Community Aged Care
e-Waitlist Priority of
Access (POA) Tool
May 2010
National Ageing Research Institute
Xiaoping Lin, Betty Haralambous, Kirsten Moore
Acknowledgements
•CACPs/EACH Electronic Waitlist Governance
Committee and ACAS Victoria for providing
funding
•ACAS teams
•Aged and community care providers
Overview
1. Background
2. Methods
3. Literature review
4. Scoping survey
5. Consultation
6. The POA tool and pilot findings
7. Implementation
8. Future considerations
1. Background
ACAS Referral Process
ACAS Electronic Waitlist
• Web-based
• Accessed through secure online portal
• Clients registered on waiting list with
appropriate providers
• Information is stored in a secure client
data repository
Priority in the E-Waitlist
• Priority decided using different
approaches
• Some using locally developed priority tool
• Some using clinical judgment
• No consistency of decision making in
regards to prioritisation
HACC POA
• NARI developed the original HACC POA in 2002
(Current version 2006)
• Feedback from staff
– Quick and easy to use
– Systematic process for allocating priority
– A means for confirming staff judgments
– Provides a transparent process for potential clients
and referring agencies
– Provides a tool for measuring and recording demand
for services
HACC POA4
Background
• Aim: to develop, pilot and finalise a
statewide priority of access tool for the
CACPs/EACH Electronic Waitlist
Governance Committee and ACAS Victoria
• This tool would promote consistency of
decision making in regards to prioritisation
of client need, benefiting clients by
ensuring services are targeted
appropriately
2. Methods
Methods
• A literature review
• A scoping survey of current approaches
• Consultation with ACAS teams and
service providers
• Pilot and revision of the draft tool
3. Literature Review
Draft Guidelines of Community
Packaged Care Programs
• Purpose
– ‘provide individually planned and coordinated
packages of community aged care services;
– meet the needs of frail older people with
complex care needs assessed as eligible for
low or high level residential care; and
– enable those who have expressed a preference
to live at home to do so with the assistance of
a package of care including residents of
retirement villages” (DoHA, 2007)
How do we define who is most in need?
Literature review - methods
• An update of the 2002 HACC POA
literature review
• Search in medline and grey literatures
• Search relevant websites
• Key words: indicators of needs, aged
care assessment, needs & aged care, risk
& aged care, CACPs, EACH, EACHD,
community packaged care
• Limited to English language, and articles
after 2000
Literature review - findings
• Limited evidence on
– which factor/factors are most important
– Who most urgently needs services
– Which combination of factors increase the
urgency for services
• Some evidence that dependency level,
carer availability and financial situation
were important predictors of use of
service
• Needs commonly assessed using
measurement tools
Literature review - findings
• Why a measurement tool?
– Evidence suggests different clinicians use
different approaches to decision making
– Reduce individual styles/judgments
– Increase objectivity in assessment and service
allocation
– Increase transparency for clients
4. Scoping Survey
Scoping survey - methods
• Aim: to gain information on current
assessment and prioritisation practices
among Victorian ACAS and
CACPs/EACH/EACHD service providers
• Distributed to/through ACAS managers
• Returned by 11 ACAS teams (61%) and
42 providers
Scoping survey - findings
• Assessment tools used: Aged Care Client
Record(ACCR), Victorian Service
Coordination Tool Templates (SCTT)
• Various approaches in determining
priority
• Locally developed POA tools based on
client’s need
Scoping survey - findings
• Common indicators: dependency level,
risk of abuse, carer availability/state,
social/psychosocial factors, need for case
management
• Factors providers considered when
choosing clients: Client’s need, target
group, resources of the agency
5. Consultation
Consultation - methods
• 4 focus groups
– 2 with ACAS staff (one in metropolitan, one in
rural area, 20 staff from 13 ACAS teams)
– 2 with service providers (one in metropolitan,
one in rural area, 28 staff from 20 providers)
• Email survey for those unable to attend
focus groups
– 3 ACAS teams
– 9 providers
Consultation – findings
• Acceptance of need-based tool
• Welcome the idea of a statewide POA tool
• Revise some of the indicators
• Mixed ideas about weighting indicators
• No separate tool for each package
• Simplicity of the tool
6. The POA tool and pilot finding
POA Pilot
• Two options developed
• Guidelines and training materials developed
• Piloted for four weeks
• Training/information session
• Each team asked to complete 5-10
assessments
• Survey to collect general feedback
• De-identified copies collected
The POA Tool
• Need based tool
• 12 indicators on a single side page
• Each indicator is assessed on three levels:
high/medium/low
• Priority was determined by total score of the
indicators
The POA Tool
List of indicators
1. Instrumental Activities of Daily Life (IADL)
2. Personal Activities of Daily Life (PADL)
3. Cognition
4. Behaviours of concern
5. Mental health
6. Physical health
7. Social health
8. Risk of Abuse/Neglect
9. Formal and informal support
10. Informal carer or client status (coping)
11. Financial situation
12. Communication
Examples of indicators
1) Instrumental Activities of Daily Life
(IADL): Consider whether the client has any
difficulty at home with domestic activities,
e.g. doing his/her housework and laundry,
preparing meals for himself/herself, shop
for food and household items.
High-Mostly dependent;
Medium-Partially dependent;
Low-Independent
Examples of indicators
9) Informal carer or client status (coping)
– This question is not about availability of
someone to provide care, but how well the
informal carer supports are coping with this
care. This question should also consider the
sustainability of the informal carer (e.g. are
they available for the long term?).
– If carer available
High-Significant impact on carer;
Medium-Moderate impact on carer;
Low-Minimal impact on carer
Examples of indicators
9) Informal carer or client status (coping)
– If carer not available
High-Can’t manage at home without
additional support;
Medium-have impact on the client’s general
well being;
Low-Client coping well
What the POA tool does not do
• Identify individual needs
• Specify levels or types of service provision
for clients
• Provide a comprehensive assessment tool
• Determine eligibility for CACP, EACH and
EACHD
• Replace clinical judgment and common sense
Who & When
• ACAS staff who conduct assessments of
potential clients of CACP, EACH or EACHD
• Can be completed during the assessment
with the client and/or carer or in the
office after the assessment
Pilot findings
• 150 assessments by 12 ACAS teams (67%)
• 72% assessors found the tool easy to use
• Average time taken to complete the tool was
4.9 minutes
• 61% assessors felt confident about the
results of the POA tool
• 61% assessors reporting agreement
between POA and clinical judgment
Pilot findings
45%
40% POA
Clinical judgement
35%
30%
25%
20%
15%
10%
5%
0%
High Medium Low
Pilot findings
• Agreement between clinical judgment and
POA tool in completed assessments
Clinical judgment
High Medium Low
High 11% 7% 2%
POA Medium 11% 23% 7%
Low 2% 12% 24%
Pilot findings
• Explanations for disagreement:
– Four levels of priority
(critical/urgent/routine/low) in old
system
– Training
– Atypical clients/factors outside the tool
– Client extremely high on one indicator
Pilot Findings
• Some suggestions:
- Longer trial
- Space for summary/comments
- Consider extra score outside the listed
factors/indicators
In Summary
• Promote consistency in prioritisation
• Easy to use
• Most assessors were confident about
results from the tool
• Acceptable agreement with clinical
judgment
• Requires further testing
7. Implementation
Implementation
• Implemented in late 2009
• All ACAS teams who use the E-waitlist are
using the tool
• No major issues in implementation
• A survey in April 2010
• Response from both ACAS (n=49) and
providers (n =30)
Findings from the survey
– ‘I find the tool satisfactory and easy to
use’
– ‘Quick and easy to use’
– ‘I really like the tool ‘
– ‘I find the tool sufficient’
– ‘Happy with current format’
Findings from the survey
• 72% respondents received enough training
and support when the tool was
implemented
• 61% respondents found the scoring useful
• 68% respondents felt confident about the
results
• 43% respondents found results from the
tool consistent with clinical judgment
Findings from the survey
• Explanations for disagreement:
– Circumstance changed
– No weighting for indicators
– Factors outside the tool
– Same tool for CACP/EACH
– Urgency for service
Further consideration
• Priority is relative
• Weighting indicators
• Separate tool for CACP/EACH
• Urgency for service
• Further data collection
Thank you!