can reduce the above notice periods.
However approvals made by the Department to transfer places cannot be
backdated.
Unless the transferor and the transferee agree to a later date, the Secretary will
approve or reject the application at least 14 days before the proposed transfer day.
Circumstances may change which prevent the transfer occurring on the nominated
day. In cases like this, the action the parties to the transfer are required to take is
outlined as follows.
l e g i s l a t i v e r e f e r e n c e s
s 4.61, Allocation
Principles 1997
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THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
ALLOCATED PLACES
25
l e g i s l a t i v e r e f e r e n c e s
If an application to transfer places has not yet been approved by the Secretary:
and either an earlier transfer day is required (that is, a date earlier than that
nominated in the application to transfer places) or a later transfer day is required
(that is, a date later than that nominated in the application to transfer places)
then the transferor and transferee must jointly advise the Secretary in writing
of the proposed change. See legislative reference.
If an application to transfer places has been approved by the Secretary:
and an earlier transfer day is required (that is, a date earlier than that nominated
in the application to transfer places)
then a new application is required. This can be done by advising the Secretary in
writing of the proposed new transfer day and stating that this, together with
the information in the original application, be treated as a new application
a later transfer day is required (that is, a date later than that nominated in the
application to transfer places)
then the approved provider should apply in writing to the Secretary.
See legislative reference.
In making a decision about an application for a transfer, the Secretary must consider
a number of matters specified under the Act and the Principles, including but not
limited to: See legislative reference.
whether the proposed transfer meets the objectives of the allocation planning
process. See also Planning the provision of residential aged care services on
page 17
the suitability of the proposed transferee to provide the required aged care
the financial viability of the transferor’s service if the transfer were to occur
the financial viability of the transferee’s service
whether the care needs of residents will continue to be appropriately met
the impact on continuity of care
the aged care record of the transferee and its key personnel
the suitability of the premises, and in particular whether it meets certification
requirements
the eect of the proposed transfer on current and future care recipients in the
region from which the places would be transferred and the region to which the
places would be transferred.
In making a decision the Secretary will also take into account all the information
provided in the application. If further information is needed to assess the application
the Secretary may ask the transferor and/or the transferee for more information—for
example, financial information that is independently verified.
The Secretary may also use any other relevant information available to the
Department, such as Aged Care Approvals Round applications, planning information,
complaints and compliance information and prudential compliance statements.
The Secretary may also obtain information and documents from other persons or
organisations, including the Aged Care Standards and Accreditation Agency and
organisations able to undertake financial probity and credit/debt investigations.
s 16-2(8), Aged
Care Act 1997
s 16-7(2), Aged
Care Act 1997
s 16-4, Aged Care
Act 1997, s 4.63,
Allocation
Principles 1997
ALLOCATED PLACES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
ALLOCATED PLACES
26
The Secretary may take into account the transferee’s record of compliance with
care standards and whether it is meeting obligations arising from receipt of payments
from the Government for providing aged care and any strategies the applicant has
to improve compliance with Government requirements.
The responsibilities and obligations of the transferor in relation to accommodation
bonds and resident agreements become responsibilities and obligations of the
transferee from the day of transfer day. See legislative reference.
Approval for the transfer is only given if the transferee is an approved provider by the
transfer date. In some cases, the transferee will not be an approved provider at the
time the application is made, or will have its current approval limited to particular
types of aged care or services. In this case, the transferee must complete a separate
approved provider status’ application form and attach it to the application for
transfer. See References at the end of this section for a link to this form.
Proposals are unlikely to be approved if they will move places from under-supplied
regions to over-supplied regions. The Secretary also needs to be sure that the
transferee and/or transferor have appropriate arrangements in place to ensure
ongoing care for residents in the service. The transferor must advise the department:
how it has informed residents and their carers about the proposed transfer
how it plans to deal with any residents’ concerns
what guarantees they are oering to ensure that residents will not be
disadvantaged because of the transfer.
The transferor and transferee must also include further information, listed in s 4.61
of the Allocation Principles, with the application. See legislative reference.
Existing residents have security of tenure in their current aged care service, while it
stays operational and can meet the resident’s assessed care needs. A transfer will
only be approved if the transferee demonstrates care recipients’ needs will continue
to be met.
If the transferee intends to close its service after a transfer, it is legally obliged to
inform residents of their rights about leaving, including their right of access to
internal and external complaints processes and advocacy services. The transferee
must not take action to make the resident leave, or imply that the resident must
leave, before suitable alternative and aordable accommodation is available that
meet the resident’s assessed long-term needs.
The Secretary cannot approve a transfer of places where it would have the eect
of the care being provided in a dierent state or territory. An approval of transfer
notification from the Secretary will include statements setting out, among other
things:
the proportion of care to be provided to people with special needs, and
supported, concessional and assisted residents
the number of respite care places
proposals for ensuring that care needs are appropriately met for care recipients
whose places are being transferred
the level of care for the residential places involved in the transfer.
l e g i s l a t i v e r e f e r e n c e s
s 16-10, 16-11,
Aged Care Act
1997
s 4.61, Allocation
Principles 1997
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ALLOCATED PLACES
27
l e g i s l a t i v e r e f e r e n c e s
The Department will contact the transferor and transferee to ensure that the transfer
will settle or has settled on the proposed transfer date, and to ensure that both
parties are aware that the transferee will assume responsibility for those places
from that date.
Special conditions apply to the transfer of extra service places. See also section on
Allocations, transfers and variations in chapter on Extra service places in this Manual.
TRANSFERRING PROVISIONALLY ALLOCATED PLACES TO
ANOTHER PROVIDER
Provisionally allocated places can be transferred in certain circumstances.
See legislative reference.
This change allows a transfer of provisionally allocated places in exceptional
circumstances. A transfer of provisionally allocated places might be approved if for
example a provider has progressed a residential aged care development to a point
where significant delays in the provision of care would occur if the development was
not completed in a short timeframe; and the transferor is able to demonstrate that
another provider could ensure completion and commence providing care at the
same location.
In deciding whether to approve a transfer of provisionally allocated places, the
Department must consider a number of factors, including:
whether the proposed transfer meets the objectives of the allocation planning
process
whether the transferor has made such significant progress towards being in a
position to provide care, in respect of the places, that it would be contrary to
the interests of the aged community in the region not to permit the transfer
whether the transferee is likely to be in a position to provide care within a short
timeframe after the transfer
the suitability of both the transferee and the premises proposed to be used for
the provision of the required type of aged care
whether the transferee can properly provide care in relation to places allocated
for people with special needs or for a particular type of aged care
the record of the transferee and its key personnel in the provision of aged care,
including compliance with Government obligations
the financial viability of the transferee and the service to which the places are
to be transferred
provision for protection of the rights of care recipients
other matters set out in the Allocation Principles.
See legislative reference.
Where an approved provider seeks to transfer provisionally allocated places, they will
need to apply to the Department and include all required information.
See legislative reference.
Approved providers should discuss their particular circumstances with their relevant
state or territory oce before submitting an application.
Subdivision 16-B,
Aged Care Act
1997, Part 7A,
Allocation
Principles 1997
s 4.66I, Allocation
Principles 1997
s 16-14 Aged Care
Act 1997, s 4.66G
Allocation
Principles 1997
ALLOCATED PLACES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
ALLOCATED PLACES
28
RELINQUISHING OPERATIONAL PLACES
An approved provider can voluntarily relinquish operational places by writing to the
Secretary. To ensure that the needs of residents are met when operational places are
relinquished, the approved provider must: See legislative reference.
notify the Secretary at least 60 days before the day on which the places will be
relinquished
provide details of the service and the number of places to be relinquished
specify how the care needs of residents who are aected will be appropriately
met
deal with a range of other matters set out in the Allocation Principles.
See legislative reference.
The Secretary will decide whether the proposal is satisfactory; and may request the
approved provider modify any proposal if it is not satisfactory. If the approved
provider does not comply with the request, the Secretary may set out new proposals
for ensuring that the care needs of residents are appropriately met. Penalties may
apply if the approved provider does not comply with the Secretary’s requirements.
REVOKING PLACES
The Secretary may revoke operational places if they have not been used for the
purpose of their allocation for a continuous period of 12 months. In such a case,
the Secretary will notify the approved provider of the reasons for considering the
revocation; and ask the approved provider to explain in a submission why the places
have not been used.
In deciding whether to revoke the allocation of a place, the Secretary will consider,
amongst other matters:
why the places have not been used
whether they are likely to be used in the near future
whether revoking the allocation would have detrimental eects on the local
community.
The Secretary may also revoke provisionally allocated places if the conditions
to which the allocation is subject have not been met. In this circumstance, the
Secretary will invite the provider to explain in writing within 28 days why the
provisional allocation should not be revoked.
EXCHANGE OF CARE TYPE
Exchange of care type refers to the mechanism through which one of the three
types of aged care may be exchanged for another type of care, with the approval of
the Secretary. It is a two step process. An approved provider must relinquish existing
operational places under Division 18 of the Act and apply for an allocation of places
under Division 14. See legislative reference. Only places that have taken eect may
be exchanged. The places that can be reallocated are limited to the number of
places relinquished and the state or territory in which the places have been
relinquished.
l e g i s l a t i v e r e f e r e n c e s
s 4.72, Allocation
Principles 1997
Division 14,
Division 18, Aged
Care Act 1997
Division 18, Aged
Care Act 1997
ALLOCATED PLACES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
ALLOCATED PLACES
29
The types of care that can be exchanged are permanently allocated. They include:
residential care places
community care places
and flexible care places, including Extended Aged Care at Home (EACH) places
and places for multi-purpose services.
Other flexible aged care places such as EACH Dementia, transitional care or
innovative pool places cannot be exchanged.
Applying for exchange of care type
Before applying for exchange of care type, approved providers should obtain the
Exchange of Care Type—Guidelines for Approved Providers to ensure that they are
fully aware of the requirements of this application and of any future action resulting
from the application. When applying for an exchange of care type, approved
providers should used the standard form. See References at the end of this chapter
for a link to this form.
About special needs groups
The Government is committed to providing access to quality aged care services for
special needs groups. People with special needs include those:
from Aboriginal and Torres Strait Islander communities
from non-English speaking backgrounds
who live in rural or remote areas
who are financially or socially disadvantaged
who are veterans (including a partner, widow or widower of a veteran)
people who are homeless or who are at risk of homelessness.
Approved providers must be able to provide appropriate care to special needs
groups. Providers may also have obligations in relation to people with special needs
in their allocation conditions.
ABOUT SUPPORTED, CONCESSIONAL AND ASSISTED RESIDENTS
The Department determines a proportion of supported, concessional and assisted
residents for each region. All aged care services in a region are expected to accept
an appropriate proportion of supported (including concessional or assisted) residents
to meet these levels. The proportions are determined by comparing information on
the number of people in these groups aged 70 years and over with the general
population aged 70 years and over in each region. The Department publishes
regional ratio concessional and assisted resident targets.
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30
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Aged care approvals round—residential aged care places and capital
grant allocations
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acar2007-
index.htm
Aged care approvals round—Essential Guide
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acar2008-
essential-guide.htm
Aged Care Information Line
Ph 1800 500 853
Application to Exchange Care Type—guidelines and form
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-exchange-
care.htm
Approved provider status guidelines and application form
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-approvedp-
index.htm
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Form—transfer of places—application to transfer places other than
provisionally allocated places to another approved provider
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-transfer-
agedcare.htm
Form—variation of conditions—application for a variation of conditions
of allocation—residential, community and flexible care places
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-app-vca.htm
Form—variation of conditions, respite—application for a variation of conditions
of allocation—residential respite form for respite only—application form
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-app-vca-
respite.htm
Form—variation of provisional allocation of places—application for a variation
of a provisional allocation of places
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-forms-
appprov.htm
I
Relevant legislation 31
Overview 31
Additional information 31
What is an extra service place? 31
How is extra service status granted? 32
Criteria for approval 32
Access to residential aged care 33
Accommodation, food and services 33
Record of the applicant 34
Certification and accreditation 34
Competitive assessment 34
Notification of extra service status 35
Conditions of extra service status 35
When does extra service status cease? 36
Lapsing of extra service status 36
Revoking or suspending extra service status as a sanction 36
Revoking or suspending extra service status on request 36
Fees and payments 37
Extra service fee 37
Extra service amount and extra service reduction 37
Respite supplement 38
Changes in the levels of the extra service fee 38
Claiming arrangements 39
Extra service agreement 40
New residents 40
Existing residents 40
EXTRA SERVICE PLACES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXTRA SERVICE PLACES
Eligibility for subsidies and additional funding 40
Extra service status and capital repayment 41
Extra service status and supported resident requirements 42
Allocations, transfers and variations 42
Transitional arrangements—existing approvals 43
Fees and subsidies 43
References—links, guides and forms referred to in this chapter 43
EXTRA SERVICE PLACES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
II
EXTRA SERVICE PLACES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
31
l e g i s l a t i v e r e f e r e n c e s
EXTRA SERVICE PLACES
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 2.5,
Aged Care Act 1997 (the Act)
Section 58-5,
Aged Care Act 1997
Part 2.5,
Aged Care (Consequential Provisions) Act 1997
Extra Service Principles 1997
(the Extra Service Principles)
OVERVIEW
Extra service places provide a significantly higher standard of accommodation and
services to residents, without impacting upon the level of care being provided.
Residents are usually charged a higher daily fee for the extra service—ie, the extra
service amount—and as a consequence, the provider receives a lower amount of
residential care subsidy from the Government for an extra service place.
All aged care services funded under the Act, as well as distinct parts of a service,
may be eligible for extra service status.
Extra service places are subject to the conditions which apply to other residential
aged care places. For example, to receive subsidies, an aged care service with extra
service status must meet its accreditation requirements and it needs to be certified.
In addition, there are other conditions that relate specifically to extra service.
Additional information
This chapter has been updated and revised to help approved providers comply with
their responsibilities under the Act; and to assist sta of aged care services understand
the regulation of residential aged care. Additional information can also be accessed
through the Aged Care Information Line on 1800 500 853.
WHAT IS AN EXTRA SERVICE PLACE?
An extra service place is a place: See legislative reference.
in an aged care service which has approved extra service status
to which an approved extra service fee applies
in which residential aged care is provided on an extra service basis.
Extra service status may be granted to an aged care service or a distinct part of a
service—for example, a separate wing. This allows more flexibility and choice, both for
residents and providers. A distinct part is an area of the service that: See legislative
reference.
is physically identifiable as separate from the rest of the premises
includes sucient living space for the residents
s 31-3, Aged
Care Act 1997
s 30-3, Aged Care
Act 1997, s 14.5,
Extra Service
Principles 1997
EXTRA SERVICE PLACES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
EXTRA SERVICE PLACES
32
includes dining and lounge areas (located together or separately) that are for
the exclusive use of the residents
has at least five extra service places.
In this chapter, references to an aged care service with extra service status includes
services with extra service status in a distinct part of the service.
HOW IS EXTRA SERVICE STATUS GRANTED?
The Secretary invites applications for extra service status twice a year. One of these
application rounds coincides with the annual Aged Care Approvals Round in which
new and existing providers can apply for new residential aged care places.
Applications are sought from both providers with existing places and providers
seeking new places in the Aged Care Approvals Round.
Both an allocation of places and a grant of extra service status are required for an
aged care service, or a distinct part of a service, to operate on an extra service basis.
An application for extra service status does not constitute an application for an
allocation of places; and an approval of extra service status does not necessarily
result in an allocation of new residential places.
Following the Secretary’s invitation to apply for extra service status, applicants can
contact the Department to obtain an application form and guidelines, or an
application can be downloaded from the Department’s website. See References
at the end of this chapter for a link to the application form.
Applicants may be required to provide documents, photographs, samples,
architectural drawings or other information to support statements made in their
applications.
In order to be able to properly assess the application against the selection criteria,
the Secretary can ask an applicant for further information or to agree to an on-site
visit. See legislative reference.
Criteria for approval
All applications will be assessed against standard criteria. In order to be approved,
an application must meet all the assessment criteria. If any one of these criteria is
not met, the Secretary will not approve the application. See legislative reference.
The criteria are:
the applicant must be an approved provider, or have applied for approved
provider status, at the time of applying for extra service status See legislative
reference.
access to residential aged care must not be unreasonably reduced for
supported, concessional or assisted residents, or for people aged 70 years and
over, in the same service, who may have diculty aording an extra service
amount. See s 44-7 of the Act for a definition of concessional resident
See legislative reference.
the proposed standard of accommodation, food and services, must be
significantly higher than the average standard provided in non-extra service
services or places
if the applicant has already been providing aged care, the applicant must have
a very good record of conduct as an aged care provider and compliance with
its responsibilities as a provider
s 32-3, Aged Care
Act 1997
s 32-3(1), Aged
Care Act 1997
s 44-7, Aged Care
Act 1997
s 32-4, Aged Care
Act 1997, Division
4, Extra Service
Principles 1997
l e g i s l a t i v e r e f e r e n c e s
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33
if the applicant has relevant key personnel in common with a person who is or
has been an approved provider, the person has a very good record of conduct
as an aged care provider and compliance with its responsibilities as a provider
the service must be certified
the service must meet its accreditation requirements
there will be significant benefit to current and future residents in the region if
the application is granted
there will be a significantly increased diversity of choice for current and future
residents, and their carers and families, if the application is granted
the extra services would provide current and future residents in the region with
better access to continuity of care, if the application is granted.
More detail on some of these criteria follows.
Access to residential aged care
An application for extra service will not be approved if granting extra service status
will unreasonably reduce access to residential aged care for people who:
live in the state, territory or region concerned
are concessional residents
are aged at least 70, who would have diculty aording an extra service
amount.
Factors which will be considered in determining whether access in the state, territory
or region would be unreasonably reduced by approving the places sought in the
application include:
the number of existing and allocated residential aged places in the state,
territory or region concerned
the proportion of residential aged care that must be provided to concessional
and assisted residents
the estimated number of places providing care mainly or exclusively to special
needs groups in the region, including whether the applicant has a particular
focus on, or is required to provide places for residents from a special needs
group—for example, residents from a culturally and linguistically diverse
background. See also Conditions applying to particular allocations in chapter
on Allocated places in this Manual.
if the application is approved, the level of remaining non-extra service places
for that state, territory or region
the socio-economic status of the region, including concessional resident data
relevant factors relating to the population or services in an adjoining region.
Accommodation, food and services
To be approved for extra service status, an aged care service must oer a
significantly higher standard of accommodation, food and services than the average
standard in an aged care service that does not have extra service status. This
criterion is measured at the time of application.
The benchmarks for significantly higher standards of accommodation, food and
services are met by providing a list of extra service choices that providers can oer.
Providers do not have to oer each item listed but must score at least 60 out of
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34
a possible 100 points in order for the significantly higher criterion to be satisfied, and
must achieve minimum scores in the three categories of accommodation, food and
services. Each category allows points to be earned for innovation and special
features. There is also a mandatory requirement in regard to building standards.
Points cannot be claimed for services that must be provided to all residents as
specified care and services, or for services that are claimable under the Aged Care
Funding Instrument (ACFI).
The application form provides some examples of significantly higher standards of
food, accommodation and services. These examples are not intended to be
prescriptive, but rather provide guidance for applicants. Applicants are encouraged
to be innovative in their proposals in regard to additional facilities and services for
residents.
Record of the applicant
If an applicant for extra service status has been a provider of aged care then the
applicant must have a very good record of conduct as a provider over the previous
three years or over their period of operation, if less than three years. See legislative
reference.
The applicant’s record in the following areas will be considered:
compliance with responsibilities and obligations arising from the receipt
of Government funding for aged care
compliance with standards of care
the number and nature of any complaints against the applicant
the applicant’s conduct in relation to other aged care services which are,
or have been, operated by the applicant
strategies the applicant has put in place to improve compliance with
Government requirements.
Applications from new providers and from providers operating other services will also
be considered. If the application is for a service that is not yet operating, the overall
standards provided at any other services operated by the applicant are considered.
Certification and accreditation
An aged care service must be certified and meet its accreditation requirement to be
granted extra service status. If a service ceases to be certified or no longer meets its
accreditation requirement, its extra service status also ceases at the same time.
Competitive assessment
See legislative reference.
Applications may be assessed competitively if the Department receives more than
one application for a state, territory or particular region, and if the Secretary is
satisfied that approving the extra service status in each application would:
unreasonably reduce access to residential aged care by concessional residents
or by people aged 70 years and over who may find it dicult to aord an extra
service amount
or exceed the maximum number of extra services places which have been
allowed by the Minister (currently 15 per cent of the total number of residential
aged care places in each state and territory).
s 14.19, Extra
Service Principles
1997
s 32-5, Aged Care
Act 1997, Division
4, Extra Service
Principles 1997
l e g i s l a t i v e r e f e r e n c e s
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l e g i s l a t i v e r e f e r e n c e s
Consideration will be given to:
applications that best meet the assessment criteria
the level of extra service fees proposed in the application.
Notification of extra service status
If extra service status is granted, the Secretary will notify an applicant within 90 days
of receiving an application, unless the Secretary has requested further information
from the applicant. In this case, the Secretary must notify the applicant of the
outcome of the application within 90 days of receiving the additional requested
information. See legislative reference.
If extra service status is granted, the notice will include:
See legislative reference.
any conditions to which the grant is subject
when the extra service status commences
when the extra service status ceases.
The notice can also specify that certain conditions must be met before extra service
status commences. See legislative reference. If extra service status taking eect
depends on certain conditions being met, the provider must write to the
Department’s relevant state or territory oce and advise that the provider considers
that the conditions can be met. The applicant must write 28 days before the
proposed commencement, unless the proposed extra service status will become
eective less than 60 days after the Department gives the notice granting extra
service status. In this case, the applicant must write to the Department within seven
days. See legislative reference.
Conditions of extra service status
A grant of extra service status is subject to the conditions set out in the Act and the
Extra Service Principles, and the specific conditions set out in a notice relating to the
grant of extra service status. See legislative reference.
A grant of extra service status is made for a particular service at a service’s particular
address. Conditions that may be included relate to the following:
details of the accommodation, food and services to be provided
arrangements regarding capital repayments
agreements with residents setting out the terms on which they are to receive
residential aged care on an extra service basis
the level of the extra service charges.
Conditions can also include:
criteria that must be met before the extra service status can take eect
protection for residents—for example, residents must be oered the choice to
occupy his or her place on an extra service basis, and elect not to receive care
on an extra service basis if they were being provided with residential aged care
through the aged care service or distinct part immediately before extra service
status became eective.
s 32-9(1), Aged
Care Act 1997
s 32-9(2), Aged
Care Act 1997
s 14.25(3),
Extra Service
Principles 1997
s 32-8(1), Aged
Care Act 1997
s 14.25(1)(b),
Extra Service
Principles 1997
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36
Conditions, other than those specified in the Act or the Extra Service Principles, may
be varied by agreement between the provider and the Department. See legislative
reference. The Department can take into consideration any relevant matter, and
must consider the extent of any change in the level of the accommodation, food
and services that may result from a proposed variation.
WHEN DOES EXTRA SERVICE STATUS CEASE?
Extra service status ceases when:
the extra service status lapses
the extra service status is revoked or suspended
or the aged care service in which the place is located is no longer certified
or does not meet its accreditation requirements. See legislative reference.
Lapsing of extra service status
Extra service status lapses if:
an allocation in respect all the places in the aged care service or distinct part,
is relinquished or revoked
a provisional allocation does not take eect before the end of the provisional
allocation period
or the approval of the person as a provider of aged care services ceases to have
eect under Division 10 of the Act. See legislative reference.
Revoking or suspending extra service status as a sanction
If a provider has not complied with its responsibilities under the Act, the Secretary
can impose a sanction on the approved provider. See legislative reference. In some
instances this may relate to the extra service status of the service, including:
revoking or suspending the extra service status of a residential aged care
service
prohibiting the grant of extra service status in a residential aged care service.
Revoking or suspending extra service status on request
See legislative reference.
If a provider requests it in writing, the Department must revoke or suspend extra
service status at any time. A revocation or suspension has eect on the date
requested by the provider, unless otherwise specified by the Department. However,
the date of eect must not be earlier than 60 days after the request is received by
the Department.
The Department will notify the provider in writing of the day from which extra
service status is revoked or suspended.
s 32-5, Aged Care
Act 1997, Division
4, Extra Service
Principles 1997
s 33-1, Aged Care
Act 1997
Division 10, Aged
Care Act 1997
s 66-1, Aged Care
Act 1997
s 33-4, Aged Care
Act 1997
l e g i s l a t i v e r e f e r e n c e s
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l e g i s l a t i v e r e f e r e n c e s
FEES AND PAYMENTS
Extra service fee
As part of the application for extra service status, the provider must apply to the
Secretary to set an extra service fee. See legislative reference. The extra service fee
can vary for dierent places in an aged care service—for example, a provider can set
a higher fee for a bigger room with a private bathroom.
An application will be approved only if aged care services operated by the applicant
have a very good record of compliance with standards of care and meeting
obligations arising from Government payments. See legislative reference.
The Secretary cannot approve extra service fees where:
the fee is a nil amount
See legislative reference.
the average daily extra service fee across all extra service places in the service
is less than $10. See legislative reference.
EXAMPLE
How to calculate the average extra service fee
This is the average of the extra service fee for all places in the
service or distinct part of the service with extra service status.
The average must be at least $10 a place per day.
For example:
ROOM TYPES PLACES EXTRA SERVICE FEE TOTAL
Single with ensuite 23 x$12 = $276
Single without ensuite 23 x$10 = $230
Double 4x$9 = $36
Total: 50 $542
$542 divided by 50 places = $10.84 average extra service fee
Extra service amount and extra service reduction
If eligible, approved providers may receive a residential care subsidy from the
Government for each resident. See legislative reference. However, if the resident
is occupying an extra service place then the residential care subsidy is reduced by
25 per cent of the approved extra service fee for that place. See legislative reference
The extra service amount is the maximum amount a provider can charge a resident
for receiving extra service. A resident pays an extra service amount in addition to
other fees, which may include the standard resident contribution (also known as the
basic daily fee) and the daily income tested reduction (also known as the income
tested fee).
s 35-1(1), Aged
Care Act 1997
s 14.29,
Extra Service
Principles 1997
s 35-3(1), Aged
Care Act 1997
s 35-3(2), Aged
Care Act 1997
s 42-1, Aged
Care Act 1997
s 44-18, Aged
Care Act 1997
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38
The extra service amount equals the extra service fee plus the extra service
reduction. See the example below; and Extra service fee in chapter on Funding for
Residential aged care in this Manual. See legislative reference.
EXAMPLE
If the extra service fee for a place is $20 per day, then the Government
subsidy for a resident receiving extra service care in the place will be reduced
by 25 per cent or $5 per day. The $5 per day is the extra service reduction.
The extra service amount is $25—ie, the extra service fee ($20 per day) plus
the extra service reduction ($5 per day).
An aged care service cannot charge any fees above the extra service amount, for
any of the accommodation, services or food specified in the conditions of grant
of extra service status.
They can however charge GST for any item included in the extra service package
that is not GST-exempt. This GST may be included in extra service payments agreed
between the approved provider and the resident. Any accommodation, food or
services listed in Schedule 1—Specified Care and Services of the Quality of Care
Principles are GST-exempt. See also chapter on Specified care and services in this
Manual. See legislative reference.
An aged care service can decide to charge less than the full extra service amount.
If they do so, the extra service agreement with the resident should specify the
circumstances under which they can increase the fee. In this instance, the extra
service reduction is still calculated using the approved extra service fee. A resident
receiving care on an extra service basis must have an extra service agreement with
the provider. See Extra service agreement on page 40.
Extra service care recipients who are former prisoners of war would usually pay the
extra service amount, while the Department of Veterans’ Aairs may pay the resident
contribution on their behalf.
Respite supplement
Aged care services with extra service status are eligible for the respite supplement.
See legislative reference. Residents receiving respite care on an extra service basis
may also be charged the extra service amount. The extra service reduction also
applies to the extra service amount charged. See also chapter on Residential respite
care in this Manual.
Changes in the levels of the extra service fee
An aged care service can apply to change the extra service fee for a place or places:
as part of their overall application for extra service status
while their extra service status is current. In this case, the application must be
submitted to the Department’s state or territory oce at least 60 days before
the proposed starting date of the new fee. This will allow time for the
application to be considered and if approved, for residents to be notified.
l e g i s l a t i v e r e f e r e n c e s
s 58-5, Aged Care
Act 1997
Schedule 1,
Quality of Care
Principles 1997
Part 7, Residential
Care Subsidy
Principles 1997
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39
l e g i s l a t i v e r e f e r e n c e s
The maximum amount by which an extra service fee may be increased is the total of:
20 per cent of the current fee
plus the national consumer price index (CPI) percentage change, published for
the most recent twelve month period, in which the additional extra service fee
is currently being charged. See legislative reference.
EXAMPLE
An aged care service has been charging an extra service fee of $20 per day
per place for three years; and their extra service amount is $25 per day. The
service applies to the Department to increase the extra service fee by $2, up
to $22. The application is received on 1 September 2009, with a request for
the new fees to apply from 1 January 2010. The service sent the request
more than 60 days before the proposed starting date of the new fee.
The current fee: $20
The permitted increase: 20 per cent plus 2.5 per cent (the national CPI rate
change) which equals 22.5 per cent. 22.5 per cent of $20 equals $4.50.
Therefore, the maximum increase is $4.50, up to $24.50
The requested $2 increase falls within this maximum. An application to vary
the fees has not been approved in the previous 12 months. Therefore, subject
to the other conditions for approval, the application is approved and the new
fees can apply from 1 January, 2010.
Extra service fees cannot be adjusted until 12 months have elapsed from the date the
most recent extra service fee variation or approval took eect. See legislative reference.
Claiming arrangements
Providers need to notify the Department in writing when they start or stop providing
a resident with care on an extra service basis.
The room type and start date should be entered on the monthly claim form for
residential care subsidy when a resident first starts extra service care or moves to
another room type. The start date should correspond with the date from which the
extra service agreement takes eect, and the room type should correspond to the
particular type of accommodation the resident has agreed to occupy—for example,
a single room with private ensuite and balcony.
s 14.34,
Extra Service
Principles 1997
s 35-3(3), Aged
Care Act 1997
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40
Extra service agreement
A resident receiving care on an extra service basis must have an extra service
agreement. See legislative reference.
The agreement must contain: See legislative reference.
the level of extra service amount
how the extra service amount may be varied
the standard of the accommodation, food and services to be provided
to the resident
the provision set out in s 14.38 of the Extra Service Principles in relation
to revocation, suspension or variation. See legislative reference.
The extra service agreement may be included as part of a standard resident agreement.
The original of the agreement should be given to the resident and the aged care
service should retain a copy.
For each extra service place, the approved provider must provide the resident with
the accommodation, services and food to the standard specified in the extra service
agreement. See legislative reference.
In entering an agreement, the resident must not be subject to duress,
misrepresentation or threat of disadvantage or detriment. See legislative reference.
See also section on Accommodation payments—information provided to residents
and resident agreements in chapter on Funding for permanent residential aged
care; and section on Resident agreements in chapter on Residents’ rights in this
Manual.
New residents
If a service has extra service status, a new resident entering on an extra service basis
will pay the extra service amount from the time they commence residing in the service.
Existing residents
Special arrangements apply for residents who are already living in an aged care
service when extra service status becomes eective. These residents must be given
a choice as to whether or not they wish to receive care on an extra service basis.
They can continue to reside in the aged care service on a non-extra service basis,
and therefore, cannot be charged an extra service amount. While services do not
have to provide an extra service standard of accommodation, food and services to
these residents, general provider responsibilities continue to apply.
Existing residents may choose to receive care on an extra service basis at any time,
with a three month ‘cooling o’ period from the date of eect of the agreement,
during which time they may change their mind. These residents need only notify
the provider of their decision. The extra service agreement for such a resident must
specify that the resident may terminate the agreement during this period without
penalty of any kind. See legislative reference.
ELIGIBILITY FOR SUBSIDIES AND ADDITIONAL FUNDING
An aged care service with extra service status is not eligible for the following
subsidies or payments:
s 14.38,
Extra Service
Principles 1997
s 36-2, Aged
Care Act 1997
s 36-4, Aged
Care Act 1997
l e g i s l a t i v e r e f e r e n c e s
Aged Care
(Conditions of
Allocation—Extra
Service Places)
Determination
2006 (No. 1)
Division 36, Aged
Care Act 1997, Part
7, Extra Service
Principles 1997
s 36-3, Aged Care
Act 1997
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EXTRA SERVICE PLACES
41
l e g i s l a t i v e r e f e r e n c e s
a viability supplement for any place in the service
a hardship supplement, concessional resident supplement or supported
resident supplement for a resident receiving care on an extra service basis
capital grants. See
Extra service status and capital repayment following.
See legislative reference.
EXTRA SERVICE STATUS AND CAPITAL REPAYMENT
Aged care services may receive funding under the Residential Care (Capital) Grants
program, with funds provided in a capital payment. A service which has received a
capital grant under the residential care capital grants programs will have to repay all
or part of the grant if the service is approved for extra service status.
An aged care service will have capital repayment amounts deducted from the
service’s subsidy if:
the service is granted extra service status
the Department has previously made capital payments for the service, even
if the payment were not made to that approved provider
the payments have not been repaid to the Department.
See s 43-6 of the Act for a description of a capital payment. See legislative
reference. See also section on Capital funding and extra service status in chapter
on Capital grants for residential aged care in this Manual.
Capital repayments can be deducted under an agreement signed between the
provider and the Department and must be completed in three years. An aged care
service will be required to repay only a proportion of the capital payment if:
extra service status is granted for only a distinct part of a service. The
proportion of capital to be repaid is equal to the proportion of places in the
service which have extra service status
or some or all of the capital payments were approved more than 5 years before
the first of the deductions is to be made. The amount to be repaid is reduced
by 10 per cent for each year beyond this 5 year period. See the example following.
EXAMPLE
An aged care service was approved for capital funding on 25 May 2000 for
$100,000. The service, which has a total of 80 places, was granted extra
service status for 20 places on 10 December 2008. These 20 places constitute
a distinct part. cont. p42
s 43-6, Aged
Care Act 1997
s 43-6, Aged
Care Act 1997
EXTRA SERVICE PLACES
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42
ExamplE continuEd
The service would be liable for capital repayment deductions. The service and
the Government would enter an agreement for those capital repayments to be
repaid over three years. The proportion of capital repayment is calculated in
the following way:
a period of at least 6 months is counted as a complete year. In this
example, the year 2000 is counted as a complete year.
there are 9 complete years between date of approval and the due date
for the first capital repayment deduction. For each complete year after
5 years, the proportion is reduced by 10 per cent. This means the amount
to be repaid is reduced (by 4 x 10 per cent) to 60 per cent.
$100,000 x 60 per cent = $60,000
in addition, the service is being granted extra service status for a distinct
part of 20 places from a total number of places of 80. The 20 places
represent 25 per cent of the total places and therefore this means the
amount to be repaid is further reduced to 25 per cent
$60,000 x 25 per cent = $15,000
the total amount to be repaid is $15,000.
EXTRA SERVICE STATUS AND SUPPORTED RESIDENT
REQUIREMENTS
Aged care services which have extra service status for the whole facility generally
do not have to meet supported resident requirements, unless specified under the
conditions relating to the allocation of places or the grant of extra service status
to that service.
However, if a service has a separate wing with extra service status, it will have to
meet supported resident requirements for the remainder of the places in the service
which do not have extra service status.
ALLOCATIONS, TRANSFERS AND VARIATIONS
Additional conditions apply if the allocation, transfer or variation of places involves
relocating or allocating the places to an aged care service which has extra service
status.
The Department can approve the allocation, transfer, or variation of places
to an aged care service with extra service status if:
the extra service places to be allocated, transferred or varied are able to form
one or more distinct parts of the aged care service. In this case, the newly
allocated or relocated places do not have extra service status (although this
can later be applied for)
or the existing extra service places do not form a distinct part but the Secretary
is satisfied that the allocation, transfer, or variation meets the criteria for
approving extra service status. In this case, the newly allocated or relocated
places do have extra service status.
See also the chapter on Allocated places in this Manual.
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l e g i s l a t i v e r e f e r e n c e s
TRANSITIONAL ARRANGEMENTSEXISTING APPROVALS
Aged care services that were approved for exempt status under the National Health
Act 1953 will continue to have this status under transitional arrangements made
under the Aged Care (Consequential Provisions) Act 1997. These approvals are
subject to conditions set out in the Act, the Extra Service Principles and any specific
conditions that were attached to each approval. See References at the end of this
chapter for a link to ComLaw for the National Health Act 1953.
Fees and subsidies
The approved levels of extra service fees made under the previous arrangements
continue under the new arrangements.
The extra service amount is treated dierently for dierent residents:
for new residents who commence care on an extra service basis in the place
on or after 1 October 1997, the extra service reduction is 25 per cent of the
approved extra service fee. These residents will be income tested and may pay
the extra service reduction
or for people who were receiving care in an exempt bed prior to 1 October
1997, the extra service reduction is 50 per cent of the approved extra service
fee. See legislative reference.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Aged Care Information Line
Ph 1800 500 853
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Form—application for extra service status
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-ess-
essprov.htm#application
Legislation—other
Go to ComLaw to access other legislation mentioned in this chapter, including
the National Health Act 1953
www.comlaw.gov.au
s 39AB(3)(1)(B),
National Health
Act 1953, s 64,
Aged Care
(Consequential
Provisions) Act 1997
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44
I
Relevant legislation 45
Overview 45
Additional information 46
About the Aged Care Standards and Accreditation Agency 46
Accreditation 46
Who audits aged care services? 46
Accreditation fees 46
Accreditation—commencing services 47
Accreditation—existing services 47
The accreditation decision 48
What happens once an aged care service is accredited? 49
Monitoring after accreditation 49
Exceptional circumstances 50
Non-compliance with the Accreditation Standards 50
Appealing, reconsiderations and reviewable decisions 51
Review audits 51
Referral to the Department 53
Nursing and related stang requirements 53
The Accreditation Standards 53
Standard 1: Management systems, stang and organisational development 54
Standard 2: Health and personal care 54
Standard 3: Resident lifestyle 55
Standard 4: Physical environment and safe systems 56
References—links, guides and forms referred to in this chapter 56
ACCREDITATION AND QUALITY OF CARE
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
ACCREDITATION AND QUALITY OF CARE
ACCREDITATION AND QUALITY OF CARE
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
II
ACCREDITATION AND QUALITY OF CARE
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45
l e g i s l a t i v e r e f e r e n c e s
ACCREDITATION AND QUALITY OF CARE
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Aged Care Act 1997
, Part 4.1 (the Act)
Quality of Care Principles 1997
Accreditation Grant Principles 1999
(the Accreditation Grant Principles)
Accountability Principles 1998
OVERVIEW
Ensuring that residents of aged care services have a good quality of life and receive
good quality care is a priority for the Department and for the sector, and is central
to the wellbeing of residents themselves. Accreditation plays an important role in
achieving this outcome.
Accreditation is the arrangement established by the Government to verify that
aged care services provide quality care and services for residents. It involves an
independent team of quality assessors, appointed by the Aged Care Standards and
Accreditation Agency Ltd (the Agency), evaluating the achievements of a service
against a pre-determined set of Accreditation Standards. See legislative reference.
All residential aged care services must be accredited in order to receive funding from
the Australian Government through residential care subsidies. For exceptions to this,
see Exceptional circumstances on page 50. Individual services, rather than an
approved provider, are accredited. Once a service is accredited, it is monitored
to check that it continues to comply with the Accreditation Standards.
Accreditation is formal recognition that the service is:
operating in accordance with the Act and the Principles made under it
providing high quality care including
working within a continuous improvement framework
making required improvements.
In addition to meeting the requirements of the Accreditation Standards, approved
providers must also:
comply with relevant local, state and Australian Government regulatory
requirements
comply with professional standards and guidelines
adhere to requirements about charging fees, providing specified care and
services and having appropriate stang. See also chapter on Specified care
and services in this Manual.
s 54-2, Aged
Care Act 1997,
Schedule 2,
Quality of Care
Principles 1997
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Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can
also be accessed through the Aged Care Information Line on 1800 500 853.
ABOUT THE AGED CARE STANDARDS AND ACCREDITATION
AGENCY
The Agency was established to:
manage the accreditation process using the Accreditation Standards
promote high quality care including
identifying best practice in the industry, in order to help the industry
improve
providing information, education and training to the industry
assess services working towards accreditation
monitor compliance with the Accreditation Standards and liaise with the
Department about services that do not comply with the standards.
See References at the end of this chapter for the Agency’s contact information.
ACCREDITATION
Who audits aged care services?
A team of quality assessors appointed by the Agency carries out accreditation audits
of residential aged care services. All assessors have completed an approved training
course and are registered as aged care quality assessors with the registrar of
assessors. Quality assessors may either be employed by or contracted by the
Agency. All assessors must update their registration annually.
In applying for re-accreditation, an approved provider can nominate up to three
registered aged care quality assessors, one of whom is to be part of the assessment
team which conducts the audit of their service. In selecting the members of an
assessment team, the Agency considers any nominations made by the applicant,
the availability of assessors for the full period of the audit, and potential conflicts of
interest. Where an applicant has nominated one or more quality assessors who are
eligible for inclusion in the team, the Agency must include one of the nominees on
the team.
Accreditation fees
The Government subsidises the accreditation process. Aged care services with less
than 20 places do not have to pay accreditation fees. Fees for larger services are
subsidised. See References at the end of this chapter for a link to accreditation
fees on the Agency’s website.
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l e g i s l a t i v e r e f e r e n c e s
Accreditation—commencing services
An aged care service is considered a commencing service if an approved provider
has been allocated places for that service, residential aged care has not previously
been provided for those places and the service is not currently accredited by the
Agency. See legislative reference.
An accreditation application for a commencing service is assessed mainly on
the basis of the information given by the applicant. No site audit is conducted,
as persons are not yet receiving care at the service. However, once residents are
admitted, the Agency monitors commencing services’ provision of care and services.
The Agency must decide whether to accredit a commencing service within 14 days
of receiving an application and application fee from the approved provider. The
Agency must notify the applicant of its decision within 28 days of the decision.
Commencing services are accredited for 12 months. See legislative reference.
Accreditation—existing services
For existing services, the accreditation process involves the steps below:
an approved provider applies to the Agency for accreditation for an aged care
service, using the Agency’s standard form. See References at the end of this
chapter for a link to the form.
the application must include;
a self-assessment of the service’s performance against each of the
Accreditation Standards
the appropriate fee
a commitment that the service will undertake continuous improvement.
within 49 days of receiving the application, a team of aged care quality
assessors appointed by the Agency generally completes an assessment of
the application and information provided by the Department about the service;
and provides a report to the Agency which recommends whether or not the
Agency continue with the application. This is called completing a desk audit
within 7 days of receiving the completed desk audit, the Agency decides
whether to continue processing or to reject the application for accreditation.
The applicant must be informed in writing within 7 days of this decision
if the Agency decides to proceed with the application for accreditation, a team
of quality assessors conducts an on-site accreditation audit of the service—this
is called a site audit. The site audit must be completed within 56 days after the
Agency notifies the applicant of its decision to proceed with the application
within 3 days of being told when the site audit will start, the approved provider
must tell residents when the site audit will be carried out and that they will have
an opportunity to talk to members of the assessment team
during the site audit, the team assesses the service’s performance against each
of the 44 expected outcomes of the Accreditation Standards. The team looks
at relevant documentation, observes practices and talks with sta, residents
and others
during a site audit, the assessors value the time and information given to them
by residents. The assessors are required not to reveal the identity of residents
or representatives of residents
Division 14, Aged
Care Act 1997
Division 3,
Subdivision 1,
Accreditation
Grant Principles
1999
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at the end of the site audit the assessment team conducts an exit interview at
which the aged care service is provided with a report which includes the major
findings of the site audit
within 14 days of the completion of the site audit, the assessment team is
required to provide a written report to the Agency which, among other things,
makes a recommendation about accreditation of the service and about the
period of accreditation.
The accreditation decision
See legislative reference.
Within 28 days of receiving the site audit report from the assessment team, the
Agency must decide whether or not to grant a further period of accreditation to the
service. (This is unless a later date is agreed between the Agency and the applicant.)
In deciding whether to accredit a service, the Agency considers: See legislative
reference.
the desk audit report (if any)
the site audit report
information received from the applicant in response to the report of the site audit
information from the Department
whether it is satisfied that the service will undertake continuous improvement
measures against the Accreditation Standards.
If the Agency decides not to accredit the service they must: See legislative reference.
decide when the decision is to take eect from
decide the form and frequency of support contacts
advise the applicant and the Secretary of the decision within 28 days
give the applicant written reasons for the decision, including a recommendation
about the improvements that would be necessary to demonstrate compliance
with the Accreditation Standards and
give the applicant a copy of the information provided by the Department for the
assessment, a copy of the site audit report, information about arrangements for
support contacts, information about how and when to submit an improvement
outline and information about how to apply for reconsideration by the Agency
of the decision.
If the Agency decides to accredit the service they must decide: See legislative
reference.
the period of accreditation
the form and frequency of support contacts with the service
any improvements that must be made to improve the service’s compliance
with the Accreditation Standards.
The Agency must notify the applicant of the decision within 14 days and also provide
the applicant with: See legislative reference.
information on the period for which the service is to be accredited
information on how to apply for reconsideration of the period of accreditation
Division 3
Subdivision 4,
Accreditation
Grant Principles
1999
s 2.27,
Accreditation
Grant Principles
1999
s 2.28,
Accreditation
Grant Principles
1999
s 2.29,
Accreditation
Grant Principles
1999
s 2.31,
Accreditation
Grant Principles
1999
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information on the arrangements for support contacts and how these may be varied
information on whether there are any improvements that must be made
to improve the service’s compliance with the Accreditation Standards
information on the circumstances in which a review audit may be conducted
the arrangements for a further period of accreditation after the accreditation
period ends and the date by which an application should be provided for that
further period
a copy of the site audit report
a certificate of accreditation for the service, which sets out the period for which
it is accredited.
A copy of the site audit report is also placed on the Agency’s website.
If the Agency believes that a service presents a serious risk to the health, safety
or wellbeing of residents, it will immediately notify the Department and make
recommendations about whether or not sanctions under the Act should be imposed
on the approved provider. In these circumstances, the aged care service may be
granted a reduced period of accreditation or may not be accredited.
What happens once an aged care service is accredited?
The service is required to submit a plan for continuous improvement to the Agency.
The Agency maintains regular contact with the service to monitor the service’s
progress and to ensure that the Accreditation Standards continue to be met. Services
need to re-apply for another period of accreditation before the current one expires.
The date by which an application must be provided for any further period of
accreditation is advised at the time of accreditation.
Monitoring after accreditation
The Agency continues to monitor the performance of each service, through support
contacts and other means, during its period of accreditation. Once a service has been
accredited:
the Agency carries out regular supervision to ensure
it is complying with the Accreditation Standards and its other responsibilities
under the Act
and to help the service undertake continuous improvement.
the Agency may also do a review audit if
it believes on reasonable grounds that a service is not complying with the
Accreditation Standards or other responsibilities under the Act
there is a change in the service which the approved provider must tell the
Department about—for example, a change in ownership or key personnel
it is requested to do so by the Department.
See Review audits on page 51.
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EXCEPTIONAL CIRCUMSTANCES
An approved provider is eligible to receive residential care subsidies for any day, if the
approved provider has a current allocation of places; is providing care to approved
residents; and the service meets its accreditation requirement. See legislative reference.
If an aged care service has applied for accreditation—but has not achieved
accreditation or the Agency has revoked accreditation—the Secretary can decide that
the service meets its accreditation requirements. See legislative reference. However,
this can only happen if the Secretary is satisfied that exceptional circumstances apply
to the service.
A determination of exceptional circumstances:
cannot be made if there is an immediate or severe risk to the safety or wellbeing
of residents at the aged care service and/or where the approved provider has
not applied for accreditation
is for a maximum of six months and cannot be extended. A second
determination cannot be made in relation to a service unless the service has
been accredited by the Agency after the first exceptional circumstances
determination was made
must be revoked, if the original reasons for granting exceptional circumstances
no longer applies, or if an immediate or severe risk to the safety or well-being
of residents arises at the service.
If an aged care service is not accredited but a determination is in place:
the Agency will continue to monitor its performance, including any progress
made in improving its performance, and the approved provider will continue
to receive residential care subsidies for the residents in the service.
NONCOMPLIANCE WITH THE ACCREDITATION STANDARDS
The Agency can organise a review audit, if they assess a service and find:
that it is not complying with the Accreditation Standards
or has failed to implement required improvements.
Depending on the findings of a review audit:
the Department may impose sanctions
the Agency may decide to
vary the period of accreditation
revoke accreditation. See also section on
What sanctions can be imposed?
in chapter on Providers’ responsibilities and non-compliance in this Manual
not revoke accreditation, in which case it may agree on a timetable for
improvement. See legislative reference.
ss 42-1 and
42-4, Aged
Care Act 1997
s 42-5, Aged
Care Act 1997
Part 4,
Accreditation
Grant Principles
1999
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APPEALING, RECONSIDERATIONS AND REVIEWABLE DECISIONS
An approved provider can ask for reconsideration and/or review of a range of
decisions resulting from the accreditation site audit, including: See legislative
reference.
refusal to include a nominated assessor on the assessment team
inclusion of a specific qualified assessor on the assessment team
refusal of application for accreditation following a desk audit
the period of accreditation
a decision not to accredit.
The timeframes and processes for seeking reconsideration or review are outlined
in the Accreditation Grant Principles and vary depending on the particular decision.
When the Agency receives a request for reconsideration, the decision is made by
a new decision-maker—that is, someone within the Agency other than the original
decision-maker considers requests for decisions to be reconsidered. Following
reconsideration of a decision by the Agency, in some circumstances, the approved
provider can also apply to the Administrative Appeals Tribunal (AAT) for a review of
that decision. Most decisions must be reconsidered by the Agency prior to review by
the AAT, although a small number of decisions may go straight to the AAT for review.
See References at the end of this chapter for a link to the Administrative Appeals
Tribunal.
REVIEW AUDITS
A review audit assesses a service’s quality of care against the Accreditation Standards.
The Agency may arrange for an assessment team to conduct a review audit of an
accredited aged care service if: See legislative reference.
it believes on reasonable grounds that the service is not complying with the
Accreditation Standards or other responsibilities under the Act
there has been a change to the service, such as change of ownership or key
personnel
there has been a change to the premises of the service
there has been a transfer of allocated places
the service has not complied with arrangements made for support contacts
the Department directs the Agency to do so.
A review audit: See legislative reference.
is conducted by a team of at least two quality assessors
may be announced or unannounced
is carried out on the service’s premises
assesses the service’s systems against all 44 expected outcomes of the
Accreditation Standards
considers information and comments received from the Secretary, residents
and former residents and the approved provider of the service.
Part 7,
Accreditation
Grant Principles
1999
s 3.21,
Accreditation
Grant Principles
1999
s 3.22,
Accreditation
Grant Principles
1999
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At the end of a review audit the assessment team will meet with the approved
provider to discuss the assessment and provide a written report of the major findings
of the review audit. Within 7 days of that meeting, the approved provider or key
personnel can give the Agency and the assessment team a written response to the
report. See legislative reference.
The assessment team prepares a written report, which it gives to the Agency within
7 days of completing the review audit. The report makes a recommendation about
whether or not the service’s accreditation should be revoked and the reasons for
that recommendation.
If the report recommends revoking accreditation, it will also include a recommendation
about improvements which would be necessary for the service to be recommended
for accreditation if it applied in the future.
If the report does not recommend revoking accreditation, then it will include
recommendations about whether the period of accreditation should be varied; and
details of further support contacts with the service.
After it receives the review audit report from the assessment team, the Agency must
decide whether or not to revoke the accreditation of the service or to vary the
period of accreditation. The Agency must tell the aged care service in writing of its
decision within 14 days of receiving the review audit report. See legislative reference.
If the Agency decides not to revoke accreditation it must decide: See legislative
reference.
if there are matters which require improvements to be made to ensure the
service complies with its responsibilities for continuous improvement
the need to agree on a timetable to make improvements in these matters and
the form and frequency of support contacts with the service.
The Agency must advise the approved provider about these decisions. Within 14 days
of being told about the decision, the approved provider can write to the Agency and
ask it to reconsider its decision. If the Agency receives a request for reconsideration,
it must decide whether or not to confirm its decision, and advise the approved
provider, in writing, within 14 days of receiving the request.
If the Agency decides to vary the period of accreditation, then it must give the
approved provider written reasons for the variation.
If the Agency decides to revoke accreditation then it must:
give the approved provider written reasons for the revocation, including
recommendations about improvements that would be necessary to
recommend continuation of the service’s accreditation
tell the approved provider when the decision takes eect
advise the approved provider how to apply for reconsideration and review of
the decision and about arrangements for the supervision of the service during
the review period.
Within 14 days of being told about the decision, the approved provider may ask the
Agency to reconsider a decision to revoke the accreditation of the service.
If serious risk or non-compliance is identified during the review audit, the Secretary
is notified. In cases of serious risk, a report on the serious risk is prepared; and the
Secretary can consider imposing sanctions. See legislative reference.
l e g i s l a t i v e r e f e r e n c e s
s 3.23,
Accreditation
Grant Principles
1999
s 3.24,
Accreditation
Grant Principles
1999
s 3.25,
Accreditation Grant
Principles 1999
s 54.6
Accreditation
Grant Principles
1999
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REFERRAL TO THE DEPARTMENT
The Department will be notified immediately if an aged care service’s accreditation is
revoked. When accreditation is revoked Government funding to the service will stop.
The Agency must notify the Department of any serious risk or non-compliance
identified during an audit or found at the end of a timetable for improvement.
See legislative reference. A delegate to the Secretary makes the decision about
whether or not to apply sanctions in such cases.
NURSING AND RELATED STAFFING REQUIREMENTS
Skilled nursing and other sta play a major role in delivering quality care in residential
aged care services. There are specific legislative and other requirements about the
level and qualifications of sta employed in an approved aged care service, which
providers need to consider when deciding on the stang mix that best meets the
needs of residents.
The Act and the Principles require providers to maintain an adequate number of
appropriately skilled sta, including skilled nursing sta, to meet the care needs of
residents. See legislative reference. Residents who need high level care must be
provided with certain care and services, including nursing services provided by
a registered nurse or other appropriate professional.
Initial and ongoing assessment, planning and management of care for high
care residents must also be carried out by a registered nurse.
Where assessed care needs require nursing or other skilled sta, those sta
must be engaged. For example, an expected outcome for residents with
specialised nursing needs is that those needs are identified and met by
appropriately qualified nursing sta. See legislative reference.
The accreditation requirements take this further by explicitly requiring aged care
services to have a skills mix in place which is appropriate to the needs of their
residents.
If the range of resident dependency in the service changes, the service needs
to ensure stang skills also change to match resident need.
There must be at least one responsible person continuously on call to provide
emergency assistance.
THE ACCREDITATION STANDARDS
Services that apply for accreditation will be assessed against the four standards
outlined below: See legislative reference.
management systems, stang and organisational development (Part 1)
health and personal care (Part 2)
resident lifestyle (Part 3)
physical environment and safe systems (Part 4).
Each standard includes a number of expected outcomes. There are 44 expected
outcomes in total.
Part 4,
Accreditation
Grant Principles
1999.
s 54-1(1)(b) Aged
Care Act 1997
Schedule 1, Part 3,
Schedule 2, Part 2,
Quality of Care
Principles 1997
Schedule 2,
Quality of Care
Principles 1997
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Standard 1: Management systems, stang and
organisational development
See legislative reference.
Within the philosophy and level of care oered in the residential care service,
management systems are responsive to the needs of residents, their representatives,
sta and stakeholders, and the changing environment in which the service operates.
Continuous improvement—The organisation actively pursues continuous
improvement.
Regulatory compliance—The organisation’s management has systems in place
to identify and ensure compliance with all relevant legislation, regulatory
requirements, professional standards and guidelines.
Education and sta development—Management and sta have appropriate
knowledge and skills to perform their roles eectively.
Comments and complaints—Each resident (or his or her representative) and
other interested parties have access to internal and external complaints mechanisms.
Planning and leadership—The organisation has documented the residential care
service’s vision, values, philosophy, objectives and commitment to quality
throughout the service.
Human resource management—There are appropriately skilled and qualified
sta sucient to ensure that services are delivered in accordance with these
standards and the residential care service’s philosophy and objectives.
Inventory and equipment—Stocks of appropriate goods and equipment for
quality service delivery are available.
Information systems—Eective information management systems are in place.
External services—All externally sourced services are provided in a way that
meets the residential care service’s needs and service quality goals.
Standard 2: Health and personal care
See legislative reference.
Residents’ physical and mental health will be promoted and achieved at the optimum
level in partnership between each resident (or their representative) and the health
care team.
Continuous improvement—The organisation actively pursues continuous
improvement.
Regulatory compliance—The organisation’s management has systems in place
to identify and ensure compliance with all relevant legislation, regulatory
requirements, professional standards and guidelines, about health and
personal care.
Education and sta development—Management and sta have appropriate
knowledge and skills to perform their roles eectively.
Clinical care—Residents receive appropriate clinical care.
Specialised nursing care needs—Residents’ specialised nursing care needs are
identified and met by appropriately qualified nursing sta.
Other health and related services—Residents are referred to appropriate health
specialists in accordance with the resident’s needs and preferences.
l e g i s l a t i v e r e f e r e n c e s
Schedule 2, Part
1, Quality of Care
Principles 1997
Schedule 2, Part
2, Quality of Care
Principles 1997
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Medication management—Residents’ medication is managed safely and correctly.
Pain management—All residents are as free as possible from pain.
Palliative care—The comfort and dignity of terminally ill residents is maintained.
Nutrition and hydration—Residents receive adequate nourishment and hydration.
Skin care—Residents’ skin integrity is consistent with their general health.
Continence management—Residents’ continence is managed eectively.
Behavioural management—The needs of residents with challenging behaviours
are managed eectively.
Mobility, dexterity and rehabilitation—Optimum levels of mobility and dexterity
are achieved for all residents.
Oral and dental care—Residents’ oral and dental health is maintained.
Sensory loss—Residents’ sensory losses are identified and managed eectively.
Sleep—Residents are able to achieve natural sleep patterns.
Standard 3: Resident lifestyle
See legislative reference.
Residents retain their personal, civic, legal and consumer rights, and are assisted to
achieve active control of their own lives within the residential care service and in the
community.
Continuous improvement—The organisation actively pursues continuous
improvement.
Regulatory compliance—The organisation’s management has systems in place
to identify and ensure compliance with all relevant legislation, regulatory
requirements, professional standards and guidelines, about resident lifestyle.
Education and sta development—Management and sta have appropriate
knowledge and skills to perform their roles eectively.
Emotional support—Each resident receives support in adjusting to life in the
new environment and on an ongoing basis.
Independence—Residents are assisted to achieve maximum independence,
maintain friendships and participate in the life of the community within and
outside the residential aged care service.
Privacy and dignity—Each resident’s right to privacy, dignity and confidentiality
is recognised and respected.
Leisure interests and activities—Residents are encouraged and supported
to participate in a wide range of interests and activities of interest to them.
Cultural and spiritual life—Individual interests, customs, beliefs and cultural and
ethnic backgrounds are valued and fostered.
Choice and decision-making—Each resident (or his or her representative)
participates in decisions about the services the resident receives, and is enabled
to exercise choice and control over his or her lifestyle while not infringing on
the rights of other people.
Resident security of tenure and responsibilities—Residents have secure tenure
within the residential care service, and understand their rights and
responsibilities.
Schedule 2, Part 3,
Quality of Care
Principles 1997
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Standard 4: Physical environment and safe systems
See legislative reference.
Residents live in a safe and comfortable environment that ensures the quality of life
and welfare of residents, sta and visitors.
Continuous improvement—The organisation actively pursues continuous
improvement.
Regulatory compliance—The organisation’s management has systems in place
to identify and ensure compliance with all relevant legislation, regulatory
requirements, professional standards and guidelines, about physical
environment and safe systems.
Education and sta development—Management and sta have appropriate
knowledge and skills to perform their roles eectively.
Living environment—Management of the residential care service is actively
working to provide a safe and comfortable environment consistent with
residents’ care needs.
Occupational health and safety—Management is actively working to provide
a safe working environment that meets regulatory requirements.
Fire, security and other emergencies—Management and sta are actively working
to provide an environment and safe systems of work that minimise fire, security
and emergency risks.
Infection control—An eective infection control program.
Catering, cleaning and laundry services—Hospitality services are provided in a
way that enhances residents’ quality of life and the sta’s working environment.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Accreditation fees—administered by the Aged Care Standards And
Accreditation Agency
www.accreditation.org.au/accreditation/accreditationfees
Administrative Appeals Tribunal
www.aat.gov.au
Aged Care Information Line
Ph 1800 500 853
Aged Care Standards And Accreditation Agency
www.accreditation.org.au
National Oce
PO Box 773
Parramatta NSW 2124
Ph: (02) 9633 1711
Fax: (02) 9633 2422
Victoria and Tasmania oce
PO Box 398
Box Hill VIC 3128
1800 288 025
Ph: (03) 9897 4322
Fax: (03) 9898 7577
l e g i s l a t i v e r e f e r e n c e s
Schedule 2, Part
4, Quality of Care
Principles 1997
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Tasmania
GPO Box 313
Hobart TAS 7001
1800 288 025
Ph: (03) 6224 6482
Fax: (03) 6223 2410
New South Wales and
Australian Capital Territory
PO Box 674
Parramatta NSW 2124
1800 288 025
Ph: (02) 9633 2099
Fax: (02) 9687 0415
South Australia and
Northern Territory
GPO Box 620
Adelaide SA 5001
1800 288 025
Ph: (08) 8217 6000
Fax: (08) 8212 8544
Queensland
PO Box 1032
Spring Hill QLD 4004
1800 288 025
Ph: (07) 3852 3100
Fax: (07) 3852 3011
Western Australia
PO Box 718
Osborne Park WA 6916
1800 288 025
Ph: (08) 9201 1344
Fax: (08) 9201 1355
Form—accreditation application—from the Aged Care Standards
And Accreditation Agency
www.accreditation.org.au/accreditation/applicationforaccreditation
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
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I
Relevant legislation 59
Overview 59
Additional information 60
The Certification Assessment Instrument 60
Fire and safety 60
Privacy and space 60
Privacy and space requirements for buildings constructed post-July 1999 61
Privacy and space requirements for buildings constructed pre-July 1999 61
Certification assessments 61
The entire service is certified 61
Applying for certification 62
Preparing for an inspection 62
The inspection process 63
Serious hazards 64
After the inspection 64
Suitability of residential care service for certification 64
Accommodation bonds 65
Reviewing, revoking or suspending certification 65
Reviewing certification 65
Lapse of certification 65
Revoking certification 65
Suspension 66
Accommodation payments and the revocation or suspension of certification 66
Appeals 66
Fire safety declaration 66
References—links, guides and forms referred to in this chapter 67
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CERTIFICATION
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 2.6, Divisions 37-39; Part 4.2, Divisions 57, 57A,
Aged Care Act 1997 (the Act)
Certification Principles 1997
(the Certification Principles)
Residential Care Subsidy Principles 1997
User Rights Principles 1997
OVERVIEW
The certification process is designed to provide an incentive for approved providers
to improve their buildings by investing in them; and providing an income stream to
enable them to do so. Only certified services can:
charge residents accommodation payments—ie, either an accommodation bond
or an accommodation charge. See Accommodation bonds on page 65
or receive the accommodation supplement or the concessional resident
supplement.
When assessing whether a service can be certified under s38-1 of the Act, the
Secretary must consider: See legislative reference.
the standard of the buildings and equipment that are being used to provide
residential care
the standard of residential care provided by the service
the conduct of the approved provider and whether the provider has complied
with its responsibilities and obligations under the Act
any of the matters set out in s 8.10 of the Certification Principles.
See legislative
reference.
To achieve certification, a service must demonstrate, in an on-site building inspection,
that it has achieved specified building quality measures. The service’s buildings are
assessed using the Aged Care Certification Assessment Instrument. See References
at the end of this chapter for a link
The requirements of the certification program are also explained in Building Quality
for Residential Care Services—Certification. See References at the end of this chapter
for a link.
Certification is not time-limited—ie, a service’s certification status generally does
not expire. However, certification status can be reviewed. See legislative reference.
A review may be undertaken if, for example, there are significant changes to the
structure of the premises or an increase in the number of allocated places.
s 38-1, Aged
Care Act 1997
s 8.10,
Certification
Principles 1997
s 39-4, Aged
Care Act 1997
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Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can also
be accessed through the Aged Care Information Line on 1800 500 853.
THE CERTIFICATION ASSESSMENT INSTRUMENT
Services are inspected under the Aged Care Certification Assessment Instrument,
November 2002 Revision. See References at the end of this chapter for a link.
To be eligible for certification, a service must:
achieve an overall mark of at least 60 out of a possible 100 points
score at least 19 out of 25 for Section 1: Safety.
THE CERTIFICATION ASSESSMENT INSTRUMENT INCLUDES THE SEVEN
SECTIONS BELOW:
ASPECT OF BUILDING QUALITY MAXIMUM POSSIBLE POINTS
Section 1 safety 25 points
Section 2 hazards 12 points
Section 3 privacy 26 points
Section 4 access, mobility and occupational
health and safety
13 points
Section 5 heating/cooling 6 points
Section 6 lighting/ventilation 6 points
Section 7 security 12 points
In addition to the seven criteria above, services are also required to meet a set of
Australian Government standards relating specifically to fire, safety, privacy and space.
Homes are not eligible to receive the increased fees and subsidies introduced by the
Government on 20 March 2008 until the targets for fire and safety and privacy and
space are achieved.
Fire and safety
Aged care homes were expected to meet specific fire and safety standards by the
end of 2005. Homes must score at least 19 out of 25 in section 1 of the Certification
Assessment Instrument (Safety) to meet fire and safety standards
Privacy and space
Aged care homes had until December 2008 to meet specific standards relating to
privacy and space. The specific standards for privacy and space in residential aged
care homes are based on the date of construction of the buildings.
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Privacy and space requirements for buildings constructed
post-July 1999
Number of residents per room
an average of no more than 1.5 residents per room
no one room can accommodate more than 2 residents
rooms to accommodate a higher number of residents may be approved
in limited cases where the provider is able to demonstrate that a higher
number of residents per room is culturally appropriate on an ongoing basis.
Access to toilets and showers:
no more than 3 residents per toilet
no more than 4 residents per shower or bath
toilets, showers and baths distributed across the building to ensure that
all residents have equitable and ready access. Showers and toilets used
primarily by sta are not included when these averages are calculated.
Privacy and space requirements for buildings constructed
pre-July 1999
Number of residents per room
an average of no more than 4 residents per room. It is expected however,
that providers will strive to meet the optimal target of a maximum of
2 residents per room
rooms to accommodate a higher number of residents may be approved
in limited cases where the provider is able to demonstrate that a higher
number of residents per room is culturally appropriate on an ongoing basis.
Access to toilets and showers
no more than 6 residents per toilet
no more than 7 residents per shower
toilets, showers and baths distributed across the building to ensure that
all residents have equitable and ready access. Showers and toilets used
primarily by sta are not included when these averages are calculated.
See legislative reference.
CERTIFICATION ASSESSMENTS
The entire service is certified
Certification is granted for an entire service, not for any one building or one part
of a residential care service See legislative reference. If residential care is provided
at more than one location through the same residential care service, only one
application may be made for all those locations. See legislative reference.
If a certified service moves to another site, certification lapses and the service must
seek certification again for the new location.
Every residential aged care service must be certified separately, including separate
services run by the one provider and separate residential care services conducted
in the same premises. See legislative reference.
Schedule 1,
Residential
Care Subsidy
Principles 1997
s 39-2(4)(a), Aged
Care Act 1997
s 38-2(3), Aged
Care Act 1997
s 38-2(4)(b), Aged
Care Act 1997
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Applying for certification
An application for certification of an aged care service must be made on the
approved form, by a provider who has an allocation of places at that service.
See legislative reference. See References at the end of this chapter for a link
to the form. The application must be signed by a person authorised in writing
to act for the provider. See legislative reference.
The application must include: See legislative reference.
the name of the aged care service
the address where the service is being provided
the postal address of the service
the number of places allocated to the applicant for the service
if a building in which the service is being provided is leased—the term
of the lease and the lessor’s name and address.
A provider can apply for certification at any time. However, a service must be
certified to be eligible to:
charge an accommodation bond
See legislative reference.
charge an accommodation charge
See legislative reference.
receive the accommodation supplement
See legislative reference.
or receive the concessional resident supplement
.
It is recommended that a provider applies for certification at least 30 days prior
to occupancy. See legislative reference.
If a service is a new service—ie, a commencing service—the provider can apply for
a certification inspection before residential care services commence, provided that
the appropriate building approval authority has issued a certificate of occupation
or classification.
The following non-refundable application fees are charged:
$150 for a service with less than 10 places allocated to it
$700 for a service with more than 46 places allocated to it
for any other service, $15 for each place allocated to the service.
See legislative reference.
The fee is deducted from a service’s first monthly subsidy payment after the
certification decision has been made. Services applying for certification should
authorise the deduction on the Authority to Deduct form included as part of the
application. A certification assessment will not take place until the Authority to
Deduct has been signed.
Preparing for an inspection
Prior to applying for certification, an approved provider should be familiar with:
Part 2.6, Divisions 37 to 39 of the
Aged Care Act 1997 See legislative reference.
Part 2, sections 8.5 to 8.19 of the Certification Principles
See legislative
reference.
the Aged Care Certification Assessment Instrument
s 38-2, Aged Care
Act 1997
s 57-16, Aged
Care Act 1997
s 57A-8, Aged
Care Act 1997
s 44-5A(2)(c)
Aged Care Act
1997
s 44-6(2)(c), Aged
Care Act 1997
Part 2.6, Divisions
37-39, Aged Care
Act 1997
Part 2, s 8.5-8.19,
Certification
Principles 1997
s 8.17,
Certification
Principles 1997
s 8.6, Certification
Principles 1997
s 8-7, Certification
Principles 1997
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the Aged Care Certification Guidelines
the Aged Care Certification Assessment Scoring Matrix
the Building Quality for Residential Care Services—Certification guide.
See References at the end of this chapter for these links.
After the Department receives an application for certification, it will contact an
authorised assessor to conduct an inspection at that facility. See legislative reference.
The Department has contracted a company with expertise in building survey and
engineering to carry out assessments of residential care services. See legislative
reference. An assessor will contact the approved provider to arrange a suitable time
and date for the inspection.
Before the inspection takes place, an approved provider should:
tell residents and sta when and why the inspection is taking place
arrange for an appropriate person such as the proprietor, the director of nursing
or a senior manager to be on hand during the visit
have building documentation ready—eg, floor plans, emergency exit plans,
certificates, licences or other approval documentation for the premises,
including any document that verifies the premises comply with state or local
government fire, health and/or safety regulations.
The inspection process
On average, inspections take between 1 ½ and 3 hours. At larger services, they may
take up to 4 hours. Inspections will focus on:
whether the service provides a safe and secure environment
exits from the service
whether the service has adequate smoke-free compartments
fire safety, including adequate fire protection and emergency evacuation systems
hazards within or outside of buildings
whether the service provides adequate personal privacy to residents
facilities to allow access and mobility for residents to move freely within
the building
adequate heating and cooling
adequate lighting and ventilation
whether the service provides a home-like environment
whether there is access to community services.
See legislative reference.
If the service is new, the assessor will also determine whether the service meets the
privacy and space requirements for new buildings. See The Certification Assessment
Instrument on page 60.
s 38-4, Aged
Care Act 1997
s 8-12,
Certification
Principles 1997
s 8.13,
Certification
Principles 1997
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Serious hazards
During the inspection, the assessor will look for serious hazards—ie hazards which
are potentially life threatening. Serious hazards include:
blocked fire escape doors
exposed electrical wiring
contaminants such as flaking lead paint
structural instability
the absence of a fire emergency warning system or fire suppression system
as required under the Building Code of Australia.
If a facility has a serious hazard, certification assessment will not proceed until the
hazard has been removed or rectified. See also Reviewing, revoking or suspending
certification on page 65.
After the inspection
Immediately after the inspection, the assessor will discuss with the provider the
general scoring methodology and aspects of building quality assessed. However,
an assessor is not allowed to provide detailed and prescriptive advice on future
upgrading priorities. Providers should seek independent professional advice for this.
Service providers will receive a copy of the assessment report and a copy of any
other findings used by the Department in deciding whether to certify the service.
See legislative reference.
SUITABILITY OF RESIDENTIAL CARE SERVICE FOR
CERTIFICATION
While the assessor inspects the buildings and physical aspects of a service applying
for certification, it is the Secretary who decides to either certify a service or to reject
an application for certification. In assessing an application for certification, the
Secretary must consider a range of matters, including: See legislative reference.
the standard of the buildings and equipment used by the service to provide
residential care
the standard of residential care provided by the service
if the applicant has been a provider of aged care, its conduct as a provider,
including compliance with responsibilities and obligations related to any
Commonwealth payments made for providing aged care
if key personnel are also relevant key personnel in common with a current or
former approved provider, the conduct of that person as a provider of aged care
will be considered
the assessment of the residential care service carried out under s 38-4(1) of the Act
See legislative reference.
whether the Department has imposed sanctions or taken any other action
against the provider for non-compliance
whether the service’s buildings and equipment and the residential care it
provides meet the requirements of any relevant state law or state or local
government authorities
s 8.15(1),
Certification
Principles 1997
s 38-4(1), Aged
Care Act 1997
s 38-3, Aged Care
Act 1997, s 8.10,
Certification
Principles 1997
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whether any of the service’s equipment or buildings are fire hazards or
dangerous to the health or safety of residents or sta and therefore subject
to an order by a state or local government authority for repair, renovation or
restoration
any findings by a Commonwealth, state or local government authority about
the standard of the buildings or equipment or the standard of residential care
being provided by the service.
Accommodation bonds
A resident can only be required to pay an accommodation bond after a service has
been certified for six months See legislative reference. However, if a resident enters
a service in the first six months after it has been certified, the service can charge the
amount equivalent to the interest the provider could have derived from the resident’s
bond if it was charged from the date the service was certified. For more information
see section on Accommodation bonds in chapter Funding for permanent residential
aged care in this Manual.
REVIEWING, REVOKING OR SUSPENDING CERTIFICATION
Reviewing certification
The Secretary may review the certification of a service, and for the purpose of review
authorise a person or body to assess the service. An assessment can relate to any
aspect of the residential care service that the Secretary considers relevant to the
ongoing suitability of the service for certification. Providers will receive at least
5 business days’ notice before the start of a review. See legislative reference.
Lapse of certification
Certification of a service will lapse if, after the service has been certified, there is a
change in the location at which the residential care is provided through the service.
See legislative reference.
Revoking certification
The Secretary must revoke the certification of a residential care service:
if the service is no longer suitable for certification
See legislative reference.
or if the provider’s application for certification contained information that was
false or misleading in a material way. See legislative reference.
The Secretary may also revoke the certification of a residential care service:
if an approved provider has not complied with their responsibilities. See also
chapter on Providers’ responsibilities and non-compliance in this Manual
or if an approved provider requests it.
See legislative reference. Providers must
make the request at least 60 days before the day on which the revocation is
requested to take eect. The Secretary must notify the approved provider of
the revocation by written notice at least 14 days before the day on which
revocation is to take eect.
s 57-16(2)(b), Aged
Care Act 1997
s 39-4, Aged
Care Act 1997
s 39-2, Aged
Care Act 1997
s 39-3(1)(a), Aged
Care Act 1997
s 39-3(1)(b), Aged
Care Act 1997
s 39-5, Aged
Care Act 1997
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Before deciding to revoke the certification, the Secretary must: See legislative
reference.
notify the provider in writing that revocation is being considered
explain the reasons for considering the revocation
and invite the provider to make a written submission to the Secretary within
28 days after receiving the notice.
Suspension
The Secretary may suspend the certification of a residential care service if an
approved provider has not complied with its responsibilities. See also What sanctions
can be imposed? in chapter on Providers’ responsibilities and non-compliance in this
Manual.
Accommodation payments and the revocation
or suspension of certification
If a residential care service ceases to be certified, the service must refund
accommodation bond balances or cease charging accommodation charges. Until
the date certification is revoked or ceases to have eect, the service can retain any
retention amounts and income derived (ie, interest) on accommodation bonds.
APPEALS
A service can seek reconsideration of a decision to:
reject an application for certification
revoke the certification of a residential care service
impose conditions on revocation of the certification, where the provider
has requested that certification be revoked
impose a sanction, including revoking or suspending certification.
For reconsideration of a decision, the approved provider must write to the Secretary
within 28 days of receiving notice of the decision See legislative reference. The
approved provider should give reasons for the request and include any relevant
supporting material.
The Secretary must then reconsider the decision, and either confirm, vary or set
aside and substitute a new decision. If the Secretary does not give notice of a
decision within 90 days after receiving the request, the Secretary is taken to have
confirmed the decision. If an approved provider wants to appeal against the decision
after review by the Secretary, then it can apply to the Administrative Appeals Tribunal
for external review.
FIRE SAFETY DECLARATION
All residential care services must complete an annual fire safety declaration. Every
January, the Department sends declaration forms to providers who have until 31
March of that same year to send declarations back to the Department, indicating
whether or not they comply with all applicable state, territory and local government
laws relating to fire safety. See legislative reference.
l e g i s l a t i v e r e f e r e n c e s
s 39-3(2), Aged
Care Act 1997
s 85-5, Aged
Care Act 1997
s 18.6B,
Quality of Care
Principles 1997
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As the Australian Government does not have responsibility for fire safety laws, any
non-compliant declarations are referred to the relevant local council (in the ACT,
they are forwarded to the ACT Fire Brigade). A copy of each of the non-compliant
declarations is also provided to the Aged Care Standards and Accreditation Agency.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Aged Care Certification Assessment Instrument
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-certification-
download-assessin-cnt.htm
Aged Care Information Line
Ph 1800 500 853
Building Quality for Residential Care Services—Certification Guidelines
and Scoring Matrix
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-certification-
buildqual.htm
Fire safety declaration form—enquiries
Phone the Department on (02) 6289 8977.
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Form—application for classification
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rcspage-
form2568.htm
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I
Relevant legislation 69
Overview 69
Additional information 69
Approval for Government-subsidised residential aged care 70
Who can be approved for residential care? 70
What limits can be placed on approval to receive care? 71
Approval for high level residential care 71
Payment of subsidy 71
When does an approval cease to have eect? 72
When should an aged care service request an ACAT reassessment? 72
Emergency approvals 73
Approval form 74
Reviewable decisions 74
References—links, guides and forms referred to in this chapter 75
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APPROVAL OF RESIDENTS
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 2.3, Division 20, s 20-1–20-2, Division 21, s 21-1–21-4, Division 22,
s 22-1–22-6, Division 23, s 23-1–23-4, Aged Care Act 1997 (the Act)
Approval of Care Recipients Principles 1997
(Approval of Care Recipients Principles)
Aged Care Principles 1997
OVERVIEW
To be eligible for Australian Government-subsidised aged care, a person must have
a current Aged Care Assessment Team (ACAT)* approval, or have a decision made
by the Secretary that exceptional circumstances exist such that an assessment by an
ACAT is not needed. (*Known in Victoria as Aged Care Assessment Service (ACAS).)
While it is the Secretary who approves a person as eligible to receive Government-
subsidised care, the Secretary has delegated this power to ACAT delegates and
to Departmental delegates.
A person can be approved for one or more of the following types of care:
residential care (including residential respite care)
community care
flexible care.
Flexible care in the form of Transition Care and Multi Purpose Services may
be provided in residential care facilities.
ACATs help older people and their carers work out what kind of care will best meet
their needs when they are no longer able to manage at home without assistance.
ACATs provide information on suitable care options and can help arrange access or
referral to appropriate residential or community care. ACATs cover all of Australia and
are based in the local community or hospitals.
People do not need to have a current ACAT approval to place their name on a waiting
list for an aged care service.
ACATs operate under the Act and associated principles and Commonwealth guidelines.
Additional information
This chapter has been updated and revised to help approved providers comply with
their responsibilities under the Act; and to assist sta of aged care services understand
the regulation of residential aged care. Additional information can also be accessed
through the Aged Care Information Line on 1800 500 853.
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APPROVAL FOR GOVERNMENTSUBSIDISED RESIDENTIAL
AGED CARE
It is policy that Government-subsidised aged care services are accessed by the people
who need them most. The eligibility criteria for aged care services are applied in a
nationally consistent way so that subsidised aged care services are accessed appropriately.
ACATs comprehensively assess and approve people as eligible to access Government-
subsidised aged care services.
ACATs accept referrals from any source including self-referral. Following referral the
ACAT will conduct a comprehensive, multidisciplinary assessment of the person’s
medical, physical, social and psychological needs to determine the person’s care
needs and the type of services that would be most appropriate to meet those needs.
The Aged Care Client Record (ACCR) is a record of the ACAT assessment. The ACCR
contains:
the application for approval form (completed by the client),
the client’s assessment information (completed by the ACAT),
an approval section (completed by the ACAT delegate).
The ACCR is one of the nominated source documents for an Aged Care Funding
Instrument (ACFI) appraisal and should be included by the approved provider in the ACFI
Appraisal Pack wherever possible. It is a valuable component of the ACFI Appraisal Pack
as it can also help to complete the overall picture of a person’s care needs. However, if
an ACCR is not available, it is not mandatory to obtain one to complete the ACFI appraisal.
If a person cannot complete the application for approval form themselves, it can be
completed on their behalf. See Emergency Approvals on page 73.
The Secretary approves a person as eligible to receive Government-subsidised care. The
Secretary has delegated this power to certain positions within ACATs, known as ACAT
delegates; and to nominated positions within the Department, known as Departmental
delegates.
A person can be approved for one or more of the following types of care:
residential care (including residential respite care)
community care
flexible care. Flexible care in the form of Transition Care and Multi Purpose
Services may be provided in residential care facilities. See References at the
end of this chapter for a link to the Transition Care Program Guidelines.
The delegate can decide on any limitations to an approval—for example, a person may
be approved for a low level of residential care—and will inform the person who applied
for approval of these decisions in writing. These decisions are reviewable and can be
appealed. ACAT delegates cannot revoke approvals. Only Departmental delegates can
revoke approvals. See What limits can be placed on approval to receive care? on page
71 and Reviewable decisions on page 74.
WHO CAN BE APPROVED FOR RESIDENTIAL CARE?
A person is eligible for residential care if:
they have physical, medical, social or psychological needs which require
residential care
and those needs cannot be met more appropriately through non-residential
care services.
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A person must meet the following criteria: See legislative reference.
being frail or disabled and requiring at least low level continuing personal care
being incapable of living in the community without support
meeting other eligibility criteria for a level of care for which they are assessed,
as set out in the Classification Principles 1997.
Someone who is not an aged person may also be approved for residential care if
there are no other care facilities or care services more appropriate to meet their needs.
In determining whether these criteria are met, the ACAT must consider the person’s
medical, physical, psychological and social circumstances.
WHAT LIMITS CAN BE PLACED ON APPROVAL TO RECEIVE CARE?
An approval can be limited to See legislative reference.
a particular kind of care
care provided during a specific period starting on the day after the approval
residential respite care for a specific period
any other matters or circumstances specified in the Approval of Care Recipients
Principles
a low level of residential care.
Permanent residential care and residential respite care are dierent care types. An
approval for permanent residential care does not automatically include respite care
unless specified.
APPROVAL FOR HIGH LEVEL RESIDENTIAL CARE
An ACAT approval will determine whether a person enters residential care at either
a high or low level. See legislative reference.
The ACAT will approve a person to receive a high level of residential care when their
needs are significant enough to require it. See legislative reference. A person
approved for a high level of residential care will often require some nursing services.
If a person is approved to receive high level residential care (permanent or respite),
they are also eligible to receive residential care at a low level. See legislative reference.
Once a person enters permanent residential care, the aged care service must
commence the ACFI appraisal within 28 days of their entry, to classify the resident
for funding purposes. See also chapter on Classification of residents in this Manual.
PAYMENT OF SUBSIDY
A Government subsidy can only be paid:
for people who have a current approval to receive care
for the type and level of care approved
for care provided in line with any limits set by the approval.
s 22, Aged
Care Act 1997
s 5.5, Approval
of Care Recipient
Principles 1997
s 22-4, Aged
Care Act 1997
Part 3, Quality
of Care Principles
1997
s 5.9, Approval of
Care Recipients
Principles 1997
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In claiming a subsidy, an approved provider must ensure that the prospective care
recipient has current ACAT approval for the type and level of care to be provided.
ACATs are unable to backdate an approval, except in emergency circumstances.
See Emergency approvals on page 73.
For a person receiving residential respite care, subsidy will not be paid if:
the person has already used 63 days of respite care in each financial year
covered by the approval and no additional 21-day extension periods have been
approved prior to the end of the financial year. See legislative reference.
WHEN DOES AN APPROVAL CEASE TO HAVE EFFECT?
Approvals for high level residential care and residential respite care at the high and
low levels do not lapse, but can expire if time limited.
An approval for residential care can cease to have eect in one of three ways—it can
expire, lapse or be revoked:
an approval
expires if it is limited to a specified period of care and that period
ends See legislative reference.
an approval can be
revoked if the Secretary is satisfied that the person has
ceased to be eligible to receive the care for which they were approved. Only
Departmental delegates of the Secretary can revoke an approval See legislative
reference.
An approval for low level residential care (not provided as residential respite
care) lapses 12 months from the day after the approval was given
See legislative reference..
An approval for transition care
lapses if the person does not enter care within
four weeks from the day after the approval was given. Approval will also lapse
if the person leaves transition care for at least one day after the lapsing period
ends. See legislative reference.
A person should be reassessed at any time if their care needs change. See also
chapter on Classification of residents in this Manual.
WHEN SHOULD AN AGED CARE SERVICE REQUEST AN ACAT
REASSESSMENT?
Approvals for high level residential care and residential respite care at the high and
low levels do not lapse. A reassessment for these approvals would only be required
if the approval was time limited.
For other approvals, an aged care provider may request an ACAT reassessment when:
there has been a significant change in the person’s care needs and they require
approval for a dierent type or level of care
a person approved for transition care is not provided with the care to which
their approval relates for a period of at least one day after the lapsing period
and the person needs additional transition care
a person’s approval was time limited and has expired
a person is transferring between facilities, they have aged in place and have a
high ACFI classification and they want to pay an accommodation charge rather
than rolling over the accommodation bond
s 21.18,
Residential Care
Subsidy Principles
1997
s 23-2, Aged Care
Act 1997
s 23-4, Aged Care
Act 1997
s 23-3, Aged Care
Act 1997
s 23-3(3), Aged
Care Act 1997, s
5.14(1), Approval
of Care Recipients
Principles 1997
l e g i s l a t i v e r e f e r e n c e s
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a person with a low level residential care approval leaves residential care for
more than 28 days (excluding approved leave) after their approval has lapsed and
they want to access Government subsidised care in an aged care service
a service provider wishes to remove the Interim Low subsidy limitation. An ACAT
approval for high care is one way the full ACFI high care subsidy may be paid for
a resident
a person’s approval for residential respite care is limited to low and the person’s
care needs have changed and they would be eligible for high level respite approval
an approved provider asks a care recipient to leave a residential care service. The
long term care needs of the care recipient may be assessed by an ACAT or (in
certain circumstances) at least 2 medical or other health professionals who meet
the criteria. See legislative reference. See also section on Four steps—asking
a resident to leave in chapter on Residents’ rights in this Manual.
For information on ageing in place, see section on Ageing in place in Classification of
residents chapter in this Manual.
EMERGENCY APPROVALS
A person can receive care before approval by an ACAT if they urgently need care and
it is not practicable to apply for approval beforehand.
Emergency admissions should occur rarely and will usually be precipitated by a crisis
situation—for example, if there is no primary carer for the person and there are no
other options available. See legislative reference.
In order for subsidy to be payable for the care recipient from the day that the emergency
care started, the ACAT delegate must firstly be satisfied that an emergency existed at
the time the care started and service providers must satisfy the 5 business day rule.
Within 5 business days the provider should:
inform the local ACAT of the emergency admission and ask for a copy of the
statement of application (the front page of the ACCR) to be sent to them by fax.
The ACAT should ensure that the care recipient’s name is written on the form
prior to faxing
ensure that the Statement of Application is completed by the care recipient
(or by someone else on their behalf)
ensure that the Statement of Application identifies the date the care recipient
entered the aged care service and the aged care service’s address and telephone
number, to enable the ACAT to arrange an assessment
fax the signed and completed Statement of Application to the local ACAT within
5 business days (or any period as extended under the Act) after the day on
which the care started
provide the original statement of application to the ACAT at the time of assessment.
If an applicant is unable to sign the application, someone else can sign for them. If
someone other than the applicant signs the application, additional information under
the applicant’s signature must be provided and the applicant must be informed that
the application has been made.
If the applicant has a legal guardian, the guardian is the preferred person to sign the
application on the person’s behalf. If they do not sign on behalf of the person, they
must be informed that the person has entered care.
s 23.5, User
Rights Principles
1997
s 22-5, Aged
Care Act 1997
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An emergency situation is the only circumstance in which approval can take eect
from the day on which the care started, rather than the day the approval was signed
and dated.
If the person is approved by the ACAT as a care recipient for the level and type of
care they are receiving, the subsidy will be paid from the date the care started.
The delegate must be satisfied that there was an emergency when the person
entered care.
Government subsidy will not be paid for a person who receives care prior to an ACAT
assessment and approval, if the ACAT delegate determines that they did not urgently
require that care.
APPROVAL FORM
The ACCR form is held by the ACAT and contains:
statement of application—completed by the person seeking approval
record of assessment—completed by the ACAT
approval—completed by the ACAT delegate.
Approval for high level residential care and all residential respite care does not lapse,
but an approval may expire if it is time limited. Approval for low level residential care
lapses 12 months from the day after approval was given if the person has not entered
care within that timeframe.
When a client enters residential care, they are responsible for providing the aged care
service with a copy of the ACCR as evidence of their approval status. Aged care
services with access to Medicare’s Aged Care Online Claiming Gateway should
always check if a potential client’s approval is valid. See References at the end of this
chapter for a link. It is the provider’s responsibility to ensure that a client holds the
requisite approval prior to entry if a subsidy is to be paid.
REVIEWABLE DECISIONS
A decision not to approve a person to receive care, and to set limitations to an
approval can be reviewed. A revocation of approval to receive care can also be
reviewed. See legislative reference.
The delegate must notify a person in writing about a reviewable decision. The letter
must include the reason for the decision and information about the person’s review
rights.
Anyone whose interests are aected by such a decision, including aged care services,
potential and current care recipients and their families or carers can ask the Secretary
to reconsider the decision. However, discussing the issue with the ACAT involved in
the first instance can often produce a speedy resolution of any dierences or
misunderstandings.
If someone wants to appeal a decision, they should:
write to the Secretary within 28 days of receiving the decision (or within any
extended period allowed by the Secretary) explaining their reasons for
requesting a reconsideration of the decision
send the letter to the state or territory oce of the Department in the state
or territory where the decision was made. See References at the end of this
chapter for address.
Division 85, Aged
Care Act 1997
l e g i s l a t i v e r e f e r e n c e s
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After receiving a request to review a decision, the Secretary will either:
See legislative reference.
confirm the original decision
vary the decision
or make a new decision.
If the Secretary has not replied within 90 days of receiving the request, this means
that the original decision stands. If the person is dissatisfied with the Secretary’s
reconsideration of the decision, they can apply to the Administrative Appeals Tribunal
(AAT) to review the decision. See References at the end of this chapter for a link to
the AAT.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
ACAT finder
www.agedcareaustralia.gov.au/internet/AgedCare/Publishing.nsf/content/acat+finder
Administrative Appeals Tribunal
www.aat.gov.au
Aged Care Assessment Program Guidelines
www.health.gov.au/acats
Aged Care Information Line
Ph 1800 500 853
Appealing a decision
If someone wants to appeal a decision, they should write to the Secretary of the
Department, within 28 days of receiving the decision:
The Secretary
Department of Health and Ageing
GPO Box 9848
Capital city, state/territory, postcode
Draft Community Packaged Care Guidelines
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-cacp-
guidelines.htm1
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Medicare’s Aged Care Online Claiming Gateway
www.medicareaustralia.gov.au/provider/aged-care/gateway-logon.jsp
Transition Care Program Guidelines
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-transition-
guidelines.htm
s 85-5, Aged
Care Act 1997
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I
Relevant legislation 77
Overview 77
Additional information 77
About the Aged Care Funding Instrument (ACFI) 77
Applications for classification 78
Classification of residents 78
Figure 1—Weightings and range of points for each category 79
High and low care classifications 80
Classification expiry 80
ACFI appraisals—when must an appraisal be undertaken 81
New residents 81
Reappraisals for existing residents 81
Existing resident—significant change in care needs 82
Existing resident—reappraisal of lowest applicable classification 82
Existing resident—transfer from another aged care service 82
Existing resident—ageing in place 83
Reappraisal period 83
Late applications for reappraisal 84
Review of ACFI appraisals 84
Notice of a review visit 86
Roles and responsibilities 86
Exit meetings 87
Notifying the approved provider of the review outcome 87
Inaccurate assessments 87
Complaints and concerns 88
Risk assessment approach 88
Appeals to the Department for the reconsideration of decision 88
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Notification of the reconsideration decision 89
Date of eect 90
Administrative Appeals Tribunal 90
Subsidy rate 90
Grandparenting of Resident Classification Scale (RCS) subsidies 90
References—links, guides and forms referred to in this chapter 91
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CLASSIFICATION OF RESIDENTS
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 2.4,
Aged Care Act 1997 (the Act)
Part 6.4,
Aged Care Act 1997
Classification Principles 1997
OVERVIEW
Residents of residential aged care services are given a classification according to
the level of care they need. The classification of a resident is undertaken primarily
to determine the level of care funding payable for that resident. The care funding
model is divided into the following three domains:
activities of daily living (ADL)
behaviour (BEH)
complex health care (CHC).
The level of funding provided depends on the assessed level of care need in each of
the three domains. The level of care need is assessed using a funding tool called the
Aged Care Funding Instrument (ACFI).
The current funding model and the funding instrument commenced on
20 March 2008, replacing the Resident Classification Scale (RCS).
Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can
also be accessed through the Aged Care Information Line on 1800 500 853.
ABOUT THE AGED CARE FUNDING INSTRUMENT ACFI
The ACFI consists of 12 care need questions, and collects diagnostic information
about mental and behavioural disorders and other medical conditions. This
information is used to categorise residents as having nil, low, medium or high
needs in each of the three care domains. No funding is provided for a domain
if the resident has no or minimal assessed care needs in that domain.
The assessment of a resident’s care needs utilising the ACFI is called an appraisal.
The aged care provider undertakes the appraisal of the resident’s care needs using
an ACFI Answer Appraisal Pack. See legislative reference. An ACFI User Guide is
available to assist providers to undertake appraisals. See References at the end
of this chapter for a link to the ACFI User Guide; and email and phone contacts
for ACFI queries.
s 9.17(2),
Classification
Principles 1997
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APPLICATIONS FOR CLASSIFICATION
The outcomes of the ACFI appraisal are included in the Application for Classification,
a form which must be submitted to Medicare Australia in order for the resident to be
allocated a classification.
Applications for classification can be submitted electronically or in hard copy.
Electronic applications can be submitted via:
Medicare Australia’s ACFI web form (preferably broadband access)
Medicare Australia’s Online Claiming Business to Business (B2B) and file upload
channel. This requires software developed by a registered software vendor.
Hard-copy ACFI assessments can be sent to Medicare Australia in the relevant capital
city. See References at the end of this chapter for Medicare Australia contact
information. Medicare Australia will return any incomplete applications or
applications with errors to the aged care service to be corrected. The application
receipt date will be the date the correctly completed application is received by
Medicare Australia.
It is an oence to provide false or misleading information on the application for
classification form. See legislative reference. The Act also provides a number of
other possible consequences of giving false, misleading or inaccurate information
in appraisals or reappraisals. See Inaccurate assessments on page 87.
The information provided in an application for classification may also be used by
the Department and/or Medicare Australia to check that the funding provided in
response to an application is used in accordance with:
the requirements of the Act
any other requirements determined by the Minister, the Secretary or the Chief
Executive Ocer of Medicare Australia.
CLASSIFICATION OF RESIDENTS
The Department determines the classification of a resident based on the application
for classification completed by the aged care provider and sent to Medicare Australia.
This involves the following steps: See legislative reference.
Step 1—For the activities of daily living (ADL) and behaviour (BEH) domains, the
Department will identify a score for the A, B, C or D rating given for each
question. The scores for each domain are then added to calculate a total score
for each domain. The total score for each domain is then used to categorise
the resident as having:
nil (N)
low (L)
medium (M)
or high (H) needs for that domain.
See Figure 1 on page 79 for scores and thresholds. See legislative reference.
Step 2—For the complex health care (CHC) domain, the Department will use
the complex health care matrix. See Figure 1 on page 79. See legislative
reference.
Step 3—The resident’s classification is summarised as a three part code. For
example, the code for a resident assessed as being medium in the ADL domain,
s 25-4, Aged Care
Act 1997, Part 7.4,
Criminal Code
Act 1995
s 9.3B,
Classification
Principles 1997
Parts 1, 2, Schedule
1, Parts 1 and 2,
Schedule 2,
Classification
Principles 1997
Part 3, Schedule 1,
Part 3, Schedule 2,
Classification
Principles 1997
l e g i s l a t i v e r e f e r e n c e s
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l e g i s l a t i v e r e f e r e n c e s
low in the BEH domain and having no or minimal needs in the CHC domain,
would be M-L-N. A provider is not required to submit an application for a
resident who has no or minimal assessed care needs in all three domains—ie,
an N-N-N classification.
Exceptions:
If a valid behavioural diagnosis code is not supplied, the maximum level for
the behaviour (BEH) domain is medium (M). See legislative reference.
A resident whose approval by the Aged care Assessment Team (ACAT) delegate
for permanent residential care is limited to low care but whose initial appraisal
indicates the resident requires a high level of residential care will be classified at
an interim low classification. The rate of subsidy for this classification will not
exceed the amount determined by the Minister. The resident will remain on the
interim low classification until:
the resident ages in place including when a Departmental review ocer
confirms that the resident requires a high level of residential care during
a review. See Existing resident—ageing in place on page 83.
or a new approval by an ACAT delegate for permanent residential care
is provided, which is not limited to low care.
Figure 1—Weightings and range of points for each category
ACTIVITIES OF DAILY LIVING ADL AND BEHAVIOUR BEH CARE DOMAINS SCORES
ADL QUESTION NUMBER
Rating 1 2 3 4 5
A 0.00 0.00 0.00 0.00 0.00
B 6.69 6.88 7.89 6.11 5.79
C 13.39 13.76 15.75 12.21 11.53
D 20.09 20.65 23.63 18.31 17. 31
BEH Question number
Rating 6 7 8 9 10
A 0.00 0.00 0.00 0.00 0.00
B 6.98 5.91 7.04 7.70 5.71
C 13.91 11.82 14.10 15.40 11.43
D 20.88 17.72 21.14 23.11 17. 15
THRESHOLD SCORES FOR EACH LEVEL
Levels Low Medium High
ADL 18 62 88
BEH 13 30 50
s 9.3B(2) Step 2
(b), Classification
Principles 1997
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Figure 1 cont.
COMPLEX HEALTH CARE CHC DOMAIN MATRIX
QUESTION 12COMPLEX HEALTH CARE
Question 11—medication A B C D
A Nil Nil Medium Medium
BNil Low Medium High
C Low Low Medium High
D Medium Medium High High
High and low care classifications
In addition to determining the level of care funding, ACFI classifications are used
to define a resident as requiring either a high level or a low level of care. In order
to be considered high care, the resident must be classified at one or more of the
following levels:
medium or high in the activities of daily living (ADL) domain
high in the behaviour domain (BEH)
medium or high in the complex health care (CHC) domain.
However, providers should note that from 1 January 2010, the classification levels,
in order for a resident to be considered high care, will be amended. An addendum
to this chapter, detailing the amendments, will be provided in 2010.
Classification expiry
Classifications allocated based on an ACFI appraisal generally do not expire.
However, they will expire in the following circumstances: See legislative reference.
the resident ceases being provided with residential or flexible care, without
being on leave, and has not within 28 days entered a residential or flexible aged
care service
the resident has taken extended hospital leave (30 days or more)
six months after a resident enters care directly from an in-patient hospital
episode, if the person was not on leave from a residential aged care service
during their hospital stay
six months after a significant change in a resident’s care needs
if a resident returns to an aged care service from extended hospital leave, the
classification which takes eect from the date of their return to care will expire
six months after the resident returns from that extended hospital leave
the Secretary has given the approved provider a notice requiring reappraisal
of the level of care needed by a resident
the resident is being provided with respite care.
s 27-2, Aged Care
Act 1997
l e g i s l a t i v e r e f e r e n c e s
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ACFI APPRAISALSWHEN MUST AN APPRAISAL BE UNDERTAKEN
New residents
An ACAT delegate will initially approve a person for entry into residential care. The
ACAT delegates will also determine whether the care level required for a person
should be limited to low-level care. See also chapter on Approval of residents in this
Manual.
If a person is approved for residential aged care, after he or she enters care, the
person will need to be appraised using the ACFI. A new ACFI appraisal is also required
for a resident entering an aged care service for high dependency care leave.
Appraisals:
cannot be conducted in the first 7 days after a resident enters care
See legislative
reference.
except if a resident leaves care before 7 days have passed. In this instance,
an appraisal can be conducted in less than 7 days See legislative reference.
cannot be submitted to Medicare Australia, in an application for classification,
until after the resident has been in care for 28 days, unless a resident has left
care before 7 days have passed
should be conducted within two months of the resident entering care.
See legislative reference. Any application received by Medicare Australia more
than two months after a resident has entered care is considered a late appraisal.
If an application is received late, the subsidy paid for that resident will be reduced
if the application is received within 3 months of the end of the appraisal
period, the daily subsidy will be reduced by $25 for the period from entry,
to the day before the late form is received by Medicare Australia
if the application is received more than 3 months after the end of the
appraisal period, no subsidy will be paid from entry to the day before the late
form is received by Medicare Australia—ie, a subsidy can only be paid from
the day the late form is received by Medicare Australia
if an aged care service believes it sent the application to Medicare Australia in
sucient time to be received, the service can write requesting a review of the
decision. The service should provide all information that is relevant to whether
the application was sent in time. See References at the end of this chapter
for address.
REAPPRAISALS FOR EXISTING RESIDENTS
Reappraisals must be completed in the following circumstances:
when the classification expires. See section on
Classification of residents on
page 78.
when the Department writes to the aged care service requesting a resident be
reappraised. See legislative reference.
s 25-3(2)(a), Aged
Care Act 1997
s 9.16,
Classification
Principles 1997
s 26-1, Aged
Care Act 1997
s 27-3, Aged
Care Act 1997
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A resident’s care needs can be reappraised in the following circumstances:
See legislative reference.
at any time 12 months or more after the existing classification took eect
when the resident has a significant change in care needs
at any time when a resident is classified at the lowest applicable classification level.
within 2 months of a resident transferring from another aged care service.
See Existing resident—transfer from another aged care service on page 82.
Existing resident—significant change in care needs
During the life of a classification, another application for classification may be
submitted if the resident’s care needs have significantly changed. This change
is defined as:
an increase of two or more classification levels—this increase can be within
a single care domain—eg, an increase from low to high in the ADL domain;
or across two separate domains—eg, increase from low to medium in both
the BEH and CHC domains See legislative reference.
a single increase from medium to high in the CHC domain if the resident
is already categorised as high in ADL. No change in the behaviour domain
is required in these circumstances See legislative reference.
for a resident who is classified at an interim low classification, the resident’s
care needs are taken to have changed significantly if this is the result of
applying the above rules to the classification level that was determined for
the resident by assessing their care needs using the ACFI. See Exceptions
on page 79. See legislative reference.
for a resident with a RCS classification, a significant change reappraisal can also
be submitted for a resident if their calculated subsidy from the reappraisal would
be $30 or more above the RCS saved rate. See legislative reference.
A new ACFI classification following a significant change remains in eect for 6 months
starting from the date that the application was received by Medicare Australia, unless
another circumstance takes eect during that 6 month period.
Existing resident—reappraisal of lowest
applicable classification
A reappraisal can be done at any time for a resident classified at the lowest applicable
classification level. For ACFI purposes, this is a resident assessed as having no or
minimal care needs in each of the three care domains. Such a resident would be
classified as N-N-N. The new classification will take eect from the date that the
application is received by Medicare Australia.
Existing resident—transfer from another aged care service
ACFI classifications will generally not expire, including when a resident leaves one
aged care service:
and enters the care of another service within 28 days
or returns to the same service within 28 days.
See legislative reference.
s 9.29(2),
Classification
Principles 1997
s 27-4(5), Aged
Care Act 1997
l e g i s l a t i v e r e f e r e n c e s
s 27-4, Aged
Care Act 1997
s 9.28(1)(a),
Classification
Principles 1997
s 9.28(1)(b),
Classification
Principles 1997
s 9.28(2),
Classification
Principles 1997
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However, an aged care service can reappraise a resident within 2 months of the
resident entering care, if the existing classification does not reflect the resident’s
current care needs. The provider of the original service can provide a copy of the
resident’s ACFI Answer Appraisal Pack to the new aged care service.
Because approval for permanent residential care will not lapse, a new ACAT approval
is not required when a resident transfers from one aged care service to another. This
includes situations where the initial ACAT approval was limited to low care and the
resident has aged in place to high care in the original service.
Exceptions:
An ACAT may be requested to approve the resident for a high level of care
when the resident transfers from one aged care service to another, if the
resident wants to pay an accommodation charge to the new service rather
than rolling over an existing bond.
An ACAT may be asked to assess the care needs of a resident where the
existing aged care service can no longer provide the required level of care
for the resident. This assessment can also be performed by two independent
medical practitioners.
Existing resident—ageing in place
A resident, whose initial approval by the ACAT delegate for residential aged care
is limited to low care, will continue to be able to age in place to a high care ACFI
classification without the need for an ACAT reassessment.
Under ACFI, the high care subsidy may be paid for a resident with an ACAT approval
limited to low care when the resident ages in place—that is, a high care ACFI
reappraisal can be conducted if:
an existing ACFI classification expires—eg, following a period of extended
hospital leave, or six months after entering care directly from hospital
there is a significant change in care needs
there is a voluntary reappraisal 12 months or more after a previous appraisal
there is a voluntary reappraisal within 28 days of a transfer. See
Existing
resident—transfer from another aged care service on page 82.
the resident’s ACAT assessment is not limited to low care
a Departmental review ocer confirms the resident requires a high level of care
during a classification review.
Reappraisal period
A reappraisal can usually be conducted in a two month period, beginning one
month before the existing classification expires and running until one month after
it expires.
Exceptions:
If a resident’s classification expires while they are on extended hospital leave,
the reappraisal period is for two months starting on the day the person returns
to the service from leave.
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The reappraisal period may also be extended in limited circumstances if an
appraisal expires while the resident is on leave (other than extended hospital
leave) or within one month after that leave ended.
If the Secretary gives an approved provider a notice requiring a reappraisal,
the reappraisal period is the period specified in the notice.
Late applications for reappraisal
If an application for classification is not received during the normal two month
reappraisal period, the amount of subsidy paid for the resident will be reduced.
If the application is received within 3 months of the end of the reappraisal
period, the daily subsidy will be reduced by $25 from the day after the existing
classification expires to the day before the late form is received by Medicare
Australia.
If the application is received more than 3 months after the end of the
reappraisal period, no subsidy is payable from the day after the existing
classification expires to the day before the late form is received by Medicare
Australia.
If an aged care service believes it sent the application to Medicare Australia
in sucient time to be received, the service can write to the Department
requesting a review of the decision. The service should provide all information
that is relevant to whether the application was sent in time. See References
at the end of this chapter for address.
REVIEW OF ACFI APPRAISALS
A classification review program has been established to ensure that ACFI appraisals are
conducted correctly. All reviews take into account the aged care service’s appraisal
using the ACFI User Guide that was in force at the time of the original appraisal.
The Secretary has the power to change an incorrect classification. See legislative
reference. Before changing a classification, the Secretary must review the
classification by examining any relevant material on which it was based. The
Secretary will examine relevant material or information, including material or
information that has become available since the classification was made. See legislative
reference.
Classification reviews are undertaken by authorised ocers from the Department.
See legislative reference. If requested by the occupier of the aged care premises,
the ocer must produce their identity card, which includes their name and
a photograph, on arrival at the aged care service. A classification review is not
a reassessment. Review ocers are seeking to confirm that the ACFI appraisal
accurately reflected the level of care needed by the resident at the time it was
completed by the aged care service.
Normally, a review ocer must not enter an aged care service without consent and
must leave if consent is withdrawn. See legislative reference. However, an approved
provider has responsibility to cooperate with a review ocer. See legislative
reference. The Department can seek a warrant to conduct reviews without consent
if it believes that an aged care service may be using fraudulent or deceptive
practices. See legislative reference. If a high proportion of incorrectly appraised
residents are found during a review visit, the Department may review the
classification of any other residents in the same service, at its discretion.
l e g i s l a t i v e r e f e r e n c e s
Division 29, Aged
Care Act 1997
s 29-1(3)(c), Aged
Care Act 1997
s 91-1(2)(c), Aged
Care Act 1997
s 91-1(3), Aged
Care Act 1997
s 63-1(1)(b), Aged
Care Act 1997
Division 92, Aged
Care Act 1997
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Most review visits will be conducted along the following lines:
A review ocer will check the completeness and accuracy of ACFI Answer
Appraisal Packs for a sample of residents in a service.
For each reviewed resident, the review ocer will then see if the checklists and
supporting documentation enclosed in the ACFI Answer Appraisal Pack (eg, the
Aged Care Client Record (ACCR), the medication chart, diagnoses) correspond;
and may ask to meet the resident.
If there is incongruence between the checklists and the supporting
documentation, the review ocer may seek further information by:
interviewing sta
interviewing the resident
observing the resident
assessing the resident’s impairment using simple task assessments
or undertaking an ACFI assessment such as the Psychogeriatric Assessment
Scales (PAS) to confirm that the classification is correct.
Some review visits will focus on particular questions.
Some ACFI questions/categories may be reviewed as a desk audit—for
example, the service may be asked to provide the Department with copies
of the depression diagnoses for residents where there is a C or D claim for
ACFI 10 (Depression).
The ACFI record keeping requirements include the complete ACFI Answer Appraisal
Pack including the specified enclosures (refer to the ACFI User Guide). In addition,
post-appraisal treatment records for some specific complex health care procedures
in ACFI question 12 can be requested as part of the validation process. This applies
where there is a claim in relation to any of the following items in ACFI question 12:
ITEM PROCEDURES
1 Daily pressure measurement
2 Daily glucose measurement
3 Pain management involving therapeutic massage or application of heat packs
4a Complex pain management and practice undertaken by an allied health
professional or registered nurse involving therapeutic massage and/or pain
management involving technical equipment
4b Complex pain management and practice undertaken by an allied health
professional involving therapeutic massage and/or pain management involving
technical equipment
7 Administration of suppositories or enemas
10 Management of chronic wounds
18 Continuous monitoring of vital signs
The service can be asked to produce the treatment record for the above procedures
to demonstrate that the treatment was a usual and ongoing care need at the time of
appraisal.
When the appraisal conducted by the aged care service is not accurate, the resident’s
classification will be corrected. A review classification applies for the same period as
the classification that was being reviewed. However, a change of a classification will
not be backdated more than 6 months from the date of the review decision letter.
Adjustments will be made to the subsidy to reflect the changed funding category.
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Notice of a review visit
The Department will usually phone and give at least 2 business days notice to the
aged care service before the proposed date of the review visit. The advance notice
is to ensure that the care manager/director of nursing and the sta member who
completed or is familiar with the ACFI appraisal process are available during the
review and if required can clarify any aspects of the appraisal documentation.
A review visit to an aged care service can only be postponed after the service
consults with the review ocer. If a service wants to postpone a visit, they must
give the review ocer at least 2 business days notice before the date of the original
proposed visit.
Roles and responsibilities
A review ocer and the aged care service sta both have responsibilities to ensure
that the ACFI review process is conducted in a professional and amicable manner.
A review ocer should:
provide the care sta with a clear explanation on how the visit will be conducted,
approximate duration of the visit and a list of the residents who are going to be
reviewed on that day
outline the rights of the approved provider under the Act in relation to the visit
leave the contact details of the ACFI Program Manager in that state or territory
and other contact details as agreed at the review.
The aged care service should:
provide the necessary documentation—while the Act allow records to be kept
in written or electronic form, approved providers must provide assistance so
that electronic records can be read and reviewed or produce a paper copy
of the record
assist the review ocer seeking further information about a resident’s care
needs—this may include having a senior sta member available to provide the
review ocer with information
allow the review ocer access to sta who have a knowledge of a resident’s
care needs
further assist the review ocer seeking additional information about a resident’s
care needs if there are any incongruities
respect the privacy of the review ocer to complete the review without
disturbance.
There will be increasing use of electronic record keeping systems, including for
the ACFI. In some cases, the completed ACFI Appraisal Answer Pack may be stored
partly in hard copy—with third party documents such as medical practitioner notes
and directives, comprehensive medical assessments and the Aged Care Client
Record in hard copy—and partly electronically.
If the electronic record being substituted for a paper record requires signature, date
and identification details, the electronic record must contain the same details. If an
electronic signature or graphic is used then an approved provider must be able to
show that there are systems in place to ensure that the electronic signature or
graphic uniquely identifies a person. See also chapter on Record keeping in
this Manual.
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The aged care service should also provide the review ocer with a work area which
allows them to operate in a safe, clean and well-lit environment. If possible, this
should include:
a desk-height work area that has sucient space to accommodate laptops and
documentation for the number of ocers conducting the review
adjustable oce chairs
heating/cooling
access to power points.
Exit meetings
After the review process, review ocers may conduct an exit meeting with appropriate
care sta. Where there are classification changes, the exit meeting can provide the
opportunity for the service to understand why a classification has been changed.
At the exit meeting the review ocer talks about general findings and any specific
issues in relation to the use of the ACFI. This discussion can assist care sta to
improve their understanding of the classification system.
During the exit meeting the care sta may realise that the review ocer has not
been provided with all the relevant material. If additional relevant material is made
available at this stage it can be taken into account.
Notifying the approved provider of the review outcome
The Department will send a letter to an approved provider, informing them of the
review outcome, usually within 14 business days of the review visit. This letter will
include the following information:
the date of the review visit
the total number of reviews undertaken
the name/s of the review ocer/s
a list of the names of residents whose classifications have changed, together
with their original and revised categories
for these residents, copies of the review sheets that constitute the reasons
for the decision will also be included
the right to request a reconsideration of these decisions and the timeframe
for doing so.
In certain circumstances there may be a delay of more than 14 days before the
Department sends the letter to the approved provider—for example, where the
review ocer allows the service additional time to locate documentation to support
ACFI claims. In such cases, the review ocer will notify the service of the delay.
The letter is sent to the approved provider, which is not always located at the same
address as the service. It is the approved provider’s responsibility to forward this
information to the relevant aged care service.
Inaccurate assessments
The Department can send a letter asking an approved provider to reappraise one or
more residents in its care if the Department believes that the approved provider has
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continued to give false, misleading or inaccurate information in appraisals or
reappraisals following a review. The Department can also vary or revoke such
a request. See legislative reference.
The Department may suspend an approved provider from making ACFI appraisals
or reappraisals if the approved provider or the authorised person gives false,
misleading or inaccurate information in a substantial number of appraisals that
have been reviewed. See legislative reference. If an approved provider is suspended
from appraising or reappraising, the Department can defer the suspension if the
approved provider agrees to:
provide training for ocers, employees and agents
and/or appoint an advisor to assist the approved provider to conduct appraisals
and reappraisals in a proper manner. See legislative reference.
The Department can also impose sanctions on an approved provider if the approved
provider has not complied, or is not complying, with one or more of its responsibilities
in terms of accountability. See legislative reference.
Complaints and concerns
The review should be conducted in a manner that allows the review visit to be
completed without disruption. If a review ocer considers that a review can’t continue,
they may stop the review process. If this happens, the management of the service
will be advised of alternative arrangements for the review.
Management of the service may also request that a review be terminated if it is
concerned about the manner in which the review is being conducted. However,
prior to making such a request the review ocer should be consulted and alternative
options for conducting the review arranged.
If there is disagreement with the potential outcomes of the review or the way in
which it is being conducted, then a service should discuss those concerns with the
ACFI Program Manager in the Department’s state or territory oce. See References
at the end of this chapter for a list of contact numbers.
Risk assessment approach
The classification review program uses a risk assessment approach to determine
the priority of conducting review visits. This approach has both targeted and random
elements. An aged care service could be visited as part of the risk assessed component
or the random component. Review ocers undertaking visits do not select the
services or residents for review and usually do not know why a service has been
selected.
APPEALS TO THE DEPARTMENT FOR THE RECONSIDERATION
OF DECISION
An approved provider may request a reconsideration of these other types of decisions:
to suspend an approved provider from making appraisals and reappraisals
to refuse to lift such a suspension
that an appraisal or reappraisal was not sent in sucient time
to refuse to renew a classification
to change the classification of a care recipient.
See legislative reference.
l e g i s l a t i v e r e f e r e n c e s
s 27-3, Aged
Care Act 1997
s 25-4, Aged
Care Act 1997
s 25-4A(1), Aged
Care Act 1997
Part 4.4, Aged
Care Act 1997
s 85-1, Aged
Care Act 1997
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l e g i s l a t i v e r e f e r e n c e s
There is no right to seek internal reconsideration if the review ocer has changed
a score against the ACFI, but the change has not resulted in a change to the
classification level of the resident.
If a provider has a concern regarding a review visit, which relates to issues other
than classification changes or other types of decision that can be reconsidered, the
provider should contact the ACFI Program Manager in the relevant state or territory
oce. See References at the end of this chapter for a list of contact numbers.
Before asking for a decision to be reconsidered, the approved provider should check
that the appraisal or reappraisal was conducted in a proper manner. See legislative
reference.
To seek a reconsideration, an approved provider must write to the Department
within 28 days of receiving the notification of the decision, stating that they are
seeking a reconsideration of the decision. See References at the end of this chapter
for address. The approved provider must indicate the classification change sought,
including the questions and the ratings with which they disagree. Any information an
authorised person provides in support of the request will be considered, along with
other relevant material, before a reconsideration decision is made.
The Department will generally acknowledge receiving a request for reconsideration
within five working days, including providing a contact name and telephone number
for future enquiries regarding the reconsideration.
The reconsideration ocer who conducts the internal reconsideration will not have
been involved in the original decision.
A reconsideration decision will be made using the ACFI guidelines in force at the
time of the original appraisal by the aged care service. The reconsideration process
may require a visit to the aged care service. As reconsideration decisions must be
made within a limited timeframe (90 days), a service may not be able
to defer such a visit.
The reconsideration ocer will:
examine all relevant documents used by the aged care service, contained in the
ACFI Answer Appraisal Pack, to assess the care needs of the resident against
the ACFI, in determining whether the resident’s classification is accurate
if necessary, interview the resident whose classification is the subject of the review
clarify with the appropriate care sta, if required, any inconsistent or unclear
documentation.
Notification of the reconsideration decision
The Department must inform an approved provider of the outcome of the
reconsideration within 90 days of receiving the request. The Department will:
notify the approved provider in writing of the reconsideration decision
inform the relevant Departmental state or territory oce of the reconsideration
decision
advise Medicare Australia to make any necessary adjustments to the subsidy
paid to the aged care service.
If the Department does not inform an approved provider of a decision within this
timeframe, then the original decision is confirmed.
s 63-1(h), Aged
Care Act 1997
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Date of eect
If no date is specified, the reconsideration decision takes eect on the date
that the reconsideration decision was made. In exceptional circumstances,
the reconsideration decision may specify the date the decision takes eect.
ADMINISTRATIVE APPEALS TRIBUNAL
If an approved provider disagrees with the reconsideration decision, within 28 days
of receiving the letter, they can apply to the Administrative Appeals Tribunal (AAT).
However, an approved provider cannot appeal directly to the AAT if there is a
disagreement with the outcome of classification review. The approved provider must
first request an internal reconsideration by the Department. See References at the
end of this chapter for contact information.
SUBSIDY RATE
A care subsidy is paid for each level of each of the three care domains, except the
nil level. Under the funding model, the total care subsidy paid for each resident
is usually the sum of the rates for all three domains.
However, in the initial period of the operation of the current funding model,
the maximum funding rate has been capped at:
$10 more than the RCS S1 rate (as indexed) from 20 March 2008
$20 more than the RCS S1 rate (as indexed) from 1 July 2009
$30 more than the RCS S1 rate (as indexed) from 1 July 2010.
From 1 July 2011, the maximum funding rate will not be capped.
The funding rates are determined by the Minister under section 44-3(2) of the Act.
See legislative reference. These amounts are subject to indexation—ie, they are
updated annually.
Grandparenting of Resident Classification Scale
(RCS) subsidies
Residents initially classified using the Resident Classification Scale (RCS) have been
progressively appraised using the ACFI from 20 March 2008. Grandparenting
arrangements ensure that an aged care service continues to receive at least the
same subsidy for these residents as was paid under the RCS.
Once the ACFI appraisal has been submitted for existing residents previously
classified using the RCS, Medicare Australia will compare the calculated subsidy
under the new funding model with the existing RCS subsidy. If the subsidy under the
new model is $15 or more above the RCS amount, the new subsidy amount will be
payable. If not, the existing RCS amount will continue to be paid.
If the calculated subsidy under the new funding model is $15 or more above the RCS
subsidy, but the calculated subsidy is greater than the capped amount, the capped
rate will be paid.
l e g i s l a t i v e r e f e r e n c e s
s 44-3(2), Aged
Care Act 1997
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REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
ACFI Program Managers—contact details
ACT Oce
(02) 6289 3377
NSW State Oce
(02) 9263 3862
VIC State Oce
(03) 9665 8290
(03) 9665 8118
TAS State Oce
(03) 6221 1455
(03) 6221 1488
QLD State Oce
(07) 3360 2560
SA State Oce (also NT)
(08) 8237 8325
WA State Oce
(08) 9346 5229
ACFI queries
Contact the Aged Care Information Line
Ph 1800 500 853
Or email acfi@health.gov.au, please include contact details.
Queries about ACFI review program
Email scale.accountability@health.gov.au
Please include contact details.
ACFI User Guide
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acfi-1007-
userguide.htm
Administrative Appeals Tribunal
www.aat.gov.au
Aged Care Information Line
Ph 1800 500 853
Appeals—lodging an appeal for a change of a resident’s classification
to be reconsidered.
Send appeals to:
The Director
Accountability Section
Department of Health and Ageing
MDP 74
GPO Box 9848
Canberra ACT 2601
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Applications for classification—to Medicare Australia
Hard-copy applications for classification should be sent to Medicare Australia in the
relevant state or territory capital city. In order to be processed, all questions on the
application form must be answered clearly, the form must be signed and dated and
a pen, not a pencil, must be used.
NSW and ACT
GPO Box 9923
Sydney NSW 2001
Ph 1800 195 206
VIC and TAS
GPO Box 9923
Melbourne VIC 3001
Ph 1800 195 206
SA and NT
GPO Box 9923
Adelaide SA 5001
Ph 1800 195 206
QLD
GPO Box 9923
Brisbane QLD 4001
Ph 1800 195 206
WA
GPO Box 9923
Perth WA 6001
Ph 1800 195 206
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Late applications for reappraisal—request for review of decision
The Assistant State Manager
Ageing and Aged Care
Department of Health and Ageing
GPO Box 9848
capital city of the relevant state or territory
I
Overview 93
A. ACCOMMODATION AND HOTEL SERVICES 95
Relevant legislation—resident fees (including the standard resident contribution) 95
Relevant legislation—accommodation payments 95
Overview 95
Rates and additional information 95
How to calculate fees payable by a resident 96
Standard resident contribution (basic daily fee) 96
Protected resident contribution 96
Phased resident contribution 97
Table 1—phased resident contribution rate 97
Resident contribution top-up supplement 97
Non-standard resident contribution 97
Accommodation payments 98
Accommodation payments and assets testing 98
The value of a resident’s assets 99
Accommodation charge 100
How much is the accommodation charge? 101
Charge exempt residents—residents who entered care prior to 1 October 1997 101
Residents who entered care 1 October 1997–30 June 2004 102
Concessional residents 102
Assisted residents 103
Insucient assets to pay an accommodation charge but not
concessional 103
Charge-paying residents 103
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Residents who entered care 1 July 2004–19 March 2008 (inclusive) 104
Concessional residents 104
Assisted residents 104
Charge-paying residents 104
Insucient assets to pay an accommodation charge but not
concessional 104
Residents who entered from 20 March 2008; or entered 1 July 2004–
20 March 2008 with break in care and re-entered on/after 20 March 2008 105
Accommodation supplement 105
Calculating a resident’s supplement 106
Accommodation supplement—assets test 106
Encouraging quality 106
Supported resident ratios 106
Accommodation charge top-up supplement 107
Residents who move to another aged care service 108
Interest on delayed payments 108
Accommodation charge and hardship arrangements 108
Accommodation bonds 108
Which residents can be charged an accommodation bond? 109
Varying amount of accommodation bond with existing resident 110
Amount of accommodation bond 110
Types of accommodation bond payments 111
Retention amounts 111
Interest charges 112
Periodic payments 113
Retention component of a periodic payment 114
Calculating periodic payments 114
Refunding the accommodation bond balance 115
Residents who move to another aged care service 115
What if the resident’s care needs increase after entry? 116
Transitional accommodation supplement 116
Accommodation bonds and hardship 116
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III
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Accommodation payments—information provided to residents and resident
agreements 116
Essential information in accommodation charge agreements 116
Essential information in accommodation bond agreements 117
Accommodation bond agreements 118
Extra service fee 119
Fees for additional services 119
Grandparenting arrangements 120
Concessional resident supplement 120
Concessional resident—eligibility 120
Structure of the concessional resident supplement 121
Assisted residents 121
Charge exempt resident supplement 121
Charge exempt residents and supported resident ratios 122
Pensioner supplement 122
Transitional supplement 122
Grandparenting of hostel variable fees 122
Transitional arrangements for entry contributions 123
B. FUNDING AND INCOME FOR CARE SERVICES 124
Relevant legislation 124
Overview 124
Rates and additional information 124
How to calculate fees payable by a resident 124
Residential care subsidy 125
How residential care subsidy is paid 125
Claims for residential care subsidy 126
Working out the amount of residential care subsidy 127
Basic subsidy amount 127
Transitional measures 127
Conditional adjustment payment 128
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Eligible oxygen treatment and enteral feeding supplement 128
Oxygen supplement 128
Enteral feeding supplement 129
Payroll tax supplement 129
Who can claim the payroll tax supplement? 130
How the supplement is calculated 130
Income-tested fee 130
Which residents cannot pay an income tested fee? 131
Maximum income tested fee 131
Working out the amount of income tested fee 131
Income testing process 132
Reviews of income tested fees 133
Refunds of overcharged income tested fees 134
Remote area allowance 135
C. GOVERNMENT-FUNDED SUPPLEMENTS AND SUBSIDY REDUCTIONS 136
Relevant legislation 136
Overview 136
Rates and additional information 136
How to calculate fees payable by a resident 136
Viability supplement 137
Viability supplement—current 2005 scheme 137
Viability supplement—previous schemes 137
Respite supplement 138
Reductions in subsidy 138
Compensable residents 138
Claim not settled yet 138
Extra service reduction 138
Adjusted subsidy reduction 138
D. HARDSHIP 140
Relevant legislation 140
Overview 140
Rates and additional information 140
V
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Class hardship determinations 140
Individual hardship determinations 141
How are hardship assessments conducted? 141
How do hardship determinations end? 142
Revoking financial hardship 142
Reviewable decisions 142
Hardship, standard resident contribution and care payments (income tested fee) 143
How is a hardship supplement paid where financial assistance is given
for the basic daily fee? 143
How is subsidy paid where financial assistance is given for income
tested fees? 143
Hardship and accommodation payments 143
Financial hardship—circumstances 144
E. LEAVE 145
Fees during periods of leave 145
Hospital leave 145
Extended hospital leave 145
Social leave 145
Pre-entry leave 145
High-dependency care leave 146
References—links, guides and forms referred to in this chapter 147
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l e g i s l a t i v e r e f e r e n c e s
FUNDING FOR PERMANENT
RESIDENTIAL AGED CARE
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
OVERVIEW
Approximately 70 per cent of the total funding for residential aged care is provided
by the Australian Government, paid directly to providers of aged care services on
behalf of the residents in those services. Residents who can aord to do so also
contribute to the cost of their care and accommodation.
These accommodation and care subsidies and payments can be grouped into two
main categories:
payments for accommodation and hotel-type services, which cover the
cost of food, utilities and providing accommodation for residential aged care.
These payments include the standard resident contribution (or basic daily fee),
accommodation payments and related supplements. In general, residents pay
for the majority of these charges. However, if a resident cannot aord one of
these payments, the Government can assist them and the provider, paying the
approved provider in lieu of the resident or paying the approved provider
additional amounts—for example, viability supplement.
care payments—for example, the basic subsidy amount and income tested fees.
These payments fund care and related services. In general, the Government
funds these payments, through the basic subsidy and supplements such as the
oxygen and enteral feeding supplements. Residents who have sucient income
can be asked to help contribute to the cost of their care through an income
tested fee. The amount of subsidy payable by the Government is reduced by
the amount of the income tested fee.
The basic subsidy amount mentioned above is based on a resident’s classification
under the Aged Care Funding Instrument (ACFI).
When a person enters residential aged care, an approved provider must oer the
person a resident agreement, which both the provider and the resident sign, and
which sets out the policies and practices the provider will follow in setting fees for
the resident and the resident’s date of permanent entry to the aged care service.
See legislative reference.
Providers may also be eligible to charge additional fees on top of the daily fees
and any accommodation payment. A provider may charge an extra service fee, for
providing a higher than standard level of accommodation services or food. Residents
can also pay providers for additional services—such as hairdressing or hiring a
television. Providers whose aged care service is located in a remote area may charge
all of the residents of that service an additional daily amount. These additional fees
must be outlined and agreed to in the resident agreement. For more information
on extra service, see chapter on Extra service places; and for more information on
resident agreements, see section on Resident agreements in chapter on Residents’
rights in this Manual.
While the provider and the resident negotiate the level of a resident’s fees and
accommodation payment, the Government sets the maximum amount that can
be charged.
s 59-1, Aged
Care Act 1997
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In addition, funding for residential aged care includes hardship arrangements, which
ensure that residents who cannot aord to make certain payments still have equal
access to residential aged care. The Government helps these residents through
hardship assistance. If a resident meets the criteria for hardship assistance, the
Government will pay subsidies to the provider and the provider will deduct these
subsidy amounts from the daily fees for that resident.
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A. ACCOMMODATION AND HOTEL SERVICES
RELEVANT LEGISLATIONRESIDENT FEES INCLUDING THE
STANDARD RESIDENT CONTRIBUTION
Sections 42-2 and 42-3 of the
Aged Care Act 1997 (the Act)
Division 58 of the
Aged Care Act 1997
Section 70 of the
Aged Care (Consequential Provisions) Act 1997
Part 5,
User Rights Principles 1997
RELEVANT LEGISLATIONACCOMMODATION PAYMENTS
Division 44 of the
Aged Care Act 1997
Divisions 57 and 57A of the
Aged Care Act 1997
Part 6,
Residential Care Subsidy Principles 1997
Parts 4 and 4A,
User Rights Principles 1997
OVERVIEW
Payments for accommodation and hotel-type services are designed to help providers
meet the costs of providing accommodation and related services—such as meals,
cleaning, laundry, heating and cooling in the service—for residents in their care.
These payments include:
the standard resident contribution (also known as the basic daily fee)
accommodation payments, including:
the daily accommodation charge (high care residents)
and accommodation bonds (low care or extra service residents)
supplements, such as:
the resident contribution top-up supplement
the accommodation charge top-up supplement
and the accommodation supplement
grandparenting arrangements and payments for residents who entered care
before 20 March 2008 and 20 September 2009.
Rates and additional information
The maximum rates for fees and charges, including the standard resident contribution,
change several times every year. For this reason, actual dollar amounts payable are
not included in this Manual. Current rates are available on the Department’s website,
in the Aged Care Essentials newsletter (formerly known as Payment Essentials) and
from the Aged Care Information Line on 1800 500 853. See References at the end
of this chapter for links and contact information.
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How to calculate fees payable by a resident
To calculate the maximum daily fee that a resident may be asked to pay, approved
providers should: See legislative reference.
(1) work out the applicable standard resident contribution—ie, the maximum basic
daily fee
(2) add any compensation payment reduction that applies for the resident
(3) add any applicable maximum income tested fee for the resident
(4) subtract any hardship supplement that applies for the resident
(5) add any other amounts agreed between the provider and the resident, that is,
agreed fees for additional services
(6) if the resident is in an extra service place and receiving care on an extra
service basis, add the extra service amount
(7) for an aged care service located in a remote area, add the remote area
allowance amount.
A resident may also be asked to pay an accommodation bond or an accommodation
change.
STANDARD RESIDENT CONTRIBUTION BASIC DAILY FEE
The standard resident contribution—also known as the basic daily fee—is paid by all
residents as a contribution towards their accommodation and the costs of daily living
in the aged care service—such as meals, cleaning, laundry, heating and cooling in
the service. From 20 September 2009, the general rule is that the standard resident
contribution is 84 per cent of the basic aged pension. See legislative reference.
This includes residents receiving respite care.
While this is the general rule, there are exceptions which fall into three groups:
protected
phased
and non-standard.
Residents in financial hardship can apply for help paying the standard resident
contribution under financial hardship provisions. See Hardship, standard resident
contribution and care payments (income tested fee) on page 143.
Protected resident contribution
Aged care residents who were in care on 19 September 2009, and who are self-
funded retirees or part pensioners, whose pension, on 20 September 2009, did
not increase by more than the corresponding increase in the standard resident
contribution, are protected from paying higher fees. These residents will remain on
their existing contribution rate subject to 6 monthly indexation commencing on 20
September 2009, until they leave care. This is the protected resident contribution.
s 58-1(a), Aged
Care Act 1997
s 58-3, Aged
Care Act 1997
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Phased resident contribution
Residents who enter care from 20 September 2009 to 19 March 2013 inclusive,
who are self-funded retirees or part pensioners, whose pension did not increase by
more than the corresponding increase in the standard resident contribution, and who
therefore did not benefit from the changed pension arrangements of 20 September
2009 are phased residents. Phased residents can be asked to pay a daily fee at the
phased resident contribution rate.
The phased resident contribution for the period 20 September 2009 to 19 March
2010 is the same rate as the protected resident contribution. For the period 20 March
2010 to 19 March 2013, the contribution will increase every 6 months until it equals
84 per cent of the basic age pension. The rate of the phased resident contribution
for each 6 month period as a percentage of the basic age pension is provided in
Table 1 following.
TABLE 1PHASED RESIDENT CONTRIBUTION RATE
IF THE PARTICULAR DAY IS IN THE PERIOD ... THE RELEVANT PERCENTAGE IS
20 March 2010 to 19 September 2010 (inclusive) 78 per cent
20 September 2010 to 19 March 2011 (inclusive) 79 per cent
20 March 2011 to 19 September 2011 (inclusive) 80 per cent
20 September 2011 to 19 March 2012 (inclusive) 81 per cent
20 March 2012 to 19 September 2012 (inclusive) 82 per cent
20 September 2012 to 19 March 2013 (inclusive) 83 per cent
After 19 March 2013 there will no longer be any phasing arrangements. From 20
March 2013, residents who were previously phased residents will pay the standard
resident contribution rate—ie, 84 per cent of the basic age pension.
Resident contribution top-up supplement
So that providers will be paid the same amount for all residents who enter care on
or after 20 September 2009, a Government subsidy, the resident contribution top-up
supplement can be paid to providers for phased residents for the period 20 September
2009 to 19 March 2013 inclusive. The amount of the supplement is the dierence
between the standard and phased rates of resident contribution.
Non-standard resident contribution
Some residents who entered care prior to 20 March 2008 and who meet certain
criteria pay the non-standard resident contribution rate until their circumstances
change or they leave care.
To pay the non-standard resident contribution rate, a resident must have first entered
residential aged care before 20 March 2008, and on 19 September 2009 and on each
day since that day, the resident must:
not have a dependent child
not be receiving an income support payment
or have paid an accommodation bond that is a big bond
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a big bond is more than 10 times the basic age pension amount at the time
of entry into care, if the person entered the service before 20 September
2009
or 9 times the basic age pension amount at the time of entry if the person
entered the service on or after 20 September 2009
or have not provided income and asset information to Centrelink (means not
disclosed).
If a resident’s circumstances change on or after 20 September 2009 and the criteria
are no longer met, the person would no longer fall into this group and the standard
resident contribution rate would apply.
ACCOMMODATION PAYMENTS
Accommodation payments, which include accommodation bonds and daily
accommodation charges, are worked out according to a resident’s assets—ie, the
proportion of an accommodation payment which the Government will pay and the
proportion which the resident will be asked to pay depends on the resident’s assets.
Residents with assets above a minimum threshold can be asked to make a contribution
toward the cost of their accommodation, through either an accommodation bond or
a daily accommodation charge.
Accommodation supplements—including the accommodation supplement, the
concessional supplement, the accommodation charge top-up supplement and
transitional accommodation supplement—are paid to providers, for residents in their
care who have very few assets.
While the provider and the resident negotiate accommodation payments, and the
Government does not set the accommodation bond or accommodation charge,
it does set various legal requirements for accommodation payments.
Only certified aged care services can receive accommodation payments. See also
chapter on Certification in this Manual.
A provider cannot charge an accommodation bond unless the service is certified and
complies with the various prudential requirements. See also chapter on Protection
and responsibilities relating to accommodation bonds in this Manual.
A resident can apply to the Secretary that paying an accommodation bond or charge
would cause financial hardship to themselves, to their partner or to their dependent
child. See section on Hardship and accommodation payments on page 143.
Accommodation payments and assets testing
The amount of accommodation charge or bond a provider can ask a resident
to pay—and any subsidies the Government may pay for that resident if they have
supported, concessional or assisted resident status—depends on the resident’s assets.
Most residents will have had an assets test done by either Centrelink or the Department
of Veterans’ Aairs (DVA) before they enter aged care. See References at the end of
this chapter for links to the request for an asset assessment form.
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The approved provider works out the amount of a new resident’s accommodation
payment on the basis of this asset information provided by the resident.
For example, a resident’s asset letter from Centrelink or DVA will state if a resident
is a supported, concessional or assisted resident, allowing the provider to work out
what fees, subsidies and supplements may apply for that resident.
Some residents may choose not to give information about their assets or do not
provide enough information for the value of their assets to be properly determined.
In these cases, the resident can be asked to pay the amount agreed between the
resident and the provider, up to the maximum as listed in the current rate sheet;
and is not eligible for concessional, assisted or supported resident status and any
corresponding supplements.
The value of a resident’s assets
The value of a resident’s assets is the net value of all the resident’s property,
including property outside Australia, at the time of entry to the aged care service.
However, a home owned by the resident is not included as an asset if, at the time
of the resident’s entry to care:
the resident’s partner or dependent child is living in it
a carer of the resident has been living there for at least two years, and is eligible
to receive an income support payment, from either Centrelink or the DVA
a close relation has been living there for at least five years, and is eligible to
receive an income support payment. See legislative reference.
If the resident is a member of a couple, the value of the resident’s assets is half the
value of the couple’s combined assets. A person will be a member of a couple:
if they are legally married or in a relationship registered under a state or territory
law, providing they are not living separately or apart from the other person on
a permanent basis
or if they are living in a de facto relationship.
The other person in the relationship may be the same or a dierent sex.
Where an asset is held jointly, or in common, with a person other than the resident’s
partner, the value of the asset is taken to be the value of the resident’s interest in
the asset.
Assets can include the following: See legislative reference.
accounts including interest free accounts, with banks, building societies and
credit unions
interest-bearing deposits
fixed deposits
bonds
debentures
shares
investments in property trusts, friendly societies, equity trusts, mortgage trusts
and bond trusts
s 44-10(2), Aged
Care Act 1997
s 21.15,
Residential
Care Subsidy
Principles 1997
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real estate (the family home may be exempt in some circumstances)
businesses
farms
loans, including interest-free loans
motor vehicles, boats and caravans
surrender value of life insurance policies
investment collections, including investment collections of coins or stamps
superannuation assets, from which lump sums can be withdrawn
household contents and personal eects. The value of household contents and
personal eects is taken to be $5000 if there is no evidence of another value.
ACCOMMODATION CHARGE
Eligible residents who enter an aged care service at a high level of care may be
asked to pay an accommodation charge. It is in addition to the basic daily fee and
any income tested fee that may apply for that resident.
Providers must use income from accommodation charges:
to meet capital works costs relating to residential care
to retire debt relating to residential care
to improve the quality and range of aged care services, if no capital expenditure
is necessary. See legislative reference.
For residents to pay an accommodation charge, they must have assets above the
minimum asset level and must have entered into an accommodation charge
agreement with the approved provider, which specifies the amount of the
accommodation charge. The provider must also advise the resident
of the interest rate to be charged on amounts owed under the accommodation
charge or resident agreements
and when the accommodation charge is not required or, if paid, is refundable.
See Accommodation payments—information provided to residents and resident
agreements on page 116.
The accommodation charge is payable for the entire period of the resident’s
admission (however, some exceptions apply) and is paid directly to the provider.
The accommodation charge cannot be charged more than one month in advance.
Residents can be asked to pay an accommodation charge if they have assets above
the minimum asset level at date of entry and require high level residential aged care
that is not on an extra service basis and cannot be charged an accommodation
bond. See legislative reference.
The following residents cannot be asked to pay an accommodation charge:
residents with assets below the minimum asset level at date of entry
residents receiving low level residential aged care
respite residents
s 57A-2(1)(l), Aged
Care Act 1997
s 57A-2(1)(a), Aged
Care Act 1997
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fully supported residents
concessional residents
a resident who has applied for a determination of financial hardship from the
Secretary; or for whom a current financial hardship determination applies.
These residents can only be asked to pay an accommodation charge
if their application is rejected—ie, if the Secretary declines to make a
determination of financial hardship for that resident. If the resident has
agreed to pay an accommodation charge, the accommodation charge
is payable from their day of entry as a permanent resident
if a determination of financial hardship ceases to be in force. If the resident
has agreed to pay an accommodation charge, the charge is payable from
the day after the determination ceases to be in force
residents entering an extra service place—however, they may be asked to pay
an accommodation bond
residents who first entered permanent care before 1 July 2004 and have
already paid daily accommodation charges for a total of five years
charge exempt residents
residents who were in care before 1 October 1997, as long as they remain
in the same service.
A person other than the resident cannot be required to pay an accommodation
charge as a condition of a resident’s entry to an aged care service.
How much is the accommodation charge?
The upper limit for any accommodation charge is set by legislation. The maximum
amount of any accommodation charge, up to this limit, depends on the level of the
resident’s assets when they enter the service as a permanent resident.
Whilst the Department advises on the maximum rate of accommodation charge for
most residents, the actual amount payable can be negotiated between the resident
and provider.
See also Accommodation payments and assets testing on page 98.
Charge exempt residents—residents who entered care prior
to 1 October 1997
A person who was receiving high level care in an approved bed in an approved nursing
home on 30 September 1997, and who then enters an aged care service as a
permanent resident, where they are otherwise eligible to pay an accommodation
charge (including residents who would be assessed as assisted or partially
supported), will be a charge exempt resident. See legislative reference.
The Department will advise of a resident’s charge exempt status in a fee advice letter.
A charge exempt resident cannot be asked to pay an accommodation charge.
See legislative reference.
Charge exempt resident supplement will be paid by the Government where a charge
exempt resident is being provided with residential care in a certified residential care
service (except if that care is provided on an extra service basis). See legislative
reference.
s 44-8B, Aged
Care Act 1997
s 57A-2(1)(b),
Aged Care
Act 1997
s 44-8A(2), Aged
Care Act 1997
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The following residents, however, cannot be charge exempt:
residents of uncertified aged care services cannot start paying an
accommodation charge and therefore, cannot become charge exempt
residents until the service becomes certified.
residents receiving low level care and those receiving care on an extra service
basis cannot be asked to pay the accommodation charge and therefore, cannot
be charge exempt residents
concessional and fully supported residents cannot be charge exempt residents,
as they cannot be asked to pay an accommodation charge
residents who were receiving a low level of care on 30 September 1997.
Residents who entered care 1 October 1997–30 June 2004
Depending on their assets, residents who entered care between 1 October 1997 and
19 March 2008 (inclusive):
may be a concessional resident
may be an assisted resident
may have insucient assets to pay an accommodation charge but are not
concessional
may pay an accommodation charge.
Concessional residents
Concessional residents cannot be asked to pay an accommodation charge.
The Government will pay the concessional resident supplement to the provider.
A person who entered care between 1 October 1997 and 30 June 2004 (inclusive),
even if they have had a break in care of 28 days or more, will be a concessional
resident if, at the time they entered care:
they had assets less than the minimum permissible asset level
they were receiving an income support payment
they had not been a homeowner for 2 years or more or if they owned a home
during that period, the home was occupied by:
their partner
their dependent child
a carer who had occupied the home for at least 2 years and was eligible
to receive an income support payment
a close relation who had occupied the home for at least 5 years and was
eligible to receive an income support payment. See legislative reference.
A person who entered care between 1 October 1997 and 30 June 2004 (inclusive)
will also be a concessional resident if there is a determination that paying an
accommodation charge will cause the person financial hardship. See legislative
reference.
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s 44-7, Aged
Care Act 1997
s 44-7(3), Aged
Care Act 1997
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Assisted residents
A person who entered care between 1 October 1997 and 30 June 2004 (inclusive),
even if they have had a break in care of 28 days or more, will be an assisted resident
if, at the time they entered care:
they had assets more than the minimum permissible asset level
and for admissions prior to 20 September 2009, less than 4 times the basic
age pension amount
for admissions on, or after, 20 September 2009, 3.61 times the basic age
pension amount
they were receiving an income support payment
they had not been a homeowner for 2 years or more or if they owned a home
during that period, the home was occupied by:
their partner
their dependent child
a carer who had occupied the home for at least 2 years and was eligible
to receive an income support payment
a close relation who had occupied the home for at least 5 years and was
eligible to receive an income support payment. See legislative reference.
The maximum accommodation charge payable by assisted residents is the margin
of assets above the minimum that the resident must be left with divided by 2,080
up to the maximum pre-1 July 2004 assisted accommodation charge rate.
For residents who meet the assisted resident criteria, the Government will also pay
the concessional supplement at the assisted resident rate to the provider.
Insucient assets to pay an accommodation charge but not concessional
Residents with assets below the minimum asset amount may not meet the criteria
to be a concessional resident—for example, because they were not in receipt of an
income support pension. While the concessional resident supplement is not payable
for these residents, they cannot be asked to pay an accommodation charge.
Charge-paying residents
All other residents who entered care between 1 October 1997 and 30 June 2004
(inclusive), even if they have had a break in care of 28 days or more, may be asked
to pay an accommodation charge. The rate of accommodation charge is set at the
date of entry.
However, if the person has paid the daily accommodation charge for a total of five
years, they cannot be asked to pay further accommodation charges.
Note that the five-year period for these residents paying an accommodation charge
is cumulative. For instance, if a resident moves from one service to another after
paying an accommodation charge to the first service, then the accommodation
charge is payable to the second service only for the remainder of this five-year period.
s 44-8, Aged
Care Act 1997
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Residents who entered care 1 July 2004–19 March 2008
(inclusive)
The amount of the accommodation charge for residents who entered care between
1 July 2004 and 19 March 2008 (inclusive) can be asked to pay will be based on their
asset assessment letter from Centrelink or DVA. The approved provider determines
the accommodation charge based on this letter.
Depending on their assets, residents who entered care between 1 October 1997 and
19 March 2008 (inclusive):
may be a concessional resident
may be an assisted resident
may have insucient assets to pay an accommodation charge but are not
concessional
may pay an accommodation charge.
If a resident first entered care between 1 July 2004 and 19 March 2008 (inclusive)
but had a break in care of 28 days or more and re-entered care on or after 20 March
2008, they will be treated in the same way as a resident who first entered care on or
after 20 March 2008.
Concessional residents
Residents with assets below the minimum asset amount who also meet the other
concessional resident criteria cannot be asked to pay an accommodation charge.
The Government will pay the concessional resident supplement to the provider.
Assisted residents
Residents with assets more than the minimum permissible asset level; and for
admissions prior to 20 September 2009, less than 4 times the basic age pension
amount; and for admissions on or after 20 September 2009, 3.61 times the basic
age pension amount can be asked to pay a small accommodation charge.
The maximum accommodation charge payable by assisted residents is the margin
of assets above the minimum that the resident must be left with, divided by 1,825
up to the maximum pre-20 March 2008 assisted accommodation charge rate.
For residents who meet the assisted resident criteria, the Department may also pay
the concessional supplement at the assisted resident rate to the provider.
Charge-paying residents
If the resident is non-concessional, the maximum accommodation charge payable
is the margin of assets above the minimum that the resident must be left with, divided
by 1,825, up to the maximum pre-20 March 2008 accommodation charge rate.
Insucient assets to pay an accommodation charge but not concessional
Residents with assets below the minimum asset amount may not meet the criteria
to be a concessional resident—for example, because they were not in receipt of
an income support payment. While the concessional resident supplement is not
payable for these residents, they cannot be asked to pay an accommodation charge.
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Residents who entered from 20 March 2008; or entered 1
July 2004–20 March 2008 with break in care and re-entered
on/after 20 March 2008
Depending on their assets, post-2008 reform residents—ie, residents who either
entered care after 20 March 2008; or who entered care between 1 July 2004 and
19 March 2008 (inclusive) but who had a break in care of 28 days or more and
re-entered care on or after 20 March 2008, may be:
fully supported residents
partially supported residents and also may be asked to pay
an accommodation charge
asked to pay an accommodation charge.
Residents with assets below the minimum permissible asset threshold are known
as fully supported and cannot be asked to pay an accommodation charge. The
Department will pay the maximum amount of accommodation supplement
(appropriate to the service) to the provider.
If the resident is a pensioner resident, paying the maximum pensioner accommodation
charge, then an accommodation charge top-up supplement will be payable to the
provider for that resident. See also Accommodation charge top up supplement
on page 107.
If the resident’s assets are below the maximum asset amount, the maximum
accommodation charge is the margin of assets above the minimum that the resident
must be left with, divided by 2,080. These residents are known as partially supported
and the Department will pay an accommodation supplement to the provider. The
amount of accommodation supplement, when added to the amount of
accommodation charge, will equal the maximum accommodation charge.
If the resident is not a fully or partially supported resident, the provider may charge
the maximum applicable rate of accommodation charge.
ACCOMMODATION SUPPLEMENT
Starting on 20 September 2010, the cap on the accommodation charge will
be gradually increased until 20 September 2011, when it will be $32.38 per day
(indexed). From 20 March 2012, the maximum rate of the supplement will be
increased on 20 March and 20 September each year, in line with movements in the
Consumer Price Index (CPI). However, dierent caps will continue to apply to new
pensioner and self funded retiree residents who enter before 20 March 2010.
The accommodation supplement will ensure that providers receive the equivalent
of the maximum accommodation charge for all residents, either from the resident
or the Government or from a combination of both.
The maximum rate of the accommodation supplement payable for residents in an
aged care service depends on:
the proportion of residents who are supported residents
and whether or not the service complies with the 1999 fire safety and 2008
space and privacy building certification requirements.
From 20 March 2008, the single asset-tested accommodation supplement also
replaces the concessional resident supplement and the pensioner supplement.
Under these new arrangements, the maximum level of the new accommodation
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supplement was increased and eligibility for it was extended. Self-funded retiree
residents with few assets are also eligible for accommodation assistance.
The accommodation supplement is only payable for eligible permanent residents
who entered an aged care service from 20 March 2008.
Calculating a resident’s supplement
The level of a new resident’s accommodation supplement depends on:
the level of their assessable assets
whether the aged care service meets the 1999 fire safety and 2008 privacy and
space requirements
whether the aged care service provides more than 40 per cent of its eligible
care days to supported residents
supported residents are residents receiving one of the following: the
concessional resident supplement; the hardship (accommodation bond)
supplement; the hardship (accommodation charge) supplement; or the new
accommodation supplement.
The maximum supplement will be paid to all new residents, including self funded
retirees, with assets below the minimum permissible asset amount.
For residents with assets above this threshold, the amount of the supplement will
be reduced by the amount of the accommodation charge payable.
Accommodation supplement—assets test
Centrelink or the Department of Veterans’ Aairs (DVA) will assess a resident’s assets
on behalf of the Department. A person will not be eligible for an accommodation
supplement if they choose not to have the level of their assets assessed by
Centrelink or DVA and can be asked to pay the maximum accommodation charge.
See Accommodation payments and assets testing on page 98.
Encouraging quality
A lower maximum supplement rate will apply to residents in aged care services that
do not meet the 1999 fire safety and 2008 privacy and space requirements. This
lower maximum supplement rate will equal the sum of the indexed maximum rates
of the current concessional resident supplement and the pensioner supplement.
Supported resident ratios
All aged care services, whether or not they are certified, are required to meet the
supported resident ratio—formerly known as the concessional resident ratio—which
applies to their region. Sanctions may be applied to those services that do not meet
the required ratio.
For example, a 25 per cent discount will be applied to the supplement paid to residents
in services that do not provide more than 40 per cent of their eligible care days to
supported residents. Services where more than 40 per cent of their new residents
receive the new accommodation supplement or a hardship (accommodation bond
or charge) supplement will be paid the undiscounted rate for those new residents.
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Supported, concessional and assisted residents count towards the supported
resident ratio.
Because the definition of a supported resident is more generous than the definition
of concessional/assisted residents, many more aged care services will be able to
achieve the 40 per cent concessional threshold. About 50 per cent of post-March
2008 residents are expected to qualify for some level of accommodation supplement
(and so be supported residents); while pre-March 2008, only about 30 per cent of
new residents would have qualified as either concessional or assisted residents.
Providers who are unsure about which region they are in should contact the state
or territory oce of the Department. See References at the end of this chapter for
contact information.
These ratios do not apply to services with extra service status or with extra service
status in a distinct part of a service. However, the ratio does apply to the non-extra
service places in a service with an extra service distinct part.
ACCOMMODATION CHARGE TOPUP SUPPLEMENT
To compensate aged care providers for the phasing in of the new cap on the
accommodation charge for pensioners, approved providers will receive an additional
accommodation supplement for all pensioner residents who enter an aged care
service for high-level care from 20 March 2008 to 19 March 2010.
The accommodation charge top up supplement (ACTUS) is an additional primary
supplement paid for residents for whom the combined accommodation supplement
and the accommodation charge (as a result of a cap), is less than the maximum
accommodation supplement on the day they enter care. See legislative reference.
Providers may receive ACTUS payments for eligible post-2008 reform pensioner
residents if:
the resident is in receipt of an income support payment
and is eligible to pay an accommodation charge on entry to the residential
aged care service that is less than the accommodation charge the resident
would have been eligible to pay if they had not been receiving income support
payment.
Depending on the resident’s assets, the accommodation supplement will go some
way towards making up this gap. However, in some cases the accommodation
supplement will not equal the gap. The ACTUS supplement, therefore, seeks to
remove any potential disadvantage to approved providers by covering the gap and
compensating the provider for the lower accommodation charge which pensioners
may be asked to pay to the service.
The ACTUS is not payable during pre-entry leave (because the resident does not pay
the accommodation charge for pre-entry leave days). See Leave on page 145.
For a given eligible resident, the rate of the additional accommodation charge top-
up supplement will equal:
the maximum rate of the accommodation supplement payable for residents
in that aged care service
less the maximum rate of the accommodation charge payable by that resident
less the amount of the accommodation supplement paid in respect of the resident.
Aged Care
(Residential care
subsidy—amount
of accommodation
charge top-up
supplement)
Determination
2008 (No.2)
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Residents who move to another aged care service
Special arrangements apply to residents if they move aged care services within
28 days of leaving the previous service.
If the resident transfers within 28 days, the maximum rate of accommodation charge
payable can be no more than the rate payable at the previous aged care service.
There is also no requirement for another asset assessment to be done unless the
resident believes that there has been a decrease in their assets since the time of the
previous asset assessment.
Pre-20 March 2008 residents who were assessed as concessional or assisted in their
previous admission can roll over their concessional or assisted status provided that
this was determined through an asset assessment done by either Centrelink or DVA.
Pre-1 July 2004 concessional or assisted residents will need to have an asset
assessment done to determine their status if this had previously been determined
by the aged care provider.
If the resident originally entered care after 1 July 2004 and there has been a break in
care of 28 days or more, the maximum rate of accommodation charge payable will
be reassessed at the date of re-entry into care as though the resident had not had
any previous admissions into care.
Interest on delayed payments
If the accommodation charge is not paid when it is due, the provider can charge
interest on the outstanding amount, provided this was specified in the resident
agreement or accommodation charge agreement. Information on interest charges
that can apply should by clearly outlined in the accommodation charge agreement.
Interest can be charged starting from one month after the due date. The maximum
permissible rate of interest which may be charged is twice the below threshold rate
as outlined in the Social Security Act 1991. See References at the end of this chapter
for a link to Comlaw for this Act. See legislative reference.
Accommodation charge and hardship arrangements
See Hardship and accommodation payments on page 143 for information about
residents who cannot aord to pay an accommodation charge.
ACCOMMODATION BONDS
An accommodation bond may be payable by a resident who enters permanent care
in a residential aged care service at a low level of care. Residents who enter permanent
high level care in an extra service facility can also be asked to pay an accommodation
bond. Residents who have previously paid an accommodation bond and who are
moving to high care may elect to roll over their accommodation bond.
Some residents entering a multi-purpose service for the equivalent of low level care
in a residential setting may also be asked to pay an accommodation bond. See
legislative reference.
An accommodation bond only becomes payable if the residential care service
is certified. See legislative reference.
l e g i s l a t i v e r e f e r e n c e s
Division 2
(Objects), Aged
Care Act 1997
s 57-2(1)(a), Aged
Care Act 1997
s 57-2(I)(aa)(iv),
Aged Care Act
1997, 23.28B,
User Rights
Principles 1997
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l e g i s l a t i v e r e f e r e n c e s
Residents can choose to pay an accommodation bond as a lump sum, a regular
periodic payment or a combination of both. See Types of accommodation bond
payments on page 111.
The provider can keep an amount out of the accommodation bond—a retention
amount—with the balance of the bond to be refunded to the resident, or their estate,
when they leave the service. Providers can also keep any interest from
accommodation bonds.
The bond amount is negotiated between an approved provider and a resident. The
Department does not receive any of the accommodation bond and does not determine
the amount, although the maximum bond that can be paid must leave the resident
with a certain level of assets. Providers are not required by law to ask residents for
an accommodation bond. However, if they do there are various legal requirements
regulating accommodation bonds. See Amount of accommodation bond on page
110; and Types of accommodation bond payments on page 111. See also chapter on
Protection and responsibilities relating to accommodation bonds in this Manual.
Providers must use the income from accommodation bonds and retention amounts to:
meet capital works costs relating to residential care
retire debt relating to residential care
improve the quality and range of aged care services, where no capital
expenditure is necessary. See legislative reference.
The accommodation bond must not be used for a purpose that is not related
to providing aged care to care recipients or does not comply with prudential
requirements. See legislative reference.
Which residents can be charged an accommodation bond?
In order for a provider to ask a resident to pay an accommodation bond, a resident
must meet the following criteria. They must:
not be eligible to pay an accommodation charge
be a low care level resident or be in a service or a distinct part of a service
with extra service status, or have agreed to roll over an accommodation bond
have assets which exceed the minimum permissible asset level
have entered into an accommodation bond agreement which specifies the
amount of the accommodation bond
have been provided with information about accommodation bonds by
the approved provider before they enter care. See legislative reference.
The following residents cannot be asked to pay an accommodation bond:
residents receiving high level residential aged care (except if they are in a
service, or a distinct part of a service, with extra service status, or have agreed
to roll over their accommodation bond)
residents with assets below the minimum asset level
fully supported residents
concessional residents
respite residents
charge exempt residents
s 57-2(1)(n), Aged
Care Act 1997
s 57-2(1)(k), Aged
Care Act 1997
s 57-2(1)(d), Aged
Care Act 1997,
s 23.28, User
Rights Principles
1997
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residents for whom a hardship determination is in place
if such a determination is subsequently revoked or ceases to be in force,
the resident can then be charged an accommodation bond, provided that
they agreed to the accommodation bond at the time of entry
residents who were in a nursing home or hostel before 1 October 1997, as long
as they remain in the same service—these residents can only be charged an
accommodation bond if they move to another service
bonds can be charged to existing residents only where the service moves
to a totally new catchment area or to a new purpose-built service, either on
the same site or in another location, and is classified by the Department as
a new service.
A person other than the resident cannot be required to pay an accommodation
bond as a condition of a resident’s entry to the aged care service.
Varying amount of accommodation bond with
existing resident
The amount of an accommodation bond can be varied by mutual agreement
between a provider and a resident, provided that any revised amount is not more
than the maximum that applied at the time of the person’s entry to care.
Any agreed increase in a bond amount should be associated with an improvement
in accommodation for the resident—for example, the resident moving from a shared
to a single room.
This does not alter the requirement of the Act that a person transferring between
providers cannot be charged as a bond an amount that is greater than the bond
balance refundable by the provider they are transferring from, either at the time
of transfer or thereafter.
Amount of accommodation bond
The maximum amount of any accommodation bond that a person can be asked
to pay depends on the level of the resident’s assets when they enter the service
as a permanent resident. See also Accommodation payments and assets testing
on page 98.
Provided that the resident is left with the minimum permissible asset amount, there
is no ceiling on the amount of an accommodation bond that can be charged. As of
20 September 2009, the minimum asset amount which a resident must be left with
is 2.25 times the annual single rate age pension, rounded to the nearest $500, as at
the day they enter care. This rate applies for people whose date of entry to care is
after 20 September 2009.
Some residents may choose not to give an approved provider sucient information
to determine their assets. In these cases, the resident can be asked to pay the amount
specified in the accommodation bond agreement, as long as the provider is assured
that if the resident pays this amount, the resident will still have at least the minimum
permissible asset level.
Residents who choose to pay an accommodation bond wholly or partly by periodic
payments must still be left with at least the minimum permissible asset value when
they enter the aged care service.
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Types of accommodation bond payments
Residents can pay an accommodation bond as a lump sum, a regular periodic
payment or a combination of both.
A resident must not be required to pay a lump sum accommodation bond, including
retention and interest amounts, until six months after they have entered care. They
can, however, choose to pay before this date. Retention amounts and interest may
accrue from the resident’s date of entry to the service. If the service is not certified
when the resident enters, the resident must not be required to pay an
accommodation bond until the service has been certified for six months.
Periodic payments are payable from the date the resident enters the service, or the date
the service is certified if this is later. The resident and the service provider must agree
on the frequency of periodic payments, which cannot be more often than weekly.
If the resident has applied for a determination of financial hardship, the resident
must not be required to pay an accommodation bond unless the Secretary declines
to make such a determination, or the determination of financial hardship ceases
to be in force. See Hardship and accommodation payments on page 143.
If the resident has agreed to pay an accommodation bond, and the Secretary does
not make a determination of financial hardship, or a determination ceases to be in
force, the resident must not be required to pay an accommodation bond until six
months after receiving notice from the Secretary.
If the resident has agreed to pay an accommodation bond by periodic payment,
these are usually payable from the resident’s date of entry.
Retention amounts
A retention amount may be deducted from an accommodation bond balance for
each month, or part of a month, for a maximum of five years. The maximum monthly
retention amount that a provider may keep from a resident’s accommodation bond
is the lower amount of:
the capped maximum amount applicable at the time the resident enters the
aged care service. The capped maximum amount is indexed annually in July
in line with the consumer price index (CPI)
the amount the provider and resident agree on in the accommodation bond
agreement entered into when the resident entered the service.
The retention amount is not set down in the legislation, but the legislation does specify
the maximum amounts that may be deducted. The amount needs to be agreed on by
the provider and the resident and included in the accommodation bond agreement.
Bond agreements may not specify an amount that exceeds the capped maximum.
Where a bond is paid partly by lump sum and partly by periodic payments, the maximum
retention amount applies to the total (lump sum equivalent) accommodation bond.
The monthly retention amount that providers can keep cannot change while the
resident lives at that aged care service.
Once the five year limit is reached no further retention amounts can be deducted
from the bond. The five-year period is cumulative and is reduced by each month for
which retention amounts were deducted from an accommodation bond (or entry
contribution) the resident paid to another aged care service.
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If a resident is provided with care for two months or less, retention amounts can
be retained for a total of three months—ie, the whole of the month in which the
resident entered the aged care service plus the following two months.
Months commence on the date the resident entered the service and end on the day
before the corresponding date in the next month. If there is no such corresponding
day, the month ends on the last day of that next month.
The five-year period generally commences on the day the recipient enters as
a permanent resident. However:
if the aged care service is not certified on that day, it commences on the day
the service becomes certified
or if a determination of financial hardship is in force for that resident, the day
after the day it ceased to be in force
or if the resident is transferred from respite care to permanent accommodation,
the day of the transfer.
If a resident transfers to another aged care service, the maximum retention amount
that applies in the new service may be dierent to the maximum retention amount
that applied in the old service:
in some cases it will increase—for example, where it is linked to CPI and a CPI
increase has taken eect See legislative reference.
in other cases it will decrease—for example, where it is linked to the amount of
the bond and the new bond is less than the old bond due to the deduction of
retention amounts See legislative reference.
in some cases, it will stay the same—for example, where it is linked to the amount
of the bond, but no retention amounts have been deducted; or where it is linked
to CPI, and the CPI increase matches the eect of the deduction of retention amounts.
EXAMPLE
Peggy is a bond-paying resident, who entered an aged care service on 30
January 2008 and left on 26 February 2009. The provider could keep 13 months
worth of retentions from Peggy’s bond—ie, 12 full months from 30 January 2008
to 29 January 2009, plus the part month from 30 January to 26 February 2009.
EXAMPLE
Frank is a bond-paying resident who entered an aged care service on 31
January 2008 and left on 1 March 2009. The provider could keep 14 months
worth of retentions from Frank’s bond—ie, 13 full months from 31 January
2008 to 28 February 2009 plus the part month of one day in March.
Interest charges
Provided that the accommodation bond agreement allows interest to be charged,
providers can charge interest on overdue accommodation bonds. While the legislation
sets a maximum rate of interest that can be charged, agreements may specify a rate
that is less than the maximum permissible interest rate.
l e g i s l a t i v e r e f e r e n c e s
s 23.71(1)(a),
(c), (3), (4),
User Rights
Principles 1997
s 23.71(1)(b),
User Rights
Principles 1997
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The legislation determines the maximum permissible interest rate which residents
may be asked to pay:
on lump sum accommodation bonds which are paid after the date due, including
bonds which are unpaid at the time of departure from the aged care service
on periodic payments of accommodation bonds
on amounts owed which may be deducted from the bond balance
in certain situations where the resident leaves the aged care service within two
months of entering care.
The rate that applies when the resident arrives is the maximum that can be charged
for the period that the resident stays in the service—ie, the rate does not change. The
maximum permissible interest rate for each quarter is available on the Department’s
website, in the Aged Care Essentials newsletter (formerly known as Payment Essentials)
and from the Aged and Community Care Information Line. See References at the end
of this chapter for links and contact information.
Interest can be charged:
when the resident pays a lump sum bond after the due date—for the days starting
on the due date and ending on the day the lump sum was paid. The due date
will usually be the date of the resident’s entry to the aged care service; or may
be the date of certification, if the service is uncertified when the resident enters
when the resident receives care for two months or less and their bond is
refunded within three months of their entry to the aged care service—for the
number of days between the day of the refund and the three months after
they entered
when the resident pays a lump sum bond after the due date and it is refunded
within three months of entry, the total of the two points above
when the resident was provided with care for two months or less, and agreed
to pay an accommodation bond but did not pay it before they left the aged care
service—for the days starting on the due date and ending three months after
they entered
when the resident was provided with care for more than two months, and
agreed to pay an accommodation bond, wholly or partly as a lump sum, but did
not pay before they left the aged care service—for the days starting on the first
day of the month in which the resident entered and ending on the last day of
the month in which they left the service.
Interest cannot be charged when a service is uncertified. The number of days
detailed above must be reduced to exclude any period during which the service
was not certified.
Periodic payments
Periodic payments are:
regular payments from a resident to a provider
of an amount equivalent to the amount of interest the provider could have
derived from the accommodation bond if it had been paid as a lump sum
plus a retention amount.
Periodic payments are not refundable, unless they are paid for a period for which the
resident was not liable for a periodic payment.
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The provider may charge the full amount of the periodic payment for the month that
the resident leaves the service.
If a resident is in care for less than three calendar months, the service can still charge
an amount equal to the periodic payments payable for three months.
A periodic payment includes a component for the retention amount the provider
could have received on the lump sum equivalent, and a component for the income
that the provider could have derived from the lump sum equivalent. See Interest
charges on page 112.
Retention component of a periodic payment
Periodic payments can only include a retention component for a maximum of five
years. For the remainder of the person’s period in care, the periodic payment would
be based only on the income the provider could have derived from the lump sum
equivalent.
If an accommodation bond is paid partly as a lump sum, and partly through periodic
payments, the retention amounts can be included wholly in the periodic payment
formula or deducted wholly from the lump sum, or partly through each in an agreed
proportion.
Calculating periodic payments
The formula for calculating the periodic payment for the first five years in care
is (rounded to the nearest cent):
(lump sum equivalent x
interest rate per cent*) + (12 x monthly retention amount),
divided by number of periodic payments in the year.
*
A provider can charge interest up to the maximum permissible interest rate.
The current maximum permissible interest rate is available on the Department’s
website. See References at the end of this chapter for a link.
Examples
The total accommodation bond is $90,000 and is not paid at date of entry. The
interest rate is 10 per cent (example rate only*), and payments are made monthly.
The monthly periodic payment, including retention and interest, is:
($90,000 x 10 per cent) +(12 x $299.00) = $1049.00
12
* A provider can charge interest up to the maximum permissible interest rate.
The current maximum permissible interest rate is available on the Department’s
website. See References at the end of this chapter for a link.
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After the first five years in care, the payment would be calculated only on the
interest* payable on the lump sum. In the above example, the monthly periodic
payment would be reduced to:
$90,000 x10 per cent = $750
12
* A provider can charge interest up to the maximum permissible interest rate.
The current maximum permissible interest rate is available on the Department’s
website. See References at the end of this chapter for a link.
The total accommodation bond is $90,000. The resident pays $60,000 of it as
a lump sum with a remaining lump sum equivalent of $30,000. If the monthly
retentions of $299.00 were taken equally from the periodic payment and the lump
sum, then the monthly periodic payment for the first five years in care would be:
($30,000 x 10 per cent*) +(12 x $299.00 ÷ 2) = $399.50
12
* A provider can charge interest up to the maximum permissible interest rate.
The current maximum permissible interest rate is available on the Department’s
website. See References at the end of this chapter for a link.
The total accommodation bond is $90,000, with $60,000 of it agreed to be paid
as a lump sum and the remaining lump sum equivalent of $30,000. If the monthly
retentions were taken wholly from the lump sum, with none of them included in the
periodic payments, then the periodic payment for the whole of the period in care
would be:
($30,000 x 10 per cent*) +$0 = $250
12
* A provider can charge interest up to the maximum permissible interest rate.
The current maximum permissible interest rate is available on the Department’s
website. See References at the end of this chapter for a link.
Refunding the accommodation bond balance
See section on Refunding accommodation bond balances in chapter on Protection
and responsibilities relating to accommodation bonds in this Manual.
Residents who move to another aged care service
Special arrangements apply to residents if they move aged care services within
28 days of leaving the previous service.
If the resident transfers to another service, to receive low level care, the maximum
amount of accommodation bond that can be charged by the second service is the
balance of the previous accommodation bond.
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If the resident transfers to another service to receive high level care, they can choose
(with the agreement of the service provider) to either have the balance of their
accommodation bond rolled over to the second service or to begin to pay an
accommodation charge.
Pre-20 March 2008 residents who were assessed as concessional or assisted in their
previous admission can roll over their concessional or assisted status provided that
this was determined through an asset assessment done by either Centrelink or DVA.
Pre-1 July 2004 concessional or assisted residents will need to have an asset
assessment done to determine their status if this had previously been determined
by the aged care provider.
What if the resident’s care needs increase after entry?
If a bond-paying resident’s care needs increase from low to high care after entering
a service, the original bond agreement cannot be changed into an accommodation
charge agreement.
However, if a resident moves from one service to another because the first service
is unable to provide the higher level care the resident needs, then a new
accommodation payment agreement may be entered into for the second entry.
Transitional accommodation supplement
Approved providers will be eligible for a transitional accommodation supplement for
some new residents who enter low level care.
The transitional accommodation supplement will be paid for new permanent
residents who entered low-level care after 20 March 2008 and before 19 September
2011, for whom the level of the accommodation supplement would be less than the
level of the pensioner supplement it replaces. Initially, this transitional accommodation
supplement will fully oset the loss of pensioner supplement and largely oset the
loss of the additional basic fee for these residents. This will allow providers time to
adjust to the new arrangements. The rate of the supplement will depend on the
resident’s entry date.
Accommodation bonds and hardship
Financial hardship assistance is available to aged care residents who do not have
sucient assets to pay their accommodation payment. See Hardship and
accommodation payments on page 143.
ACCOMMODATION PAYMENTSINFORMATION PROVIDED
TO RESIDENTS AND RESIDENT AGREEMENTS
Essential information in accommodation charge
agreements
Providers must include the following in an accommodation charge agreement:
the amount of the daily accommodation charge
the resident’s date of permanent entry to the aged care service
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l e g i s l a t i v e r e f e r e n c e s
how the daily accommodation charge is to be paid and when it is payable
the interest rate payable if interest is to be charged because there is a delay
in paying the daily accommodation charge
if the agreement charge entitles the resident to specific accommodation or
additional services (additional services are those which the provider is not
required to provide under the Act)
if the resident has obtained or has applied to the Department for a
determination that paying an accommodation charge would cause financial
hardship, the amount of daily accommodation charge which will be payable
if the determination stops being in force, or if the Department declines to make
such a determination
information about the accommodation charge which the resident agrees that
the provider can give to the approved provider of a dierent residential aged
care service, if a resident wants to move to that service. This includes whether
the care recipient has agreed to pay an accommodation charge and the period
remaining for which accommodation charges may be levied. See legislative
reference.
If an agreement does not include the above detail, it is not an accommodation
charge agreement under the Act. No provision in an accommodation charge
agreement can override the provisions of the Act or the Aged Care Principles.
See legislative reference.
Essential information in accommodation bond agreements
If a provider asks a resident to pay an accommodation bond, the provider must give
the resident the following information before they enter the service:
the range of bonds charged
payment options available to the resident—eg lump sum, periodic or
a combination of both
the retention amount and the periods for which retention amounts can be
retained by the provider
the interest rate on the bond if there is a delay in payment, or if the bond
is paid wholly or partly by periodic payments, and the periods when interest
is payable by the resident
that amounts owed by the resident under the accommodation bond agreement,
any resident agreement and any extra service agreement, plus any accrued
interest on these amounts owed, can be deducted from the accommodation
bond balance before it is refunded to the resident
when a bond is not required, or is refundable
refund arrangements
information about the service’s prudential arrangements—this includes
providing a copy of the service’s most recent annual prudential statement
if the resident has given the provider sucient information to establish the
value of their assets, the requirement that the resident must be left with assets
of at least the minimum permissible asset value after paying the bond.
ss 57A-3(1) and
57A-12(1)(c), Aged
Care Act 1997, ss
23.81M and 23.81N,
User Rights
Principles 1997
Division 57A,
s 57A-5, Aged
Care Act 1997
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Accommodation bond agreements
An accommodation bond agreement must specify:
the bond amount
the resident’s date of permanent entry to the aged care service
how and when the bond is to be paid
if the bond is to be paid wholly or partly by periodic payments
the amount of the lump sum equivalent
the amount and frequency of periodic payments
the components representing retention and income
whether interest charges are payable if periodic payments are overdue
the right of the resident to convert to a lump sum at any time
the interest rate payable if there is a delay in payment of the bond or if the
bond is paid wholly or partly by periodic payments
that before the accommodation bond balance is refunded to the resident,
amounts owed by the resident under the accommodation bond agreement,
resident agreement or extra service agreement, plus any accrued interest on
these amounts can be deducted from the balance
conditions which will apply if a person agrees to pay a bond but does not enter
the aged care service
if agreement to pay a bond, or a bond of a certain size, entitles the resident
to specific accommodation or additional services (additional services are those
which the provider is not required by legislation to provide)
if the accommodation bond is more than 9 times (10 times if prior to 20
September 2009) the annual single age pension, any additional resident fees
payable by the resident as a result of the aged care service not being entitled
to pensioner supplement for that resident
if the resident has obtained, or has applied to the Department for a
determination that payment of an accommodation bond would cause financial
hardship, the amount of accommodation bond that would be payable if the
determination stopped being in force, or if the Department declined to make
such a determination
the amount the provider can charge if the resident stays 2 months or less
the dollar amount of each retention amount and when it will be deducted
such an amount must not exceed the maximum retention amount which
applies at the time of entry to the aged care service
if transferring to another aged care service, the retention amount should
be the amount calculated on the bond payable at the second service
the circumstances in which the bond must be refunded and the way the refund
will be worked out
prudential arrangements for the bond
information about the accommodation bond which the resident agrees that the
service provider may provide to the new aged care service when the resident
wishes to move to that new service, including:
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l e g i s l a t i v e r e f e r e n c e s
the amount of any accommodation bond agreed, including the lump sum
equivalent if the amount is to be paid wholly or partly by periodic payments
the retention amounts and the period remaining in which retention amounts
can be deducted
any amounts owed under an accommodation bond agreement, resident
agreement or extra service agreement which can be deducted from the
accommodation bond balance, if the bond was paid wholly or partly as
a lump sum. See legislative reference.
If an agreement does not set out the above matters, it is not an accommodation
bond agreement under the Act. No provision in an accommodation bond agreement
can override the provisions of the Aged Care Act 1997 or the Aged Care Principles.
See legislative reference.
An accommodation bond agreement can be incorporated into another agreement,
for instance a resident agreement or extra service agreement.
EXTRA SERVICE FEE
The extra service amount is the maximum additional amount a provider can charge
a resident for receiving extra service in a residential care service with extra service
status. Extra service status is granted for services, or distinct parts of services, where
residents are provided with significantly higher standards of accommodation and food.
A resident pays an extra service amount in addition to other fees, which includes the
resident contribution (also known as the basic daily fee) and may include an income
tested fee.
The amount of the extra service fee must be approved by the Secretary. A provider
cannot charge any fees above the approved extra service fee amount, for any of the
accommodation, services or food specified in the conditions of grant of extra
service status.
If a resident is occupying an extra service status place, the residential care subsidy for
that resident is reduced by 25 per cent of the approved extra service fee for that place.
EXAMPLE
If the extra service fee for a place is $20 per day, then the Government subsidy
for a resident receiving extra service care in the place will be reduced by 25 per
cent or $5 per day. The $5 per day is the extra service reduction.
The extra service amount is $25—ie the extra service fee ($20 per day) plus the
extra service reduction ($5 per day).
See section on Fees and payments in chapter on Extra service places in this Manual.
FEES FOR ADDITIONAL SERVICES
An approved provider may charge a resident additional fees for additional services—
for example hairdressing—which the resident has asked the provider to provide and
which have been set out in the resident agreement. The amount of any charge for
additional services must be agreed beforehand with the resident and an itemised
account given to the resident once the service has been provided. See legislative
reference.
s 57-9, Division 5,
Part 4, User Rights
Principles 1997
Division 57,
s 57-11, Aged
Care Act 1997
s 56-1(d), Aged
Care Act 1997
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Residents cannot be asked to pay extra for the care and services that the provider is
required to provide. See also chapter on Specified care and services in this Manual.
GRANDPARENTING ARRANGEMENTS
Concessional resident supplement
A concessional resident is a person who cannot aord to pay an accommodation
bond or accommodation charge and who initially entered permanent care prior to
20 March 2008. The Government pays the concessional resident supplement for
them and providers are required to set aside a certain number of places for
concessional and supported residents.
A person can also be a concessional resident if the Secretary has made a determination
that paying an accommodation bond or charge would cause the person financial
hardship. See legislative reference. The concessional resident supplement stops if
this determination ceases to be in force because, for example, previously unrealisable
assets have actually been realised.
Concessional resident supplement can only be paid
for concessional and assisted residents who initially entered an aged care
service between 1 October 1997 and 19 March 2008
and who are in a certified service.
Concessional resident supplement cannot be paid for:
residents receiving care on an extra service basis
respite residents
the lowest classification level. The supplement can be paid if the resident’s
classification level rises. The supplement may still be paid when a resident,
classified at a higher level, is attracting basic subsidy at the lowest level only
because the resident is on extended hospital leave.
Providers must meet regionally-based ratios for concessional, assisted and supported
residents. Assisted residents are also counted towards concessional resident ratios.
Concessional resident—eligibility
Concessional resident status is determined based on a resident’s circumstances
on the day he or she entered the aged care service. To be a concessional resident,
a resident:
must be a pre-March 2008 reform resident—ie, have initially entered an aged
care service before 20 March 2008
must not have had an absence from care for a continuous period of more than
28 days after 20 March 2008
must be receiving an income support payment
must not have owned a home for the past 2 years or more
and have assets of less than the applicable minimum asset level.
For concessional resident purposes, a person is taken not to have owned a home
if at the time they entered the aged care service their home is occupied by:
their partner or dependent child
l e g i s l a t i v e r e f e r e n c e s
ss 57-14 and
57A-9, Aged
Care Act 1997
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a dependent child includes a child under 16 years or a full-time student
under 25 years. A child is dependent even if the resident does not have
custody of that child, if the resident is paying child support for that child
under the Child Support Scheme or another legally binding arrangement
a carer who has lived in the home continuously for the past 2 years and that
carer is eligible for an income support payment at the time the person enters
the aged care home
or a close relation who has lived in the home continuously for the past 5 years
and that close relation is eligible for an income support payment at the time
the person enters the aged care home.
The resident is not classed as a home-owner in determining concessional resident
status if the value of their interest in the home does not exceed an amount that is
2.25 times the basic age pension amount at the time they enter the aged care
service. The value of their home is still included in calculating their assets.
A person is not considered to be a home-owner in determining assisted resident
status if the value of their interest in the home does not exceed an amount that is
3.61 times the annual single basic rate age pension. The value of their home is still
included in calculating their assets.
Structure of the concessional resident supplement
The concessional resident supplement is paid at a high and a low rate depending
on the proportion of place days occupied by the combined number of concessional
and assisted residents.
the lower rate is paid for all concessional residents in services where up to 40 per
cent of post-30 September 1997 residents are concessional or assisted residents
the higher rate is paid for all concessional residents in services where more
than 40 per cent of their post-30 September 1997 residents are concessional
or assisted residents—ie, a service where 60 per cent of their post-30
September residents were concessional or assisted residents would receive the
higher rate for each concessional resident.
Aged care services will be paid the full rate of the accommodation supplement for
new residents, if more than 40 per cent of their permanent residents are supported
residents. See Accommodation supplement on page 105.
Assisted residents
Aged care services receive an assisted resident supplement. The criteria for determining
assisted resident status are the same as for concessional resident status except that:
an assisted resident has assets of between 2.25 and 3.61 times the annual single
basic age pension amount, rounded to the nearest $500.
An assisted resident, unlike a concessional resident, may be asked to pay an
accommodation bond or charge as long as the resident is left with assets
of at least 2.25 times the annual single basic pension amount.
Charge exempt resident supplement
The rate of charge exempt resident supplement is equal to the concessional
supplement and is also indexed in March and September each year. The charge
exempt resident supplement rate is reduced by the amount of the assisted or
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supported resident supplement for charge exempt residents who are also assisted
or supported residents. See References at the end of this chapter for a link to current
supplement rates.
Charge exempt residents and supported resident ratios
Service providers should encourage any potential charge exempt residents to
complete a request for an assets assessment form if they have not already done so,
even though the resident will not be asked to pay an accommodation charge.
Residents assessed as concessional, assisted or supported will be counted towards
an aged care service’s supported ratios, whereas charge exempt residents are not.
Pensioner supplement
Pensioner supplement is payable for pre-March 2008 reform residents who either have
a dependent child or receive an income support payment and have not agreed to pay
a big bond. A big bond is more than 10 times the basic age pension amount at the
time of entry into care, if the person entered the service before 20 September 2009;
or 9 times the basic age pension amount at the time of entry if the person entered
the service on or after 20 September 2009.
Transitional supplement
Residents who were already in aged care services prior to 1 October 1997 cannot
be asked to pay an accommodation charge or an accommodation bond or be
considered for a supported or concessional resident status while they remain
a resident in the same service.
Providers also have a responsibility to provide security of tenure for all residents, and
it is a condition of approval that residents are not discharged and readmitted in order
to receive extra funding.
Providers therefore receive a transitional supplement for these residents.
Grandparenting of hostel variable fees
Residents who entered a hostel before 1 October 1997 and who had sucient income
may have agreed to pay a higher variable fee at that time. The grandparenting
arrangements allow providers to continue to charge the 30 September 1997 variable
fee for these residents, less any residential care allowance (rent assistance) the
residents may have received at that time.
The grandparenting arrangements only apply to residents who:
occupied a hostel place on 30 September 1997
on that day, paid a fee which, after deducting any residential care allowance
they may have received, was greater than the fee would otherwise be under
the Act.
Grandparented fees cease permanently if:
the resident leaves the hostel
the resident’s fee under the grandparenting arrangements falls below the
applicable resident contribution.
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Providers must review the resident’s grandparented fee annually or more often if the
resident requests it. The grandparented fee must be reduced if the review indicates
that the resident’s income has fallen from the 30 September 1997 level, or from the
most recently reviewed level of income. The amount of the reduction to the
grandparented fee is the amount of reduction in the resident’s net income.
The grandparented fee cannot be increased as a result of a review.
Income for the purpose of reviews of grandparented fees is to be calculated in
accordance with the General Conditions formulated under section 10F of the Aged or
Disabled Persons Care Act 1954. Actual income, rather than the deemed amount is to
be used and the income amount should be net of any income tax and Medicare levy.
Where residents get non-weekly income, such as periodic interest payments through
the year, the payments are averaged to a weekly rate and added to any other weekly
income to produce an average weekly income. See References at the end of this
chapter for a link to ComLaw for this Act.
Transitional arrangements for entry contributions
Special transitional arrangements apply for residents who agreed, prior to
the 1 October 1997 introduction of the current arrangements, to pay an entry
contribution under the Aged or Disabled Persons Care Act 1954.
The requirements of the general conditions under section 10F of the Aged or Disabled
Persons Care Act 1954 continue to apply for those entry contributions, including:
refunds of the appropriate entry contribution amount must be made within
6 calendar months of the resident’s departure from the service, unless the
resident moves to another aged care service within 28 days of departing, in
which case the rules of the Aged Care Act apply
in calculating the amount of the entry contribution refund, retention amounts may
be deducted for each 6-month period the resident has lived in the hostel. If the
resident’s period of residence is not exactly divisible by 6-month periods, the
final period is deemed to be a 6-month period
if a resident delays payment of the entry contribution, in addition to the usual
retention amounts, the service can retain an amount equivalent to the retention
amount for each 6 month period, or part thereof, that the payment is delayed,
up to a maximum of five years.
if a resident moves to another aged care service within 28 days of leaving the
first aged care service where an entry contribution was paid, or agreed to be
paid, the maximum accommodation bond which may be charged by the second
service is the amount of the entry contribution refund from the first service
the entry contribution refund from the first service must be made within 7 days.
The five-year period for which retention amounts can be deducted from
accommodation bonds are aected by any periods for which the resident’s entry
contribution has had retention amounts deducted. Each 6-month period for which
retention amounts have been deducted from the entry contribution count as
6 months toward the five-year period.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN PART A OF THIS CHAPTER
See References at the end of this chapter.
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B. FUNDING AND INCOME FOR CARE SERVICES
RELEVANT LEGISLATION
Part 3.1,
Aged Care Act 1997 (the Act)
Division 42,
Aged Care Act 1997
Residential Care Subsidy Principles 1997
(the Residential Care Subsidy Principles)
Part 2,
Aged Care Act 1997
s 96-4,
Aged Care Act 1997
Division 43,
Aged Care Act 1997
Division 44,
Aged Care Act 1997
OVERVIEW
Care payments contribute to the cost of providing care for residents of aged care
services.
The care payment includes a basic subsidy or residential care subsidy amount, which
is based on a resident’s classification under the Aged Care Funding Instrument (ACFI)
and additional supplements.
The amount of basic subsidy which the Government pays to a provider for providing
residential care to a resident may be reduced if the resident is able to contribute to
the cost of their own care and pay an income tested fee. If they can contribute, then
an amount known as the income tested subsidy reduction will apply to the basic
subsidy.
The Government sets the maximum income tested fee that the provider may charge,
depending on the resident’s income.
From 1 January 2010, the income tested fee will apply from the day of entry.
Before 1 January 2010, an income tested fee will not apply until the 29th day after
a resident’s date of admission.
Rates and additional information
The rates for fees, subsidies and supplements, including the basic subsidy and the
income tested fee, change several times every year. For this reason, actual dollar
amounts payable are not included in this Manual. Current rates are available on the
Department’s website, in the Aged Care Essentials newsletter (formerly known as
Payment Essentials) and from the Aged Care Information Line. See References at the
end of this chapter for links and contact information.
How to calculate fees payable by a resident
To calculate the maximum daily fee that a resident may be asked to pay, approved
providers should: See legislative reference.
(1) work out the applicable standard resident contribution—ie, the maximum basic
daily fee
(2) add any compensation payment reduction that applies for the resident
(3) add any applicable maximum income tested fee for the resident
l e g i s l a t i v e r e f e r e n c e s
s 58-1(a), Aged
Care Act 1997
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(4) subtract any hardship supplement that applies for the resident
(5) add any other amounts agreed between the provider and the resident, that is,
agreed fees for additional services
(6) if the resident is in an extra service place and receiving care on an extra
service basis, add the extra service amount
(7) for an aged care service located in a remote area, add the remote area
allowance amount.
A resident may also be asked to pay an accommodation bond or an accommodation
change.
RESIDENTIAL CARE SUBSIDY
The Government pays approved providers an amount of residential care subsidy,
where they are eligible to receive subsidy, for the residential care they provide to
residents approved for that form of care.
Residential care subsidy is paid monthly and is calculated by adding the amounts
due for each resident for each day of the month. Providers submit a claim for each
month, including the details of each resident for whom they are claiming subsidy in
that month. They receive an advance payment in the first few days of each month.
This advance payment is then reconciled with the claim for that month and the
following month’s payment is adjusted accordingly, either by making an additional
payment or by reducing the total amount paid in lieu of the previous month.
A provider can be paid residential care subsidies in the following circumstances:
only accredited services are eligible for subsidies
on any day, subsidy can only be paid for the number of places allocated
to the provider
if subsidy is claimed for more residents than the allocated number of places,
residents are excluded from subsidy in reverse order—ie, the last resident
who entered is the first one excluded from the claim
if another person is operating the aged care service, for example under a
contract or a lease arrangement, the approved provider remains the person
eligible for the subsidy. This means that it is the approved provider who is
responsible for meeting all the responsibilities of providing approved
residential care
providers are paid for a resident’s first day of care
a resident’s day of entry and day of departure are counted as one day.
How residential care subsidy is paid
Residential care subsidy is payable to approved providers for each eligible approved
resident cared for during the claim period. If a provider has approved places in more
than one service, separate claims must be made for each service.
The claim period for residential care subsidy is one calendar month:
if a service opens during a month, the first claim period is from the opening
day to the end of the month, and thereafter monthly
if a service closes during a month, the claim period is from the first day of the
month to the day of closure.
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Medicare Australia makes an advance payment at the start of each month, generally by
the third working day of each month. The calculation of the monthly advance payment
is based on a service’s actual entitlements for the monthly claim period two months ago.
For example, the calculation of the advance payment for September is based on the
actual entitlements for July.
Therefore, a service’s claim form must have been received and processed by Medicare
Australia before the advance can be made. In the case of new services, the first two
advances will be manually estimated by Medicare Australia.
At the end of each month, a service must submit a formal claim for payment to
Medicare Australia. To assist services, Medicare Australia provides each service with
a pre-populated claim form listing their residents’ details. Each service is then required
to confirm or amend the details on the claim before the form is submitted to
Medicare Australia for processing.
Upon receipt of the claim form, Medicare Australia calculates the actual entitlement
of the service. If the entitlement exceeds the advance, an additional payment will be
made to Medicare Australia; whereas if the advance exceeded the entitlement, a
negative amount will be carried forward to a future claim. At this stage Medicare
Australia will also send the service a payment statement and include a pre-populated
claim form for the next month.
Example
This is how the funding cycle would operate for September and October:
the September advance is based on the final entitlement for July
this July entitlement is pro-rated for the number of days in September—ie, if
the final calculated entitlement for July was $100,000, the September advance
would be $100,000 divided by 31 days (the number of days in July) times
30 days (number of days in September)
the July entitlement is calculated in late August and paid in early September
the provider acquits the September advance in October, advising changes
to resident details that occurred during September
the September claim is processed within seven working days of it being
received and any adjustments are made to the advance
if the advance was too small, a further payment is made
if the advance was too large, a negative amount is carried forward to a future claim
late in September, the October advance is calculated, based on the final
entitlement for August, and paid by the third working day in October.
Claims for residential care subsidy
Every month the Department sends providers an explanatory advice about their
payments and provides forms to be completed for claiming subsidy for residents
within the aged care service.
For each month, the claim for payment:
must be forwarded on the approved form
along with any supporting documentation, such as a medical practitioner’s
certification for a claim for enteral feeding
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l e g i s l a t i v e r e f e r e n c e s
providers should ensure that any changes to bank account details are notified
promptly on the banking details for the direct deposit of payments form. See
References at the end of this chapter for a link.
Working out the amount of residential care subsidy
A provider’s residential subsidy amount for the claim period is: See legislative reference.
the sum of the subsidy for each resident of the aged care service
for each day during which residential care was provided to the resident
and for each day on which the resident was eligible for subsidy.
The amount of residential care subsidy for a month can be calculated from:
(1) the basic subsidy amount, given the service’s number and mix of residents
and their classification under the Aged Care Funding Instrument (ACFI)
(2) plus any primary supplements
(3) less any reductions in subsidy
(4) less any reduction resulting from income testing of residents
(5) plus any other supplements.
In certain circumstances, some other amounts may also be deducted from the
payments to a provider in relation to repayment of capital grants, payment of
additional recurrent funding and recovery of overpayments.
Basic subsidy amount
The basic subsidy for a resident, for the payment period, is obtained by adding
the amounts applicable for each day in the period for which the resident received
residential care through the aged care service. Dierent rates apply depending on
a range of factors. These include: See legislative reference.
each resident’s ACFI classification
whether the care provided is respite. Respite care recipients can be admitted
at either high care or low care level
each resident’s Aged Care Assessment Team (ACAT) assessment
periods of leave.
Subsidies will not be paid:
for the day a resident leaves an aged care service
to one provider if another provider is being paid for providing care to the
resident for that same day—this ensures that if a resident is on leave, the original
service is still eligible for subsidy for that resident, even if the resident enters
another service during the leave period. See High-dependency care leave
on page 146 for the only exception to this rule.
Transitional measures
Because nursing service proprietors were paid for the last day of care rather than
the first prior to 1 October 1997, nursing service proprietors are paid for the day
on which existing residents at 1 October 1997 leave the aged care service.
s 44-3, Aged Care
Act 1997, s 21.11,
Residential Care
Subsidy Principles
1997
s 44-2(1), Aged
Care Act 1997
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Conditional adjustment payment
The conditional adjustment payment (CAP) provides financial assistance to residential
care providers to assist them to become more ecient and to improve their
corporate governance and financial management practices.
Receipt of CAP funding by individual approved providers is voluntary, and is conditional
on compliance with requirements set out in the Residential Care Subsidy Principles.
The CAP payment is calculated as a percentage of the basic subsidy payable in respect
of each resident. The CAP is also applied to the basic subsidy amounts in calculating
the rates of payment for the Multi-purpose Services program and the flexible services
funded under the Aboriginal and Torres Strait Islander Aged Care Strategy.
For providers to remain eligible to receive CAP, they must satisfy the following three
eligibility conditions: See legislative reference.
encourage sta training
prepare a general purpose financial report for each financial year; have that
report audited and be able to provide a copy of that report to residents or
a person or agency authorised by the Secretary to the Department
participate in any aged care workforce census conducted by the Department.
Eligible oxygen treatment and enteral feeding supplement
Oxygen and enteral feeding supplements are primary supplements paid to aged care
services for residents with a specified medical need for the continual administration
of oxygen and /or enteral feeding. This includes residents receiving respite care and is
irrespective of the classification level of the resident.
A medical practitioner must certify in writing that the care recipient has a continual
need for the administration of oxygen or a medical need for enteral feeding and
Medicare Australia must sight this documentation.
Standard supplements are available for residents who require oxygen and/or enteral
feeding. A higher supplement may be approved where higher costs are incurred.
To apply for the oxygen and/or enteral feeding supplement, the aged care service
must complete an application for the oxygen and/or enteral feeding supplement. This
form is available on the Medicare Australia website. See References at the end of this
chapter for a link.
Oxygen supplement
To be eligible for the oxygen supplement, a resident must have an ongoing medical
need for the administration of oxygen—ie, the resident must need oxygen on a
continual basis rather than for episodic or short-term illnesses, such as bronchitis.
This need will normally be met by a concentrator.
The standard supplement allows for some cylinder oxygen, such as for social outings
and required use within the aged care service.
A higher supplement may be approved for a resident whose medical requirements
cannot be met by concentrator oxygen. A higher level supplement may only be
approved if the costs incurred are 25 per cent or more above the standard supplement.
Oxygen must be administered in the most economical way available, taking into
account the medical needs of the resident. See legislative reference.
l e g i s l a t i v e r e f e r e n c e s
Division 4, Part
10, Residential
Care Subsidy
Principles 1997
s 21.21(4),
Residential
Care Subsidy
Principles 1997
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l e g i s l a t i v e r e f e r e n c e s
To verify the care recipient’s medical needs, a medical practitioner must certify
in writing:
the care recipient’s particular oxygen requirements
that the care recipient has a continual need for the administration of oxygen.
Enteral feeding supplement
To be eligible for an enteral feeding supplement a resident must be receiving
a nutritionally complete formula by means of a nasogastric, gastrostomy or
jejunostomy feeding method.
The enteral feeding supplement is not payable for intermittent or supplementary
enteral feeding that is given in addition to oral feeding. See legislative reference.
There are two levels of the supplement, one for bolus and another for non-bolus
feeding.
A higher level supplement may only be approved if the costs incurred are 25 per cent
or more above the standard supplement.
The enteral feeding must be administered in the most economical way available,
taking into account the medical needs of the care recipient.
To verify the care recipient’s medical needs, the following is required:
written certification by a medical practitioner that the care recipient has
a medical need for enteral feeding See legislative reference.
written certification by a medical practitioner or dietician that the dietary
formula prescribed is nutritionally complete See legislative reference
the care recipient’s particular enteral feeding requirements. These can be
detailed in the medical certificate, the resident’s care plan, hospital discharge
papers or in the dietician’s enteral feeding instructions.
Payroll tax supplement
Payroll tax is a state/territory based tax levied upon employers whose total payroll
costs exceed the relevant threshold amount in their particular state or territory. The
payroll tax supplement is paid to aged care services in recognition of the unique
costs associated with the provision of aged care.
The supplement is meant to represent a proxy for wages of care related sta only, rather
than for sta employed by all business enterprises, such as administrative assistants.
The supplement is payable to approved residential aged care facilities only, including
Multi-Purpose Services (MPS). It is not payable to independent living units, Community
Aged Care Packages (CACPs), Extended Aged Care in the Home (EACH) packages,
day therapy centres and any other non-residential aged care initiatives.
Approved providers are eligible for the payroll tax supplement in relation to all
permanent and respite residents, except for those classified as N-N-N under the Aged
Care Funding Instrument (ACFI), and for any remaining residents classified
at Resident Classification Scare (RCS) 1 to 7, if:
they are an approved provider under the Act
they provide that resident with residential care under the Act
they have either a direct payroll tax liability or an indirect payroll tax liability.
Facilities can claim only a direct or indirect liability.
s 21.23(5),
Residential
Care Subsidy
Principles 1997
s 21.23(1),
Residential
Care Subsidy
Principles 1997
s 21.23(3),
Residential
Care Subsidy
Principles 1997
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Direct payroll tax liability is the payroll tax owed by an employer to the relevant state
or territory revenue oce for wages paid by that employer to its employees. The
employer is registered with the relevant state or territory revenue oce as being
either individually, or as part of a group, responsible for the payment of payroll tax.
A payroll tax group occurs where two or more businesses are registered with
their respective relevant state or territory revenue oce where, in total, they are
responsible for the payment of the group’s direct payroll tax liability. Groups may
consist of businesses across more than one state or territory, and/or more than
one approved provider.
Employers who are charitable and not-for-profit organisations typically incur an
indirect payroll tax liability. Indirect payroll tax liability occurs where a provider is not
registered with a state or territory revenue oce for the purposes of paying payroll
tax, but pays invoices to another business, including a cost breakdown showing the
payroll tax component of any services rendered.
Who can claim the payroll tax supplement?
To be eligible to claim the payroll tax supplement, an aged care service must meet
the following criteria:
the service must be operated by an approved provider
See legislative
reference.
the approved provider must either be a registered or non-registered entity
a registered entity is an approved provider that is registered with their
relevant state or territory revenue oce for payroll tax See legislative
reference.
a non-registered entity is an approved provider that is
not registered with
their relevant state or territory revenue oce for payroll tax. These providers
have incurred a liability to pay payroll tax to a registered entity in relation
to residential care services See legislative reference.
the approved provider must be able to substantiate to the Medicare Australia
any claims for payment of the supplement—ie, invoices or evidence of
registration for payroll tax liability.
How the supplement is calculated
The way in which the amount of supplement is calculated will vary according to
whether the approved provider has a direct or indirect payroll tax liability in relation
to residential care provided to care recipients.
However, to calculate all payroll tax supplements, subsidy and supplement payments,
as well as bed day totals paid in the previous financial year are used to determine the
payroll tax supplement in the current financial year. New facilities that have no prior
funding history to draw from are paid a default rate that is equal to the state or
territory payroll tax supplement rate for the state in which the service is located.
Approved providers should consult their financial or tax adviser for information on
the relevant state or territory payroll tax supplement rates which may apply to their
services and how to calculate payroll tax supplements.
INCOMETESTED FEE
The aged care income test determines whether a person is eligible to pay an income
tested fee and, if so, the amount of fee that is payable.
l e g i s l a t i v e r e f e r e n c e s
Part 2.1, Aged
Care Act 1997
s 21.25(4),
Residential
Care Subsidy
Principles 1997
s 21.25(5),
Residential
Care Subsidy
Principles 1997
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l e g i s l a t i v e r e f e r e n c e s
Which residents cannot pay an income tested fee?
The following residents cannot be asked to pay income tested fees: See legislative
reference.
full pensioners
respite care resident
former prisoners of war (POWs)
residents who have one or more dependent children
residents who the Secretary determines should have their income tested fees
reduced to zero—ie, because they applied for and were granted a determination
of hardship
residents who die before their maximum income tested fee has been notified
to the provider by the Department. There will be a lapse between the death of
a resident and the Department updating its records to reflect the death, so the
Department may advise of the maximum income tested fee for that resident
after they have died. Providers must not recover income tested fees from the
resident’s estate in these cases
residents who depart from the aged care service before their income tested fee
amount has been notified to the provider and who do not move to another
service
residents for whom the service is not receiving income tested subsidies (care
subsidy and/or primary supplements) and therefore whose cost of care is zero.
A resident’s cost of care is the amount worked out using steps (1), (2) and (3) of
the residential care subsidy calculator
residents who could otherwise have been asked to pay a maximum income
tested fee of less than $1.00 per day
residents who don’t receive sucient income to be asked to pay an income
tested fee
people who were permanent residents in an aged care service between 1
October 1997 and 28 February 1998 inclusive, even if they move to another
service or take a break before entering another service.
Maximum income tested fee
The maximum income tested fee that a resident can be asked to pay, is the lesser of:
the assessed income tested fee based on their income
or the maximum income tested fee
or the cost of care.
The maximum income tested fee is capped and from 20 September 2009 is
equivalent to 135 per cent of the basic age pension worked out on a daily basis.
Working out the amount of income tested fee
Residents may be asked to pay an income tested fee if their total assessable income
is above the applicable threshold rate. The income tested fee is then calculated as
5/12th of income above the applicable threshold rate.
s 44-22(1), Aged
Care Act 1997,
s 21.30, Residential
Care Subsidy
Principles 1997
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The only exception to the above calculation is for pre-March 2008 reform residents
who will have their income tested fee set at the lesser of the amounts calculated as
follows;
5/12th of all income above the threshold rate
or 25 per cent of private income above the pension income free area.
INCOME TESTING PROCESS
The major steps and processes in the income testing process are as follows.
Resident entry record (RER)
The provider completes and sends in a RER for each new resident to their Aged
Care, Medicare Australia State Oce. Providers are required to complete an RER
for each new resident within 28 days of them entering permanent care. However,
providers are advised to return the RER as soon as possible after the resident enters
care, so that the matching process can commence. See References at the end of
this chapter for a link to the RER.
Data matching and income assessment
Information from the RER is passed electronically to Centrelink and DVA for data
matching. For people receiving an income support payment such as age or service
pensions, the resident’s income amount is identified by either Centrelink or DVA
from information already on record for that person. For other residents, and for
people receiving non-means tested pensions such as aged blind pension, DVA war
widow pension, or DVA disability pension, their income amount can be worked out
on the form ‘Helping you with your residential aged care fee’ (SA316).
To protect residents’ privacy, only agreed information is transferred between
departments in the income testing process. Serious penalties apply if any of the
protection of resident privacy is breached.
Data matching occurs automatically in most cases and a person’s income amount
is passed electronically to the Department.
Applicable fees and fee advice letters
The Department uses the income amount to calculate the maximum basic daily
fee and income tested fee. The Department writes to both the resident and to the
provider to inform them of their assessed maximum basic daily fee and/or income
tested fee.
Residents cannot appeal to the Department against the advised maximum income
tested fee, since this is based on a formula applied to the assessed income. However,
they can appeal through either Centrelink or the DVA if they disagree with the
assessed income amount on which the maximum income tested fee is based.
A resident can apply to the Department under the aged care hardship provisions,
if the resident can show that paying their advised daily fee would cause genuine
financial hardship. If a determination of financial hardship is granted, the resident’s
fee will be reduced by the amount of the hardship supplement notified in the
determination. See Hardship on page 140.
For most residents, the income testing process is completed within a week of the
Department being advised of their entry to permanent care.
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However, if no letter has been received within a month of the RER being sent:
the provider should check that the information on the RER is exactly the same
as it appears on the resident’s pension concession card
check whether non-pensioner residents have completed and returned the form
‘Helping you with your residential aged care fee’ (SA316) to the local Centrelink
oce
pensioners may also need to contact Centrelink on DVA if they have not been
matched
the provider can contact the Department for further investigation.
Revised fees
Centrelink and DVA electronically pass revised income amounts to the Department
as they occur. Changes may occur automatically—for example, financial assets
reviews—or as a result of information provided by the resident. The Department uses
the revised income amount to calculate the revised maximum basic daily fee and/or
income tested fee, if applicable. The Department advises the service and the resident
about changes to the fees at quarterly review times.
Centrelink form ‘Helping you with the assessment of your residential aged
care fee’ (SA316)
For residents who cannot be automatically matched for income assessment,
Centrelink uses information obtained from this form to assess income. Residents
such as self-funded retirees and those who do not receive a means-tested payment,
should complete and return this form as soon as possible, so that this information
can be used for their income assessment.
Residents who choose not to provide income information should be informed that
they may be asked to pay the maximum fee, or their cost of care, whichever is less.
Residents should be encouraged to seek financial advice before choosing this
option. This form is available from Centrelink. See References at the end of this
chapter for a link to Centrelink.
Residents who do not provide income information (means not disclosed)
residents
Residents who cannot be identified as DVA or Centrelink means-tested pensioners and
who do not complete the form ‘Helping you with your residential aged care fee’ (SA316)
will be identified to the Department by Centrelink as means not disclosed (MND). For
these residents, the Department will apply the maximum income tested fee.
MND residents can choose, at any time, to provide their income and asset
information to Centrelink. Once Centrelink has conducted the income assessment,
the income tested fee will be reassessed and adjusted accordingly.
Reviews of income tested fees
The Department will conduct reviews of residents income tested fees. These reviews
can occur automatically when a resident’s circumstances change, at set times or
manually. Some reviews will also calculate any refund of overcharged income tested
fees that the resident may be entitled to. The dierent types of reviews are:
Significant change—this review will occur when there is a significant change
in the resident’s income status—for example, when a resident’s status changes
from MND to having provided information to Centrelink.
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ACFI—an ACFI review occurs if the initial ACFI assessment is placed on the aged
care payment system after the resident has had an initial income tested fee set.
This ensures that residents are not asked to pay an income tested fee that is
more than their cost of care.
Ad-hoc—the Department can perform ad-hoc reviews if requested to by
a resident. If the resident believes that there has been a reduction to their
income, and they have had a reassessment done by either Centrelink or DVA,
they can contact the Aged Care Information Line on 1800 500 853 to request
a review of their income tested fee.
Quarterly (which can calculate a refund amount)—the Department reviews all
residents income tested fees four times a year, in March, June, September and
November. The eective date of the changes to the income tested fees will be
20 March, 1 July, 20 September and 1 January. The set income tested fee will
only change if it has been reduced or there has been an increase of more than
10 cents per day. These reviews will also calculate any refund amount that the
resident may be entitled to for periods prior to the quarterly review eective
date. See Refunds of overcharged income tested fees following for more
information.
Discharge (which can calculate a refund amount)—when the Department
receives advice that a resident has been discharged from an aged care service,
a discharge review will be conducted to calculate any refund amount that the
resident may be entitled to for overcharged income tested fees for periods up
to the date of discharge.
Residents will only receive review advice letters if there has been a change in their
income tested fee or they are entitled to a refund.
Refunds of overcharged income tested fees
When the Department conducts quarterly and discharge reviews, a calculation of the
previously charged amounts will occur to determine whether the resident has been
overcharged for any past periods.
Generally the refund calculation will only look at periods that have not previously
been included at quarterly review times, up to the date of the last certified claim
period. For example, if a resident was admitted on 1 January and the first quarterly
review was conducted on 20 March, the refund calculation would look at the period
from 1 January to 28 February (provided that this was the last certified claim month
for the aged care service). The following quarterly review, if conducted on 10 June,
would look at the period from 1 March to 31 May (provided that this was the last
certified claim month).
However, refund calculations will also look at any periods in which the resident
has had a change to their assessed income amounts. For example, if in the above
situation the Department had received advice, on 20 May, that the resident had
a change to their income backdated to date of admission, the quarterly review
conducted on 10 June would then look at the period from date of admission
up to 31 May.
Providers are required, under the Act, to charge residents no more than the amount
permitted under the Act. They therefore must pay any advised refund amounts to
the resident or their estate. Full details of the refund, including the period and the
corrected amount of income tested fee, are provided on the next payment
statement generated after the review is conducted.
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l e g i s l a t i v e r e f e r e n c e s
REMOTE AREA ALLOWANCE
Centrelink pays a remote area allowance to pensioners who live in certain remote
areas. Providers whose aged care service is located in one of these areas may
charge residents of that service an additional daily amount. See legislative reference.
Providers who wish to check whether their aged care service is located in a qualifying
remote area should contact Centrelink.
See References at the end of this chapter for Centrelink contact information; and
for a link to the maximum amount from the remote area allowance an approved
provider can currently charge a resident.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN PART B OF THIS CHAPTER
See References at the end of this chapter.
ss 23.82 and
23.83, User Rights
Principles 1997
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C. GOVERNMENTFUNDED SUPPLEMENTS AND SUBSIDY
REDUCTIONS
RELEVANT LEGISLATION
s 58-1(a),
Aged Care Act 1997 (the Act)
ss 23.82 and 23.83,
User Rights Principles 1997
OVERVIEW
Additional supplements referred to in the following pages are funded wholly by the
Government. They are paid to approved providers in recognition of the high costs
associated with providing certain types of residential aged care, such as respite care;
or with providing residential aged care in certain locations, such as remote and rural
areas.
Information on reductions in subsidy which apply to residents who have a
compensation entitlement and to residents receiving care in extra service places,
is also outlined in Reductions in subsidy on page 138.
Rates and additional information
The rates for supplements change over the course of a year. For this reason, actual
dollar amounts payable are not included in this Manual. Current rates are available
on the Department’s website, in the Aged Care Essentials newsletter (formerly
known as Payment Essentials newsletter) and from the Aged Care Information Line.
See References at the end of this chapter for links and contact information.
How to calculate fees payable by a resident
To calculate the maximum daily fee that a resident may be asked to pay, approved
providers should: See legislative reference.
(1) work out the applicable standard resident contribution—ie, the maximum basic
daily fee
(2) add any compensation payment reduction that applies for the resident
(3) add any applicable maximum income tested fee for the resident
(4) subtract any hardship supplement that applies for the resident
(5) add any other amounts agreed between the provider and the resident, that is,
agreed fees for additional services
(6) if the resident is in an extra service place and receiving care on an extra
service basis, add the extra service amount
(7) for an aged care service located in a remote area, add the remote area
allowance amount.
A resident may also be asked to pay an accommodation bond or an accommodation
change.
l e g i s l a t i v e r e f e r e n c e s
s 58-1(a), Aged
Care Act 1997
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VIABILITY SUPPLEMENT
Some aged care services in rural and remote areas receive an additional viability
supplement in recognition of the higher costs of providing care in those regions.
The viability supplement aims to improve the capacity of small, rural aged care
services to oer quality care to residents. Providers do not need to apply for
the viability supplement. The supplement is paid automatically, every month,
to eligible providers.
Services with extra service status are not eligible for the viability supplement.
In addition to the current viability supplement scheme, which is known as the 2005
scheme, there are two previous schemes—the 2001 scheme and the 1997 scheme.
Services will continue to be paid under previous schemes, unless they would receive
an increase in the supplement under the 2005 scheme. See Viability supplement—
previous schemes following.
Viability supplement—current 2005 scheme
Funding for the current 2005 scheme is based on points scored in relation to the
three criteria below. To be eligible for the 2005 scheme, a service must score at least
50 points out of a possible 100. The criteria are:
the remoteness of a service’s location—the Accessibility/Remoteness Index of
Australia (ARIA) is used to assess the remoteness of a service. Up to 65 eligibility
points are awarded for this criterion
the number of places in the service, which is taken as an indicator of its size.
Up to 30 eligibility points are awarded for this criterion. If a service has 19 or
fewer places, it receives 30 eligibility points
the proportion of residents in the service who have special needs (excluding
people who are financially or socially disadvantaged and people living in rural
and remote areas). If more than 50 per cent of the residents are Aboriginal or
Torres Strait Islander people, people from a non-English speaking background,
veterans or war widows, the service receives 5 eligibility points.
See References at the end of this chapter for a link to ARIA scores for all locations;
and for current rates for the viability supplement.
Viability supplement—previous schemes
All services that received viability funding under the 1997 or 2001 viability funding
arrangements will continue to receive at least their level of viability funding received
under the previous arrangements until they close, relocate or cease to be eligible
under the previous arrangements.
Where a service’s score under the 2005 scheme’s criteria is such that the rate of
funding under the 2005 arrangements is greater than the rate of funding under the
previous arrangements, the service will receive its entitlement under the 2005
arrangements.
If adjacent services combine and at least one of these facilities was receiving viability
supplement under a previous scheme, the combined service will be reassessed for
the viability supplement under the 2005 viability arrangements.
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RESPITE SUPPLEMENT
An approved provider is eligible for residential care subsidy, including the respite
supplement, for each day they provide residential respite care to an approved respite
care recipient who has not used up his or her annual allocation of respite days. For
more information on the respite supplement, see Residential care subsidies in
chapter on Residential respite care in this Manual.
REDUCTIONS IN SUBSIDY
Compensable residents
If a resident with a compensation entitlement (such as an entitlement to compensation
arising from a workplace or motor vehicle accident or from a common law claim) is
admitted to an aged care service, the service must inform the Department.
The Department may then apply a compensation payment reduction amount from
the day that the resident is admitted; and will advise the aged care service and the
compensable resident of the amount of the compensation payment reduction. The
service will be able to invoice the compensable resident for the total amount of the
compensation payment reduction in addition to the other relevant resident fees
and charges.
A provider should inform the Department about a compensable resident by completing
the relevant section on the Resident Entry Record form.
If a service does not tell the Department that a resident is entitled to compensation
and the Department only becomes aware of this later, the Department will recover
the residential care subsidy paid on behalf of the compensable resident for the
period where a compensation payment reduction should have applied.
A compensation payment reduction will be applied thereafter.
Approved providers can contact the Department with queries about compensable
residents. See References at the end of this chapter for contact information.
Claim not settled yet
If a compensable resident’s claim has not been settled, the Department will continue
to pay subsidy for that resident until settlement. After settlement, conditions for
compensable residents will apply, as outlined in Compensable residents on page 138.
Extra service reduction
If a resident receives care on an extra service basis, the residential care subsidy will
be reduced for the care of this resident. The amount of this reduction is called the
extra service reduction. See also Extra service amount and extra service reduction
in chapter on Extra service places in this Manual.
Adjusted subsidy reduction
The adjusted subsidy reduction is applicable for residents in an aged care service,
or part of a service, that is determined by the Minister to be an adjusted subsidy aged
care service. Since 1 July 2007, only services that are operated by state or territory
governments are subject to this subsidy reduction.
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The adjusted subsidy reduction is indexed annually and is approximately 9 per cent
of the daily high care subsidy. Any places aected by the adjusted subsidy reduction
that are transferred to the non-Government sector have the reduction removed
eective from the date of transfer.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN PART C OF THIS CHAPTER
See References at the end of this chapter.
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D. HARDSHIP
RELEVANT LEGISLATION
Sections 44-30, 44-31, 57-14, 57-15, 57A-9, 57A-10 and 85-1,
Aged Care Act
1997 (the Act)
Part 15,
Residential Care Subsidy Principles 1997
OVERVIEW
Residents who have diculty paying the standard resident contribution,
an accommodation payment or a care fee (ie, income tested fee) can apply
for assistance under the hardship provisions.
If a resident meets the hardship criteria, the Department will pay the provider
a hardship supplement for this resident. The provider then reduces the resident’s
fee by the amount of any hardship supplement paid for that person.
In general, residents need to apply for a hardship supplement. However, there are
five classes of people for whom an amount of hardship supplement is automatically
paid. See Class hardship determinations following.
A hardship supplement will not be payable for a resident:
who is an ex-hostel resident paying a variable fee agreed to under the
Aged or
Disabled Persons Care Act 1954
who is receiving care on an extra service basis.
Rates and additional information
The rates for fees, subsidies and supplements change over the course of a year.
For this reason, actual dollar amounts payable are not included in this Manual.
Current rates are available on the Department’s website, in the Aged Care Essentials
newsletter (formerly known as Payment Essentials) and from the Aged Care
Information Line. See References at the end of this chapter for links and contact
information.
CLASS HARDSHIP DETERMINATIONS
There are five classes of people for whom an amount of hardship supplement
is automatically paid. These are: See legislative reference.
Class A—paid to residents under 21 years of age who receive an income
support payment and whose total income is below the amount of the single
age pension. The resident’s basic daily fee is reduced by the amount of
supplement. The Department will contact these residents about the reduction
in fees and to ascertain whether additional financial hardship assistance is
required. If these residents do not have an income support payment, they may
apply for financial hardship assistance.
Class B—paid to residents under 16 years of age who are dependent children
and whose total income is below the single rate of the social security pension
amount. As with Class A, the resident’s basic daily fee is reduced and the
Department will contact the resident’s representative regarding the reduction
in basic daily fees and any additional financial hardship assistance that may
be available.
l e g i s l a t i v e r e f e r e n c e s
s 21.37,
Residential
Care Subsidy
Principles 1997
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l e g i s l a t i v e r e f e r e n c e s
Class C—paid to pre March 2008 self-funded retirees who receive an income
that is just above the pension income test cut-o and therefore may be asked
to pay up to the non-pensioner rate of basic daily fees. It is recognised that
these residents may be disadvantaged by paying the dierence between the
pensioner and non-pensioner rate of the basic daily fee. The Class C Hardship
supplement ceases if a resident’s income is not within a specific range.
Class D—paid to residents who were in receipt of an income support payment
that was lost as a result of the aged care arrangements that commenced on
1 October 1997.
Class E—paid to residents who were living in a hostel on 30 September 1997,
who have not since moved to a nursing home which was approved prior
to 1 October 1997.
INDIVIDUAL HARDSHIP DETERMINATIONS
A resident can apply to the Secretary for a determination that paying the standard
resident contribution, an accommodation payment or a care fee (income tested fee)
would cause financial hardship. See legislative reference. Each case of hardship
assistance is assessed on an individual basis.
The Department may ask the applicant for further information in order to make the
determination. In these cases, the extra information will generally need to be
provided to the Department within 28 days, or the hardship application will be taken
as withdrawn. Where a legal guardian signs on behalf of the resident, a copy of their
authority to act on the resident’s behalf must be attached to the application.
The resident and the provider will be notified in writing of the decision on whether
to make a determination under the hardship provisions. This will usually happen
within 28 days of the Department receiving the application, or within 28 days
of receiving any other information that has been requested.
A hardship determination may include a specified period during which it will remain
in force or a particular event which will cause the determination to cease to be in
force. The inclusion of any such period or event is a reviewable decision.
A hardship determination can take eect retrospectively—for example, the
determination may apply from the resident’s date of entry to the aged care service,
or from the date a resident’s assets are not realisable.
An applicant may also seek a review of a decision not to make a hardship
determination. The Department will provide details of how to apply for a review with
the notification of determination.
Applications must be made on the approved application for financial hardship
assistance form. See References at the end of this chapter for a link to the form.
How are hardship assessments conducted?
An assessment of a resident’s income and assets is undertaken by Centrelink or DVA.
Currently, hardship assistance may be approved in situations where a resident retains
less than the equivalent of 15 per cent of the maximum rate single age pension,
following the payment of their essential expenses. This amount is subject to change.
The resident’s realisable assets are also taken into account by the decision maker
where a reduction in the basic daily fee and/or income tested fee has been requested.
s 44-31, Aged
Care Act 1997
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Generally speaking, only essential care-related expenses that total more than $20.00
per fortnight can be taken into account in the assessment of hardship applications for
permanent care. Examples of such expenses include:
pharmaceutical and continence aid expenses
optical, dental or podiatry expenses
other non-discretionary expenses.
For respite care, a wider range of expenses are taken into account due to the need for
a resident to maintain their service in the community. Additional expenses able
to be considered are:
utilities and rates expenses
home and contents insurance
rental or mortgage payments.
How do hardship determinations end?
If a hardship determination will end following a specified period or event, the
Department will advise both the resident and the provider of this. For example,
the notice of hardship determination may state that the determination will end
on a particular date, or earlier if the resident’s circumstances change. If the
determination ends earlier than expected due to a change in circumstances,
the aged care provider and resident will be advised.
Revoking financial hardship
A determination of financial hardship may be revoked. The Department will write
to the resident and the provider if revocation is being considered, giving 28 days in
which to respond to the Department with a written submission. If no submissions are
made within that time, revocation of the hardship determination will take eect on
the day after this 28-day period has lapsed. Once the date for submissions has
passed, the Department has a further 28 days in which to make a decision about
whether to proceed with revocation and to advise the resident and the provider.
See legislative reference.
A revocation takes eect the day after both the resident and the provider have
received notice of the decision. If they received notice on separate days, this means
the day after the later day.
Reviewable decisions
The following decisions relating to a determination of hardship are reviewable:
See legislative reference.
refusing to make a determination that a resident is eligible for a hardship
supplement
specifying that at the end of a certain period or due to the occurrence
of a certain event, a determination under s 44-31 will cease to be in force
to refuse to make a determination that payment of an accommodation payment
would cause financial hardship
l e g i s l a t i v e r e f e r e n c e s
s 57-15, Aged
Care Act 1997
s 85-1, Aged Care
Act 1997
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to refuse to make a determination that paying an accommodation payment
of more than a specified maximum amount would cause financial hardship
or to specify a particular maximum amount under such a determination
revocation of a determination that paying an accommodation payment would
cause financial hardship.
HARDSHIP, STANDARD RESIDENT CONTRIBUTION AND CARE
PAYMENTS INCOME TESTED FEE
The maximum reduction of the standard resident contribution (basic daily fee) that
is available under the financial hardship provisions is a reduction to zero. In most
instances, a favourable assessment results in a partial reduction of the basic daily
fee. Applications can be considered for both permanent and respite care.
An income tested fee may only be set to zero. Income-tested fees cannot be
partially reduced and for this reason it is more common to see a reduction in the
basic daily fee which takes into consideration the impact of the payment of the
income tested fee.
How is a hardship supplement paid where financial
assistance is given for the basic daily fee?
Where a determination has been made regarding a basic daily fee, an individual
hardship supplement is paid to the approved provider, and the resident’s basic daily
fee is reduced accordingly. The total amount of the hardship supplement the
approved provider receives for a resident must be subtracted from the total basic
daily fee that the resident would otherwise have been charged. Approval is almost
always time-limited. At the end of the specified period, a resident must reapply
if they require ongoing assistance.
How is subsidy paid where financial assistance is given for
income tested fees?
Where an income tested fee is set to zero, the provider receives increased subsidy
to compensate for not receiving the income tested fee. This is also the case for
residents who do not have sucient income to be asked to pay an income
tested fee.
HARDSHIP AND ACCOMMODATION PAYMENTS
Financial hardship assistance is available to aged care residents who do not have
sucient assets to pay their accommodation payment. Each case is assessed on
an individual basis, taking into consideration a range of issues which may be unique
to the resident.
From 1 January 2009, the financial hardship provisions have been amended to allow
for circumstances where a person has the ability to pay an amount towards their full
accommodation bond or accommodation charge. Where it has been determined
that a person’s assets are below the maximum threshold for the payment of either
a concessional resident supplement, assisted resident supplement or accommodation
supplement, the appropriate amount of supplement will be paid to the provider
where a hardship determination is in place.
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In cases where a resident’s realisable assets are determined to be above the maximum
threshold, the Act allows for a resident to pay a lesser amount of accommodation
bond for a period of time, while a hardship determination is in place. As the resident’s
assets remain above the maximum threshold, the care provider would not be
entitled to receive a supplement.
While a determination of financial hardship is in force, the resident must not be asked
to pay an accommodation bond or the daily accommodation charge greater than
the maximum amount determined under the financial hardship provisions.
If a resident has logged a financial hardship application, and if that resident would
otherwise be eligible to pay an accommodation payment, then an accommodation
payment agreement must still be entered into within 21 days of the resident’s entry
to the service. The accommodation payment agreement must specify the
accommodation payment which will be payable if the hardship application
is declined or if a hardship determination ceases to be in force.
Applications for financial hardship must be made on the approved form.
See References at the end of this chapter for a link.
Financial hardship—circumstances
The circumstances in which a determination can be made include, but are not
limited to, cases in which payment of an accommodation payment would cause
hardship to the resident, or to their partner or dependent child.
A number of factors are taken into consideration, including unrealisable assets. See
legislative reference. Unrealisable assets are assets which the resident either cannot
or cannot reasonably be expected to sell or realise or use as security for borrowing.
Examples include a farm that was supporting other family members, a property that
has been on the market for a realistic price for six months, or frozen financial
resources.
For information on assessment of hardship applications, see Individual hardship
determinations on page 141. See References at the end of this chapter for a link
to ComLaw for the Social Security Act.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN PART D OF THIS CHAPTER
See References at the end of this chapter.
s 11(12)-(13),
Social Security
Act 1991.
l e g i s l a t i v e r e f e r e n c e s
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l e g i s l a t i v e r e f e r e n c e s
E. LEAVE
FEES DURING PERIODS OF LEAVE
The Act provides the number of days a resident may be on leave from the residential
aged care service. For each day that a resident is on leave, the aged care service
receives resident fees and a Government subsidy as though the resident was actually
receiving care. This means that a provider’s responsibilities, including security of
tenure for the resident’s place, still apply when a resident is on leave.
When a provider is counting days of leave, they should:
include the day when the resident left the aged care service
and not include the day of return.
See legislative reference.
A resident and an approved provider can agree that the resident can be absent for
periods in excess of leave entitlements. In this case, the maximum fee that the resident
can be charged is the applicable resident fee plus an amount equal to the subsidies
which would normally be paid to the provider for that day. See legislative reference.
HOSPITAL LEAVE
A resident can take unlimited days of leave to receive hospital treatment. A subsidy
continues to be paid for residents during periods of hospital leave. Hospital leave
is not available until after a resident has entered the aged care service.
EXTENDED HOSPITAL LEAVE
Extended hospital leave is where a resident has hospital leave for a continuous period
of 30 days or more, in order to receive treatment in hospital.
For residents who are on extended hospital leave, the basic subsidy amount paid
to the aged care service is reduced by:
50 per cent, for residents classified under the ACFI
or 2 category levels, if the resident is still on an Residential Classification Scale (RCS).
Resident fees cannot be increased during extended hospital leave to cover the drop in
subsidy payments.
SOCIAL LEAVE
Residents are entitled to up to 52 overnight absences—ie, 52 days of social leave—per
financial year. This enables residents to spend weekends with their families, without
losing their place at the aged care service.
Subsidies to the service will continue during social leave. However, once a resident
has used up their 52 days of social leave, government subsidies for that resident will
stop. The approved provider can then charge residents the subsidy amount in
addition to their daily fee. See legislative reference.
PREENTRY LEAVE
Pre-entry leave is a maximum of 7 days of leave, which gives a prospective resident
time to make arrangements to enter an aged care service or to transfer from one service
to another. It enables the service to receive a subsidy and keep the place vacant for
the resident for up to 7 days after he or she agrees to enter care.
s 42-3(1), Aged
Care Act 1997
s 58-6, Aged Care
Act 1997
s 58-6, Aged Care
Act 1997
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See legislative reference. It is the only type of leave which can be taken before
a resident enters a service.
Pre-entry leave:
can only be taken from the date the resident agrees to enter the service
or the day 7 days before the day of entry, whichever is later
can be claimed for days on which the intending resident is in hospital
can only be taken for up to 7 days before the resident enters care
can only be claimed where the resident actually enters the service
ceases to be paid once the resident enters the service permanently
cannot be claimed where the person is on leave from another aged care service
the resident can be charged applicable aged care fees for the period of pre-
entry leave.
Up to 7 days of social leave can be used as pre-entry leave, immediately before
a resident enters an aged care service.
HIGHDEPENDENCY CARE LEAVE
High-dependency care leave is when a low care resident temporarily needs a high
level of care and is transferred to an aged care service providing high-level care.
Subsidy is payable for both service providers and the resident may be required
to pay fees to both providers.
The requirements for high dependency care leave are: See legislative reference.
the permanent service is unable to provide a high level of care
the resident temporarily requires a high level of care
the resident’s Aged Care Assessment Team (ACAT) approval cannot be limited
to low level care
the resident must have available social leave days.
Providers should advise the Department about high-dependency care leave as follows:
on the monthly claim form, the permanent service advises of the resident’s use
of social leave days while the resident is at the temporary service
the temporary service:
completes a Resident Entry Record for this new resident, identifying them
as a high dependency care leave resident
undertakes the usual resident ACFI appraisal process to determine the level
of funding for the resident’s period of stay.
The permanent and temporary aged care services will receive subsidy according to
the relevant ACFI categories—ie, the permanent service will continue to receive low
care subsidy, so long as there is a current appraisal in force, and the temporary
service will receive high care subsidy in accordance with the ACFI.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN PART E OF THIS CHAPTER
See References at the end of this chapter.
s 42-1(4), Aged
Care Act 1997
s 42-3(3), Aged
Care Act 1997
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REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Accessibility/Remoteness Index of Australia (ARIA)
ARIA scores for all locations
www9.health.gov.au/aria/ariainpt.cfm
Current rates for the viability supplement are listed with other subsidy and
supplement rates
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-whatnew.htm
Aged Care Information Line
Ph 1800 500 853
Compensable residents—queries
Providers with queries about compensable residents can call the
Aged Care Information Line
Ph 1800 500 853
Or write to
Director
Accountability Section
Department of Health and Ageing
MDP 74
GPO Box 9848
Canberra, ACT, 2601
Financial information service—free—for residents
Centrelink provides a free financial information service, for residents of aged care
services and other citizens.
Ph 13 2300
www.centrelink.gov.au
5 Steps to Entry into Residential Aged Care information pack
5 Steps is available online
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-
resentry_a.htm-copy3
or by calling the Aged Care Information Line
Ph 1800 500 853
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Form—banking details for the direct deposit of payments
Medicare Australia—Aged Care forms
www.medicareaustralia.gov.au/provider/aged-care/forms.jsp#N10185
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Form—financial hardship assistance—application for
The form can be downloaded from the Department’s website
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-fha-form.htm
or obtained by phoning the Aged Care Information Line
Ph 1800 500 853
Form—helping you with the assessment of your residential aged care fee (SA316)
This form is sent to self funded retirees by Centrelink.
Ph 132 300
www.centrelink.gov.au
Forms—oxygen treatment/enteral feeding supplement
Available from Medicare Australia Aged Care forms
www.medicareaustralia.gov.au/provider/aged-care/forms.jsp
Form—nominee—appointment of
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-nomform.htm
or www.medicareaustralia.gov.au/provider/aged-care/forms.jsp
Form—resident entry record (RER)
www.medicareaustralia.gov.au/provider/aged-care/forms.jsp
Interest rates—base interest rate and maximum permissible interest rate—current
The Department updates the base interest rate and the maximum permissible interest
rate each quarter. For current rates check
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-finance-
refundrates.htm
Legislation—other
Go to ComLaw to access other legislation mentioned in this chapter, including the
Social Security Act 1991 and Aged or Disabled Persons Care Act 1954.
www.comlaw.gov.au
Medicare Australia Aged Care forms
www.medicareaustralia.gov.au/provider/aged-care/forms.jsp
Remote area allowance
The maximum amount of the remote area allowance that an approved provider can
charge a resident is listed with other current rates information
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-finance-resfees.
htm-copy2
Request for an asset assessment form
These forms are included with the 5 Steps to Entry into Residential Aged Care
information pack, which is available online
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-resentry_a.
htm-copy3
or by calling the Aged Care Information Line
Ph 1800 500 853
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Resident entry record (RER)
www.medicareaustralia.gov.au/provider/aged-care/forms.jsp
Residential care fees, subsidies and supplements—current
For current rates for residential care fees and charges go to
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-finance-resfees.
htm-copy2
For current Australian government subsidies and supplements go to
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-subs-supplement.htm
State/territory oces of the Department—information on supported resident
ratios for each region.
See Supported resident ratios reference.
Subsidy rates—current
Current ACFI and other subsidy and supplement rates
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acfi-subsidy-rate-
0708.htm
Supported resident ratios—by region
Contact the relevant state or territory oce of the Department for information
on ratios which apply in each region.
New South Wales
GPO Box 9848
Sydney NSW 2001
Ph 02 9263 3555
Ph 1800 048 998
Fax 02 9263 3509
Queensland
GPO BOX 9848
Brisbane QLD 4001
Ph 07 3360 2555
Ph 1800 177 099
Fax 07 3360 2999
South Australia
GPO Box 9848
Adelaide SA 5001
Ph 08 8237 8111
Ph 1800 188 098
Fax 08 8237 8000
Tasmania
GPO Box 9848
Hobart TAS 7001
Ph 03 6221 1411
Ph 1800 005 119
Fax 03 6221 1412
Victoria State Oce
GPO Box 9848
Melbourne VIC 3001
Ph 03 9665 8888
Ph 1800 020 103
Fax 03 9665 8181
Western Australia
GPO Box 9848
Perth WA 6001
Ph 08 9346 5111
Ph 1800 198 008
Fax 08 9346 5222
Northern Territory
GPO Box 9848
Darwin NT 0801
Ph 08 8919 3444
Fax: 08 8919 3400
Australian Capital Territory
PO Box 9848
Canberra ACT 2601
Ph 02 6289 1555
Ph 1800 020 102
Fax: 02 6289 3388
Viability supplement
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-whatnew.htm
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I
Relevant legislation 151
Overview 151
Additional information 152
Conditions of allocation relating to the provision of respite care 152
What proportion of residential aged care should be provided as respite care? 152
What proportion of a service’s care can be provided as respite? 152
How are respite conditions of an individual aged care service varied? 153
How are places which can be used for respite allocated to new and
existing services? 153
Conditions of allocation of respite places—transferring places 153
Approval of respite care recipients 153
How does a person become approved as a respite care recipient? 154
Who is eligible for approval as a respite care recipient? 154
What are the limits on approval to receive respite care? 154
When does an approval cease to have eect? 154
Classification appraisal 155
When do classifications cease to take eect? 155
Approved period of respite care 156
Approving an extra 21 days of respite 156
Respite care for veterans and war widows and widowers 157
Extra service places 157
Residential care subsidies 157
Rules about the payment of subsidies and supplements 158
Additional amount for high care respite 158
Transfers from respite to permanent care 159
Date of entry into permanent care 159
Notification of entry into respite care 159
Monthly claim forms 159
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What fees can be charged for respite care? 159
Respite booking fees 160
Reasons for not taking up a respite admission 160
Leaving a service before the end of a booked period 161
Resident’s agreement 161
Accommodation payments 161
Residents’ rights 161
References—links, guides and forms referred to in this chapter 162
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RESIDENTIAL RESPITE CARE
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 2.2, Division 12, s 12-5; Division 13, s 13-2, 13-3; Division 14, s 14-5; Division
16, s 16-6, 16-8, Aged Care Act 1997 (the Act)
Part 2.3, Division 22, s 22-2; Division 23, s 23-3,
Aged Care Act 1997
Part 2.4, Division 25, s 25-2, 25-3; Division 26, s 26-3; Division 27, s 27-2,
Aged
Care Act 1997
Part 3.1, Division 42, s 42-2; Division 43, s 43-8; Division 44, s44-4, 44-5, 44-6,
44-12, 44-22, 44-28, Aged Care Act 1997
Part 4.2 Division 56, 56-1; Division 58, s 58-3; Division 59, s 59-1, A
ged Care Act
1997
Part 6.5, Division 96, s 96-2; Schedule 1 Dictionary—definition of “respite care”,
Aged Care Act 1997
Approval of Care Recipients Principles 1997
Allocation Principles 1997
Residential Care Subsidy Principles 1997
s 23.16(3A), s 23.16(3B), s 23.16(3), s 26.14(3A), s 26.14(3B), s 23.16(4), s 23.16(3B),
23.16(5), User Rights Principles 1997 (User Rights Principles)
OVERVIEW
Residential respite care provides a break for people living in the community and
their carers.
Respite care is defined in the Act as “residential or flexible care (as the case requires)
provided as an alternative care arrangement with the primary purpose of giving a
carer or a care recipient a short-term break from their usual care arrangement. A
person can have up to 63 days of respite care in a financial year with the possibility
of 21 day extensions if approved by an Aged care Assessment Team (ACAT or ACAS
in Victoria). Residential respite care is provided as either low or high level care.
However, it does not include residential care provided through a residential care
service while the care recipient in question is on leave under section 42-2 from
another residential care service”. See legislative reference.
This chapter of the Manual is intended as a guide to the administrative procedures
relating to the provision of residential respite care.
In summary:
as part of the planning process for residential care, the Government aims to
ensure there is adequate provision of respite care, providing for an equitable
distribution across regions
in making an allocation of places to an approved provider subject to conditions,
the Secretary can set a minimum proportion of care that must be provided as
respite See legislative reference.
Schedule 1—
Dictionary, Aged
Care Act 1997
s 14-5, 14-6,
Aged Care
Act 1997
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respite care recipients are not assessed against the ACFI. Classifications for
respite care are based on an ACAT approval for either high or low level care
permanent residents of a residential aged care service cannot be approved
for residential respite care in another aged care service
in order to provide residential respite care, service providers need to be approved
to provide residential aged care. See also chapters on Becoming
an approved provider and Allocated places in this Manual.
Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can also
be accessed through the Aged Care Information Line on 1800 500 853.
CONDITIONS OF ALLOCATION RELATING TO THE PROVISION
OF RESPITE CARE
In applying for an allocation of places through the Aged Care Allocations Round
(ACAR), an approved provider may undertake to make a certain proportion of care
available for respite care—also known as a number of respite place days. The
competitive advantage given to applications undertaking to deliver a high level of
respite care will depend on factors such as the existing regional level of supply and
demand for residential respite care.
What proportion of residential aged care should be provided
as respite care?
In making an allocation of places to an approved provider subject to conditions,
the Secretary can set a minimum proportion of care that must be provided as respite.
See legislative reference. Before determining such conditions, the Secretary must
consider:
the demand in the region concerned for respite care
the demand in the region for permanent care
the needs of carers and care recipients
equity in the respite care provided in dierent regions.
However, the Secretary may also consider any other matters relevant to the eective
provision of respite care. See legislative reference.
If an approved provider fails to meet a condition of allocation, non-compliance
deductions may apply. See legislative reference. See also section on Conditions
applying to particular allocations in chapter on Allocated places in this Manual;
see References at the end of this chapter for a link to the ACAR Essential Guide.
What proportion of a service’s care can be provided as respite?
The proportion of care to be provided as respite may be a condition of a service’s
allocation of places. The proportion can be varied through a variation of the
conditions of allocation of the places.
s 14-5, 14-6,
Aged Care Act
1997
s 4.47, Allocation
Principles 1997
s 43-8, Aged Care
Act 1997
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How are respite conditions of an individual aged care
service varied?
An approved provider may apply for a variation to the conditions of allocation
of places under Division 17 of the Act. See legislative reference.
If a service is applying to vary its conditions of allocation—including conditions
for the allocation of respite care—it should fill out the application for a variation
of conditions of allocation form. See References at the end of this chapter for
a link to this form.
If the variation is granted, this varied condition will continue into future financial years
unless the service requests another variation.
How are places which can be used for respite allocated
to new and existing services?
The Minister determines how many residential aged care places are available for
allocation. The Secretary then distributes these places among the regions, also
deciding what proportion of care is to be provided as respite care. In order to
determine this proportion, the Secretary must take into account the demand
for respite care and permanent care in the region, the needs of carers and care
recipients and equity of respite provision between regions. See legislative reference.
When it applies for an allocation of residential care places, an approved provider
must specify the proportion of care, if any, to be given as respite care. In considering
the application, the Secretary will then take into account the applicant’s readiness to
comply with respite planning objectives and their stated commitment to make the
respite place days available for respite care.
If an aged care service applies for an allocation of residential care, the Secretary may
allocate the places with a condition specifying the proportion of respite care to be
provided by that service. This is stated as a condition of approval of the service. The
applicant will be notified of this condition if their application is successful.
CONDITIONS OF ALLOCATION OF RESPITE PLACES
TRANSFERRING PLACES
When allocations of residential care places are transferred, any condition of
allocation will generally transfer with the places, unless the transferor and transferee
apply to have the conditions varied. See legislative reference. As the obligation to
provide respite is a condition of allocation of these places, the proportion of care
that must be provided as respite will continue to apply, and this obligation to provide
respite transfers to the provider who is transferred these places. See legislative
reference.
APPROVAL OF RESPITE CARE RECIPIENTS
A potential respite care client must initially be assessed by an ACAT. Based on the
assessment, residential respite care recipients will be approved for either high or low
level care. This care may be limited to a specific period. See legislative reference.
The approval must expressly cover the provision of respite care. If it does not, the
approval is limited to the provision of care other than respite care. See legislative
reference.
Division 12, Aged
Care Act 1997
s 16-2(2)(d), Aged
Care Act 1997
s 16-6(e)(iii), Aged
Care Act 1997
s 22-2(1)(c), Aged
Care Act 1997
s 22-2(1), Aged
Care Act 1997
Division 17, Aged
Care Act 1997
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Both residential care subsidy and respite supplement can only be paid where
a person is approved as a respite care recipient. See legislative reference. High level
subsidy and supplement will be paid for care recipients approved by an ACAT as
needing high level residential respite care. The lower subsidy and supplement level
is paid for all care recipients approved by the ACAT as needing low level residential
respite care. A person approved to receive high level respite care can, however,
receive low level respite care. See legislative reference. This would normally occur
if both the aged care service and the resident agree that this is more appropriate;
and in such a case, the low level respite subsidy and supplement would be payable.
See also chapter on Approval of residents in this Manual.
How does a person become approved as a respite
care recipient?
Approval for residential respite care is obtained in the same manner as approval for
permanent residential care and other forms of Government-subsidised care. The
approval must be on the Aged Care Client Record, and indicate that the person is
eligible and approved for residential respite care at either a high or low level.
Who is eligible for approval as a respite care recipient?
People who meet the eligibility criteria for approval for residential care, and who
need respite care, are eligible for approval for residential respite care. It is possible
for a person to be approved for both residential respite and permanent care at the
same time.
However, a permanent resident of a residential aged care service cannot receive
residential respite care in another aged care service.
What are the limits on approval to receive respite care?
The ACAT can limit a person’s approval for residential respite to a specific level of
care or to a specified period of time. See legislative reference. ACAT approvals
specify the level of residential respite care a person needs as either high or low.
This is used to determine the level of respite subsidy and supplement payable for
the person.
Respite care subsidies and supplements are only paid where the care recipient is
approved by an ACAT to receive residential respite care.
When does an approval cease to have eect?
An approval for residential respite care will not lapse but can expire
if it is either time limited or revoked.
An approval allows for up to 63 days of subsidised residential respite care in
a financial year. If respite care is needed for longer than this, a person can apply
for a 21-day extension. See Approving an extra 21 days of respite on page 156.
Where a care recipient’s approval is limited to a low level of residential respite care
and their care needs have changed, they must be reassessed by an ACAT before
they can be approved for high level residential respite care.
s 44-12, Aged
Care Act 1997
s 5.9(2), Approval
of Care
Recipients
Principles 1997
s 22-2, Aged Care
Act 1997
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EXAMPLE
Tessa was approved for residential respite care, limited to a low level, almost two
years ago. Since being approved by the ACAT, Tessa has twice been admitted to
hospital and her care needs have increased significantly and she requires some
nursing care. Tessa’s daughter, who is her primary carer, has booked to go on a
six week holiday and contacts the local nursing home to book Tessa in for respite
care. In discussing Tessa’s care needs and recent hospitalisations, it is clear to the
care team manager that Tessa will require high level care. The care team
manager advises Tessa’s daughter that even though Tessa’s approval for low level
respite care is current, as it does not lapse, her care needs have changed, so a
new ACAT assessment and approval for high level care is required prior to Tessa
commencing respite care, so that Tessa can occupy a high level bed and the
aged care provider can be paid the correct rate of subsidy. Tessa’s daughter
contacts the ACAT and arranges a reassessment prior to Tessa’s admission.
EXAMPLE
Bill is approved for high level residential respite care. He applies to enter an aged
care service for respite, not having used residential respite care since the ACAT
signed the approval over twelve months ago. Bill does not need to be
reassessed by the ACAT unless his care needs have changed.
CLASSIFICATION APPRAISAL
There are only two levels of classification and therefore subsidy available to respite
care residents:
high level care
or low level care.
The classification level applies from the day that the person enters care,
as determined based on their ACAT approval level only.
Respite care recipients are not appraised and the ACFI does not need to be completed
for respite care recipients.
When do classifications cease to take eect?
A respite care recipient’s classification ceases if the care recipient has used more
than 63 days of respite care in the financial year; plus any extra periods of 21 days
approved by an ACAT. In this case the classification ceases on the day after the
number of days is used. See legislative reference.
Respite care residents, if not already approved for permanent care, need to be reassessed
and approved for permanent care by an ACAT before transferring to permanent care.
They will also be assessed against the ACFI. See Transfers from respite to permanent
care on page 159; see also chapter on Approval of residents in this Manual.
Item 7, s 27-2(1),
Aged Care
Act 1997
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Approved period of respite care
Respite days used by the respite care recipient are cumulative across services. The
approved number of respite days is the maximum number a resident may use during
the approval period, regardless of the number of services that provide the care to
them. See legislative reference.
The approved provider must satisfy themselves that the care recipient has sucient
respite days remaining to cover the proposed period of respite and a valid ACAT
approval. If in doubt the provider should contact Medicare Australia to check. See
References at the end of this chapter for Medicare Australia contact information.
A care recipient can receive up to 63 days of subsidised respite in any financial year.
This total covers respite admissions to all Government-subsidised residential aged
care services. However, if a person needs more than 63 days of respite care in the
financial year, the ACAT can approve extension periods of 21 days at a time. See
Approving an extra 21 days of respite following. See legislative reference.
The service is also unable to claim subsidies for the person as a permanent care
recipient unless an ACAT:
has either approved the care recipient for both respite and permanent care
(and the approval is still valid) or has reassessed and approved the person
as eligible for permanent residential care.
Respite care residents cannot transfer to permanent residential care unless they have
a valid ACAT approval for permanent care.
Approving an extra 21 days of respite
If a care recipient has entered residential respite care, and their 63 day allocation is
due to expire, an application for a 21-day extension should be made to the Secretary
through the ACAT. More than one 21-day extension may be approved in a financial year.
In deciding whether or not to extend residential respite care, the delegate will
consider circumstances such as carer stress, a temporary or unexpected increase
in the severity of a care recipient’s condition, absence of the carer and any other
relevant matter.
The care recipient’s needs, abilities and wishes, access to and use of appropriate
community and social supports will also be considered. In extending residential
respite care, delegates must consider the appropriateness of continued respite care
arrangements or whether permanent residential care may be a more suitable option.
Any extension must be at the same level of care as approved on the Aged Care
Client Record. If an approval is limited to a low level of residential respite care and the
person now requires high level residential respite care, reassessment and approval by
the ACAT is required.
If an extension is granted the ACAT will complete a Residential Respite Extension
Form and submit the form to Medicare Australia. The care recipient automatically
becomes eligible for another 63 days of residential respite at the commencement
of the new financial year. The extension form must be completed each time an
extension is required.
l e g i s l a t i v e r e f e r e n c e s
s 44-12(2)(c), Aged
Care Act, 1997, s
21.18(1), Residential
Care Subsidy
Principles 1997
s 21.18(1), s 21.18(2)
Residential
Care Subsidy
Principles 1997
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An ACAT reassessment and approval is required if:
the original ACAT approval was time limited and has expired
the care needed is permanent and the original approval did not include
approval for permanent residential care
the original ACAT approval was limited to a low level of residential care and the
care needed is high level care.
If a person uses his or her approved number of days and an ACAT does not approve
an extension, the service will not receive further subsidy for that person.
RESPITE CARE FOR VETERANS AND WAR WIDOWS
AND WIDOWERS
Veterans and war widows and widowers share the same entitlement of up to 63 days
of respite in a financial year. Extensions are also available.
Subject to prior approval, Department of Veterans’ Aairs (DVA) beneficiaries who
have full entitlement to treatment services can have the resident’s daily fee for up
to 28 days respite care per financial year paid at DVA’s expense. This can be taken as
residential respite, in-home respite, or a combination of both, and is not cumulative
from one financial year to the next. This means that any in-home respite access will
reduce the number of days for which DVA meets the cost of residential respite.
For former prisoners of war (POWs) who receive the higher level of respite care, DVA
will meet the daily fee for the full length of stay in a residential aged care service.
EXTRA SERVICE PLACES
Services with extra service status are eligible for the respite supplement. Respite care
recipients receiving care on an extra service basis may also be charged the extra service
amount. The extra service reduction also applies to these residents. See also chapter
on Extra service places in this Manual.
RESIDENTIAL CARE SUBSIDIES
An approved provider is eligible for residential care subsidy, including the respite
supplement, for each day they provide residential respite care to an approved respite
care recipient who has not used up his or her annual allocation of respite days.
A provider is not eligible for subsidy if:
the service does not meet its accreditation requirements after the
accreditation day
the provider is not providing respite care in accordance with its conditions
of allocation
if the provider does not provide respite care in an allocated place.
Respite care recipients attract either high or low level residential care subsidy,
as determined by the ACAT assessment, including the respite supplement. Other
supplements can be paid where applicable. See the following section on Rules
about payment of subsidies and supplements.
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Rules about the payment of subsidies and supplements
The respite supplement can only be paid for days on which:
the care provided was respite care
the care recipient had been approved for respite care by an ACAT
the care recipient had not used more than 63 days of respite care in that
financial year, or an extended period of respite care approved by an ACAT
the service has provided the care in an allocated place and has met any
conditions of allocation.
The accommodation and concessional supplements are not paid for respite recipients,
as an equivalent amount is already built into the respite supplement. The days used
by respite care recipients cannot be counted towards concessional resident levels.
Services which are certified are eligible for a higher respite supplement.
Other supplements—for example, oxygen and enteral feeding—can be paid as applicable.
A service will not be paid for any form of leave for a respite care recipient.
Additional amount for high care respite
An additional amount for high care respite is available for eligible providers. Providers
are eligible for the additional rate if they use an average of 70 per cent or more of
their available respite places up to the end of the current claim period, based on an
averaging period of 12 months. If the 70 per cent target is met, a payment is made
at the end of the month for each of the high care respite days provided during that
month.
While low care respite residents count towards the 70 per cent target, they do not
attract the higher amount—ie, low and high respite care days are counted to reach
the 70 per cent but only high care respite days attract the higher payment.
The averaging period will generally be the current claim month and the preceding
11 claim months. A provider is eligible for the additional rate of the high care respite
amount if, on any given day, the average number of respite bed days provided over
the previous 11 months and current claim month is equal to or greater than
70 per cent of the average number of respite bed days required to be provided over
that period of time under the provider’s conditions of allocation.
The averaging period takes into consideration the date respite care places are first
allocated. Any increase or decrease in the level of allocation will be reflected in the
averaging methodology from the date the increase or decrease takes eect. While
the total number of places may fluctuate across the averaging period, the impact
of any increase or decrease is gradual as it is spread out across the relevant period.
Respite bed days are not counted in the averaging period if they are provided:
in excess of the level specified in the conditions of allocation relating to respite
to non-eligible care recipients
in excess of the maximum number of days per care recipient.
If a provider is eligible for any additional respite amount it will automatically be
included in the normal advance monthly payments for residential subsidy, based
on the provider’s claim form for residential respite. See References at the end of this
chapter for a link to current subsidy rates.
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The sale of an aged care home will not aect the averaging period. That is, the
averaging period will continue to be calculated regardless of changes in association,
with the new provider taking on the old provider’s usage averages.
A provider receiving the additional payment can apply for a variation to their
allocation of respite. See Applying to vary conditions for operational places in
chapter on Allocated places in this Manual.
Transfers from respite to permanent care
Care recipients can only transfer from respite to permanent care if:
they have an ACAT approval for both respite and permanent care
or they are reassessed by the ACAT and approved for permanent care.
The Minister can determine a dierent rate of respite supplement for respite care
recipients where the person subsequently transfers to permanent care in the same
service. This is to provide a disincentive for transfers from respite to permanent care.
Respite usage is monitored to see if such a rate should be set.
Date of entry into permanent care
Subsidies and supplements are payable for the day of admission, but not for the day
of discharge. If a person transfers from respite care to permanent care, respite subsidy
will be paid from the first day of admission to the day before the day of transfer.
Permanent care subsidy will then be paid from (and including) the day of transfer.
Notification of entry into respite care
Respite care recipients in receipt of pensions and allowances through Centrelink
should be advised to notify Centrelink that they are entering an aged care service
to receive respite care. This is to ensure that Centrelink can continue sending them
correspondence relating to their pensions and allowances. A person’s entry into
respite care can also aect the payment of carer’s payment or carer’s allowance.
Monthly claim forms
There is a separate monthly claim form for respite care recipients. On the form, the
area relating to leave is shaded to ensure it is not used, as leave provisions do not
relate to respite care recipients.
CARE FEES
The fee for respite recipients is the same as the standard pensioner contribution
regardless of their income or eligibility for income support payments. See legislative
reference. There is no income-testing for respite recipients. They can be charged
a booking fee. See the following section on Respite booking fees.
What fees can be charged for respite care?
There is no income-testing for respite care recipients and they pay the standard
pensioner contribution. Respite care recipients can be charged an extra service fee
if the place they occupy is an extra service place.
s 58-3(2)(b), Aged
Care Act 1997
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Respite booking fees
Booking fees are paid to a service in advance to secure a period of respite care.
Booking fees must not exceed the equivalent of the fee for one week’s respite care,
or 25 per cent of the fee for the proposed period of respite care, whichever is less.
See legislative reference.
It is one of an approved provider’s responsibilities to charge no more than the
amount permitted under the User Rights Principles by way of a booking fee for
respite care. See legislative reference. Any resident agreement must specify the
period that the care and services will be provided and any respite care booking
fee. See legislative reference.
Once the resident enters the service, the booking fee must be deducted from the
care recipient’s daily fees.
EXAMPLE
If George books two weeks of respite care he can be charged a booking fee
equivalent to 25 per cent of the period or 3 1/2 days worth of the booking
fee—ie, 25 per cent of 14 days is 3 1/2 days. He will then only need to pay fees
for the additional week and a half once he has entered the aged care service.
EXAMPLE
If Georgia books 6 weeks of respite care, she can only be charged one week’s
fee—ie, 25 per cent of 42 days is 10 1/2 days, and therefore greater than one
week. Georgia will then be charged for the remaining five weeks after she
enters for her period of respite care.
Reasons for not taking up a respite admission
If the care recipient cancels their booking more than 7 days before the proposed day
for entry into respite care, the booking fee must be refunded within 14 days after the
approved provider was notified that the care recipient cancelled the booking. See
legislative reference. However, if the care recipient cancels their booking less than
7 days before the proposed day for entry, in any circumstances other than where the
care recipient has died or is entering hospital, the approved provider can retain all
or part of the booking fee. See legislative reference.
If a person enters hospital or dies within seven days before the proposed day for
entry into respite care, the booking fee must be returned to the person or their
estate. See legislative reference. In these circumstances, the booking fee must be
refunded within 14 days after the approved provider was notified that the care
recipient cancelled their booking, regardless of whether the approved provider
was notified more than 7 days before the cancellation. See legislative reference.
The booking fee must also be refunded if the approved provider requires the
respite recipient to leave before the end of the booked period. See legislative
reference.
In any other circumstance, all or part of the booking may be retained. See legislative
reference.
l e g i s l a t i v e r e f e r e n c e s
s 23.26(1), User
Rights Principles
1997
s 59-1(1)(d), Aged
Care Act 1997
s 56-1(c), Aged
Care Act 1997
s 23.16(3A),
User Rights
Principles 1997
s 23.16(3B),
User Rights
Principles 1997
s 23.16(3),
User Rights
Principles 1997
s 26.14(3A), 26.14(3B),
User Rights
Principles 1997
s 23.16(4),
User Rights
Principles 1997
s 23.16(3B), 23.16(5),
User Rights
Principles 1997
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EXAMPLE
If Terence booked for four weeks of respite care and paid one week’s booking
fee, then died two days prior to the proposed day of entry into respite care, the
service must refund the booking fee to Terence’s estate.
Leaving a service before the end of a booked period
If the respite care recipient decides to leave the service before the end of the
booked respite period, all or part of the fee for the unused part of the booked period
may be retained from the booking fee. See legislative reference.
EXAMPLE
Denise booked for four weeks of respite care, paid one week’s booking fee
and then decided to leave after two days of care. The service may decide to
keep the remainder of Denise’s booking fee, which is equivalent to a fee for
five days respite.
Resident’s agreement
Conditions relating to the booking fee must be included in the respite resident
agreement. See legislative reference. This agreement must also state the dates
on which respite care is to be provided.
While a booking fee may be charged to respite care recipients, it must be deducted
from the fee charged for the respite care.
ACCOMMODATION PAYMENTS
Care recipients receiving respite care cannot be charged an accommodation bond
(for low level care) or accommodation charge (for high level care).
Care recipients receiving respite care who later become permanent residents can
be charged an accommodation bond, if they require a low level of residential care,
or an accommodation charge, if they require a high level of residential care. Once
they become permanent residents, the entry date is taken to be the day of transfer
to permanent care. Retention amounts, amounts representing income derived, and
periodic payments cannot be charged for the period of respite care. See also
chapter on Funding for residential aged care in this Manual.
RESIDENTS’ RIGHTS
All new respite residents must be oered a resident agreement with the approved
provider before they enter the service. See legislative reference. A resident
agreement may also be entered into at any time during the recipient’s stay. Respite
recipients have the right to choose whether or not they wish to enter into a written
agreement with the approved provider. See also section on Resident agreements
in chapter on Residents’ rights in this Manual.
s 23.16(5),
User Rights
Principles 1997
s 59-1(1)(d), Aged
Care Act 1997
s 56-1(g), Aged
Care Act 1997
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REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
ACAR Essential Guide
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acar2008-
essential-guide.htm
Aged Care Information Line
Ph 1800 500 853
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Form—approval for respite care
www.health.gov.au/internet/main/publishing.nsf/Content/514F5C8B6E979F9DCA2
56F1900106124/$File/5stepapp.pdf
Form—varying respite allocation conditions
Go to www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-
app-vca-respite.htm
Or contact the Aged Care Information Line
Ph 1800 500 853
Forms should be submitted to the relevant state or territory oce of the Department
New South Wales
GPO Box 9848
Sydney NSW 2001
Ph 1800 048 998
Fax 02 9263 3509
Queensland
GPO BOX 9848
Brisbane QLD 4001
Ph 1800 177 099
Fax 07 3360 2999
South Australia
GPO Box 9848
Adelaide SA 5001
Ph 1800 188 098
Fax 08 8237 8000
Tasmania
GPO Box 9848
Hobart TAS 7001
Ph 1800 005 119
Fax 03 6221 1412
Victoria State Oce
GPO Box 9848
Melbourne VIC 3001
Ph 1800 020 103
Fax 03 9665 8181
Western Australia
GPO Box 9848 Perth 6001
Ph 1800 198 008
Fax 08 9346 5222
Northern Territory
GPO Box 9848
Darwin NT 0801
Ph 08 8919 3444
Fax: 08 8919 3400
Australian Capital Territory
PO Box 9848
Canberra ACT 2601
Ph 1800 020 102
Fax: 02 6289 3388
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Medicare Australia
Ph 1800 195 206
Residential care fees, subsidies and supplements—current
For current rates for residential care fees and charges go to
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-finance-resfees.htm-
copy2
For current Australian Government subsidies and supplements go to
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-subs-supplement.htm
Veterans, war widows and widowers—respite care for—Department
of Veterans’ Aairs
For more information on respite care paid for by the Department of Veterans’ Aairs
Ph 133 254 (general enquiries—from anywhere in Australia)
Ph 1800 555 254 (general enquiries—country areas only)
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I
Relevant legislation 165
Overview 165
Additional information 165
Eligible capital works 165
Eligibility 166
Residential Care (Capital) Grant 166
Rural and Regional Building Fund grants 166
Services not eligible for a grant 166
Assessment of capital funding proposals 167
The grant amount 167
Deed of Agreement 168
Payment arrangements and reporting requirements 168
Ceasing to provide residential aged care 168
Revoking or decreasing an allocation 169
Varying conditions of an allocation 169
Capital funding and extra service status 170
References—links, guides and forms referred to in this chapter 170
CAPITAL GRANTS FOR RESIDENTIAL AGED CARE
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CAPITAL GRANTS FOR
RESIDENTIAL AGED CARE
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 5.1, Divisions 70–75, s 85, s 43-6
Aged Care Act 1997 (the Act)
Residential Care Grant Principles 1997
OVERVIEW
Limited capital funding is made available through the Residential Care (Capital)
Grants program and the Rural and Regional Building Fund to assist service providers
who are unable to meet the cost of necessary capital works.
Residential Care (Capital) Grants and Rural and Regional Building Fund Grants are
allocated on a competitive basis through the annual Aged Care Approvals Round.
Applicants for capital funding are responsible for providing information based on
thorough research and analysis of all aspects of the proposal, including any
associated building costs and the current and future financial capacity of the
applicant organisation. Grants may also be made outside this process to address
urgent and immediate needs. See also chapter on Allocated places in this Manual.
See References at the end of this chapter for a link to the Aged Care Approvals
Round Essential Guide
Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can
also be accessed through the Aged Care Information Line on 1800 500 853.
ELIGIBLE CAPITAL WORKS
Financial assistance is available for:
buying buildings or land on which to construct buildings, for providing
residential aged care
acquiring, erecting, altering or extending buildings to provide residential
aged care
acquiring furniture, fittings or equipment for buildings to provide residential
aged care
altering or installing furniture, fittings or equipment in buildings to provide
residential aged care.
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Capital funding is not available for:
routine administration of the service, whether or not the costs are related to the
proposed works
acquiring and operating vehicles
rent, insurance and state and local Government statutory charges—eg, rates
any taxation payable by the service, including any tax which is payable as a result
of receiving a grant.
Grants will not be made for capital works which have been contracted, commenced
or completed prior to the execution of a grant agreement—ie, the signing of the
agreement by both a grantee and an Australian government representative.
ELIGIBILITY
Residential Care (Capital) Grant
The eligibility criteria for a Residential Care (Capital) Grant are:
a majority of care recipients in the service to which the grant relates are
supported, concessional or assisted residents
a majority of care recipients who will receive care in that service are people
with special needs—ie, those from rural or remote communities, those from
Aboriginal and Torres Strait Island communities, those from Non-English
speaking background, those who are financially or socially disadvantaged and
veterans or war widows or people who are homeless or at risk of becoming
homeless. See legislative reference.
Rural and Regional Building Fund grants
Rural and Regional Building Fund eligibility is limited to residential aged care services
in all areas of Australia other than major cities, as defined by the Australian Standard
Geographical Classification (ASGC) 2006 Remoteness Structure.
Services not eligible for a grant
Capital grants are not available to:
residential care services that have been granted extra service status for
a residential care service or a distinct part of a residential care service
services run by an approved provider which is a state/territory government
or a state/territory government body.
Part 5.1, Divisions
70–75, Aged
Care Act 1997,
Residential Care
Grant Principles
1997, Allocation
Principles 1997
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ASSESSMENT OF CAPITAL FUNDING PROPOSALS
All applications are assessed on a competitive basis. In ranking applications,
the following will be considered:
how urgently work needs to be carried out:
to meet Federal, state or local government fire, safety, health or
occupational health and safety standards, including certification
requirements for aged care services
because of fire, flood, earthquake or any other unforeseen circumstances
the proportion of care recipients who are supported, concessional or assisted
residents, and people with special needs—this applies only to Residential Care
(Capital) Grants
if implemented, the extent to which the proposal would maintain or extend the
range of residential care services in the region and the consequent diversity of
choice for current and future care recipients
the provider’s ability to provide continuity of care for residents in the facility
and/or the region, both in the long term and during the capital works projects
the extent of other benefits to current or future care recipients and their
families from the implementation of the proposal, including value for money
to the Government
the extent to which the applicant has a demonstrated lack of capacity to fund
the proposed works, taking into consideration all possible sources of finance
the approved provider’s record in meeting its responsibilities and obligations
under the Act and other legislation relating to the provision of Australian
Government-subsidised aged care.
any other relevant information available to the Department.
See also chapter on Allocated places in this Manual. See References at the end
of this chapter for a link to the Aged Care Approvals Round Essential Guide
Applications from services conducted in leasehold premises are unlikely to be given
high priority in the competitive allocation of capital funds. Funding will be provided
to applicants in leased premises only if:
the lessor agrees to the proposal
and agrees to operate the premises as a residential aged care facility for a
period of interest, dependent on the size of the grant, after the capital works
are finished.
These conditions would form part of the Grant Agreement.
THE GRANT AMOUNT
In deciding the amount of the grant, the Secretary will consider:
the cost of the project
the extent to which the applicant has a demonstrated lack of capacity to fund
the proposed works, taking into consideration all possible sources of finance
The Secretary may allocate less than the amount applied for.
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There is no provision for increasing an approved grant. The maximum amount
payable is the amount approved at the time of application. Any increases in costs are
to be met by the grantee. Where a grantee requires additional funding, and the
capital works have not been contracted, commenced or completed, it may apply for
an additional capital grant. The application for an additional grant will be considered
on its merits in the competitive Aged Care Approvals Round.
DEED OF AGREEMENT
Organisations will be expected to enter into a formal, legal Deed of Agreement with
the Department, which may include the following: See legislative reference.
the kinds of people who will receive care when the project is completed
the number of concessional or assisted residents who will receive care
the period in which conditions must be complied with
the period in which the residential care service for which the grant is being paid
will be operational
the period in which the project must be completed
the amount of money the approved provider will make available for the project
the information the approved provider will give the Department
the approved provider’s compliance with:
any responsibilities regarding quality of care, the rights of care recipients and
accountability for care provided
any conditions imposed in regard to the payment of previous residential
care grants
PAYMENT ARRANGEMENTS AND REPORTING REQUIREMENTS
Payments will be made:
in line with the payment schedule set out in the Deed of Agreement
once the provider has given the Department the documentary evidence which
meets the requirements described in the Deed of Agreement.
Under the Deed of Agreement, the grantee also has to make periodic reports to the
Department on the progress of the capital works project for which the grant was
allocated.
Similar matters are covered in a Deed of Agreement for a grant from the Rural and
Regional Building Fund.
CEASING TO PROVIDE RESIDENTIAL AGED CARE
A condition of any grant is that the grantee continues to provide residential
aged care, funded under the Act, in the building constructed with the assistance
of a grant.
If the grantee stops providing residential aged care in the building, or sells, transfers
or demolishes the building, the Government can ask for all or part of the grant to be
s 73-2, Aged
Care Act 1997
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repaid. In considering whether to ask for all or part of the grant to be repaid, the
Department will consider:
the amount of the grant
the time which has elapsed since the capital works were completed/occupied
the circumstances in which the grantee stopped providing residential aged care
the proposed future use of the buildings constructed with the grant
the impact that any requirement to repay all or part of the grant might have on
achieving the Government’s aged care policy objectives
whether the building is likely to be sold, or ownership of the building otherwise
transferred to a third party
and the financial arrangements associated with any transfer
the overall financial situation of the grantee and the impact repaying all or part
of the grant may have on the organisation’s future financial viability
any other matters the grantee or the Department considers relevant.
Grantees should advise the Department as early as possible if they intend to stop
providing care in a building, to transfer ownership or eective control, or to sell,
demolish or otherwise dispose of the building.
Grantees will be given an opportunity to make a submission, before a decision on the
amount of any repayment is made. The grantee’s submission should include detailed,
relevant information and any associated documentary evidence.
Further information on decisions to seek repayment of all or part of a grant is set out
in the Recovery of Aged Care Capital Funding guidelines. See References at the end
of this chapter for a link.
REVOKING OR DECREASING AN ALLOCATION
The Secretary can revoke or decrease a residential care grant if a condition of the
grant has not been met.
Before deciding to revoke or decrease the allocation, the Secretary will advise the
approved provider in writing, and invite a written submission within a specified
timeframe (usually 28 days).
In deciding to revoke or decrease an allocation, the Secretary will consider any
submissions made within the specified time.
If no submission is received, the grant will be revoked or decreased on the day after
the last day for making submissions. The approved provide will be notified of the
decision in writing.
VARYING CONDITIONS OF AN ALLOCATION
Grantees are required to meet the conditions of allocation set out in the Deed of
Agreement. If a grantee is unable or unwilling to meet these conditions, it must apply
to vary the conditions prior to doing anything which would cause it to breach the
conditions of the grant set out in the Deed of Agreement.
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170
A grantee can apply to the Secretary at any time to vary a condition of allocation
of a residential care grant. A variation can be either to reduce the amount of the
grant or to vary any of the conditions of the grant.
CAPITAL FUNDING AND EXTRA SERVICE STATUS
If extra service status is granted after a capital grant has been allocated, the applicant
will be required to repay the grant. See legislative reference. A similar condition is
included in grant agreements for capital grants from the Rural and Regional Building
Fund. See also section on Extra service status and capital payment deductions in
chapter on Extra service places in this Manual.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Aged Care Approvals Round Essential Guide
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acar2008-
essential-guide.htm
Aged Care Information Line
Ph 1800 500 853
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Recovery of Aged Care Capital Funding guidelines
www.health.gov.au/internet/main/publishing.nsf/content/ageing-finance-
capfund.htm
s 43-6, Aged
Care Act 1997
l e g i s l a t i v e r e f e r e n c e s
I
Relevant legislation 171
Overview 171
Additional information 171
Charter of Residents’ Rights and Responsibilities 171
Information for residents 173
Resident agreements 173
Signing agreements 174
Resident agreement for respite residents 174
Transitional arrangements for agreements 175
Information for residents who do not sign agreements 175
Disclosure of financial information to residents 175
Protecting residents’ information 175
Security of tenure 176
Four steps—asking a resident to leave 176
Step 1—providing written notice 176
Step 2—considering suitable alternate accommodation 177
Step 3—assessing the resident’s long-term needs 177
Step 4—when the resident is no longer required to leave 177
Security of place within the residential service—moving residents 178
Respite booking fees 178
Resolving complaints 178
Internal complaint resolution 178
Aged Care Complaints Investigation Scheme 178
The Oce of the Aged Care Commissioner 179
Advocacy services 179
Community Visitors’ Scheme 180
References—links, guides and forms referred to in this chapter 180
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l e g i s l a t i v e r e f e r e n c e s
RESIDENTS’ RIGHTS
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 4.2,
Aged Care Act 1997 (the Act)
User Rights Principles 1997
(User Rights Principles)
Investigation Principles 2007
Accountability Principles 1998
OVERVIEW
Approved providers must ensure that the civil, human and legal rights of older
people living in subsidised aged care services are protected. In order to do so, they
must have in place systems, services and sta that respect the rights of residents.
Additional information
This chapter has been updated and revised to help approved providers comply with
their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can also
be accessed through the Aged Care Information Line on 1800 500 853.
CHARTER OF RESIDENTS’ RIGHTS AND RESPONSIBILITIES
The Charter of Residents’ Rights and Responsibilities is designed to ensure that a
person’s rights are not diminished when they move into an aged care service. The
Charter, reproduced below, also sets out that residents in aged care services should
exercise their individual rights in ways that do not adversely aect other residents’
rights. See legislative reference.
s 56-1 Aged Care
Act 1997, s 23.12,
s 23.14, User Rights
Principles 1997
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Charter of Residents’ Rights and Responsibilities
See legislative reference.
A. Each resident of a residential care service has the right:
to full and eective use of his or her personal, civil, legal and consumer rights;
to quality care which is appropriate to his or her needs;
to full information about his or her own state of health and about available
treatments;
to be treated with dignity and respect, and to live without exploitation, abuse
or neglect;
to live without discrimination or victimisation, and without being obliged to feel
grateful to those providing his or her care and accommodation;
to personal privacy;
to live in a safe, secure and service-like environment, and to move freely both
within and outside the residential care service without undue restriction;
to be treated and accepted as an individual, and to have his or her individual
preferences taken into account and treated with respect;
to continue his or her cultural and religious practices and to retain the language
of his or her choice, without discrimination
to select and maintain social and personal relationships with any other person
without fear, criticism or restriction
to freedom of speech
to maintain his or her personal independence, which includes a recognition
of personal responsibility for his or her own actions and choices, even though
some actions may involve an element of risk which the resident has the right
to accept, and that should then not be used to prevent or restrict those actions;
to maintain control over, and to continue making decisions about, the personal
aspects of his or her daily life, financial aairs and possessions;
to be involved in the activities, associations and friendships of his or her choice,
both within and outside the residential care service;
to have access to services and activities which are available generally in the
community;
to be consulted on, and to choose to have input into, decisions about the living
arrangements of the residential care service;
to have access to information about his or her rights, care, accommodation, and
any other information which relates to him or her personally;
to complain and to take action to resolve disputes;
to have access to advocates and other avenues of redress; and
to be free from reprisal, or a well-founded fear of reprisal, in any form for taking
action to enforce his or her rights.
Schedule 1, User
Rights Principles
1997
l e g i s l a t i v e r e f e r e n c e s
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l e g i s l a t i v e r e f e r e n c e s
B. Each resident of an aged care service has the responsibility:
to respect the rights and needs of other people within the residential care service,
and to respect the needs of the residential care service community as a whole;
to respect the rights of sta and the proprietor to work in an environment
which is free from harassment;
to care for his or her own health and wellbeing, as far as he or she is capable; and
to inform his or her medical practitioner, as far as he or she is able, about his
or her relevant medical history and his or her current state of health.
INFORMATION FOR RESIDENTS
Residents of aged care services must be given enough information to help them
make informed choices. When a new resident enters a service, the provider must
give the resident information about residents’ rights and obligations as specified in
the Charter, and the requirements of the User Rights Principles as set out in this
chapter. See legislative reference.
This information can be included in the formal agreement between the resident and
the service. Residents can also choose not to enter into a written agreement with
the approved provider. If a resident does not want to sign a formal agreement, the
approved provider must still give them comprehensive information, including details
about the levels of care and service the service can provide for the resident. See
Information for residents who do not sign agreements on page 175.
RESIDENT AGREEMENTS
An approved provider must oer each resident a formal resident agreement See
legislative reference. A formal agreement is usually an agreement in writing, signed
by both the approved provider and the resident when the resident enters the service.
However, the agreement may be signed by the resident at any future time during
their stay. The agreement must specify the care and services the service will provide
and the resident’s rights and responsibilities while staying in the service. It must also
provide information on fees and charges and any other matters negotiated between
the approved provider and the resident. A formal agreement may be entered into at
any time during the resident’s stay.
The agreement between the resident and the approved provider must
treat the resident and provider as equal parties to the agreement and clearly set
out the rights and obligations of each party
be written in plain language
be easy to understand.
It should specify the following:
the name of the aged care service
the levels of care and service that the provider has the capacity to provide
to the resident and any limitations to these levels of care.
the policies and practices that the provider will follow in setting fees for the
resident
the period of the agreement if the resident is not entering the service
on a permanent basis
s 23.14,
User Rights
Principles 1997
56-1 (g), Aged
Care Act 1997
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circumstances in which the resident can be asked to leave the aged care service
assistance the provider will give the resident to obtain suitable alternate and
aordable accommodation if the resident is asked to leave
the internal complaints resolution mechanism that the aged care service
provides to deal with complaints made by or on behalf of a resident
the resident’s responsibilities as a resident in the aged care service
any other matters relevant to the agreement, and/or matters negotiated
between the approved provider and the resident.
An agreement should also:
allow for the terms of the agreement to be varied, by mutual consent following
adequate consultation
allow for the agreement to be terminated upon seven days written notice from
the resident or their representative
allow for the agreement to be voided if the resident or their representative tells
the provider in writing that they wish to withdraw from the agreement, within
14 days after signing the agreement. In these circumstances, the resident is still
liable for any fees and charges accrued under the agreement during their time
in the aged care service. Providers must refund any other amount paid by the
resident under the agreement.
explain and help the resident or their representatives understand all the terms
of the agreement. See legislative reference.
The rights the agreement gives the resident are in addition to any other rights the
resident has in law. The agreement must not contain any provision that would allow
the resident to be treated less favourably than they would otherwise be treated
under any law of the Commonwealth. See legislative reference.
If a resident does not want to have a formal agreement with the aged care service,
the service must still comply with aged care legislative requirements, including those
set out in the User Rights Principles in order to continue to receive Government funding.
Signing agreements
If the resident chooses to enter into a resident agreement, the agreement must be
signed by both the provider and the resident. If a resident is physically unable to sign
the agreement, the resident can ask another person to sign on his or her behalf and
the agreement should be annotated to this eect. If a resident is cognitively impaired
and cannot understand and sign the agreement, a legally authorised representative
should sign for them.
If a resident is unable to sign an agreement and does not have a legally authorised
alternative decision maker, an approved provider can contact the relevant state or
territory guardianship authority or public advocate or public trustee. See References
at the end of this chapter for contact details for guardianship authorities, public
advocates and trustees oces.
Resident agreement for respite residents
A formal agreement between the resident and the approved provider must be
oered to all new residents, including respite residents, before they enter the service.
See Resident agreements on page 173 for details. Conditions about any booking fee
l e g i s l a t i v e r e f e r e n c e s
s 23.85,
User Rights
Principles 1997
s 59-1(3), Aged
Care Act 1997
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l e g i s l a t i v e r e f e r e n c e s
must be included in respite agreements. These agreements must also state the
dates between which respite care is to be provided. Respite residents do not pay an
accommodation bond or charge. They can occupy an extra service place and if they
do, an approved provider may ask the resident to pay additional fees for that extra
service place. See also chapters on Extra service places and Residential respite care
in this Manual.
Transitional arrangements for agreements
To ensure that existing resident agreements will continue to be honoured, agreements
between nursing service or hostel proprietors and residents which were in place
before the Act came into eect are considered resident agreements under the Act.
Information for residents who do not sign agreements
If the resident does not enter into a resident agreement, the provider must still give
them all the information in writing that would otherwise be provided in a resident
agreement, including:
the levels of care and service that the provider can provide to the resident
the policies and practices that the provider will follow in setting fees for providing
care and services to the resident
if the resident is not entering the service on a permanent basis, the period of
respite care to be provided to the resident and, if applicable, any respite care
booking fees
conditions under which the resident can be asked to leave
assistance the provider will give the resident to obtain suitable, alternative and
aordable accommodation if the resident is asked to leave
the internal complaints resolution mechanism that the aged care service provides
to deal with complaints made by or on behalf of a resident
the resident’s responsibilities as a resident in the aged care service.
Disclosure of financial information to residents
Approved providers are required to provide the following information to residents:
a copy of any accommodation bond agreement and guarantee
routine provision of information at the end of the financial year
provision of information on request, at any other time.
See also section on Disclosure to residents in chapter on Protection and
responsibilities relating to accommodation bonds in this Manual.
Protecting residents’ information
Providers must protect the personal information of a resident. See legislative
reference. Personal information can only be used:
for a purpose related to providing aged care services to the resident, by the
provider
for a purpose for which the resident or his or her representative provided the
information.
Division 62, Aged
Care Act 1997
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Without the written consent of the resident, personal information must not
be disclosed to any other person other than for:
a purpose related to the provision of aged care services to the resident
by the provider
a purpose related to the provision of aged care to the resident, by another
approved provider but only relating to the person’s accommodation bond balance
a purpose agreed to by the resident or his or her representative.
Personal information must be protected by safeguards which protect against the loss
or misuse of information. See legislative reference.
However, approved providers are not precluded from providing a resident’s personal
information to a court, tribunal or authority. See legislative reference.
SECURITY OF TENURE
Under the legislative provisions for security of tenure, a provider may ask a resident
to leave if: See legislative reference.
the aged care service is closing
the aged care service can no longer provide accommodation and care suitable
for the resident, having regard to the resident’s long-term assessed needs, and
the provider has not agreed to provide the care that the resident presently
needs in cases where the resident’s care needs have changed.
the resident no longer needs the care provided through the aged care service,
as assessed by an Aged Care Assessment Team (ACAT)
the resident has not paid any agreed fee to the provider within 42 days after the
due date, for a reason within the resident’s control
the resident has intentionally caused serious damage to the aged care service,
or serious injury to the provider, an employee of the aged care service, or to
another resident
the resident is away from the aged care service for a continuous period of at
least seven days for a reason other than permitted by the Act or an emergency.
The provider must give written notice if the resident is required to leave the service
and must give the notice to the resident or his or her representative at least 14 days
before the resident is to leave. See legislative reference.
Four steps—asking a resident to leave
There are four steps that the provider must follow in asking a resident to leave.
Step 1—providing written notice
The written notice from the approved provider must include:
the decision
reasons for the decision
when the resident is to leave (which must be at least 14 days after the notice is
given);
the resident’s rights about leaving, including his/her access to complaints
resolution mechanisms; independent complaints processes; and 1 or more
representatives of an advocacy service.
s 62-1(c), Aged
Care Act 1997
s 62-2, Aged Care
Act 1997
s 23.5,
User Rights
Principles 1997
s 23.6,
User Rights
Principles 1997
l e g i s l a t i v e r e f e r e n c e s
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Step 2—considering suitable alternate accommodation
The approved provider should discuss with the resident whether they wish to find
their own alternate accommodation. However, ultimately it is the approved provider’s
responsibility to ensure that accommodation is available for the resident, before the
resident can be required to leave.
The suitability of the alternate accommodation is linked to the assessment of the
resident’s long-term care needs—for example, a service that provided only low level
care would not be suitable alternate accommodation for a resident who was
assessed as requiring a high level of care. See also Step 3 following.
The alternate accommodation does not necessarily have to be the preferred
accommodation of the resident who is being asked to leave. However, the alternate
accommodation does have to be available and able to provide care which is suitable
to meet the needs of the resident. Some alternate accommodation may not be
considered suitable, such as a service where there are sanctions in place or a service
that is a great distance from the existing service.
The resident must be able to aord the suitable alternate accommodation—for
example, an extra service facility may not be appropriate for a concessional resident.
Hospital is not considered to be suitable alternate accommodation.
Step 3—assessing the resident’s long-term needs
Where the resident is asked to leave because the aged care service can no longer
provide accommodation and care suitable for the resident’s long-term assessed
needs, and the provider has not agreed to provide the care that the resident
presently needs, the long-term needs of the resident must be assessed by:
an ACAT
or at least two medical or other health practitioners who meet the following
criteria
one must be independent of the provider and the aged care service and
chosen by the resident
and both must be competent to assess the aged care needs of the resident.
After such an assessment, if those conducting the assessment consider that the
present accommodation and care cannot continue to meet the care needs of the
resident, then the process associated with requiring the resident to leave must be
undertaken.
Step 4—when the resident is no longer required to leave
If the decision requiring the resident to leave was based on their behaviour, and
since giving the original notice to leave, the approved provider has agreed with the
resident that the resident should stay because their behaviour has changed, then the
approved provider should give the resident a notice stating that they are no longer
required to leave.
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Security of place within the residential service—moving
residents
It is important that residents feel secure in their room or bed within an aged care
service. Accordingly, a resident can only be moved to another bed or room in the
following circumstances: See legislative reference.
if the resident asks to be moved
if the resident agrees to move, after being fully consulted and without any pressure
if the move is necessary on genuine medical grounds as assessed by an ACAT
or at least two medical or other health practitioners
one of whom is independent of the provider and the aged care service and
chosen by the resident
both of whom are competent to assess the aged care needs of the resident
if the place occupied by the resident becomes an extra service place and the
resident elects not to pay the extra service fee
if the move is necessary because repairs or improvements to the aged care
service need to be carried out and the resident has the right to return to the bed
or room, if it continues to exist as a bedroom for residents, once the repairs or
improvements are completed.
RESPITE BOOKING FEES
See legislative reference.
Respite booking fees are prepaid daily fees, paid to ensure a period of respite care.
Conditions relating to the booking fee must be included in a resident’s agreements.
These agreements must also state the dates on which respite care is to be provided.
See also section on Respite booking fees in chapter on Residential respite care in
this Manual.
RESOLVING COMPLAINTS
There are two systems available to people wanting to make a complaint about
an aged care service:
internal—ie, within in each service
and external, through the Aged Care Complaints Investigation Scheme.
Internal complaint resolution
Approved providers are required to establish and operate an eective process for
addressing complaints, as well as making sure that people are aware that they can
complain to the Aged Care Complaints Investigation Scheme. The internal process
established and operated by service providers must meet the requirements set out
under the Accreditation Standards. See legislative reference.
Aged Care Complaints Investigation Scheme
The Aged Care Complaints Investigation Scheme (the Scheme) is managed by the
Department’s Oce of Aged Care Quality and Compliance. The Scheme investigates
complaints and concerns about Government-subsidised aged care services, including
residential and community aged care services which are funded under the Act.
l e g i s l a t i v e r e f e r e n c e s
s 23.15,
User Rights
Principles 1997
s 23.16,
User Rights
Principles 1997
s 56-4, Aged Care
Act 1997
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179
The Scheme provides a free and confidential service. Anyone can contact the
Scheme with a concern, including care recipients, family members, care providers,
sta members or health professionals. Concerns or complaints can be about
anything that aects the quality of care or services for aged care recipients, such
as care, catering, hygiene, security, activities, choice, comfort, safety, neglect or
financial matters.
Often the best way to resolve a complaint is directly with the aged care service.
However any person who is uncomfortable doing this or who is unhappy with the
response they have received from the service is encouraged to contact the Scheme.
The Scheme can be contacted in writing, by phone or by submitting an online form
via the Department’s website. See References at the end of this chapter for contact
information.
All parties to a complaint have the right to be kept informed about what is happening
and have a right to have their case reviewed if they are not happy with the way in
which their complaint has been handled.
If a person is not satisfied with how their complaint has been handled he or she may
take their concerns to the Departmental manager responsible for the Scheme in
their state or territory.
The Oce of the Aged Care Commissioner
The Oce of the Aged Care Commissioner has been established to independently
review the way in which the Scheme handles complaints. The Commissioner can
look at decisions made by the Scheme in relation to the investigation of complaints
and also has the power to examine, as a result of a complaint, or on his or her own
initiative, the Scheme’s administrative processes for investigating complaints.
See References at the end of this chapter for contact information.
ADVOCACY SERVICES
Under the National Aged Care Advocacy Program, the Department funds an
advocacy service in each state and territory to provide free and confidential services
to assist people receiving Government-subsidised aged care services as well as other
representatives who may be acting on behalf of residents. Aged care advocacy
services can:
assist people receiving aged care services to resolve problems or complaints
in relation to aged care services
support people receiving aged care services to be involved in decisions that
aect their life
provide people receiving aged care services with information and advice about
their rights and responsibilities
promote the rights of people receiving aged care services to aged care service
providers.
Aged care advocacy services achieve this through the delivery of advocacy,
information and education. The provision of information and education, to both
recipients and providers of aged care, can contribute to the protection of consumers’
rights and foster improvements to the quality of life for consumers of aged care
services. See References at the end of this chapter for contact information.
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Aged care services must allow advocacy services access to the premises during
normal business hours, or at any other time if a resident or their representative has
asked the advocacy service to call. See legislative reference.
COMMUNITY VISITORS’ SCHEME
The Community Visitors’ Scheme (CVS) helps to establish links between people living
in an aged care service and their local community. The CVS aims to improve the
quality of life of residents of aged care services who have limited family and social
contact, and may be at risk of isolation from the general community for social or
cultural reasons, or through disability.
An aged care service can identify a resident who would benefit from being matched
with a community visitor. A community visitor then befriends that resident.
Aged care services are expected to support community visitors by welcoming them
to the service, and liaising with CVS coordinators. Where possible, aged care services
should advise the coordinator if a resident cannot receive visits, for example, if the
resident has become very ill or has passed away.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Advocacy Services
New South Wales
The Aged Care Rights Service
Level 4, 418a Elizabeth Street
Surry Hills NSW 2010
Ph (02) 9281 3600
Ph 1800 424 079
Fax (02) 9281 3672
Victoria
Elder Rights Advocacy
Level 4
140 Queen Street
Melbourne VIC 3000
Ph (03) 9602 3066
Ph 1800 133 312
Fax (03) 9602 3102
Queensland
Queensland Aged and Disability
Advocacy (QADA) Inc.
121 Copperfield Street
Geebung QLD 4034
Brisbane Oce
Ph (07) 3637 6000
Ph 1800 818 338
Fax (07) 3637 6001
South Australia
Aged Rights Advocacy Service Inc.
45 Flinders Street
Adelaide SA 5000
Ph (08) 8232 5377
Ph 1800 700 600
Fax (08) 8232 5388
Western Australia
Advocare
Unit 1/190 Abernethy Road
Belmont WA 6104
Ph (08) 9479 7566
Ph 1800 655 566
Fax (08) 9479 7599
Australian Capital Territory
ACT Disability, Aged and Carer Advocacy
Service (ADACAS)
Suite 207, Block C
Canberra Technology Park
Phillip Avenue
Watson ACT 2602
Ph (02) 6242 5060
Fax (02) 6242 5063
l e g i s l a t i v e r e f e r e n c e s
s 56-1(k), Aged
Care Act 1997
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Tasmania
Advocacy Tasmania Inc
Suite 6, Mayfair Plaza
236–244 Sandy Bay Road
Sandy Bay TAS 7005
Ph (03) 6224 2240
Ph 1800 005 131
Fax (03) 6224 2411
Darwin
Darwin Community Legal Service
Aged/Disability Rights
8 Manton Street
Darwin NT 0801
Ph (08) 8982 1111
Ph 1800 812 953
Fax (08) 8982 1112
Alice Springs
Catholic Care NT
6 Hartley Street
Alice Springs NT 0871
Ph (08) 8958 2400
Ph 1800 354 550
Fax (08) 8958 2499
Aged Care Commissioner—Oce of
Ph 1800 500 294
www.agedcarecommissioner.net.au.
Aged Care Complaints Investigation Scheme
Ph 1800 550 552
The line is open Monday–Friday, 8:30am–5pm; Saturday, Sunday and public holidays,
10am–5pm. Outside these hours, people can leave a message.
People can also write to the Scheme at:
Department of Health and Ageing
GPO Box 9848
In your Capital City
Go to www.health.gov.au/internet/main/publishing.nsf/content/ageing-
complaints-index.htm for an online complaints form
If a person is not satisfied with how their complaint has been handled, they can take
their concerns to the Departmental manager responsible for the Scheme in their
state or territory, by calling the Scheme freecall number above.
Aged Care Information Line
Ph 1800 500 853
Community Visitors’ Scheme
For more information contact the Aged Care Information Line
Ph 1800 500 853
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Guardianship authorities, public advocates and trustees oces
New South Wales
Oce of the Public Guardian
www.lawlink.nsw.gov.au/opg
Parramatta Oce
160 Marsden St
Parramatta NSW 2150
Ph (02) 8688 2650
Ph 1800 451 510 (outside Sydney)
Fax (02) 8688 9797
Sydney Oce
Level 2, Suites 204–206
83 York St
Sydney NSW 2000
Ph (02) 8083 9100
Fax (02) 8083 9111
Gosford Oce
Level 3, 4 Watt St
Gosford NSW 2350
Ph (02) 4320 4888
Fax (02) 4320 4818
Guardianship Tribunal
2a Rowntree Street
Balmain NSW 2041
Ph (02) 9556 7600
Ph 1800 463 928
Fax (02) 9555 9049
www.gt.nsw.gov.au
Oce of the Protective Commissioner
160 Marsden St
Parramatta NSW 2124
Ph (02) 8688 2600
TTY 1800 882 889
Fax (02) 8688 9783
Victoria
State Trustees Ltd
168 Exhibition Street
Melbourne VIC 3000
Ph (03) 9667 6444
Fax (03) 9663 4260
Guardianship List
55 Kings Street
Melbourne VIC 3000
Ph (03) 9628 9911
Ph 1800 133 055
Fax (03) 9628 9932
Oce of the Public Advocate
5th Floor
436 Lonsdale Street
Melbourne VIC 3000
Ph 1300 309 337
Fax (03) 9603 9501
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Western Australia
Oce of the Public Advocate
Level 1, Hyatt Centre
30 Terrace Road
East Perth WA 6004
Ph 1300 858 455
Ph 1800 807 437 (WA only)
Fax (08) 9278 7333
Public Trustee
PT Building
565 Hay Street
Perth WA 6000
Ph 1300 746 212
Ph 1800 642 777
Fax (08) 9222 6607
State Administrative Tribune
Western Australia
Level 4
12 St George Terrace Road
Perth WA 60040
Ph (08) 9219 3111
Ph 1300 306 017
Fax (08) 9325 5099
Queensland
Oce of the Adult Guardian
PO Box 13554
George Street
Brisbane 4003
Ph (07) 3234 0870
Ph 1300 653 187
Fax (07) 3239 6367
Public Trustee
444 Queen Street
Brisbane QLD 4000
Ph (07) 3213 9288
Fax (07) 3213 9489
Guardianship and Administration Tribunal
Level 9
259 Queen St
Brisbane QLD 4000
GPO Box 1639
Brisbane QLD 4001
Ph (07) 3234 0666
Ph 1300 780 666
Fax (07) 3221 9156
South Australia
Public Trustee Oce of South Australia
25 Franklin Street
Adelaide SA 5000
GPO Box 1338
Adelaide 5001
Ph (08) 8226 9200
Ph 1800 673 119
Fax (08) 8231 9518
Oce of the Public Advocate
Level 7, ABC Building
85 Northeast Road
Collinswood SA 5081
PO Box 213
Prospect SOUTH AUSTRALIA 5082
Ph (08) 8269 7575
Ph 1800 066 969
Fax (08) 8269 7490
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Guardianship Board of SA
ABC Building
Level 8
85 Northeast Road
Collinswood SA 5081
Ph (08) 8368 5600
Ph 1800 800 501 (SA only)
Fax (08) 8368 5699
Tasmania
Public Trustee
116 Murray Street
Hobart TAS 7001
Ph (03) 6233 7598
Ph 1800 068 784
Fax (03) 6231 0621
Guardianship and Administration Board
54 Victoria Street
Hobart TAS 7000
PO Box 1307
Hobart 7001
Ph (03) 6233 3085
Fax (03) 6233 4509
Oce of the Public Guardian
Level 3
15 Murray Street
Hobart TAS 7000
PO Box 825
Hobart 7001
Ph (03) 6233 7608
Fax (03) 6233 4882
Australian Capital Territory
Public Advocate of the ACT
Level 3
12 Moore Street
Canberra City
ACT 2601
PO Box 1001
CIVC SQAURE 2600
Ph (02) 6207 0707
Fax (02) 6207 0688
Public Trustee
PO Box 221
Civic Square ACT 2608
Ph (02) 6207 9800
Fax (02) 6207 9811
ACT Civil and Administrative Tribunal
ACT Magistrates Court
Knowles Place
Canberra ACT 2600
Ph (02) 6207 1740
Fax (02) 6205 1740
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Northern Territory
Oce of the Public Guardian
Darwin Oce
Shops 1 & 2
Ground Floor
Casuarina Plaza
Trower Road
Casuarina NT 0811
Ph (08) 8922 7116
Fax (08) 8922 7051
Alice Springs
AAHS Building
Flynn Drive
Alice Springs NT 0870
Ph (08) 8951 6741
Fax (08) 8951 6789
Public Trustee
Nichols Place
Corner Cavenagh & Bennett Streets
Darwin NT 0800
Ph (08) 8999 7271
Fax (08) 8999 7882
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I
Relevant legislation 187
Overview 187
Additional information 187
Use of accommodation bond funds 187
Income derived from accommodation bond balances 188
Deductions from accommodation bond balances 188
Refunding accommodation bond balances 188
Recipient of the refund 188
Refunding accommodation bond balances—resident transfers from one
service to another 189
Refunding accommodation bond balances—resident leaves a service to move
back to their home or carer’s home 189
Refunding accommodation bond balances—resident dies 190
Refunding entry contribution balances 190
Delaying refunds to secure re-entry 190
Record keeping requirements in relation to accommodation bond balance
refunds 190
Former approved providers must refund accommodation bonds 191
Paying interest 191
Base interest 192
Maximum permissible interest rate 192
Period during which interest accrues and how to calculate interest 192
Accrual of interest—resident gives approved provider more than 14 days
notice of moving to another service (applicable since 1 July 2006) 193
Accrual of interest—resident gives less than 14 days notice of moving
to another service (applicable since 1 July 2006) 193
Accrual of interest—resident leaves service to move to another service
without giving any notice (applicable since 1 July 2006) 194
Accrual of interest—resident dies (applicable since 1 July 2006) 194
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Resident paid entry contribution for entry into hostel before
1 October 1997 under formal agreement 195
Record keeping requirements in relation to interest 195
Pre-allocation lump sums of new approved providers 195
Pre-allocation lump sum paid to organisation not yet approved
as a provider 196
Protection of unregulated lump sums held by existing approved providers 196
The three prudential standards 197
The Liquidity Standard 197
Requirements of the Liquidity Standard 197
Determining the minimum level of liquidity 198
Identifying forms in which the minimum level of liquidity is maintained 199
Review of Liquidity Management Strategy 199
Other issues 200
The Records Standard—bond register 200
Information included in the bond register 201
Deductions 201
Refund of accommodation bond 202
Entry contributions 202
Additional information 202
The Disclosure Standard 203
Disclosure to residents 203
Copy of accommodation bond agreement and guarantee 203
Routine provision of information at the end of the financial year 203
Provision of information on request at any other time 203
Keeping records of disclosures to residents 204
Disclosure to prospective residents 204
Disclosure to the Secretary of the Department 204
Annual disclosure requirements 205
Information about accommodation bonds held 205
Information about compliance with accommodation bond agreement
and written guarantee requirements 205
Information about the repayment of accommodation bond balances 205
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II
III
Information about compliance with the prudential standards 205
Approved provider declaration 205
Audit opinion 205
Monitoring compliance of the prudential requirements 206
Responsibilities of approved providers 206
Mechanisms used to monitor compliance 206
Annual Prudential Compliance Statements (APCS) 206
Information obtained from an approved provider 207
Aged Care Standards and Accreditation Agency 207
Aged Care Complaints Investigation Scheme 207
Other reporting by approved providers or the public 207
Actions the Department can take in the event of non-compliance 207
No action 208
Education 208
Issue a non-compliance notice 208
Impose sanctions 208
Accommodation Bond Guarantee Scheme 208
Aged Care (Bond Security) Act 2006 (the Bond Security Act) 208
Aged Care (Bond Security) Levy Act 2006 (the Bond Levy Act) 209
References—links, guides and forms referred to in this chapter 209
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PROTECTION AND RESPONSIBILITIES
RELATING TO ACCOMMODATION BONDS
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Division 57,
Aged Care Act 1997 (the Act)
Part 4,
User Rights Principles 1997
Aged Care (Bond Security) Act 2006
Aged Care (Bond Security) Levy Act 2006
OVERVIEW
This chapter is designed to help approved providers, who hold accommodation
bonds and entry contributions, comply with:
the timeframes for repayment of accommodation bonds
requirements to pay interest to residents for the period between the resident
leaving a service and the refund of the accommodation bond balance or entry
contribution balance
prudential requirements including the Liquidity Standard, Records Standard and
Disclosure Standard.
This chapter also provides information about the use of accommodation bond funds
and the Accommodation Bond Guarantee Scheme (Guarantee Scheme).
Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can be
accessed through the Aged Care Information Line on 1800 500 853; and people
can email prudential@health.gov.au with enquiries about prudential regulation.
USE OF ACCOMMODATION BOND FUNDS
Approved providers must not use accommodation bonds for a purpose that is not
related to providing aged care to care recipients or that does not comply with
prudential requirements.
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Income derived from accommodation bond balances
Approved providers are entitled to retain income derived from investing
accommodation bond balances. Such income, including allowed retention amounts
or investment earnings, must be used in the following ways:
to meet capital works costs relating to residential care
to retire debt relating to residential care
to improve the quality and range of care services.
Deductions from accommodation bond balances
Approved providers may make the following deductions from an accommodation
bond only if a valid accommodation bond agreement has been entered into:
retention amounts. See also
Accommodation payments section in chapter
on Funding for residential aged care in this Manual
amounts owed to the approved provider by the care recipient under an
accommodation bond agreement, a resident agreement or an extra service
agreement
interest on the amounts owed to the approved provider by the care resident
under an accommodation bond agreement, a resident agreement or an extra
service agreement.
Approved providers must not deduct any other amounts from the accommodation
bond balance.
REFUNDING ACCOMMODATION BOND BALANCES
Refunding accommodation bonds is arranged under the following four headings:
to whom accommodation bonds are refunded—ie, they must be refunded
in the name of the resident
when a refund is due
the amount of the refund
interest payable on late refunds.
Recipient of the refund
The accommodation bond must be refunded in the name of the care recipient.
See legislative reference. This protects the resident who paid the accommodation
bond, by ensuring that the refund is dealt with according to their wishes, including
(where the refund occurs following the resident’s death) as set out in their will. It also
protects the approved provider by ensuring that they are able to clearly identify the
person who may deal with the refund. These protections for the resident and the
approved provider are increasingly important as the value of accommodation bonds
continues to rise over time.
If a resident moves from one service to which they had paid an accommodation
bond to another service, they may agree to pay an accommodation bond for entry
to the new service, including for moving from a low-care service to high-care
service. See legislative reference. This bond cannot be greater than the bond
balance refunded or payable to the resident by the first service.
s 57-21(2), Aged
Care Act 1997
ss 57-13 and
57-23, Aged
Care Act 1997
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When a resident leaves a service to move to another service, the first service must
refund the resident’s accommodation bond. The legislation requires that the refund
be made to the resident. However, the Department accepts that as a matter of
practical administration, the refund of the original accommodation bond and
payment of the new one can be done in one of two ways with the explicit
agreement of the resident:
if the resident transfers to a new service operated by the same approved
provider, the bond balance continues to be held so that it is not refunded
to the resident and then paid again by them
if the resident transfers to a service operated by a dierent approved provider,
the original approved provider, with whom the resident agreed to pay a bond,
pays the bond balance to the second approved provider.
These practices are only acceptable when performed with the prior agreement
of the resident or representative.
Refunding accommodation bond balances—resident
transfers from one service to another
An approved provider is required to refund the accommodation bond balance if the
care recipient is to enter another service to receive residential care. The timing of the
refund will vary, depending on whether the care recipient has notified the approved
provider that they will be leaving, as set out below:
if the care recipient has notified the approved provider more than 14 days before
they leave then the accommodation bond balance must be refunded on the
day the care recipient leaves
if the care recipient notified the approved provider only 14 or fewer days before
they leave, then the accommodation bond balance must be refunded within
14 days of the day that the notification was given
if the care recipient did not notify the approved provider they were leaving, then
the accommodation bond balance must be refunded within 14 days of the day
the care recipient leaves.
The provisions do not require a resident to notify the approved provider of the date
when the resident was to enter another service to receive residential care. As a
matter of practice, approved providers may wish to request that residents provide
notice in writing and if they do not, approved providers might wish to record the
communication. This will avoid any unnecessary dispute regarding the date of
notification.
Refunding accommodation bond balances—resident leaves
a service to move back to their home or carer’s home
If a resident leaves a service to return to their own home or the home of a carer, the
approved provider must refund the accommodation bond balance within 14 days of
the resident leaving the service.
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Refunding accommodation bond balances—resident dies
If a resident dies, an approved provider must refund their accommodation bond balance
within 14 days after the day on which the approved provider is shown the probate of
the will or letters of administration. In practice, this means the approved provider may:
make a refund at any time (which must be in the name of the former resident)
without evidence of probate or letters of administration if they are suciently
confident that the person receiving the payment may deal with it
or wait for the probate or letters of administration before refunding the
accommodation bond balance.
When an approved provider is shown grant of probate or letters of administration,
they should take a copy and date stamp it. This will assist in record keeping and
reduce the risk of any dispute regarding when the approved provider was shown
the probate or letters of administration.
Refunding entry contribution balances
Entry contributions must be refunded in accordance with the formal agreement.
Delaying refunds to secure re-entry
A resident who leaves a service, other than on leave, may agree with the approved
provider to delay refunding the accommodation bond balance, on the following
conditions:
if the resident wants to re-enter the service, the approved provider must allow
the resident to enter the service if there are any places vacant, and the resident
is an approved resident
the resident must not be charged an increased amount of accommodation
bond or a second accommodation bond for re-entry.
If the accommodation bond balance is carried over in this way, retention amounts
must not be deducted for the period from the day after the recipient leaves to the
day they re-enter the service (inclusive). This period does not count towards the five
years for which retention amounts can be deducted.
Record keeping requirements in relation to accommodation
bond balance refunds
All approved providers holding accommodation bonds or entry contributions are
required to maintain a bond register which includes details of all accommodation
bonds and entry contributions.
When an accommodation bond balance or an entry contribution is refunded by
an approved provider, certain information about the refund must be entered on the
bond register, including:
relevant dates—ie, when the resident left the service or died, the date the care
recipient notified the approved provider they were leaving, when the
accommodation bond balance or entry contribution was due to be refunded
and when the accommodation bond balance or entry contribution was actually
refunded, and any periods where the service failed to be certified
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information about the amount of the accommodation bond balance or entry
contribution that was refunded and the amount of any interest paid. See The
Records Standard—bond register on page 200.
Former approved providers must refund
accommodation bonds
From 1 January 2009, where an approved provider ceases to be an approved
provider in respect of a service and continues to run that service, they must refund
any accommodation bonds paid for entry to that service. It is an oence for a former
approved provider which is a corporation not to repay the accommodation bond
balance within the set period. A court may impose a penalty of up to 30 penalty
units (where each penalty unit is $110). See legislative reference.
The timing for the former approved provider to refund the accommodation bond
balance will be dierent depending on the circumstances of the care recipient.
If the care recipient dies within 90 days of the former approved provider ceasing to
be an approved provider, then the accommodation bond balance must be refunded
within 14 days after the former approved provider is shown the probate of the will
or letters of administration. In practice, this means the approved provider may:
make a refund at any time (which must be in the name of the former resident)
without evidence of probate or letters of administration if they are suciently
confident that the person receiving the payment may deal with it
wait for probate or letters of administration before refunding the
accommodation bond balance.
If the care recipient is entering another service to receive residential care, the timing
of the refund will vary, depending on whether the care recipient has notified the
former approved provider within 90 days of it ceasing to be an approved provider
that they will be leaving:
if the care recipient has notified the former approved provider more than
14 days before they leave then the accommodation bond balance must
be refunded on the day the care recipient leaves
if the care recipient notified the former approved provider only 14 or fewer days
before they leave, then the accommodation bond balance must be refunded
within 14 days of the day that the notification was given
if the care recipient did not notify the former approved provider they were
leaving, then the accommodation bond balance must be refunded within
14 days of the day the care recipient leaves.
In any other case, including if the care recipient decides to stay in the same service,
the refund must be made within 90 days of the day on which the former approved
provider ceased to be an approved provider.
PAYING INTEREST
Approved providers pay interest to residents at two dierent rates. Interest must
be paid to the resident on the same day that the accommodation bond balance
or entry contribution is refunded. See legislative reference.
Division 14,
15, Part 4,
User Rights
Principles 1997
57-21AA(3), Aged
Care Act 1997
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Providers pay interest:
at the base interest rate (BIR) for the period between the day after the resident
dies or leaves the approved provider’s service and the date the accommodation
bond balance is refunded OR the end of the legislated timeframe for refund of
the accommodation bond balance, whichever comes first
at the maximum permissible interest rate (MPIR) between the end of the
legislated timeframe for refund of the accommodation bond balance and the
date the accommodation bond balance is actually repaid
at the MPIR for entry contributions refunded from the day after the refund date
(in accordance with the formal agreement) or 1 July 2006, whichever occurs
later, and ending on the day the entry contribution is refunded.
Base interest
Interest is not payable for the day a resident leaves a service, but for each day after
the resident has departed the service until the accommodation bond balance is
actually refunded or the legislated timeframe expires, whichever is earlier. The base
interest rate (BIR) used in calculating interest is the BIR applicable on the day after
the resident’s departure.
The base interest payable is calculated by:
dividing the number of days for which interest is payable by 365 days and
multiplying the result by the accommodation bond balance and the
applicable BIR.
Maximum permissible interest rate
The rate of maximum applicable interest rate (MPIR) used in calculating interest is the
MPIR applicable on the day after the end of the legislated timeframe for the refund
of the accommodation bond. The interest rate remains fixed at this rate until the
accommodation bond is refunded.
The MPIR payable is calculated by:
dividing the number of days for which interest is payable by 365 days and
multiplying the result by the accommodation bond balance and the
applicable MPIR.
Period during which interest accrues and how
to calculate interest
The accommodation bond balance has been refunded:
when the approved provider deposits the money in the resident’s account
on the day the approved provider sends a cheque payable to the resident
(or their representative), regardless of when the resident actually cashes the
cheque
when the approved provider otherwise makes the funds available to the
resident (or their representative).
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In the three examples provided below
If the resident dies after leaving the service and before expiry of the legislated
timeframe for the refund of the accommodation bond then the approved
provider will accrue interest at the BIR if it chooses to await presentation of
evidence of probate or letters of administration before refunding the bond
(though it may choose to refund the bond without such evidence).
If the resident dies after expiry of the legislated timeframe for the refund of
the accommodation bond and the approved provider has not refunded the
accommodation bond within that timeframe then the approved provider is
required to pay interest at the rate of MPIR for the period from the day after
expiry of the legislated timeframe until the refund is made.
Accrual of interest—resident gives approved provider more than 14 days
notice of moving to another service (applicable since 1 July 2006)
If the resident gives more than 14 days notice, then the accommodation bond
balance is due to be refunded on the day that the resident leaves the service. If the
approved provider refunds the accommodation bond balance on the day the resident
leaves the service then they will not have to pay any interest. If the approved provider
does not refund the accommodation bond balance by the time the resident leaves
the service, then the approved provider must pay the interest calculated at the MPIR
for the period starting the day after the resident leaves the service and ending on the
day the accommodation bond balance is actually refunded.
EXAMPLE
On 1 July 2006 John told Scott’s Hostel that he would move to Andy’s Hostel
on 16 July 2006. He moves on July 16. If Scott’s Hostel gave the
accommodation bond balance to John on:
16 July 2006, then no interest would be payable.
25 July 2006, then MPIR is payable for the period 17–25 July 2006—ie,
from the day after John left the service and the accommodation bond
balance should have been refunded until the accommodation bond
balance is refunded.
Accrual of interest—resident gives less than 14 days notice of moving
to another service (applicable since 1 July 2006)
If the resident provides notice within 14 days before leaving the service, then the
accommodation bond balance must be refunded within 14 days after the day on
which notice was given. If the accommodation bond balance is refunded within 14
days, then BIR is payable from the day after the resident leaves the service until the
end of 14 days after the resident provided notice; or until the accommodation bond
balance is paid.
If the approved provider does not refund the accommodation bond balance within
14 days of when the notice was given, then the approved provider must pay the
MPIR for the period commencing on the day after 14 days’ notice was given and
ending on the day the accommodation bond balance is actually refunded.
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EXAMPLE
On 10 July 2006, Fred told Georgie’s Hostel that he was moving to Sunset
Hostel on 15 July 2006. He moves on 15 July 2006. If Georgie’s Hostel gave
the accommodation bond balance to Fred on:
15 July 2006, then no interest is payable
18 July 2006, then BIR is payable for 3 days
28 July 2006, then BIR is payable for the period 16–24 July 2006.
MPIR is payable for the period 25–28 July 2006.
Accrual of interest—resident leaves service to move to another service
without giving any notice (applicable since 1 July 2006)
The accommodation bond balance must be refunded within 14 days of the day
after the resident leaves the service. If the accommodation bond balance is refunded
within the 14 days, then the approved provider pays BIR for the period commencing
the day after the resident left the service and finishing on the day the approved
provider actually refunded the accommodation bond balance. If the approved
provider does not refund the accommodation bond balance within the 14 day
period, then the approved provider pays BIR for the period from the day after
the resident left the service to the expiration of 14 days; and MPIR for the period
commencing on the day after the accommodation bond balance should have
been refunded and finishing on the day the accommodation bond balance
is actually refunded.
EXAMPLE
Bob left Rosie’s Hostel on 10 July 2006 to move to another service and did
not provide any notice. If the accommodation bond balance was refunded on:
15 July 2006 then BIR is payable from 11 July 2006 until the
accommodation bond balance was actually refunded on 15 July 2006
28 July 2006 then BIR is payable for the period 11–24 July 2006; and
MPIR is payable for the period 25–28 July 2006.
Accrual of interest—resident dies (applicable since 1 July 2006)
BIR begins to accrue from the day after the day on which the resident dies.
If the approved provider refunds the accommodation bond balance before the
end of 14 days after the approved provider has been shown probate or letters of
administration, then the approved provider pays BIR for the period commencing on
the day after the resident died and finishing on the day the accommodation bond
balance is actually refunded. No MPIR is payable because the approved provider has
refunded the accommodation bond balance within the legislated timeframe.
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If the approved provider does not refund the accommodation bond balance within
14 days after being shown probate or letters of administration, then the approved
provider must pay:
BIR for the period from the day after the resident died to the end of 14 days after
being shown probate or letters of administration
MPIR for the period commencing on the day after the accommodation bond
balance should have been refunded and finishing on the day the
accommodation bond balance is actually refunded.
An approved provider can also decide to refund an accommodation bond balance
before being shown probate or letters of administration.
EXAMPLE
Paula died on 5 July 2006 and probate was shown to the approved provider
on 20 August 2006. The accommodation bond balance was due to be
refunded by 3 September, 2006, 14 days after probate was shown.
If the approved provider refunds the accommodation bond balance
on 2 September 2006 then BIR is payable for the period 6 July–2
September 2006.
If the approved provider refunds the accommodation bond balance on
10 September 2006, BIR is payable for the period 6 July–3 September
2006; and MPIR is payable 4–10 September 2006.
Resident paid entry contribution for entry into hostel before 1 October 1997
under formal agreement
Under this arrangement, entry contributions must be refunded by the timeframe
detailed in the formal agreement. If the entry contribution is not refunded by this
time, then the approved provider pays MPIR from the day after the entry contribution
was required to be refunded under the formal agreement, until the day the entry
contribution is actually refunded. See legislative reference.
If the formal agreement required the entry contribution to be refunded prior to 1 July
2006 and it was not, the approved provider must pay MPIR for the time between 1 July
2006 and the date the entry contribution is actually refunded. See legislative reference.
Exception! If the approved provider is awaiting probate or letters of administration
prior to refunding the entry contribution, interest is not payable for the period during
which the approved provider is awaiting probate or letters of administration.
Record keeping requirements in relation to interest
Certain information about interest payments must be entered on the bond register.
This includes information about BIR and MPIR paid to the resident. See The Records
Standard—bond register on page 200.
Pre-allocation lump sums of new approved providers
From 1 January 2009, where a person who does not already have allocated
residential care places for a particular aged care service receives an allocation of
residential care places, either by transfer or allocation of new places for that facility,
23.80C, 23.80D,
User Rights
Principles 1997
23.80C, 23.80D,
User Rights
Principles 1997
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they may be required under the conditions of allocation of those places to refund
any pre-allocation lump sums taken from existing residents.
A pre-allocation lump sum:
does not accrue daily
is for the care recipient’s entry to a residential care service or flexible care
service run by the pre-allocation lump sum holder
is not an accommodation bond, as was not paid to an approved provider
is not an entry contribution, as it is was not paid prior to 1 October 1997
for entry to a hostel
is not an unregulated lump sum as it was not paid to an approved provider
before 1 January 2009 or fails to meet the other criteria in subsection 6(3)
of the Aged Care (Bond Security) Act 2006 for unregulated lump sums.
See legislative reference.
Once the pre-allocation lump sum has been refunded, the approved provider may
then ask the care recipient to pay an accommodation bond or accommodation
charge as if the resident had entered care on the day that the approved provider’s
allocation took eect and on terms that cannot be less advantageous to the resident
than the previous agreement. See legislative reference. This will ensure that the
existing care recipients receive the same protections for their payments as new
care recipients under the Act and the Guarantee Scheme. See Accommodation
Bond Guarantee Scheme on page 208.
Pre-allocation lump sum paid to organisation not yet approved as a provider
Where an allocation or transfer of places results in an aged care service becoming
eligible to receive Government funding then the Secretary may determine conditions
of allocation for these places, which can include:
the treatment of pre-allocation lump sums by an approved provider, including
its refund or forgiveness within certain timeframes, with the consent of the
care recipient
the conditions and entry into force of any accommodation bond agreement
entered into once the pre-allocation lump sum has been refunded
Protection of unregulated lump sums held by existing
approved providers
Some approved providers hold lump sums which are not accommodation bonds
because the payment was made before the approved provider became an approved
provider.
See legislative reference. If the person to whom the payments were made was an
approved provider immediately before 1 January 2009, these unregulated lump sums
are protected by the Guarantee Scheme. The aim of this was to ensure that residents
in similar circumstances receive similar protections.
From 1 January 2009, requirements for the refund of pre-allocation lump sums
prevent the flow of new unregulated lump sums into the Government-subsidised
aged care sector.
l e g i s l a t i v e r e f e r e n c e s
s 6(3), Aged Care
(Bond Security)
Act 2006
s14-5 (5), Aged
Care Act 1997
s 6(3), Aged Care
(Bond Security)
Act 2006
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THE THREE PRUDENTIAL STANDARDS
All providers holding accommodation bonds or pre-1997 entry contributions are
required to comply with three prudential standards:
the Liquidity Standard
the Records Standard
the Disclosure Standard.
See legislative reference.
Approved providers must report to the Secretary annually on their compliance
with the prudential standards within 4 months of the end of their financial year—ie,
approved providers operating on a standard financial year of 1 July to 30 June must
report on compliance by the end of October each year.
Under these arrangements, approved providers are responsible for the financial
management of their business and meeting their regulatory responsibilities. The
aim of the prudential arrangements is to reduce the risk of default on the refund
of accommodation bond balances.
THE LIQUIDITY STANDARD
See legislative reference. The aim of the Liquidity Standard is to ensure that approved
providers have access to sucient, readily available funds so that they can refund
accommodation bond balances as they fall due over the coming 12 months.
The Liquidity Standard requires approved providers to develop, implement and
adhere to a Liquidity Management Strategy (LMS). The purpose of the LMS is to apply
a systematic approach and a level of rigour to determining the level of funding that
will be required to meet expected accommodation bond balance refunds as they
fall due. A LMS should include a nominated minimum level of liquidity.
In assessing their funding needs to ensure that they can refund accommodation
bond balances as they fall due, approved providers must:
have sources of funding that can be accessed quickly—ie, access to liquid
funding. While cash has a high level of liquidity, bank and term deposits and
lines of credit are also considered liquid
be mindful of expected accommodation bond payments received from new
residents. The minimum level of funding which approved providers may need
ready access to, may be the dierence between expected accommodation
bond refunds and expected accommodation bond payments.
Approved providers are required as part of their annual prudential compliance statement
to confirm that the approved provider has, during the financial year, complied with the
Liquidity Standard. The approved provider’s independent auditor is required to provide
an opinion on whether the approved provider has complied with all prudential
requirements including the Liquidity Standard in the relevant financial year.
Requirements of the Liquidity Standard
Any approved provider who holds at least one accommodation bond balance
(including entry contributions) during the financial year must comply with the
Liquidity Standard, which requires approved providers to:
maintain sucient liquidity to ensure that they can refund accommodation
bond balances (including entry contributions) as they fall due in the following
12 months
ss 57-3 and 57-4,
Aged Care Act
1997, Division 3,
User Rights
Principles 1997
Division 3, 3.2
User Rights
Principles 1997
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implement and maintain a written LMS, which identifies
the minimum level of liquidity—the amount required to ensure that the
approved provider has enough liquidity to refund accommodation bond
balances (including entry contributions) as they fall due
the factors an approved provider considered in determining the minimum
level of liquidity
form/s in which the approved provider will maintain the minimum level
of liquidity.
The approved provider must then:
maintain the minimum level of liquidity in the form specified in the LMS
to ensure that the LMS is up-to-date
and ensure that it complies with the requirements of the Liquidity Standard.
An approved provider must modify or replace its LMS if it no longer meets
the requirements of the Liquidity Standard.
At any point in time, an approved provider must meet the requirements of the
Liquidity Standard See legislative reference. The provider must maintain the
minimum level of liquidity identified in the LMS necessary to meet refunds over
the following 12 months. See legislative reference.
Determining the minimum level of liquidity
Each approved provider should identify and assess the factors used in determining its
minimum level of liquidity, based on their individual circumstances and experiences.
While some factors might be common to many approved providers, their relative
importance can dier for individual approved providers. Factors that approved
providers could consider in determining their minimum level of liquidity include:
cash requirements for operating and capital expenditure
their historical pattern of accommodation bond balance refunds
characteristics of the residents in their care, such as Aged Care Funding
Instrument (ACFI) categories, ages, genders and length of time spent in care,
which can aect the timing of accommodation bond balance refunds
the average value of accommodation bond balances held
the average time taken to replace departing residents
the expected number and amount of accommodation bonds that will be paid
by new residents
the time taken for new residents to make accommodation bond payments.
An approved provider should consider a range of dierent approaches in assessing
their liquidity requirements, to determine the most appropriate approach for their
circumstances. Possible approaches that approved providers could consider include
the following:
in some cases, the minimum level of funding which is readily accessible may
be the dierence between the expected accommodation bond balance refunds
and the expected accommodation bond payments over the next 12 months
the need to refund several of its largest accommodation bond in the next
12 months
l e g i s l a t i v e r e f e r e n c e s
s 23.37(2),
User Rights
Principles 1997
s 23.36, User
Rights Principles
1997
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for its minimum level of liquidity, an approved provider could use the likely value
of accommodation bond balance refunds that will be required over the coming
12 months, by identifying residents who are likely to leave the service in the
coming 12 months; and the size of their accommodation bonds. For example,
an approved provider could decide to maintain as its minimum level of liquidity
the total value of accommodation bonds held on behalf of residents with a
greater than 50 per cent likelihood of leaving, less expected accommodation
bond payments from new residents. This may be appropriate for approved
providers that have a significant proportion of residents with characteristics,
such as age or Aged Care Funding Instrument (ACFI) category, which may
mean they are more likely to leave the service over the coming 12 months.
An approved provider can also maintain a prudent margin to provide a buer against
unexpected developments. A prudent margin could be incorporated into the minimum
level of liquidity in various ways. For example, approved providers may choose to adopt
conservative estimates for key parameters or include an explicit additional buer to their
level of liquidity. Factors that could be considered include conservative assumptions for:
the average size of accommodation bonds expected to be received from new
residents in the region given market conditions
the rate of replacement of exiting residents.
Identifying forms in which the minimum level of liquidity
is maintained
To ensure that an approved provider can refund accommodation bond balances
as they fall due, it is important that the minimum level of liquidity for an approved
provider is maintained in readily accessible forms.
It is the responsibility of the approved provider to determine the appropriate form/s in
which their minimum level of liquidity will be maintained. Many financial instruments
have a high level of liquidity, including:
cash
bank bills
stand-by lines of credit
guarantees.
In considering the form/s in which they hold their minimum level of liquidity, approved
providers may also wish to consider cost issues. The cost to approved providers could
be considered in terms of both the actual cost of accessing the funds (that is the actual
cost of the transaction) and the economic cost (the dierence between the purchase
price and the price realised on disposal). For example, liquid instruments such as cash
and financial products like term deposits have relatively low costs as the fee for
accessing them is not significant and they can be redeemed at their face value.
Review of Liquidity Management Strategy
The Liquidity Management Standard (LMS) requires approved providers to:
ensure that the LMS remains up-to-date and complies with the requirements
of the Liquidity Standard
modify or replace the LMS if it no longer complies with the requirements of the
Liquidity Standard.
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Approved providers should review the LMS at least annually. This review should
include an assessment of whether the factors used to determine the minimum level
of liquidity are still appropriate. Approved providers should consider:
whether changes in services they operate or the profile of their residents
require variations to the factors included in the LMS
whether parameters or assumptions such as the size of accommodation bonds
received from new residents should be adjusted
whether to include events in the LMS that would trigger a review outside of an
annual review cycle. These events may increase the risk that they would not
have the liquidity to meet accommodation bond balance refunds over the
coming 12 months. They include:
the acquisition or divestment of residential services
a significant change in the allocated places within a residential service
a significant change in the profile of residents
a significant change in the size of accommodation bonds received
changes in legislative requirements
changes in the corporate structure of the approved provider.
Other issues
The approach to documenting the LMS is a matter for individual approved providers.
In determining their approach, approved providers should consider:
that they must be able to demonstrate their compliance with the Liquidity
Standard to their auditor
and that the Department might ask to see the LMS for monitoring and
compliance purposes.
See Monitoring compliance of the prudential requirements on page 206.
THE RECORDS STANDARDBOND REGISTER
See legislative reference. The Records Standard is designed to ensure that accurate,
comprehensive and up-to-date information on accommodation bond holdings
(including entry contributions) is collected and maintained.
An accurate record of accommodation bonds will help approved providers to refund
accommodation bond balances quickly once a resident leaves a service. It will also
enable the Department to accurately assess the amount owed to residents, if an
approved provider becomes bankrupt or insolvent and fails to refund outstanding
bonds to the residents. (This would trigger the Guarantee Scheme, under which
the Australian Government refunds accommodation bond balances to residents.)
Under the Records Standard, all approved providers holding accommodation bonds
must establish and maintain a bond register.
The bond register may be maintained at a service level or at approved provider
level. However, for the annual prudential compliance statement, approved
providers must report at approved provider level, referring to the name and
number of services covered by the statement.
If a resident has paid partly by lump sum and partly by periodic payments,
an entry on the bond register, including all of the information detailed
l e g i s l a t i v e r e f e r e n c e s
Division 3, subdi-
vision 3.3, User
Rights Principles
1997
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l e g i s l a t i v e r e f e r e n c e s
below, must be made for the lump sum component of the accommodation
bond. An approved provider might also voluntarily include additional
information in the bond register about the periodic payments.
The bond register may be kept in hard copy or electronic form. The bond
register will contain personal information that should be protected by the
approved provider. See legislative reference.
Historical bond register entries should be kept for a minimum of 3 years, after
the 30 June of the year in which the record was made, as should other records
detailed in Division 88 of the Act and in the Records Principles 1997.
Information included in the bond register
Resident details including resident ID number and resident name must be recorded
and kept for each resident. An approved provider can include additional information
in this part of the bond register. For example, they might want to include a resident’s
RCS/ACFI category. They should also include the information below:
accommodation bond details
the date the resident entered the service
if a resident is transferring from another service, the date the resident entered
the original aged care service. This information is useful so that the current
approved provider knows the period over which retention amounts may
continue to be drawn. If a resident has moved a number of times, approved
providers may wish to record any other relevant details that will enable them
to determine when retention amounts should cease being drawn
the date the accommodation bond was paid by the resident. If a resident pays
an accommodation bond in more than one instalment, each date must be
entered
the amount of accommodation bond paid by the resident. If an accommodation
bond has been paid in more than one instalment this figure must reflect the
amount of each instalment and the total paid.
Deductions
The bond register should include the following information about deductions:
the amount of accommodation bond balance as at 1 July 2006 (for
accommodation bond balances held prior to 1 July 2006)
the date, amount and reason for each deduction taken from an accommodation
bond balance (from 1 July 2006). The type of deduction may be interest on an
unpaid accommodation bond, extra services drawn from accommodation bond,
fees that the resident has agreed should be paid from the accommodation
bond, retention amounts, or any other deduction authorised under the Act.
the accommodation bond balance at the end of each calendar month. An
approved provider should update the bond register on a monthly basis. During
any month there may be one or more deductions and these deductions may
have been made on one or more dates. One of the purposes of the bond register
is to ensure that all approved providers retain a record of the details of all
deductions made (date, amount and type of deduction) from 1 July 2006.
Division 86, Aged
Care Act 1997,
Privacy Act 1988
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Refund of accommodation bond
The bond register should include the following information about the refund of an
accommodation bond:
date of refund event and other relevant dates including
the date the resident died and the date probate or letters of administration
were shown to the approved provider
or the date the resident left the service, and if notice was provided, the date
the notice was provided
or the date the service ceased to be certified.
date the accommodation bond is due to be refunded in accordance with the
requirements under Subdivision 57-G of the Act
date the accommodation bond was actually refunded
amount of accommodation bond refunded
have interest paid and the date paid
maximum permissible interest paid and the date paid.
The refund event is the initial trigger for determining when the accommodation
bond refund is due. The refund event may be the death of the resident or the
departure of the resident from the service. The date that the resident left the service
should be the date on which the resident was formally discharged from the service.
Residents may enter hospital on hospital leave and then transfer to another service
without returning to the original service, but the date to be recorded will be the date
that the resident was discharged, not the date they went on leave.
Entry contributions
The bond register should include the following information about entry
contributions:
resident details including the resident’s name and resident ID number
the date the entry contribution was paid
the amount of the original entry contribution
the date the resident left the facility
the date the entry contribution is due to be repaid in accordance with the
formal agreement
the date the entry contribution was refunded
the amount of entry contribution balance refunded
maximum permissible interest paid and the date paid.
Additional information
An approved provider can also keep other information in the bond register to assist
with record-keeping. For example, approved providers can include information on
periodic payments of accommodation bonds and accommodation charges or
information that is needed for completing the Department’s annual survey of aged
care services.
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l e g i s l a t i v e r e f e r e n c e s
THE DISCLOSURE STANDARD
See legislative reference. The Disclosure Standard requires approved providers
holding accommodation bonds (including entry contributions) to give the Secretary,
residents, prospective residents and their representatives information on their
compliance with the Liquidity and Records Standards; and information on their
financial standing.
Disclosure to residents
There are three requirements for information that must be provided to residents
(or their representatives) by approved providers.
Copy of accommodation bond agreement and guarantee
Within 7 days of an accommodation bond agreement being entered into, approved
providers must provide the resident or their representative with a copy of the
accommodation bond agreement and a copy of the written guarantee of the
refund of the accommodation bond balance.
Routine provision of information at the end of the financial year
Within 4 months after the end of the approved provider’s financial year, approved
providers are required to provide residents who have paid an accommodation bond
or an entry contribution with the following information:
the number of accommodation bond balances that were not refunded within
the statutory timeframe in the previous financial year; or for entry contributions,
in accordance with a formal agreement
a statement about whether the provider complied with the prudential standards
in the financial year
a copy of the audit opinion on whether the provider has complied with the
prudential standards in the financial year
a copy of the resident’s entry in the bond register, as at the end of the financial
year (assuming that the resident had paid an accommodation bond prior to the
end of the financial year).
Provision of information on request at any other time
If a resident who has paid an accommodation bond or entry contribution requests
the following information, an approved provider must provide it within 7 days:
the resident’s entry in the bond register, as at the time of the request
and either the most recent statement of the aged care service’s audited
financial statements
or the most recent statement of the audited financial statements of the
organisation’s aged care component, if the service is operated by a parent
organisation
if the approved provider is in receipt of the Conditional Adjustment Payment,
the statement of accounts provided to the resident could be the audited
general purpose financial statements for the previous financial year.
Division 3,
Subdivision 3.4
User Rights
Principles 1997
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Keeping records of disclosures to residents
Approved providers must demonstrate their compliance with the Disclosure Standard
on an annual basis, as part of their Annual Prudential Compliance Statement (APCS).
To do this, and to provide evidence of compliance to auditors or the Secretary,
approved providers need to keep records of the following types of information:
number of requests made
whether the information was provided within 7 days.
An approved provider may want to specify that information requests be made in
writing. If a request is made in writing, an approved provider should keep a copy
of it. If the request is not in writing, an approved provider may wish to make a note
of the date the request was made, the type of information requested and the date
the information was provided.
Disclosure to prospective residents
A prospective resident is a person approved as a recipient of residential care and
who is considering receiving residential care through that service. In the case of
residential aged care services, a prospective resident is someone who is approved
by an Aged Care Assessment Team (ACAT or ACAS in Victoria). An approved provider
might want to confirm that somebody is a prospective resident if that person
requests information. See legislative reference.
Prospective residents (or their representatives) can request the following:
a statement detailing the number of accommodation bond balances not
refunded within the statutory timeframe and the number of entry contribution
balances that were not refunded in accordance with the relevant formal
agreement in the previous financial year
a statement detailing whether the approved provider complied with the
prudential standards in the previous financial year
a copy of the audit opinion on whether the approved provider complied with
the prudential standards in the preceding financial year
the most recent statement of the approved provider’s audited accounts or the
accounts of the organisation’s aged care component, if the service is operated
by a parent organisation.
If a prospective resident or their representative requests any of the above information
then the approved provider must give the information to the prospective resident
within 7 days of the request. This does not limit the information that an approved
provider may voluntarily choose to give a prospective resident.
As detailed in the previous section, approved providers will be required to attest
to their compliance with the Disclosure Standard on an annual basis, as part of their
APCS. Approved providers will therefore need to keep records in order to be able
to demonstrate their compliance with the requirement to provide information
to prospective residents.
Disclosure to the Secretary of the Department
The APCS will require certain disclosures to be made regarding the approved
provider’s prudential compliance.
l e g i s l a t i v e r e f e r e n c e s
s 23.43
User Rights
Principles 1997
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l e g i s l a t i v e r e f e r e n c e s
Annual disclosure requirements
The Department will issue an annual prudential compliance statement (APCS)
to approved providers at the end of the approved provider’s financial year requiring
them to provide the following information.
Information about accommodation bonds held:
total number of accommodation bond balances (including entry contributions)
held by the approved provider as at the end of the approved provider’s financial
year
total value of accommodation bond balances (including entry contributions) held
by the approved provider as at the end of the approved provider’s financial year
whether there was any period during the year when the approved provider was
not entitled to charge accommodation bonds.
Information about compliance with accommodation bond agreement and
written guarantee requirements:
whether an accommodation bond agreement was entered into with all
residents who paid an accommodation bond during the year and whether
the agreements were in accordance with the legislation
whether each resident who paid a accommodation bond during the year was
provided with a written guarantee of the refund of the accommodation bond
balance and a copy of the accommodation bond agreement.
Information about the repayment of accommodation bond balances:
whether any accommodation bond balances or entry contributions were
required to be refunded
whether all accommodation bond balances (including entry contributions) that
were required to be repaid were repaid within the legislated timeframes (or in
the case of entry contributions, refunded within the time required by the formal
agreement). If not, approved providers will be required to provide details of
accommodation bonds not paid within required timeframe and the reason
for delay.
Information about compliance with the prudential standards:
whether the approved provider has complied with each of the prudential
standards during the financial year and if not how many times and the reasons
for this.
Approved provider declaration:
including all the statements and information required by the form, approved
provider details and the signature of one of the approved provider’s key
personnel who is authorised by the approved provider to sign the statement.
Audit opinion
The APCS must be supported by an independent audit opinion from an independent
auditor. The audit must be undertaken by a registered company auditor within the
meaning of the Corporations Act 2001 or a person approved by the Secretary.
See legislative reference. See References at the end of this chapter for a link
to ComLaw for the Corporations Act.
s 21.26F(6),
Residential
Care Subsidy
Principles 1997
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The Secretary will only approve an alternative auditor if the Secretary is satisfied that
the person has appropriate qualifications and experience.
The independent audit must include an audit opinion on whether the provider has
complied with the prudential standards and other prudential requirements in the
financial year.
MONITORING COMPLIANCE OF THE PRUDENTIAL
REQUIREMENTS
The Department is responsible for monitoring compliance with the prudential
requirements; and the Department’s principal focus in this area is on working
with approved providers to assist them to comply with the prudential requirements.
However, in some instances, the Department may need to take compliance
action—including imposing sanctions.
Responsibilities of approved providers
All approved providers who hold accommodation bonds must ensure that they
comply with the prudential requirements. Approved providers must implement and
maintain appropriate systems and processes to meet the legislative requirements and
also to demonstrate compliance.
If an approved provider is having diculties complying, or has any queries regarding
the requirements, they can seek further advice from their professional advisors, from
their peak body or from their auditor. The Department can help approved providers
understand their regulatory obligations, but it is the provider’s responsibility to
determine the most appropriate way to meet the requirements. See References
at the end of this chapter for the Department’s prudential email address.
Mechanisms used to monitor compliance
Possible compliance issues may be identified via information:
obtained through the APCS
obtained from an approved provider—this may be through a formal request
for information, for example under section 9-2, 9-3 or 9-3A of the Act
See legislative reference.
from the Aged Care Standards and Accreditation Agency
from the Aged Care Complaints Investigation Scheme
obtained from other reporting by approved providers or the public.
Annual Prudential Compliance Statements (APCS)
A key element of monitoring the compliance of approved providers is through the
requirement for approved providers to lodge an audited APCS. This requirement
ensures that an approved provider’s compliance is scrutinised by an independent
party (an auditor). Failing to lodge the APCS, or to obtain the opinion of a registered
company auditor (or a person approved by the Secretary), will provide the
Department with an initial indication of potential compliance concerns.
l e g i s l a t i v e r e f e r e n c e s
ss 9-2, 9-3 and
9-3A, Aged Care
Act 1997
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Information obtained from an approved provider
The Secretary can ask the approved provider for information on issues relating to
its financial management. For example, the Secretary can ask for further information
on an approved provider’s bond register or liquidity management strategy. Such a
request can be part of routine monitoring by the Department or may be in response
to more specific events such as complaints from residents or information from the
Aged Care Standards and Accreditation Agency.
Aged Care Standards and Accreditation Agency
The Aged Care Standards and Accreditation Agency has general responsibility for
checking that approved providers have systems in place to ensure their compliance
with prudential obligations under the Act. The Agency can check if providers have
these systems in place, and for documents such as a liquidity management strategy,
but the Agency is not responsible for assessing their appropriateness. The Agency
may become aware of possible prudential compliance issues through its auditing
arrangements. See References at the end of this chapter for Agency contact
information.
Aged Care Complaints Investigation Scheme
The Aged Care Complaints Investigation Scheme (the Scheme) investigates
complaints and concerns about Australian Government-subsidised aged care
including residential and community care. Concerns about compliance with the
requirements for accommodation bonds may be reported to the Scheme and will
then be investigated by the Department in accordance with the rules governing the
Scheme. See References at the end of this chapter for Scheme contact information.
Other reporting by approved providers or the public
The Department may receive information about potential compliance issues from
approved sources such as other approved providers and concerned members of
the public.
This information would be compared to information received through other
mechanisms and may also be followed up or verified with the approved provider
concerned.
Actions the Department can take in the event
of non-compliance
In the area of prudential regulation, the primary objective of Department is
to work with the aged care industry to promote compliance with the prudential
requirements. In line with this objective, the Secretary will consider taking
compliance action if the Secretary, or delegate, is concerned about the security
of accommodation bonds or the actions of an approved provider.
Any compliance action considered by the Secretary will be influenced by:
the level of risk posed by the non-compliance in terms of the security
of residents’ accommodation bonds and entry contributions
whether the non-compliance involved failure to refund an accommodation
bond balance within the required timeframe
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the extent and frequency of non-compliant behaviour by the approved provider
in relation to prudential requirements
and whether the approved provider failed to remedy the non-compliance after
it was brought to the approved provider’s attention.
The Department may respond in one of the following ways:
No action
If alleged non-compliance is unsubstantiated, no further action will be taken
although the Department/Agency may continue to monitor the provider.
Education
If an approved provider’s non-compliance was unintentional and based on a mis-
understanding of the requirements, the Department may work with the approved
provider to help put in place systems to enable it to comply.
Issue a non-compliance notice
Following assessment and possible investigation by the Department, a notice
of non-compliance may be issued. See legislative reference. The notice of non-
compliance will ask the approved provider to submit details about what it has done
or intends to do to remedy the non-compliance.
Impose sanctions
If the approved provider’s response to a notice of non-compliance is not satisfactory,
this may result in further compliance action including the imposition
of sanctions. The Secretary could impose any of the following sanctions:
prohibiting the charging of accommodation bonds
restricting funding to existing residents
revoking or suspending the existing allocation of places
revoking or suspending the provider’s approval as a provider of aged care services
varying the conditions of approval for allocated places
prohibiting any further allocation of places.
ACCOMMODATION BOND GUARANTEE SCHEME
Aged Care (Bond Security) Act 2006 (the Bond Security Act)
In addition to prudential requirements placed on approved providers and the
regulation of these requirements by the Secretary, further protection of
accommodation bonds is provided by the Bond Security Act.
The Bond Security Act establishes a scheme to guarantee the repayment of aged
care residents’ accommodation bond balances if an approved provider is bankrupt
or insolvent and cannot refund accommodation bonds.
The Bond Security Act enables the Australian Government to pay to a person an
amount equal to the accommodation bond balance owed to them by an approved
provider. In exchange for the payment, the Bond Security Act provides that any rights
that a person had to recover the amount from an approved provider are transferred
to the Commonwealth.
l e g i s l a t i v e r e f e r e n c e s
s 67-2, Aged
Care Act 1997
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The Bond Security Act does not create any day-to-day obligations with which
approved providers must comply. Approved providers should be aware that if they
become bankrupt or insolvent they must immediately notify the Department. Penalties
may be imposed for non-compliance. See References at the end of this chapter for a
link to ComLaw for the Bond Security Act.
Aged Care (Bond Security) Levy Act 2006 (the Bond Levy Act)
This Bond Levy Act operates in conjunction with the Bond Security Act and enables
levies to be imposed on approved providers to recover any costs to the Australian
Government from repaying accommodation bond balances to residents.
Approved providers would only be liable to pay a levy if there is a default on refunding
accommodation bonds by an approved provider and the Minister imposes a levy to
recover costs—for example, if costs cannot be recovered from the defaulting provider.
If this happens, the Department will notify all approved providers.
Like the Bond Security Act, the Levy Act imposes no daily obligations on approved
providers. See References at the end of this chapter for a link to ComLaw for the Bond
Levy Act.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Aged Care Complaints Investigation Scheme
Ph 1800 550 552
The line is open Monday–Friday, 8:30am–5pm; Saturday, Sunday and public holidays,
10am–5pm. Outside these hours, people can leave a message.
People can also write to the Scheme at:
Department of Health and Ageing
GPO Box 9848
In your Capital City
An online complaints investigation form is available at:
www.health.gov.au/internet/main/publishing.nsf/content/ageing-complaints-index.htm
If a person is not satisfied with how their complaint has been handled, they can take
their concerns to the Departmental manager responsible for the Scheme in their state
or territory, by calling the Scheme freecall number above.
Aged Care Information Line
Ph 1800 500 853
Aged Care Standards and Accreditation Agency
www.accreditation.org.au
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
PROTECTION AND RESPONSIBILITIES RELATING TO ACCOMMODATION BONDS
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RELATING TO ACCOMMODATION BONDS
210
Interest rates—current
BIR and MPIR—current and previous; rates are updated quarterly
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-finance-
refundrates.htm
Legislation—other
Go to ComLaw to access other legislation mentioned in this chapter, including the
Corporations Act 2001, the Privacy Act 1988, the Aged Care (Bond Security) Act
2006 and the Aged Care (Bond Security) Levy Act 2006.
www.comlaw.gov.au
Prudential regulation—enquiries
Email: prudential@health.gov.au
I
Relevant legislation 211
Overview 211
Additional information 212
Schedule 1 Specified care and services for residential care services 212
Part 1, Hotel Services—to be provided for all residents who need them 212
Part 2, Care and services—to be provided for all residents who need them 217
Part 3, Care and Services—to be provided for residents receiving a high level
of residential care 221
References—links, guides and forms referred to in this chapter 227
SPECIFIED CARE AND SERVICES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
SPECIFIED CARE AND SERVICES
SPECIFIED CARE AND SERVICES
THE RESIDENTIAL CARE MANUAL 2009, EDITION 1
II
SPECIFIED CARE AND SERVICES
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211
SPECIFIED CARE AND SERVICES
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 4.1, s 54-1(1)(a),
Aged Care Act 1997 (the Act)
Part 4.2, paragraph 56-1(b); Division 58, paragraph 54-1(1)(a),
Aged Care Act
1997
Part 4.4, s65-1, Division 66, Part 4.1, 4.2 or 4.3, s65-2, Division 67,
Aged Care
Act 1997
Quality of Care Principles 1997
(the Quality of Care Principles)
OVERVIEW
Approved providers of residential aged care are required to provide a range of care and
services to residents, as specified in the Quality of Care Principles, Schedule 1, at no
additional cost to residents. The care and services must be provided in a way which
meets the needs of the individual resident and also meets the outcomes under the
Accreditation Standards.
The resident agreement should clearly state all the care and service that a provider
is obliged to provide under the legislation, as well as any additional care or services
provided either at no additional cost to the resident or which the resident may have
to pay for. Any other matters negotiated with the resident should also be included
in the resident agreement. See also section on Resident agreements in chapter on
Residents’ rights in this Manual.
Providers are not only subsidised by the Government, but residents may also make
a significant contribution to the cost of their care and are therefore entitled to
receive the care and services they require.
While some of the items listed in Schedule 1 to the Quality of Care Principles are
non-specific, the intent of the legislation must be remembered—that is, to ensure
that residents receive the care and services they require, taking into account their
individual needs.
For example, a mattress must be provided for all residents irrespective of whether
the resident is high care or low care. In providing a mattress the provider must
ensure that the mattress meets the assessed care needs of the resident, whether that
is compromised skin integrity, falls prevention or another matter.
If a provider makes this commitment to residents in the quality of care and services
provided, then the requirements under the Accreditation Standards, set out in
Schedule 2 to the Quality of Care Principles, may also be addressed. See also
chapter on Accreditation and quality of care in this Manual.
If an approved provider does not meet the responsibilities specified in Schedule 1,
then compliance action may be taken.
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212
Approved providers have a responsibility under the Act and the Principles to:
provide the care and services specified in the Quality of Care Principles for the
type of aged care required See legislative reference.
only charge the amount permitted under Division 58 for provision of the care
and services the approved provider is responsible for providing See legislative
reference.
to charge no more for any other care or service than an amount agreed
beforehand with the resident and to give the resident an itemised account of
the other care or services See legislative reference.
to comply with the Accreditation Standards set out in Schedule 2 to the Quality
of Care Principles. See legislative reference.
Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can also
be accessed through the Aged Care Information Line on 1800 500 853.
SCHEDULE 1 SPECIFIED CARE AND SERVICES FOR RESIDENTIAL
CARE SERVICES
The three Parts to the Schedule are reproduced in the following tables. The
information set out in the third column is intended to assist providers to interpret
each Item, and has been developed in response to a wide range of enquiries from
providers, residents and their representatives about specified care and services.
However, the list of examples is not exhaustive, as it would be dicult to cover all
the care and services that could be provided under each Item. In providing specified
care and services, approved providers should bear in mind that they must meet the
individual needs of each resident; and provide a level of care and services which is
in step with current care regimes and practice.
The resident agreement must clearly state all the care and services that will be
provided at no additional cost as well as those care and services which the resident
has agreed to pay for.
Part 1, Hotel Services—to be provided for all residents
who need them
See legislative reference.
Part 1 refers to the hotel services to be provided for all residents who need them.
Aged care services are required to supply these items, unless a resident specifically
wishes to bring their own items with them, and this has been agreed on by the
provider.
s 54-1 (1) (a), Aged
Care Act 1997
s 56-1(b), Aged
Care Act 1997
s 56-1(d), Aged
Care Act 1997
s 54-1(d), Aged
Care Act 1997
Schedule 1, Part 1,
Hotel Services—
to be provided
for all residents
who need them
Quality of Care
Principles 1997
l e g i s l a t i v e r e f e r e n c e s
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ITEM AND SERVICE CONTENT EXAMPLES
Item 1.1
Administration
General operation of the
residential care service,
including resident
documentation.
An approved provider cannot charge
a resident for:
registering a resident for a place on
a waiting list
preparing a resident agreement
preparing invoices and statements for
a resident’s care
residents’ handbook
informing residents of meetings
administration/booking fees for all residents,
except for recipients of residential respite
care. See also section on Respite booking
fees in chapter on Residential respite care
in this Manual.
If specified in the resident agreement and agreed
by the resident/legal representation
a resident may be charged for:
storage fees, provided this is stated in resident
agreement
television rental
management of resident trust accounts
provided
the arrangement is voluntary—ie, residents
can handle their finances without placing
their money in a trust account with the
provider
the provider charges no more than an
amount agreed beforehand with the
resident
the provider gives the resident an account
showing the amount charged.
Item 1.2
Maintenance of
all buildings and
grounds
Adequately maintaining
buildings and grounds.
An approved provider cannot charge a resident for:
gardening
maintenance inside and outside the service
any repairs/replacements necessary because
of normal wear and tear.
If specified in the resident agreement and agreed
by the resident/legal representation a resident may
be charged for:
repairs and replacements necessary because
of deliberate damage.
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ITEM AND SERVICE CONTENT EXAMPLES
Item 1.3
Accommodation
Utilities such as electricity
and water.
An approved provider cannot charge a resident for:
inspection of the provider ’s electrical
equipment for occupational health and safety
purposes
telephone sockets
access to pay telephone
the cost of heating/cooling the service
to provide a comfortable environment
for residents
moving from one room to another within
the service.
If specified in the resident agreement and agreed
by the resident/legal representation
a resident may be charged for:
inspection of a resident’s electrical equipment
for occupational health and safety purposes.
However, a resident can choose who
performs the inspection—this could be
a qualified electrician on behalf of the service,
or a qualified electrician of the resident’s
choice
if a resident has a heating/cooling unit for
their own use (in addition to an eective
cooling/heating system provided by the
service) then the resident may be asked to
pay the cost of running the unit. The
approved provider must inform the resident
beforehand about the policies regarding
personal heating/cooling systems. This should
be included in the resident agreement or in
a variation to the resident agreement
telephone line rental and handset for the
resident’s personal use and cost of calls made
by the resident.
Item 1.4
Furnishings
Bedside lockers, chairs with
arms, containers for personal
laundry, dining, lounge and
recreational furnishings,
draw screens (for shared
rooms), resident wardrobe
space and towel rails.
Excludes furnishing a
resident chooses to provide.
An approved provider cannot charge a resident for:
a comfortable lounge chair for each resident
to meet their care, comfort and safety needs
if a high care resident has been assessed by
an appropriate allied health professional or
doctor as needing a chair with particular
features in order to provide for the safety, care
and comfort of the resident, then the
approved provider cannot charge the resident
for a chair with these features.
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ITEM AND SERVICE CONTENT EXAMPLES
Item 1.5
Bedding
Beds and mattresses, bed
linen, blankets and
absorbent or waterproof
sheeting.
An approved provider cannot charge a resident for:
beds, pillows and mattresses that meet the
assessed care, comfort and safety needs of
residents
non-standard beds if required to meet the
needs of exceptionally tall or heavy residents.
Item 1.6
Cleaning
services, goods
and facilities
Cleanliness and tidiness of
the entire residential care
service.
Excludes a resident’s
personal area if the resident
chooses and is able to
maintain it himself or
herself.
An approved provider cannot charge a resident for:
cleaning each resident’s room and ensuite
cleaning of floor covering including carpet
cleaning materials including materials for
the use of residents who choose to maintain
their own personal area.
Item 1.7
Waste disposal
Safe disposal of organic and
inorganic waste material.
This includes:
the safe disposal of sharps and contaminated
waste.
Item 1.8
General laundry
Heavy laundry facilities and
services, and personal
laundry services, including
laundering of clothing that
can be machine washed.
Excludes cleaning of
clothing requiring dry
cleaning or another special
cleaning process, and
personal laundry if a
resident chooses and is able
to do this himself or herself.
An approved provider cannot charge a resident for:
general laundry, including both washing and
ironing of clothing that can be machine
washed. Aged care services are not obliged
to hand-wash residents’ clothing.
the service must have in place a system for
identification of residents’ clothing and
laundry items. However, a resident may
choose and pay for their own identification
system as long as it is at least of an equivalent
standard to the service’s system—eg, woven
name tapes rather than laundry marking pen.
Item 1.9
Toiletry goods
Bath towels, face washers,
soap and toilet paper.
An approved provider cannot charge a resident for:
suitable soap, or soap substitute for residents
who cannot use soap because of clinical need.
If specified in the resident agreement and agreed
by the resident/legal representation a resident may
be charged for:
a resident’s personal choice to use alternative
items to those provided by the service such
as specific brands of soap.
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ITEM AND SERVICE CONTENT EXAMPLES
Item 1.10
Meals and
refreshments
(a) Meals of adequate variety,
quality and quantity for each
resident, served each day at
times generally acceptable
to both residents and
management, and generally
consisting of 3 meals per
day plus morning tea,
afternoon tea and supper;
(b) Special dietary
requirements, having regard
to either medical need or
religious or cultural
observance;
(c) Food, including fruit of
adequate variety, quality and
quantity, and non-alcoholic
beverages, including fruit
juice.
An approved provider cannot charge a resident for:
quality food in accordance with residents’
individual nutritional needs. Residents should
be consulted about menu planning to ensure
that menu choices take into account their
preferences
food appropriate to meet medical, cultural
and religious needs as well as special dietary
requirements, eg vegetarian, kosher, halal,
gluten free, low fat and thickened drinks if
required by an individual resident
nutritional supplements—for residents who
are assessed by an appropriate health
professional as needing a special dietary
supplement to ensure they receive adequate
nourishment and hydration.
Item 1.11
Resident social
activities
Programs to encourage
residents to take part in
social activities that promote
and protect their dignity,
and to take part in
community life outside the
residential care service.
Aged care services are expected to consult with
residents and/or their representatives in the care,
planning and development of activity programs
and base the activities oered on the needs,
wishes and abilities of residents.
While residents may choose not to be involved in
social activities, services should discuss the reasons
for non-participation with a resident and/or their
representative.
If specified in the resident agreement and agreed
by the resident/legal representation a resident may
be charged for:
special packaging of medication for residents
going on social leave
outing costs—for example, transport costs,
entry fees and food. However, many services
may choose to pay for these costs. Residents
must be advised in advance of any costs.
Item 1.12
Emergency
assistance
At least one responsible
person is continuously on
call and in reasonable
proximity to render
emergency assistance.
The number of residents and their dependency
levels should be considered in deciding the
number and qualifications of emergency assistance
personnel available.
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l e g i s l a t i v e r e f e r e n c e s
Part 2, Care and services—to be provided
for all residents who need them
See legislative reference.
ITEM AND SERVICE CONTENT EXAMPLES
Item 2.1
Daily living
activities
assistance
Personal assistance, including individual
attention, individual supervision, and
physical assistance, with:
(a)
bathing, showering, personal
hygiene and grooming
(b)
maintaining continence or
managing incontinence, and using
aids and appliances designed
to assist continence management
(c)
eating and eating aids, and using
eating utensils and eating aids
(including actual feeding if necessary)
(d)
dressing, undressing, and using
dressing aids
(e)
moving, walking, wheelchair use,
and using devices and appliances
designed to aid mobility, including
the fitting of artificial limbs and other
personal mobility aids
(f)
communication, including to
address diculties arising from
impaired hearing, sight or speech, or
lack of common language (including
the fitting of sensory communication
aids), and checking hearing aid
batteries and cleaning spectacles.
Excludes hairdressing.
An approved provider cannot
charge a resident to ensure that
all care needs are assessed and
appropriately met.
Assistive devises should be available
for use by residents who need this
equipment so that activities of daily
living can be appropriately
maintained.
Low care residents may be able to
access continence aids through the
Continence Aids Assistance Scheme.
See References at the end of this
chapter for a link.
Schedule 1, Part 2,
Care and services—to
be provided for all
residents who need
them,Quality of Care
Principles 1997
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ITEM AND SERVICE CONTENT EXAMPLES
Item 2.2
Meals and
refreshments
Special diet not normally
provided.
Approved providers must provide individual
residents with medically prescribed special diets or
components of special diets. See also Item 1.10 on
page 216.
Additional funding is only available for an enteral
feeding formula provided enterally.
Approved providers can apply to the Department for
an enteral feeding supplement, if this is supported
by medical certification of the resident’s ongoing
need.
See also section on Enteral feeding supplement
in chapter on Funding for permanent residential
aged care in this Manual.
Item 2.3
Emotional
support
Emotional support to, and
supervision of, residents.
An approved provider cannot charge a resident for:
individual support in adjusting to life in the
new environment and on an ongoing basis,
where needed
support in exercising rights under the Charter
of Residents’ Rights and Responsibilities
ensuring that residents have access to
support through counsellors, appropriate
health professionals, chaplains, community
visitors and advocacy.
If a resident needs professional counselling
services, they may be asked to pay the counsellor’s
fee provided that the amount is agreed
beforehand with the resident.
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ITEM AND SERVICE CONTENT EXAMPLES
Item 2.4
Treatments and
procedures
Treatments and procedures
that are carried out
according to the instructions
of a health professional or
a person responsible for
assessing a resident’s
personal care needs,
including supervision and
physical assistance with
taking medications, and
ordering and reordering
medications, subject to
requirements of state or
territory law.
An appropriately qualified health professional must
identify what treatments and procedures a resident
requires. The treatments and procedures must be
carried out by an appropriately qualified health
professional, or undertaken under the supervision
of an appropriately qualified health professional
as required under state or territory law.
An approved provider cannot charge a resident for:
nurses to come in to the service to provide
treatment. If the service chooses to employ
home and community care (HACC),
community or agency nurses then the
approved provider pays for this. This includes
nurses employed to administer regular injections
—for example, insulin injections—or to provide
complex wound care.
services must have a system in place for
ordering, reordering, safely storing and
administering medications. If a packaging
system is the chosen medication
administration system, then the service must
pay for this system and must not charge the
resident or arrange for the pharmacist to
charge the resident.
A resident may be charged for:
the cost of medications and other
pharmaceutical items unless these are for
a high care resident and are covered by Item
3.7 on page 224
a dierent medication administration system
to the one used in the service, if a resident
chooses to have a dierent system
for a low care resident, the cost of any
dressings or equipment, required for the
treatment or procedure. For high level care
residents, see Item 3.7 on page 224.
The Department provides assistance to aged care
services for those residents who have an ongoing
need for oxygen treatment irrespective of whether
the resident is classified as receiving high or low
level care. For more information about assistance
for residents with an ongoing need for oxygen
treatment, see also section on Oxygen supplement
in chapter on Funding for permanent residential
aged care in this Manual.
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ITEM AND SERVICE CONTENT EXAMPLES
Item 2.5
Recreational
therapy
Recreational activities suited
to residents, participation in
the activities, and communal
recreational equipment.
This item is considered essential for the general
health and wellbeing of residents. Services are
expected to consult with residents and/or their
representatives as part of the care planning
activities so they can provide activities that
residents enjoy and include activities that cater to
minority interests. While residents may choose not
to be involved in social activities, services should
discuss the reasons for non-participation with the
resident and/or their representative. See also Item
1.11 on page 216.
If specified in the resident agreement and agreed
by the resident/legal representation a resident may
be charged for:
outing costs—for example, transport costs,
entry fees and food. However, many services
choose to pay the costs. Residents must be
advised in advance of any costs.
Item 2.6
Rehabilitation
support
Individual therapy programs
designed by health
professionals that are aimed
at maintaining or restoring
a resident’s ability to
perform daily tasks for
himself or herself, or
assisting residents to obtain
access to such programs.
An approved provider cannot charge a resident for:
an assessment by an appropriate health
professional—for example, a physiotherapist,
occupational therapist or nurse practitioner—
of the resident’s rehabilitation support needs.
This may involve a health professional visiting
the service to design an appropriate program,
or the service making arrangements for the
resident to visit the health professional.
This should include discussion with residents
and/or their representative regarding
achievable goals.
Item 2.7
Assistance in
obtaining health
practitioner
services
Arrangements for aural,
community health, dental,
medical, psychiatric and
other health practitioners to
visit residents, whether the
arrangements are made by
residents, relatives or other
persons representing the
interests of residents, or are
made direct with a health
practitioner.
Approved providers are required to make
arrangements for the listed health practitioners
to visit the resident at the service, as appropriate to
a resident’s needs. Alternatively, they should make
arrangements for the resident to visit a health
practitioner if the practitioner is not able to visit
the service.
The provider should assist with arranging transport
to and from appointments when necessary.
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l e g i s l a t i v e r e f e r e n c e s
ITEM AND SERVICE CONTENT EXAMPLES
Item 2.8
Assistance in
obtaining access
to specialised
therapy services
Making arrangements for
speech therapy, podiatry,
occupational or
physiotherapy practitioners
to visit residents, whether
the arrangements are made
by residents, relatives or
other persons representing
the interests of residents.
Approved providers are required to:
make arrangements for the listed health
practitioners to visit the resident at the
service, as appropriate to the needs of the
resident
assist with the arrangements of transport
arrange for a relative, representative or volunteer
to accompany the resident to appointments.
Item 2.9
Support for
residents with
cognitive
impairment
Individual attention and
support to residents with
cognitive impairment
(e.g. dementia, and other
behavioural disorders),
including individual therapy
activities and specific
programs designed and
carried out to prevent or
manage a particular
condition or behaviour and
to enhance the quality of
life and care for such
residents and ongoing
support (including specific
encouragement) to motivate
or enable such residents to
take part in general activities
of the residential care service.
Part 3, Care and Services—to be provided for residents
receiving a high level of residential care
See legislative reference.
ITEM AND SERVICE CONTENT EXAMPLES
Item 3.1
Furnishings
Over-bed tables.
Schedule 1, Part 3,
Care and Services—
to be provided for
residents receiving a
high level of residential
care, Quality of Care
Principles 1997
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ITEM AND SERVICE CONTENT EXAMPLES
Item 3.2
Bedding
materials
Bed rails, incontinence
sheets, restrainers, ripple
mattresses, sheepskins, tri-
pillows, and water and air
mattresses appropriate to
each resident’s condition.
Bedding materials must meet the resident’s
individual needs as assessed by an appropriate
health professional. The service must provide
pressure-relieving items of suitable type and quality.
An approved provider cannot charge a resident for:
water, air and gel cushions and comfort chairs
used for pressure relieving purposes
if a high level care resident is unable
to walk or move about independently, and
cannot use a conventional arm chair, then the
provider should provide the resident with a
chair, such as an air, water or gel chair, which
meets the residents comfort, safety and care
needs.
Item 3.3
Toiletry goods
Sanitary pads, tissues,
toothpaste, denture
cleaning preparations,
shampoo and conditioner,
and talcum powder.
Item 3.4
Goods to assist
residents to
move
themselves
Crutches, quadruped walkers,
walking frames, walking
sticks, and wheelchairs.
Excludes motorised
wheelchairs and custom
made aids.
An approved provider must provide:
sucient numbers of the listed equipment,
including non-motorised wheelchairs, so that
they are available for a resident as required
within the aged care service
sucient wheelchairs appropriate to the needs
of high care residents, which take into account
pressure care and allow for optimum levels of
mobility and participation. The fact that one
resident needs full time use of a wheelchair
should not deny other residents access or
mean that the resident using the chair full-
time has to purchase a wheelchair in order
to have use of one.
If specified in the resident agreement and agreed
by the resident/legal representation a resident may
be charged for:
custom made aids specifically made for
a resident and only for the use of that
resident—for example, tailor made arm,
hand and/or leg splints.
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ITEM AND SERVICE CONTENT EXAMPLES
Item 3.5
Goods to assist
sta to move
residents
Mechanical devices for
lifting residents, stretchers,
and trolleys.
Approved providers must have sucient lifting
devices on hand to provide access for all residents
who need this type of support and to ensure
occupational health and safety obligations are met.
Equipment must be fit for the purpose intended
and sta trained in its use.
An approved provider cannot charge a resident for:
slings for lifting machines.
Item 3.6
Goods to assist
with toileting
and incontinence
management
Absorbent aids, commode
chairs, disposable bed pans
and urinal covers, disposable
pads, over-toilet chairs,
shower chairs and urodome,
catheter and urinary drainage
appliances, and disposable
enemas.
An approved provider cannot charge a resident for:
assessment by an appropriately qualified health
professional to ensure that the individual
continence needs of a resident are determined
and met. If a resident is assessed as requiring
continence pads or other equipment to
manage their continence and the resident is
receiving high level care, then the provider
must provide the pads/equipment at no
additional cost to the resident.
absorbent sheets
items to meet the needs of all high level care
residents in regard to toileting and
incontinence.
See References at the end of this chapter for a link
to the Continence Aids Assistance Scheme.
Stoma related products are available free of charge
through the Stoma Scheme to residents who are
ostomates. See References at the end of this chapter
for more information on the Stoma Scheme.
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ITEM AND SERVICE CONTENT EXAMPLES
Item 3.7
Basic medical
and
pharmaceutical
supplies and
equipment
Analgesia, anti-nausea
agents, bandages, creams,
dressings, laxatives and
aperients, mouthwashes,
ointments, saline, skin
emollients, swabs, and
urinary alkalising agents.
Excludes any goods
prescribed by a health
practitioner for a particular
resident and used only by
the resident.
It is expected that basic medical and
pharmaceutical supplies and equipment provided
are in accord with current care regimes and
practices, and comply with relevant state and
territory legislation.
Obtaining a doctor’s prescription for an over-the-
counter item that would normally be provided by
the aged care service at no additional cost does
not necessarily mean a resident can be charged for
this item. If large quantities of a generally available
item are prescribed by a doctor for ongoing
treatment to meet an identified care need as
documented in the resident’s care plan, and the
item is to be used only by that resident, then the
resident can be asked to pay for this item.
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ITEM AND SERVICE CONTENT EXAMPLES
Item 3.8
Nursing services
Initial and ongoing assessment,
planning and management of care
for residents, carried out by a
registered nurse. Nursing services
carried out by a registered nurse or
other professional appropriate to the
service (eg, medical practitioner,
stoma therapist, speech pathologist,
physiotherapist or qualified
practitioner from a palliative care
team). Services may include, but
are not limited to, the following:
(a) establishment and supervision
of a complex pain management
or palliative care program,
including monitoring and
managing any side eects;
(b) insertion, care and maintenance
of tubes including intravenous and
nasogastric tubes;
(c) establishing and reviewing
a catheter care program, including
the insertion, removal and
replacement of catheters;
(d) establishing and reviewing
a stoma care program;
(e) complex wound management;
(f) insertion of suppositories;
(g) risk management procedures
relating to acute or chronic
infectious conditions;
(h) special feeding for care recipients
with dysphagia (diculty with
swallowing);
(i) suctioning of airways;
(j) tracheostomy care;
(k) enema administration;
(l) oxygen therapy requiring
ongoing supervision because
of a care recipient’s variable need;
and
(m) dialysis treatment.
A service must not charge a high care
resident for nursing services or nursing
consultancy services, if an aged care
service employs a nurse consultant for
advice concerning specialist nursing care.
The list of services in this item is not
exhaustive; they are only examples
of what may be included.
Stoma related products and supplies are
available through the Stoma Scheme free of
charge to residents who are ostomates. See
References at the end of this chapter for
more information on the Stoma Scheme.
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ITEM AND SERVICE CONTENT EXAMPLES
Item 3.10
Medications
Medications subject to
requirements of State or
Territory law.
An approved provider cannot charge a resident for:
the provision of systems for dispensing
medication—for example, blister packs.
The provider pays the costs of these types
of systems. See also Item 2.4 on page 219.
Item 3.11
Therapy
services, such
as recreational,
speech therapy,
podiatry,
occupational
and
physiotherapy
services
(a) Maintenance therapy
delivered by health
professionals, or care sta
as directed by health
professionals, designed to
maintain residents’ level of
independence in activities
of daily living.
(b) More intensive therapy
delivered by health
professionals, or care sta
as directed by health
professionals, on a
temporary basis that is
designed to allow residents
to reach a level of
independence at which
maintenance therapy will
meet their needs.
Excludes intensive, long-
term rehabilitation services
required following, for
example, serious illness or
injury, surgery or trauma.
This includes assessment by a relevant health
professional.
Following the assessment the health professional
can deliver the care or direct the care, which may
be provided by care sta in accordance with the
relevant state and territory legislation.
Item 3.12
Oxygen and
oxygen
equipment
Oxygen and oxygen
equipment needed on
a short-term, episodic
or emergency basis.
This item indicates that oxygen must be available
for emergency use. It includes the provision of
tubing and masks for the administration of oxygen.
The Department provides assistance to aged care
services for those residents who have an ongoing
need for oxygen treatment irrespective of whether
the resident is classified as receiving high or low
level care. See also section on Oxygen supplement
in chapter on Funding for permanent residential
aged care in this Manual.
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227
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Aged Care Information Line
Ph 1800 500 853
Continence Aids Payment Scheme and Continence Aids Assistance Scheme
From 1 July 2010, the Continence Aids Payment Scheme will replace the current
Continence Aids Assistance Scheme. For information on both go to:
www.bladderbowel.gov.au
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Stoma scheme
www.health.gov.au/internet/main/publishing.nsf/Content/
Stoma+Appliance+Scheme-1
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I
Relevant legislation 229
Overview 229
Additional information 229
Quality of care 229
User rights 230
Accountability requirements 230
Police checks 231
What is a national criminal history record check? 232
Who is required to have a police check? 232
What are the consequences for sta and volunteers whose police checks
reveal a criminal oence? 233
When should a statutory declaration be made? 233
Maintaining and renewing police checks 233
Keeping sta and volunteers’ police checks on file 234
Missing residents 234
Monitoring compliance 234
Role of the Department of Health and Ageing 235
Role of the Aged Care Standards and Accreditation Agency 235
Compliance action 236
When can sanctions be imposed? 236
What sanctions can be imposed? 236
Agreeing to certain matters in lieu of revoking approved provider status 237
Duration of sanctions 237
Notice of non-compliance 238
Notice to remedy non-compliance 238
Notice of intention to impose sanctions 239
Notice of decision on whether to impose sanctions 239
Review rights 240
PROVIDERS’ RESPONSIBILITIES
AND NONCOMPLIANCE
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Publishing sanctions and notices of non-compliance 240
Case management and consumer information 240
Notices of non-compliance 241
References—links, guides and forms referred to in this chapter 241
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229
PROVIDERS’ RESPONSIBILITIES
AND NONCOMPLIANCE
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Chapter 4,
Aged Care Act 1997 (the Act)
Division 85,
Aged Care Act 1997
Quality of Care Principles 1997
(the Quality of Care Principles)
Sanctions Principles 1997
(the Sanctions Principles)
User Rights Principles 1997
(the User Rights Principles)
Accountability Principles 1998
(the Accountability Principles)
Accreditation Grant Principles 1999
(the Accreditation Grant Principles)
Sections 19.5A and 19.5B,
Records Principles 1997
OVERVIEW
This chapter explains the actions that can be taken when providers do not comply
with their responsibilities under the Act for:
quality of care
See legislative reference.
user rights—ie, the rights of residents
See legislative reference.
accountability for the care that is provided.
See legislative reference.
Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care.
More information about police check requirements is available in the Police
Certificate Guidelines for Aged Care Providers. See References at the end of this
chapter for a link. Additional information can also be accessed through the Aged
Care Information Line on 1800 500 853.
QUALITY OF CARE
Approved residential care providers must:
provide such care and services specified in the Quality of Care Principles
in respect of the type of aged care that is provided by the service
maintain an adequate number of appropriately skilled sta to ensure that the
care needs of residents are met
provide care and services of a quality that is consistent with any rights and
responsibilities of residents specified in the User Rights Principles
comply with the Accreditation Standards.
See legislative reference.
Part 4.1, 4.2, 4.3
Aged Care Act
1997
Schedule 2,
Quality of Care
Principles 1997
l e g i s l a t i v e r e f e r e n c e s
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USER RIGHTS
Approved providers must:
provide quality care and services consistent with the Charter of Residents’
Rights and Responsibilities and requirements in the User Rights Principles
relating to:
residents’ security of tenure for their places in an aged care service
access to the aged care service by residents’ representatives, advocates and
community visitors
providing information to residents about their rights and responsibilities and,
on request, about the financial viability of the aged care service
restrictions on moving a resident within an aged care service
booking fees for respite stays
comply with prudential and other requirements in relation to any
accommodation payments charged for a resident’s entry to an aged care
service
not charge more than the amount permitted under the Act and the User Rights
Principles for the care and services which the approved provider is responsible
for providing
not charge more for other care or services than an amount agreed beforehand
with the resident, and to provide an itemised account of the care and services
provided
oer to enter into a resident agreement with the resident and enter into such
an agreement if the resident wishes
ensure that a resident’s personal information is only used for a purpose
connected with providing aged care to the resident, or for a purpose for which
the information was given to the provider See legislative reference.
comply with the requirements of the Act in relation to complaints resolution
mechanisms for the service See legislative reference.
if the aged care service has extra service status, comply with the requirements
of Division 36 of the Act See legislative reference.
take reasonable steps to identify residents, or the legal representatives of their
estate, and when directed by the Secretary, refund fees or charges to care
recipients who paid accommodation charges while they were charge exempt
residents.
ACCOUNTABILITY REQUIREMENTS
Approved residential care providers must:
keep and maintain records that enable claims for payments of subsidies to be
verified and proper assessments to be made of whether the approved provider
is complying with its responsibilities
cooperate with anyone exercising the powers of an authorised ocer under
Part 6.4 of the Act and comply with the obligations in that Part in relation
to the ocer’s exercise of those powers See legislative reference.
notify the Department of any change of key personnel or change of
circumstances that materially aects the provider’s suitability to be a provider
l e g i s l a t i v e r e f e r e n c e s
s 62-1, Aged
Care Act 1997
s 56-4, Aged
Care Act 1997
Division 36, Aged
Care Act 1997
Part 6.4, Aged
Care Act 1997
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of aged care within 28 days after the change occurs; and respond within 28
days to any request by the Secretary for information about the provider’s
suitability, payments made to the provider or information relating to
accommodation payments
comply with any conditions on the allocation of any places in the aged care
service, for example:
people with special needs
supported, concessional and assisted residents
people needing a particular level of care
people receiving respite care
other people specified in the notice of allocation of places to the provider
provide records or copies of records to another approved provider in accordance
with s 16-10 of the Act, for any places transferred to that provider See legislative
reference.
if the provider has relinquished any places:
notify the Department at least 60 days before the proposed date of
relinquishment
comply with any proposal accepted, modified or set out by the Secretary to
ensure that the care needs of residents in those places are appropriately met
allow people authorised by the Secretary access to the aged care service
to assess the care needs of any person provided with care at the service
conduct appraisals or reappraisals of the care required by residents
in a proper way
comply with the conditions under which extra service status was granted
or renewed
allow people authorised by the Secretary access to the aged care service
to review the service’s certification
comply with any agreement the approved provider undertakes in lieu
of revocation of approved provider status imposed as a sanction, or any
undertaking they give to the Secretary, to remedy non-compliance with the
provider’s responsibilities
allow representatives from the Aged Care Standards and Accreditation Agency
(the Agency) access to the aged care service to assess compliance with the
Accreditation Standards through accreditation site visits, review audits, support
contacts and spot checks.
POLICE CHECKS
From 1 January 2009, approved providers must ensure that all sta and unsupervised
volunteers who are likely to have access to residents have a current police certificate.
Approved providers are therefore required to ensure that all sta and unsupervised
volunteers undergo a police check every three years to determine their suitability
to work in aged care. (Previous police check requirements related only to sta and
volunteers who were reasonably likely to have unsupervised access to residents.)
l e g i s l a t i v e r e f e r e n c e s
s 16-10, Aged
Care Act 1997
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What is a national criminal history record check?
State or territory police, or the Australian Federal Police, can conduct a national
criminal history record check to determine if a person has been charged with and/or
convicted of a criminal oence which has not been removed from their record
under a spent conviction scheme.
Who is required to have a police check?
All people who are employed, hired, retained or contracted by an approved provider,
whether directly or through an employment or recruitment agency, to provide care
or services within an aged care service, who are reasonably likely to have access to
residents, are required to have a police check. See legislative reference.
This covers people over the age of 16 who work or provide services at the aged care
service, including:
key personnel of the approved provider
employees and contractors of the approved provider who provide care
allied health professionals contracted by the approved provider to provide care
kitchen, laundry, garden and oce personnel employed by the approved
provider
consultants, trainers and advisors for accreditation support or systems
improvement who are under the control of the approved provider
sta who are not directly engaged by the approved provider but who are under
the control of the approved provider, for example, agency sta
where an approved provider has a contract with an agency that provides
sta, the contract should be amended to include the requirement for police
checks. The contract should state that any sta provided must have had a
police check, and that the check does not preclude them from working in
aged care
volunteers who are organised by the provider and who have, or are reasonably
likely to have, unsupervised access to a resident
volunteers visiting residents under the Community Visitors Scheme.
This excludes:
volunteers who are under the age of 16 or under the age of 18 if they are a full-
time school student
visiting people who attend the service at the invitation of a resident
visiting medical practitioners, pharmacists and other allied health care
personnel who are requested by, or on behalf of, the resident but not
contracted by the approved provider
tradespeople and independent contractors—for example, plumbers,
electricians, delivery people—who provide services on an ad hoc basis
volunteers who only have supervised access to residents
For further information about who is required to have a police check, contact the
Aged Care Information Line on 1800 500 853.
l e g i s l a t i v e r e f e r e n c e s
s 1.18,
Accountability
Principles 1998
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What are the consequences for sta and volunteers whose
police checks reveal a criminal oence?
Approved providers must be satisfied that the police certificate does not record that
the person has been:
convicted for murder or sexual assault
or convicted of, and sentenced to imprisonment for, any other form of assault.
If the approved provider cannot be satisfied of this, the person is not permitted
to work within an aged care service. See legislative reference.
For convictions for other oences it is up to the approved provider to determine
whether the individual is suitable to be engaged in the service. Providers should
consider the seriousness and relevance of the conviction, the level of access the
person has to care recipients and the length of time since the conviction. There are
a range of factors to weigh up, and providers should consult the Police Certificate
Guidelines for Aged Care Providers when making their decision. However, the
overriding responsibility that providers should bear in mind is the health, safety and
well-being of care recipients. See References at the end of this chapter for a link
to the Guidelines.
When should a statutory declaration be made?
There are two circumstances in which a sta member or unsupervised volunteer will
be required to make a statutory declaration:
where, prior to receiving a police certificate, a new sta member commences
working within the service they will be required to make a statutory declaration
stating that they have never been convicted of murder or sexual assault, or
convicted of, and sentenced to imprisonment for, any other form of assault.
The application for a police certificate must have been made and until the
certificate is received, the person must be subject to appropriate supervision.
See legislative reference.
if a sta member, since turning 16 years of age, was a citizen or permanent
resident of any country other than Australia, they are required to make a
statutory declaration stating that they have never been convicted of murder or
sexual assault, or convicted of, and sentenced to imprisonment for, any other
form of assault in Australia or another country. See legislative reference.
Maintaining and renewing police checks
Approved providers have a responsibility to take reasonable measures to require each
of their sta members and volunteers to notify the approved provider if they are
convicted of a precluding oence in the three year period between obtaining and
renewing their police check.
Where an approved provider is satisfied on reasonable grounds that a sta member
or volunteer has been convicted of a precluding oence they must ensure that
person does not continue as a sta member or volunteer. See legislative reference.
Approved providers have a continuing responsibility to ensure that for each person
who is a sta member or unsupervised volunteer there is a police certificate that is
not more than 3 years old. See legislative reference.
s 1.22,
Accountability
Principles 1998
s 1.24,
Accountability
Principles 1998
ss 1.21(3) and (4),
Accountability
Principles 1998
s 1.21(1),
Accountability
Principles 1998
l e g i s l a t i v e r e f e r e n c e s
s 1.19 and
s 1.21(2),
Accountability
Principles 1998
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Keeping sta and volunteers’ police checks on file
Approved providers are required to retain records demonstrating that police checks
not more than 3 years old have been undertaken for all sta and relevant volunteers.
See legislative reference. Storage of personal information about sta and volunteers
must be in accordance with the Privacy Act 1988. See References at the end of this
chapter for a link to ComLaw for the Privacy Act 1988. See legislative reference.
To help approved providers complete and assess records for sta and volunteers,
there are two templates at Appendix 3 of the Police Certificate Guidelines for Aged
Care Providers.
For a link to the Guidelines; and for a link to the oce of the Privacy Commissioner,
see References at the end of this chapter.
MISSING RESIDENTS
Approved providers are required to notify the Department if:
there is an unexplained absence of a care recipient from a residential aged
care service
and the police have been notified.
After the provider has notified the missing resident’s family and the police, the
approved provider must then notify the Department. The notification should be
made to the Aged Care Complaints Investigation Scheme as soon as practicable
and in any case within 24 hours of reporting to the police. See legislative reference.
See References at the end of this chapter for contact information.
These requirements do not override an approved provider’s responsibility to comply
with the Charters of Residents’ Rights and Responsibilities, which includes the resident’s
rights to move freely both inside and outside the service without undue restriction.
This notification will enable the Department to determine whether appropriate
action has been taken by the approved provider in respect of the missing residents
and whether there are adequate systems and processes in place to ensure other
residents’ safety. This reporting requirement is part of an approved provider’s
responsibility under the Act to provide a safe and secure environment.
The Department’s response to the notification will be to review the matter to
establish whether there is an ongoing risk to residents. For example, it is unlikely
further action will be taken where a missing resident turns up, having spent a
day with family or friends. Whereas, if a resident is reported as missing without
reasonable explanation and it is considered that the approved provider did not
have adequate systems and processes in place to prevent the absence, then the
Department can investigate and compliance action could be taken.
MONITORING COMPLIANCE
Both the Department and the Agency are responsible for monitoring aged care
services’ compliance with their responsibilities under the Act.
l e g i s l a t i v e r e f e r e n c e s
s 19.5A, Records
Principles 1997
s 19.5B, Records
Principles 1997
s 62-1, Aged Care
Act 1997, s 1.14A,
Accountability
Principles 1998
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Role of the Department of Health and Ageing
The Department is required to take appropriate action when an approved provider is
not complying with their responsibilities in relation to quality of care, user rights and
accountability under the Act. See legislative reference. This includes taking into
account a provider’s compliance with the Accreditation Standards.
The Department monitors approved providers’ responsibilities under the Act.
While the Agency’s regulatory role focuses on a provider’s compliance with the
Accreditation Standards, ocers authorised by the Department can also monitor
compliance with the Accreditation Standards, particularly if compliance notices
or sanctions are being considered.
In order to monitor compliance by approved providers, the Secretary can appoint
authorised ocers who can conduct spot checks—or unannounced visits—on aged
care services. See legislative reference. Authorised ocers can also conduct site
visits. For a site visit, an authorised ocer will notify an approved provider of the
intended visit and agree on a time for the visit. At all times, an authorised ocer
must be able to produce an identity card verifying their authority to conduct
a compliance monitoring visit.
The authorised ocer must obtain the consent of the occupier of the premises
before entering the service. An approved provider can also withdraw their consent
at any time. See legislative reference. However, if an approved provider fails to
cooperate with an authorised ocer, for example, by denying access or refusing
to provide reasonable assistance, the Department may take compliance action.
If a service breaches their responsibilities under the Act, the Department can start
compliance action. This can include issuing a notice of non-compliance to the
approved provider or imposing sanctions. Dierent sanctions can be imposed
depending on the type of non-compliance.
Role of the Aged Care Standards and Accreditation Agency
The Agency manages the process of accreditation of residential aged care services
in accordance with the Accreditation Grant Principles. It assesses and monitors
Government-subsidised aged care services against the Accreditation Standards.
If the Agency finds that a service is not complying with the Accreditation Standards
and its other responsibilities under the Act, but the non-compliance has not placed
the safety, health or wellbeing of the residents at serious risk, it will write to the
service informing them of: See legislative reference.
areas where improvements must be made to ensure compliance with the
Accreditation Standards
the timetable set to make the necessary improvements
the program of support contacts by an Agency representative to assess
progress in making the necessary improvements
If the level of care provided at the end of the timetable does not comply with
the Accreditation Standards, the Agency must give the approved provider and the
Department information and evidence about the way in which the level of care
is not satisfactory. The Agency must also recommend to the Department that
sanctions be imposed. See legislative reference.
l e g i s l a t i v e r e f e r e n c e s
Part 4.1, 4.2,
4.3, Aged
Care Act 1997
Part 6.4, Aged
Care Act 1997
s 91-1, Aged
Care Act 1997
s 4.6(4),
Accreditation
Grant Principles
1999
s 4.7,
Accreditation
Grant Principles
1999
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If the Agency finds that an aged care service is not complying with the
Accreditation Standards or other responsibilities under the Act and is putting the
safety, health or wellbeing of residents at serious risk, then the Agency must inform
the Department of this in writing. See legislative reference. The Agency may also
make recommendations on whether sanctions should be imposed by the
Department; and may decide to vary or revoke a service’s period of accreditation.
The Department can take compliance action, consistent with the Act and
appropriate to the nature and level of non-compliance. See Compliance action
following.
For more information on the Agency, see chapter on Accreditation and quality
of care in this Manual.
COMPLIANCE ACTION
The Act sets out a series of formal steps leading to sanctions which the Department
can take if an approved provider is not complying with its responsibilities.
See legislative reference.
When can sanctions be imposed?
Sanctions can be imposed on a provider if: See legislative reference.
the approved provider is not complying with one or more of its responsibilities
in relation to quality of care, user rights and/or accountability
the Secretary is satisfied that it is appropriate to impose sanctions.
In deciding whether or not to impose sanctions, the Secretary will consider:
See legislative reference.
whether the non-compliance is minor or serious
whether the non-compliance has occurred before, and if so, how often
whether the non-compliance threatens the health, welfare or interests of the
residents or of future residents
whether the approved provider has failed to comply with any undertaking
to remedy the non-compliance
the desirability of deterring any future non-compliance
any other matters specified in the Sanctions Principles.
Sanctions can be imposed in two ways: See legislative reference.
immediately, if the Secretary believes there is an immediate and severe risk
to the safety, health or wellbeing of residents as a result the provider’s non-
compliance
if there is no immediate or severe risk to the safety, health or wellbeing of
residents, the Secretary must first issue a series of notices, starting with a notice
of non-compliance, before imposing sanctions.
What sanctions can be imposed?
The Secretary can impose one or more of the following sanctions, by notice
in writing See legislative reference.
l e g i s l a t i v e r e f e r e n c e s
s 4.4(1)(a),
Accreditation
Grant Principles
1999
Part 4.4, Aged
Care Act 1997
s 65-1, Aged Care
Act 1997
s 65-2, Aged Care
Act 1997
s 67-1, Aged Care
Act 1997
s 66-1, Aged Care
Act 1997
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revoking or suspending approval as a provider of aged care services See
Agreeing to certain matters in lieu of revoking approved provider status following.
restricting approval to existing services or places
restricting funding to existing residents
revoking or suspending the existing allocation of places
varying the conditions of approval for allocated places
prohibiting the further allocation of places
revoking or suspending extra service status
prohibiting granting of approval for extra service status
revoking or suspending certification
prohibiting the charging of accommodation charges or accommodation bonds
requiring repayment of grants
other sanctions as specified in the Sanctions Principles.
Agreeing to certain matters in lieu of revoking approved provider status
See legislative reference.
If a provider’s approval is revoked, the provider can agree to certain matters to ensure
that the revocation does not take eect. If the sanction notice specifies that this
is an option, the provider can agree to:
provide, at its expense, training for ocers, employees and agents
provide security for a debt owed to the Commonwealth
appoint an adviser or an administrator, approved by the Commonwealth
and/or transfer some or all of its allocated places to another approved provider.
The Department has established adviser and administrator panels and the Sanctions
Principles sets out the timetable for nominating and appointing people from those
panels for sanctions purposes.
Duration of sanctions
Some sanctions are for an indefinite period of time—for example, revocation of
approved provider status. Other sanctions can be applied progressively, for example,
a provider may no longer have approval for high care residents; or may be imposed
for a specific period of time
Sanctions no longer apply when the sanction period set out in the notice expires.
A provider can also apply to have sanctions lifted before the specified expiry date.
An application must provide the following details: See legislative reference.
what the provider has done to remedy the non-compliance
where relevant, any assessments of the aged care service made against the
Accreditation Standards while the sanction was in eect
any consultations with sta, residents, residents’ relatives or representatives
about the non-compliance
the provider’s proposals for sustaining its compliance with its responsibilities.
l e g i s l a t i v e r e f e r e n c e s
s 66-2, Aged
Care Act 1997
s 22.20, Sanctions
Principles 1997
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The Secretary must notify the provider of the decision within 28 days of
receiving the application; or if the Secretary requests the provider to submit further
information, within 28 days of that information being provided. See legislative
reference.
The following sanctions cannot be lifted, but may be reconsidered if the provider
applies for a review of the decision to impose sanctions: See legislative reference.
the revocation of approved provider status
the revocation of the allocation of places
the revocation of extra service status
the revocation of certification
requiring the provider to repay grants, where the provider has not complied
with responsibilities related to those grants.
Notice of non-compliance
See legislative reference.
If the provider is not complying with its responsibilities under the Act in relation
to quality of care, user rights or accountability, and the risks to residents are not
immediate or severe, the Secretary can issue a notice of non-compliance,
including:
details of the non-compliance
broadly what action the Secretary requires the provider to take to remedy the
non-compliance
the timeframe in which the provider must make a written submission to the
Department
what sanctions can be imposed.
The provider will be invited to make a written submission within 14 days of receiving
the notice, including what action will be taken to address the non-compliance.
After considering any submissions made by the provider, the Secretary can decide to:
issue a notice of intention to impose sanctions
issue a notice to remedy the non-compliance
or issue a combination of these
See also Publishing sanctions and notices of non-compliance on page 240.
Notice to remedy non-compliance
See legislative reference.
If the Secretary thinks the provider’s submission in response to a notice of non-
compliance:
proposes appropriate action to remedy the non-compliance
provides sucient reason for the non-compliance
or is otherwise satisfactory
the Secretary can give the provider a notice to remedy the non-compliance. The
notice will require the provider to give a written undertaking within 14 days of receiving
l e g i s l a t i v e r e f e r e n c e s
s 68-6(1), Aged
Care Act 1997
Division 85, Aged
Care Act, 1997
s 67-2, Aged Care
Act 1997
s 67-4, Aged Care
Act 1997
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the notice to remedy the non-compliance. The notice will also inform the provider
that failure to either give, or fulfil, the undertaking can lead to sanctions being
imposed.
The undertaking that the provider must sign will set out: See legislative reference.
a description and acknowledgement of the provider’s non-compliance with its
responsibilities
the action which the provider proposes to take to remedy the non-compliance
the timetable for carrying out the action
an acknowledgment that failure to fulfil the undertaking may lead to sanctions
being imposed.
Notice of intention to impose sanctions
See legislative reference.
If the provider does not make a submission in response to a notice of non-
compliance or if the Secretary thinks the submission:
does not propose appropriate action to remedy the non-compliance
fails to establish that the non-compliance did not occur or is not occurring
(ie, does not challenge the charge of non-compliance)
fails to provide a sucient reason for the non-compliance
is otherwise unsatisfactory
the Secretary can give the provider a notice of intention to impose sanctions.
The notice will set out in writing:
a description of the provider’s non-compliance with its responsibilities
the reasons for proposing to impose sanctions
the consequences of imposing the proposed sanctions.
The provider will be invited to make a submission in writing in relation to the matter
within 14 days of receiving the notice.
Notice of decision on whether to impose sanctions
See legislative reference.
After considering any submissions from a provider in response to a notice of
intention to impose sanctions, the Secretary will decide whether or not to impose
sanctions and inform the provider.
If the decision is to impose sanctions, the Secretary will give the provider a notice
of decision to impose sanctions. See When can sanctions be imposed? on page 236.
If the Secretary decides not to impose sanctions, the Secretary will give the provider
a notice of the decision not to impose sanctions, including reasons for this decision.
A notice to impose sanctions will set out: See legislative reference.
a description of the provider’s non-compliance
the sanction to be imposed
the consequences of imposing the sanction
s 67-5(2), Aged
Care Act 1997
l e g i s l a t i v e r e f e r e n c e s
s 67-4(3), Aged
Care Act 1997
s 67-4(3), Aged
Care Act 1997
s 67-5, Aged Care
Act 1997
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when the sanction commences
where applicable, the sanction period
the reasons for imposing the sanction.
Review rights
A decision to impose a sanction can be reviewed. If the Secretary refuses to lift
a sanction, this is also a reviewable decision. See legislative reference.
Broadly, if an approved provider considers that the Secretary has made an invalid
decision in terms of imposing or refusing to lift a sanction, they can apply to the
Department for these decisions to be reconsidered. After reconsideration, the decision
will either be confirmed, varied or set aside. If the provider still believes that the
decision is invalid, they can seek a review of the decision at the Administrative
Appeals Tribunal. See References at the end of this chapter for a link to the
Administrative Appeals Tribunal.
However, giving a provider a notice of non-compliance, a notice to remedy
or a notice of intention to impose sanctions are not reviewable decisions.
PUBLISHING SANCTIONS AND NOTICES OF NONCOMPLIANCE
Information about current and archived sanctions imposed on approved providers
is available on the Department’s website. The Department publishes online:
the names and addresses of aged care services where sanctions are in place
the names of the approved providers of the aged care services
sanctions action taken under the Act and the reasons for that action
the status of the sanction action.
The site is updated with information about new sanctions, as they are applied.
Information on sanctions which have expired or have been lifted is archived on
the Department’s website. See References at the end of this chapter for a link
Case management and consumer information
A key element in managing sanctions action is an early meeting between the
Department and the approved provider to establish the provider’s plans for the
future. The Department also requests that the provider arrange a meeting for
residents and their nominated representatives to outline the current situation
and the approved provider’s plans for improvement in order to achieve and maintain
compliance.
When sanctions are imposed, the Department writes to all residents and their
representatives to ensure that they are kept well informed. Information about the
sanctions may also be sent to other relevant stakeholders including Aged Care
Assessment Teams, advocacy services, peak industry organisations, and the Agency.
l e g i s l a t i v e r e f e r e n c e s
s 85-1, Aged Care
Act 1997
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Notices of non-compliance
Information from notices of non-compliance (NNCs) issued in the last 2 years
is available on the Aged Care Australia website. See References at the end of this
chapter for a link.
The information about current NNCs includes the name and address of the service;
the name of the approved provider; the date the NNC was issued; and general
information on the non-compliance. This information is only made available online
after the delegate has considered any submission made by the due date specified
in the NNC.
Information about the NNC is moved from the current NNCs page to an archived
NNCs page following confirmation by the Department or the Agency that the non-
compliance has been addressed. Additional information on the archived page will
indicate whether the provider had addressed the non-compliance, or was issued
with a sanctions notice.
The NNC site is updated weekly to reflect the current status of NNCs. Any change
of provider status is also amended in cases where this may apply to archived
information.
If a sanction notice is issued, it will appear on the sanctions page of the
Department’s website. See References following, for a link.
Providers are encouraged to inform residents, or their legal representatives, about
the issuing of a NNC and the action taken to address the non-compliance. Providers
may also wish to include specific information on their own websites regarding any
non-compliance and action taken to address the matter.
Concerns about information in regard to a previous or current NNC issued should be
raised with the manager in the relevant state or territory oce of the Department or
emailed to the Department’s compliance email address. See References following,
for the address.
REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Accreditation—for information about accreditation or accreditation reports
www.accreditation.org.au
Administrative Appeals Tribunal
www.aat.gov.au
Aged Care Complaints Investigation Scheme
Ph 1800 550 552
The line is open Monday–Friday, 8:30am–5pm; Saturday, Sunday and public holidays,
10am–5pm. Outside these hours, people can leave a message.
People can also write to the Scheme at:
Department of Health and Ageing
GPO Box 9848
In your Capital City
Providers’ resPonsibilities and non-comPliance
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An online complaints investigation form is available at:
www.health.gov.au/internet/main/publishing.nsf/content/ageing-complaints-index.htm
for an online complaints form
If a person is not satisfied with how their complaint has been handled, they can take
their concerns to the Departmental manager responsible for the Scheme in their state
or territory, by calling the Scheme freecall number above.
Aged Care Information Line
Ph 1800 500 853
Crimtrac—National Criminal History Check
www.crimtrac.gov.au/criminal_history_checks/index.html
Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Legislation—other
Go to ComLaw to access other legislation mentioned in this chapter, including
the Privacy Act 1988.
www.comlaw.gov.au
National Criminal History Checks—Australian Federal Police
www.afp.gov.au/business/national_police_checks
National Criminal History Check—consent, fees, form and guidelines
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-approvedp-index.htm
Notice of non-compliance—concerns about
Concerns about information in regard to a previous or current notice of non-compliance
(NNC) issued should be raised with the manager in the relevant state or territory oce
of the Department or emailed to Aged.Care.Compliance@health.gov.au
Notice of non-compliance—current and archived
www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/content/quality+of+care
Notice of non-compliance—information about
Information from notices of non-compliance (NNCs) is available on the Aged Care
Australia website
www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/content/quality+of+care
Police Certificate Guidelines for Aged Care Providers
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-quality-police.htm
or contact the Aged Care Information Line, Ph 1800 500 853
Privacy—Oce of the Privacy Commissioner
www.privacy.gov.au
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Privacy—Oce of the Privacy Commissioner
www.privacy.gov.au
Sanctions—current and archived sanctions
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-sanction.htm
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I
Relevant legislation 245
Overview 245
Additional information 245
The 5 key elements to compulsory reporting requirements 246
Reportable assaults 246
Unlawful sexual contact 247
Unreasonable use of force 247
Making a report to the Department 247
Approved provider responsibilities regarding compulsory reporting of assault
on a resident 248
Reporting reportable assaults 248
Requiring sta members to report reportable assaults 248
Specified circumstances in which the responsibility to report does not apply 249
Assaults perpetrated by a resident with cognitive or mental impairment 249
Health professionals who can assess cognitive and mental impairment 250
Similar or previously reported incidents 250
Responding to allegations of assault on a resident 250
Role of the Department 250
Role of the Agency 251
Protecting an informant’s identity 251
Record keeping and privacy 253
References—links, guides and forms referred to in this chapter 254
COMPULSORY REPORTING
COMPULSORY REPORTING
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COMPULSORY REPORTING
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 4.3 and s 96-8,
Aged Care Act 1997 (the Act)
Investigation Principles 2007
Accountability Principles 1998
Records Principles 1997
(Records Principles)
OVERVIEW
This chapter explains the compulsory reporting requirements which commenced
on 1 July 2007 following amendments to the Act. These requirements aim to ensure
that any allegation or suspicion of a reportable assault—ie, unlawful sexual contact or
unreasonable use of force—on a resident of an aged care service is reported and
managed appropriately.
This chapter includes information about:
the definition of reportable assaults
approved providers’ responsibilities regarding compulsory reporting
of a reportable assault on a resident
making a report to the Department
responding to allegations of assault on a resident
protecting the identity of informants
record keeping and privacy.
Compulsory reporting requirements are part of an approved provider’s responsibilities
under the Act to provide a safe and secure environment for care recipients.
Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can also
be accessed through the Aged Care Information Line on 1800 500 853; and further
information about compulsory reporting can be found on the Department’s website.
See References at the end of this chapter for a link.
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THE 5 KEY ELEMENTS TO COMPULSORY REPORTING
REQUIREMENTS
Except in very specific circumstances, approved providers of residential aged care
must report all allegations or suspicions of a reportable assault.
Exception
The exception to reporting a reportable assault applies to circumstances involving
residents aected by an assessed cognitive or mental impairment, or where there
are repeated allegations of the same assault. See Specified circumstances in which
the responsibility to report does not apply on page 249.
An approved provider should not wait until an allegation is substantiated. The fact
that a person has alleged, or the approved provider suspects, that someone has
assaulted a resident is sucient to trigger the reporting requirements.
So that approved providers can comply with their responsibilities under the Act,
approved providers must take reasonable measures to require sta to report alleged
or suspected reportable assaults. See legislative reference. This requirement
recognises that in many cases, it may be sta who first suspect or become aware
of assaults. Approved providers are therefore required to:
give sta information about how to report assaults
actively require sta to make reports if they see, or suspect, an assault
on a resident.
Reports must be made to both the police and the Department, via the Aged Care
Complaints Investigation Scheme, within 24 hours of the allegation being made, or
the approved provider starting to suspect on reasonable grounds that a reportable
assault may have occurred. See legislative reference. This timeframe ensures that
alleged assaults are acted upon immediately.
If a sta member makes a report, the approved provider must take reasonable
measures to ensure the identity of that sta member is not disclosed, except to:
See legislative reference.
a police ocer
the Secretary
a person, authority or court to which the approved provider is required
to disclose the identity of the person
one of the approved provider’s key personnel.
An approved provider is responsible for ensuring that the sta member who
discloses the information is not victimised. This is important in encouraging ongoing
reporting by sta members.
If an approved provider fails to meet compulsory reporting requirements, the Department
can take compliance action. Compliance with the compulsory reporting requirements
is monitored by the Department and the Aged Care Standards and Accreditation Agency.
REPORTABLE ASSAULTS
A reportable assault means: See legislative reference.
unlawful sexual contact with a resident of an aged care service
or unreasonable use of force on a resident of an aged care service.
l e g i s l a t i v e r e f e r e n c e s
s 63-1AA(5), Aged
Care Act 1997
s 63-1AA(2), Aged
Care Act 1997
s 63-1AA(7), Aged
Care Act 1997
s 63-1AA(9), Aged
Care Act 1997
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The definition of reportable assault used in the Act provides a simple and readily
understood definition. It avoids the diculties of applying legalistic definitions that
vary widely throughout Australia.
Unlawful sexual contact
The term unlawful sexual contact is intended to cover any sexual contact with
a resident, without consent, that is unlawful under any Commonwealth, state or
territory law. If the contact involves a resident with an assessed cognitive or mental
impairment, the resident may not be able to provide informed consent.
The term unlawful sexual contact has been used:
to avoid the use of specific terms, such as sexual intercourse, rape and sexual
assault, which are terms defined dierently under Commonwealth, state and
territory legislation
and to ensure that all unlawful sexual contact, no matter how described,
is covered.
It is not intended to cover situations where there is no physical contact.
Unreasonable use of force
Unreasonable use of force is intended to cover assaults ranging from deliberate and
violent physical attacks on residents to the use of unreasonable physical force on
a resident. The definition includes hitting, punching or kicking a resident regardless
of whether this in fact causes visible harm, such as bruising.
There may be circumstances where a sta member could be genuinely trying to assist
a resident, and despite their best intentions, the resident is injured because they
bruise easily or have fragile skin. Injury alone therefore may not provide conclusive
evidence of the use of unreasonable force or the seriousness of an assault.
The following guides can assist providers to identify signs of abuse:
the Benevolent Society’s Policy and Procedures for Residential Aged Care
—Preventing and Responding to Abuse
Aged and Community Care Victoria (AACV), in collaboration with Victoria
Police, have developed a Compulsory Reporting Resource Guide.
See References at the end of this chapter for links.
MAKING A REPORT TO THE DEPARTMENT
Approved providers have a responsibility to make compulsory reports to the
Department via the Aged Care Complaints Investigation Scheme. See References
at the end of this chapter for Scheme contact information.
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APPROVED PROVIDER RESPONSIBILITIES REGARDING
COMPULSORY REPORTING OF ASSAULT ON A RESIDENT
Reporting reportable assaults
An approved provider is responsible for reporting an alleged or suspected reportable
assault as soon as possible and in any case must report within 24 hours, to:
See legislative reference.
the local police service
and the Department via the Aged Care Complaints Investigation Scheme.
An approved provider is required to report as soon as they start to suspect on
reasonable grounds that a reportable assault has occurred. This is to ensure that
both allegations and suspicions of reportable assaults are reported.
An allegation usually requires a claim or accusation to have been made to the
approved provider; and can be linked to physical evidence of an assault or
witnessing an assault.
Reporting suspicion allows reports to be made where there is no allegation or where
the suspected assault may not have been witnessed but a sta member observes
signs that an assault may have occurred. Approved providers should have internal
policies and processes in place aimed at creating a culture of reporting and responding
to alleged or suspected assaults on residents and documenting critical incidents.
The Benevolent Society and Aged and Community Services Australia have developed
guides that approved providers could adapt for their own use. See References at the
end of this chapter for links.
Requiring sta members to report reportable assaults
An approved provider is responsible for taking reasonable measures to require each
sta member who works in the aged care service and who suspects on reasonable
grounds that a reportable assault has occurred, to report the suspicion as soon
as reasonably practicable. See legislative reference.
A sta member can report to one or more of the following:
the approved provider
one of the approved provider’s key personnel or another person authorised
by the approved provider to receive reports of suspected reportable assaults
approved providers must ensure that sta know who these authorised
people are
a police ocer with responsibility relating to the area, including the place
where the assault is suspected to have occurred
the Department.
The Act allows sta members to report directly to the police or the Department. This
may occur if a sta member does not feel comfortable reporting alleged incidents
involving the service’s personnel or the approved provider.
Approved providers have a responsibility to ensure that sta are trained in, and
familiar with, issues such as recognising if an assault may have occurred and how
to respond. This includes awareness of the following:
l e g i s l a t i v e r e f e r e n c e s
s 63-1AA, Aged
Care Act 1997
s 63-1AA(5), Aged
Care Act 1997
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the requirement and procedures for reporting any alleged or suspected
incidents of assault on a resident as soon as possible; and who they should
report to
the option to report to the Department if they are concerned about anonymity,
or where the manager or approved provider may be the subject of the allegation
the protections in place and the circumstances in which they would qualify for
protection
that providing false or misleading information is a prosecutable oence.
Specified circumstances in which the responsibility
to report does not apply
There are two specified circumstances under which the requirement to report
a reportable assault does not apply: See legislative reference.
alleged assaults that are perpetrated by residents with an assessed cognitive
or mental impairment
Cognitive impairment refers to declining ability in judgment, memory,
learning, comprehension, reasoning and/or problem solving. Cognitive
impairment can result from a number of conditions, including dementia,
delirium and/or depression.
Mental impairment includes senility, intellectual disability, mental illness,
brain damage, and severe personality disorder. See legislative reference.
subsequent reports of the same or similar incident.
The requirements an approved provider must comply with in these circumstances
focus on an approved provider’s responsibility to provide a safe environment for all
residents. This includes managing the behaviour of a resident who has an assessed
cognitive or mental impairment and may have committed an assault.
These circumstances do not prevent an approved provider from reporting an assault
to the police or the Department if this is the appropriate response. Depending on
the severity of an assault, and in cases where a resident is seriously harmed, the
Department strongly encourages providers to report.
Assaults perpetrated by a resident with cognitive or mental impairment
An approved provider has a discretion not to report an allegation or suspicion
of a reportable assault if: See legislative reference.
within 24 hours of starting to suspect or receiving an allegation, the approved
provider believes that the assault was committed by a resident
prior to the receipt of the allegation or start of the suspicion, the resident has
been assessed by an appropriate health professional as suering from
a cognitive or mental impairment
and the approved provider has a copy of the assessment (or other
documents) regarding the resident’s cognitive or mental impairment
within 24 hours of receiving the allegation, or starting to suspect that an assault
has occurred, the approved provider makes arrangements to manage the
resident’s behaviour
and the approved provider has a record of these behaviour management
arrangements.
s 1.31(1),
Accountability
Principles 1998
l e g i s l a t i v e r e f e r e n c e s
s 63-1AA(3),
Aged Care Act
1997, s 1.31,
Accountability
Principles 1998
s 7.3(8), Criminal
Code Act 1995
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A behaviour management plan for such a resident must be developed, documented
and regularly reviewed by a suitably qualified health professional. It must include
information regarding:
environmental factors which could contribute to or cause the behaviour
possible health or medical factors which could contribute to or cause the
behaviour
possible communication needs of the person which may be contributing
to the behaviour
and interventions being trialled or used to manage the behaviour, including
alternatives to restraint.
Health professionals who can assess cognitive and mental impairment
One or more of the following people are appropriate to assess a resident’s cognitive
or mental impairment, in either a community or hospital setting:
an Aged Care Assessment Team (ACAT) or an Aged Care Assessment Service
(ACAS)
a resident’s GP
a registered nurse (RN)
another health professional with the appropriate clinical expertise, such
as a geriatrician, psycho-geriatrician, geriatric nurse or clinical psychologist.
Similar or previously reported incidents
The requirement to report reportable assaults does not apply to later allegations
which could include the following:
related to the same or substantially the same factual situation or event as an
earlier allegation
has previously been reported to the police and the Department under 63-1AA
of the Act See legislative reference.
where dierent people report the same event
the same person makes allegations repeatedly and these allegations have been
followed up.
Approved providers must keep records in relation to the above circumstances and
in accordance with the Records Principles See legislative reference.
RESPONDING TO ALLEGATIONS OF ASSAULT ON A RESIDENT
Role of the Department
When incidents of alleged or suspected assault are reported, the police are
responsible for investigating the incident. The police will determine whether the
allegation involves a criminal oence and what further action is required. Only the
police can investigate criminal activity.
l e g i s l a t i v e r e f e r e n c e s
s 63-1AA, Aged
Care Act 1997
s 19.5AA, Records
Principles 1997
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The Department’s role is to make sure that an approved provider has met its
responsibilities so that:
the victim of the alleged or suspected assault has received appropriate care
and support
residents are safe
compulsory reporting requirements are complied with
the provider has appropriate internal systems and protocols in place for
compulsory reporting.
When an alleged or suspected assault is reported, the Department will take the
following steps:
establish the details of the alleged or suspected assault, including when it took
place (and if it has been reported within 24 hours)
establish if the alleged or suspected assault has been reported to the police.
If it has not, the Department will refer the incident to the relevant state or
territory police service
advise any sta member or approved provider who makes a report, of the
informant identity protections and whether and how they qualify for protection
establish that residents are not at further risk from the alleged perpetrator
undertake an investigation to ensure that the approved provider has met its
responsibilities under the Act. This includes ensuring appropriate medical care
and support for the victim and notifying legal representatives or family
members if required.
The Department can take compliance action where an approved provider does not
meet the compulsory reporting requirements.
Role of the Agency
The Aged Care Standards and Accreditation Agency (the Agency) monitors approved
provider compliance with the compulsory reporting requirements. The Agency does
this through its usual audit and accreditation processes. These include:
monitoring that processes are in place to require sta to report suspicions
of incidents of assault on a resident
monitoring that an approved provider is keeping records of all incidents of assault
reviewing circumstances in which the discretion not to report an incident
of assault was exercised
informing the Department where a breach of the legislation is identified.
PROTECTING AN INFORMANT’S IDENTITY
There are a range of protections for sta and approved providers who report alleged
or suspected assaults. See legislative reference.
A disclosure of information regarding a suspected reportable assault by a person
qualifies for protection if: See legislative reference.
the person is an approved provider of an aged care service or a sta member
of an approved provider
the disclosure is made to:
l e g i s l a t i v e r e f e r e n c e s
s 96-8, Aged
Care Act 1997
s 96-8(1), Aged
Care Act 1997
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a police ocer
the Department
the approved provider
one of the approved provider’s key personnel
another person authorised by the approved provider to receive such reports
the discloser informs the person to whom the disclosure is made of their name
before making the disclosure
the discloser has reasonable grounds to suspect that the information indicates
that a reportable assault has occurred.
the discloser makes the disclosure in good faith.
The approved provider or sta member who makes a protected disclosure
is protected in a number of dierent ways, as outlined below.
The discloser is protected from any civil or criminal liability for making the
disclosure. See legislative reference.
The discloser is protected from someone enforcing a contractual or other
remedy against that person based on the disclosure. See legislative reference.
For example, if a sta member had a contract of employment that specified
that they must not discuss issues that arise in an aged care service with anyone
outside the service, a disclosure by the sta member that qualifies for protection
under this section would not give the employer the right to terminate the
contract. However, if a sta member disclosed information to a person who
is not specified in the list above, their contract could be terminated or other
disciplinary action could be taken by their employer.
The discloser has qualified privilege in proceedings for defamation relating
to the disclosure and is not liable to an action for defamation relating to the
disclosure. See legislative reference.
This provision does not aect any other right, privilege or immunity the discloser
has as a defendant in proceedings, or an action, for defamation. See legislative
reference. For example, if a person assaulted a resident and then informed the
Department of this fact, they would not be protected from prosecution for the
assault. The person is only protected from liability in disclosing the information.
The discloser is protected from a contract to which they are a party being
terminated, on the basis that the disclosure constitutes a breach of the contract.
See legislative reference. For example, if a sta member has a contract of
employment that specifies that they must not discuss issues that arise in an
aged care service with anyone outside the service, a disclosure by the sta
member under these provisions would not give the employer the right to
terminate the contract. If a court is satisfied that an employee made a protected
disclosure and the employer—either an approved provider or a recruitment
agency who employs the person on behalf of the approved provider—
terminates the employer’s contract because of the disclosure, the court can
order that the employee be reinstated or that compensation be paid to them.
See legislative reference.
The discloser is protected from victimisation. A person must not cause
detriment or threaten the discloser on the grounds that a disclosure was made
or may be made. See legislative reference. The provider has a responsibility
to ensure that all sta comply with this requirement. Compliance action may
be taken if the provider does not comply with this responsibility.
l e g i s l a t i v e r e f e r e n c e s
s 96-8(2)(a), Aged
Care Act 1997
s 96-8(2)(b), Aged
Care Act 1997
s 96-8(4), Aged
Care Act 1997
s 96-8(3)(a), Aged
Care Act 1997
s 96-8(2)(b), Aged
Care Act 1997
s 96-8(5), Aged
Care Act 1997
s 96-8(6) Aged
Care Act 1997
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Residents of aged care services, their families and advocates, visiting medical
practitioners, other allied health professionals, volunteers and visitors are not
compelled to report assaults and are not aorded statutory protection under the
legislation. However, these people are strongly encouraged to report incidents of
abuse or neglect of an aged care resident to the Department’s Aged Care
Complaints Investigation Scheme. The person providing information may do so
openly, anonymously or ask the Scheme to keep their identity confidential. See
References at the end of this chapter for contact information.
These people also have access to common law protections from defamation action.
As these people can often identify if an assault of a resident is reasonably likely to
have occurred, an approved provider should consider establishing visitor policies and
protocols encouraging reporting where it is in the best interests of the residents.
RECORD KEEPING AND PRIVACY
Approved providers must keep consolidated records of all incidents involving
allegations or suspicions of reportable assaults. See legislative reference. These
records will be monitored by the Department and the Agency and they must:
be distinguishable from other incident records
be retained in one central place
be accessible to the Department and Agency when required.
The record for each incident must include: See legislative reference.
the date the approved provider received the allegation, or started to suspect
on reasonable grounds, that a reportable assault had occurred
a brief description of the allegation or the circumstances that gave rise to the
suspicion
information about whether a report of the allegation or suspicion has been
made to a police ocer and the Department in accordance with subsection
63-1AA(2) of the Act; or whether the allegation or suspicion has not been
reported to a police ocer or the Department because of the discretion under
subsection 63-1AA (3) not to report, as outlined above. See legislative
reference.
Approved providers must also have in place systems and procedures which will allow
them to:
comply with requirements relating to protection of personal information
See legislative reference.
comply with all relevant legislation and regulatory requirements in relation
to privacy issues, including state, territory or Commonwealth legislation such
as the Privacy Act 1988. See References at the end of this chapter for a link
to ComLaw for this Act.
l e g i s l a t i v e r e f e r e n c e s
s 19.5AA(1),
Records
Principles 1997
s 19.5AA(2),
Records
Principles 1997
s 63-1AA(2),
63-1AA (3), Aged
Care Act 1997
s 62-1, Aged
Care Act 1997
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REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Aged Care Complaints Investigation Scheme
See Compulsory reporting—reporting to the Department, via the Aged Care
Complaints Investigation Scheme below.
Aged Care Information Line
Ph 1800 500 853
Compulsory reporting—by people not given statutory protection under the Act
Residents of aged care services, families and advocates, visiting medical practitioners,
other allied health professionals, volunteers and visitors are not compelled under the
Act to report assaults. These people may still report incidents of abuse or neglect to
the Department’s Aged Care Complaints Investigation Scheme.
Ph 1800 550 552
Compulsory reporting—further information
Further information about compulsory reporting can be found on the Department’s
website
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-quality-
guidelines-cr-ap.htm
Compulsory reporting—reporting to the Department, via the Aged Care
Complaints Investigation Scheme
People can report to Department via the Aged Care Complaints Investigation Scheme,
Ph 1800 550 552
The line is open Monday–Friday, 8:30am–5pm; Saturday, Sunday and public holidays,
10am–5pm. Outside these hours, people can leave a message.
People can also write to the Scheme at:
Department of Health and Ageing
GPO Box 9848
In your Capital City
An online complaints investigation form is available at:
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-complaints-
index.htm
If a person is not satisfied with how their complaint has been handled, they can take
their concerns to the Departmental manager responsible for the Scheme in their
state or territory, by calling the Scheme number above.
Guides—reporting abuse, preventing and responding to abuse
Compulsory Reporting Resource Guide—available to Aged and Community Care
Victoria (AACV) members. Providers in other states should contact their peak body
to access this report.
www.accv.com.au
Policy and Procedures for Residential Aged Care—Preventing and Responding
to Abuse, published by the Benevolent Society. Find the report via the resources
page on this site.
www.bensoc.org.au
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Forms—all
All Departmental forms are available on the Department’s website at
www.health.gov.au/internet/main/publishing.nsf/Content/health-forms.htm
Legislation—other
Go to ComLaw to access other legislation mentioned in this chapter, including
Criminal Code Act 1995 and Privacy Act 1988.
www.comlaw.gov.au
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Relevant legislation 257
Overview 257
Additional information 257
Kinds of records 257
False or misleading records 258
References—links, guides and forms referred to in this chapter 259
I
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RECORD KEEPING
This Manual has been written in plain English and as a result, some aspects of the
legislation and policy have been simplified. It is intended to be a general guide only
and does not constitute legal advice. In cases of discrepancy between the Manual
and the legislation, the legislation will be the source document for payment of
Australian Government benefits and enforcement of approved provider responsibilities.
RELEVANT LEGISLATION
Part 6.3, Divisions 87–89,
Aged Care Act 1997 (the Act)
Records Principles 1997
OVERVIEW
An approved provider must keep records so that:
claims for payment of Government subsidies can be verified
and approved providers can be assessed to see if they are meeting their
responsibilities under Chapter 4 of the Act
to provide quality care
in relation to user rights
to be accountable for the care they provide.
See legislative reference.
Providers must keep these records for three years after the end of the financial year:
in which the record was made
See legislative reference.
in which the provision of care ceased permanently.
See legislative reference.
Providers will have to decide if they need to keep records for longer than a three-
year period in order to comply with taxation regulations, state government legislation
or possible medical or legal matters.
A record may be kept or retained in written or electronic form. See legislative reference.
Additional information
This chapter has been updated and revised to help approved providers comply
with their responsibilities under the Act; and to assist sta of aged care services
understand the regulation of residential aged care. Additional information can also
be accessed through the Aged Care Information Line on 1800 500 853.
KINDS OF RECORDS
An approved provider must keep the following records relating to residents:
See legislative reference.
resident assessments
appraisal and reappraisal records in the form of Answer Appraisal Packs
copies of applications for classification for residents that are not provided to the
Department in electronic form
individual care plans for residents
l e g i s l a t i v e r e f e r e n c e s
s 88-1(1)(a), Aged
Care Act 1997
s 88-1(1)(b), Aged
Care Act 1997
s 88-1(2), Aged
Care Act 1997
s 88-1(3), Aged
Care Act 1997
s 19.5, Records
Principles 1997
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medical records, progress notes and other clinical records of residents
schedules of fees and charges (including retention amounts relating to
accommodation bonds and/or accommodation charges) for previous and
current residents
agreements between residents and the approved provider
residents’ accounts
records relating to the approved provider’s compliance with prudential
requirements for accommodation bonds
records about the payment and repayment of accommodation bonds
(including periodic payments)
records about the payment of accommodation charges
records about a resident’s entry, departure and leave arrangements, including
death certificates where appropriate
records about a financial hardship determination for a resident
records about the amount of accommodation charge refunded to residents
who were charge exempt residents
up-to-date records of the name and contact details of at least one
representative of each resident and the name and contact details of any other
representative of a resident, both according to information given to the
approved provider by the resident, or by the representative.
An approved provider who permanently ceases to provide care must retain these
records in relation to residents for a period of three years commencing on the day
that the person ceased to be an approved provider. See legislative reference.
An approved provider must also keep:
consolidated records of all incidents involving allegations of or suspicions about
reportable assaults. See also sections on Record keeping and privacy in
chapters on Providers responsibilities and non-compliance and Compulsory
reporting in this Manual.
records showing compliance regarding police certificate requirements for sta
members and volunteers. See also section on Police checks in chapter on
Providers’ responsibilities and non compliance in this Manual.
The requirements referred to in this chapter relate to Australian Government
requirements only. Providers may also be required to keep records to meet state
or territory requirements.
False or misleading records
A person who makes a false or misleading record may be guilty of an oence
punishable by a fine. See legislative reference. Sanctions can also be imposed
on an approved provider who makes a record that is false or misleading. See
legislative reference.
l e g i s l a t i v e r e f e r e n c e s
s 89-1, Aged
Care Act 1997
s 19.6, Records
Principles 1997
s 88-3(1), Aged
Care Act 1997
s 88-3(2), Aged
Care Act 1997
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REFERENCESLINKS, GUIDES AND FORMS REFERRED
TO IN THIS CHAPTER
Aged Care Information Line
Ph 1800 500 853
Legislation—other
See ComLaw for a link to the Privacy Act 1988.
www.comlaw.gov.au
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