ATTENDANT CARE PROGRAM _ACP_

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					   ATTENDANT CARE PROGRAM (ACP)




     M ANUAL OF PROCE DURE S
            AND G UI DELI NES




Department of Ageing, Disability and Home Care




            NOV EM BE R 2003
         ATTENDANT CARE PROGRAM MANUAL OF PROCEDURES AND GUIDELINES




                                                     TABLE OF CONTENTS

SECTION 1: INTRODUCTION .................................................................................................................1

          BACKGROUND:
          THE REV IEW OF SERV ICES FOR PEOP LE WITH A PHYS ICA L DISABILITY:
SECTION 2: SERV ICE SPECIFICA TION - ATTE NDANT CARE .................................................................2

            SERVICE DEFINITION
            OBJECTIVES
            SERVICE FEATURES
            SERVICE ACTIVITIES
            ASSOCIA TE D SERV ICE FUNCTIONS
            SERVICE TYPES TO BE PROV IDED
            TA RGE T GROUP
            SERVICE STA NDA RDS
            LOCA TION

SECTION 3: ROLES OF P ROGRAM PARTICIPA NTS ...............................................................................6

          DEPARTME NT OF A GEING DISABILITY A ND HOME CARE
          SERVICE ORGANISA TIONS
                THE SERVICE USE R

SECTION 4 - PROCESSING AN A TTE NDANT CARE APPLICA TION…………………………………………....8

SECTION 5 - ASSESSMENT A ND APPROVAL OF APPLICA NTS………………………………………………..8

                ASSESSMENT OF APPLICANTS
                ACTION P RIOR TO ASSESSMENT
                THE ASSESSMENT
                ON COMPLE TION OF THE ASSESSMENT
                RE-ASSESSMENT OR REV IEWS
                ON COMPLE TION OF THE RE-ASSESSMENTS
                APPROVAL TO ALLOCA TE PLACES AND ADDITIONA L HOURS IF APPROP RIA TE WITHIN THE
                 CAP OF 34 HOURS
                APPROVAL TO DE LAY COMMENCEMENT OF SERVICE
                WITHDRAWL OF APPLICA TION
                INE LIGIB LE APPLICANTS
                WHERE ELIGIB ILITY CAN BE FURTHER CONS IDERE D
                ACTION FOLLOWING THE APPROVAL OF A N ACP PLACE
                ACTION FOLLOWING APPROVAL TO VARY NUMBE R OF APPROVE D HOURS OF SERVICE
SECTION 6 - PRIORITY SE TTING……………………………………………………………………………….14
        PRIMA RY CA TEGORIES
        PRIORITY FACTORS
SECTION 7 - TRA NSITION AND S TART-UP FUNDING……………………………………………………….16
        TRANS ITION FUNDING
        DESCRIP TION
        AMOUNT PROV IDED
        ELIGIB ILITY
        STA RT-UP ASSIS TANCE
        DESCRIP TION
        AMOUNT PROV IDED
        ELIGIB ILITY
        PROCEDURES FOR CLAIMING TRANS ITION AND STA RT-UP ASSIS TA NCE
SECTION 8 - SERVICE PROV IS ION……………………………………………………………………………18
        CONSUME R CONTROL
        TRAINING OF CA RERS
        HEALTH CA RE
        USE OF ATTE NDANT CARE HOURS
        ASSISTA NCE WITH TASKS WHICH ARE NOT 'PERS ONA L CARE ' OR RELA TE D
        SAVING OF HOURS
        HOURS UNUSED DUE TO HOSP ITALISA TION
        POOLING OF HOURS
        CLIENTS NOT REQUIRING SERVICE TEMPORARILY
        INITIAL A TTE NDA NT TRA INING HOURS INITIA L TRA NSITION HOURS
        EMERGENCY HOURS
SECTION 9 - ELIGIB LE SERVICE ORGANISA TIONS………………………………………………………..22
SECTION 10 - FINA NCIAL P ROCEDURES …………………………………………………………………… 25
        GENERA L FUNDING ARRA NGEME NTS
        FINA NCIA L MONITORING PRINCIPLES FOR THE A TTE NDA NT CA RE PROGRAM
        ALLOCA TION OF NEW PLACES
        COMMITME NT OF FUNDS
        VARIA TION TO APPROVED HOURS
        INTE RS TA TE TRA NSFE R OF SERV ICE USE RS
        CHA NGE OF SERV ICE PROV IDE R
        PAYMENTS TO ATTE NDANTS
        SECTION 1          -        INTRODUCTION


        Background:

        The Attendant Care Program (ACP) was established in the context of the 1986 -87
        Federal Budget to enable people with severe physical disabilities to move out of the
        restricted institutional setting of nursing homes and to live in thei r own homes in the
        community. New Directions (the report of the Handicapped Programs Review) and
        the Nursing Homes and Hostels Review identified younger long-term residents of
        nursing homes as a particularly disadvantaged group. The eligibility for the Pro gram
        has now been extended to cover residents of disability and aged hostels and people
        living at home whose only alternative to receive appropriate support is admission to
        hospital or nursing home.


        The ACP was transferred to the Disability Services Act i n 1991 under the terms of
        the Commonwealth State Disability Agreement and organisations are now funded
        under Section 6 of the Act.


        Since 1995 the NSW State Government has progressively increased the number of
        places available through the Program. In 2003 -04 provision was made through the
        State budget to add an additional 100 places bringing the total number of places to
        314.

        The Review of Services to People with a Physical Disability:
        A review of services to people with a physical disability was conducted in
        2002/2003. This review included the ACP, the 325 Program and the High Needs
        Pool within the Home Care Service of NSW (HCS). The review has focussed on
        improvements to the service model that will increase the responsiveness and
        flexibility of service provision for people with a physical disability who have high
        support needs.


        The review considered the report to the Minister prepared by a working group
        representative of service users, service providers and peak bodies advocating for the
        needs of this target group.


        Changes to the above-mentioned programs will be progressively introduced. These
        guidelines should be read in this context.


Attendant Care Program                                                             Page 1
        SECTION 2           -       SERVICE SPECIFICATION – ATTENDANT CARE


        Service definition:
        Attendant Care services include the provision of up to 34 hours per week of personal
        care and support to assist service users with daily self-care and living tasks to help
        them live in their own home and manage their life in the community.


        Objectives:
        The objectives of the program are to:

             provide a comprehensive and integrated range of basic personal care and support
              services to assist people with a disability with tasks of daily living;

             help eligible people to be more independent at home and in the community,
              thereby preventing their premature or inappropriate admission to long term
              residential care and enhancing their quality of life; and

             enhance the abilities of people with a disability to live as independently as they are
              able.


        Service Features:
        The features of the Attendant Care Program are that:

             services are flexible and responsive to changing needs to ensure that people can
              maintain typical patterns of daily living;

             assistance is provided to match lifestyle requirements i.e. outside normal working
              hours and on weekends;

             service providers facilitate service user involvement in matters relating to choice,
              recruiting and managing carers and assuming greater levels of responsibility
              relating to their attendant care arrangements;

             service is person centred;

             services are portable within NSW;

             service users may bank hours (up to 50 hours in a year) to enable them to take a
              holiday or fulfil additional goals; and

             a maximum of 34 hours per week of personal care can be provided to any one
              client. Clients identified as requiring higher levels of service should be referred to

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              appropriate assessment agencies for consideration of alternative program
              supports.



        Service Activities:
        Activities include, but are not limited to, assistance with (or supervision) of:

             bathing, showering or sponging;

             dressing and undressing;

             shaving, hair care and grooming;

             mobility (in bed and out of bed) such as to sit up, turn, stand and walk, sit, to
              transfer to commode, wheelchair, chair or vehicle;

             toileting;

             exercise or therapy programs;

             fitting and use of appliances such as splints and callipers or hoists;

             hearing aids and communication devices;

             basic day-to-day cleaning and laundry;

             eating, drinking and meal preparation;

             banking and use of computer for essential shopping;

             monitoring self medication;

             meal preparation; and

             limited nail care, following appropriate professional assessment.

        The service activities do not include home maintenance.

        For MDS reporting purposes, Attendant Care is recorded as hours and minutes of
        actual service.


        Associated Service Functions:
        Associated with service provision is:

             a range of client intake and service planning functions;

             provision of information on special or generic services that may enhance and
              support the person‟s life in the community, and where required, assistance to gain
              access to these services;


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             regular review of the client‟s needs and working collaboratively to identify goals
              and strategies to address these in the short and long term;

             the co-ordination and establishment of links between the client and appropriate
              and relevant specialist support services, mainstream services, peer support
              networks, and specialist technical aid support which address short and long term
              priorities; and

             the provision or procurement of carer support services for the client and the
              monitoring of quality, cost and amount of service delivered by contracted service
              providers.


        Service Types to be Provided:
        The following service types are to be provided as part of an Attendant Care package:

             In-home personal care;

             Domestic assistance;

             Training for carers and clients;

             Personal care to enable the person to undertake leisure or educational activities;

              and

             Meal preparation.



        Target Group:
        Attendant Care services are designed to target people, aged 16 to 65 years, who have
        a physical disability, who have the capacity to manage their own environment and direct
        their own carers, and who require more than 15 hours but less than 35 hours of
        personal care support in a week.


        The target group includes but is not limited to people with a physical disability caused by
        spinal cord injury, cerebral palsy, limb injury/amputee, stroke/CVA, multiple sclerosis,
        muscular dystrophy, polio and spina bifida. Clients may also have sensory or mental
        impairments. However, clients must be able to exercise control over their
        environment and to direct and supervise their attendant carers. Where the disability
        presents difficulties such as severe speech impairment, the client may use a friend or
        advocate to direct attendants if they wish.




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        People who have only a limited ability to make decisions a nd direct those who assist
        in meeting their personal care needs, may require accommodation support in a more
        structured environment, such as community-based accommodation with appropriate
        support and training.


        Some people with severe and/or multiple impairments may not be able to live in the
        community with a maximum of 34 hours of attendant care per week. These people
        may require more extensive levels of assistance and alternative forms of
        accommodation support.


       Service Standards:
        Attendant Care services must be delivered in accordance with the standards of
        performance prescribed by the Disability Services Standards which are:

             Each service user seeking a service has access to that service on the basis of
              relative need and available resources

             Each person with a disability receives a service which is designed to meet his/her
              individual needs, in the least restrictive way

             Each person with a disability has the opportunity to participate as fully as possible
              in making decisions about the events and activities of his/her daily life in relation to
              the services he/she receives

             Each service user‟s right to privacy, dignity and confidentially in all aspects of
              his/her life is recognised and respected

             Each person with a disability is supported and encouraged to participate and be
              involved in the life of the community

             Each person with a disability has the opportunity to develop and maintain the skills
              required to participate in activities that enable him/her to achieve valued roles in
              the community

             Each service user is free to raise and have resolved, any complaints and disputes
              he/she may have regarding the agency or the service

             Each agency adopts sound management practices which maximise outcomes for
              service users




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             Each person with a disability receives a service which recognises the importance
              of preserving family relationships, informal social networks and is sensitive to their
              cultural and linguistic environments

             The Agency ensures that the legal and human rights of people with a disability are
              upheld in relation to the prevention of sexual, physical, and emotional abuse within
              the service.


        Location:
        Service is provided in the client‟s home. Where appropriate the service user may
        negotiate within the approved hours for personal assistance to be provided in other
        locations, such as at a holiday or work/study location. Service users must be resident in
        NSW.

        SECTION 3            -       ROLES OF PROGRAM PARTICIPANTS

        The following are the broad roles for the various participants in the Attendant Care
        Program.

        Department of Ageing, Disability and Home Care:
             Develop policy, guidelines and procedures for administering the Program.
             Establish assessment and acceptance priorities
             Develop and maintain a data base for the Program
             Monitor Program funds at a State and Regional level
             Oversight and co-ordinate processing of applications and review of consumers
             Register and acknowledge all applications
             Advise service users and service providers of the outcomes of each stage in the
              process
             Allocate places to eligible applicants according to places and funds available and
              approved prioritisation criteria
             Make payments to service providers in respect of service users and maintain first
              contact points for queries from service providers and service users
             Monitor the quality of service and review service contracts
             Collect data as required
             Provide advice relating to targeting and other funding policy where necessary
             Participate in the ongoing development and evaluation of the Program
             Conduct initial assessments of applicants referred for the Program as places are
              available



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             Make recommendations on eligibility, priority, viability of the Program for the
              applicant, hours and types of support required
             Provide information which will assist an applicant and/or case coordinator, where
              requested, to make referrals to appropriate community supports needed for
              transition and establishment of service.


        Service Organisations:
             Be eligible under Section 6 of the DSA NSW and accredited by the Department as
              eligible to provide ACP services.
             Provide support for service users in a manner consistent with the aims of the ACP
              and the philosophy of the DSA as expressed in its Objects, Principles and
              Objectives.
             Facilitate service user involvement in matters relating to choice, individual
              development and to the assumption of control of their attendant care
              arrangements where appropriate.
             Provide a system of emergency back-up and support to service users
             Be responsible for training of carers in consultation with service users
             Meet requirements of the Occupational Health and Safety, Privacy, and other
              related legislation
             Provide service users with information on other special and generic services that
              may enhance and support their life in the community and, where required, assist
              them to gain access to these services
             Provide service users with information on how to access advocacy and peer
              support networks
             Account to the Department for ACP funds provided and for negotiated client
              outcomes, as required under Section 6 of the DSA NSW.


        The Service User:
             As a recipient of Attendant Care, upho ld any agreements made with the service
              provider, the carers and the Department, and generally cooperate in the
              provision of the service
             Provide clear direction to carers in respect of their duties, using assistance with
              communication if necessary
             Manage allocated hours and account for the use of these hours in a manner that
              will permit the service provider to account to the Department.




Attendant Care Program                                                                   Page 7
        SECTION 4          -        PROCESSING AN ATTENDANT CARE APPLICATION


        This section of the manual sets out the administrative procedures involved in processing
        an application for receipt of attendant care under the ACP.


        Procedures:
        Applications should be made by individuals on the ACP application form.
        All ACP application forms should be forwarded to DADHC.
        Forms should then be:
             registered and stamped with the date of receipt
             acknowledged in a letter to the applicant stating that they will be contacted
              when a suitable vacancy occurs
             checked for completion of details
             checked for basic eligibility and priority category (age, disability type , current
              residential status)
        Where an applicant does not satisfy the basic eligibility check:
             the application should be attached to a file for ineligible applications
             the applicant should be advised by the Department of their ineligibility and the
              reason
             the applicant should be referred to the Department‟s regional office reception
              or Community Access intake          for information and/or consideration of
              appropriate alternatives.




        SECTION 5          -        ASSESSMENT AND APPROVAL OF APPLICANTS


        Assessment of applicants :

        Assessments for the Attendant Care Program are conducted by appropriately
        qualified/experienced assessors. The purpose of assessment is to determine the
        applicant's general eligibility for the Program, their priority for consideration and the
        amount and nature of personal assistance hours they require.          The process also
        involves identifying, in conjunction with the applicants, other requirements for
        successful transition (if appropriate) from nursing home/hospital to community living.


        While assessments are only arranged if vacancies are available on the Program, the
        conduct of an assessment does not of itself guarantee an approved place on the


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        Program. Approval for a place is conducted after the assessment. Approval is
        dependent upon a number of factors including the number of available places, the
        priority for a place, any risks or concerns in relation to the applicant managing on an
        ACP package and the readiness of the applicant to take up a package and establish
        service.


        Full instructions for the conduct o f assessments, the report template to be
        completed, and other guidance such as information about aids and equipment have
        been developed for use by assessors.


        Action prior to the assessment:
        The assessor will contact the applicant and determine an appropriate time and
        location for the assessment and any support required by the applicant to be
        available for the assessment such as the use of an interpreter, the presence of an
        advocate, a family member and/or the presence of another relevant professional.


        The assessment:
        During the assessment the assessor will identify:
             factors relating to an applicant's eligibility and priority for the Program;
             the number of personal care hours and the types of personal assistance
              required;
             an applicant's broader needs and the status of referrals required e.g.
              accommodation, aids and equipment, home modifications and training needs.
              This also includes an examination of the type and extent of services and
              informal supports required in conjunction with the attendant care eg meals,
              Community Nursing, home help. After examining these needs, information will
              be reported on the viability of informal supports and the availability of relevant
              services
             the need for accessible housing and/or home modifications and the status of
              referrals for these. The assessor will ensure that the information regarding the
              need for referrals is made to the applicant and a case coordinator.


        Applicants may need to be assisted to apply for support and then liaise with the
        relevant State Housing Authority, modification service or support service to facilitate
        the provision of appropriate supports and/or housing/modification.




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        The assessor will make recommendations on whether or not the ACP is viable for
        the applicant as the capped number of support hours is 34 per week plus one
        emergency hour. The assessment will contain details of personal care required and
        other assistance necessary to sustain the community placement. In relation to
        assistance other than personal care, the assessment will clarify the activities and
        service types that are recommended under the Attendant Care Program.




        On completion of the assessment:

        An assessment summary sheet is to be completed as well as an assessment
        report. The report is to be signed by the assessor and the applic ant. The summary
        sheet should be attached to the front of the assessment document and forwarded
        to the delegate in DADHC within one week of the completion of the assessment.


        Re-assessments or reviews:
        If an applicant previously assessed, service user already in receipt of an ACP
        service or service provider requests a review of hours DADHC will arrange for re -
        assessment if necessary and review:
             the service user's continuing eligibility
             the appropriateness of the initial allocation of support hours, or any variation
              required
             the suitability of general supports and services previously organised to
              complement the ACP and the need for further supports and services.


        On completion of the Re-assessments:
        Once the re-assessment form has been completed it must be signed by the
        assessor and the applicant/service user. The re -assessment summary sheet must
        also be completed and then attached to the re -assessment document, and
        forwarded to DADHC.


        Approval to allocate places and additional hours if appropriate within the cap of
        34 hours:
        DADHC delegated officers will use the assessment report and any related
        documentation submitted with the report and:
             apply eligibility and priority criteria for admission to the Program
             clearly document recommendations based on these criteria

Attendant Care Program                                                               Page 10
             approve eligible and prioritised individuals for a place on the Program (where
              new places are the result of additional funding made available to the
              Department through budgetary processes this delegation remains with the
              Minister as it is the approva l of new recurrent funds to a service provider)
             approve additional hours for existing service users, within the cap of 34
              hours and subject to funds being available to the Program
             exercise delegations and follow Departmental processes in relation to
              payments to service organisations, Funding Agreements or variations to
              Funding Agreements.


        Approved places need to be taken up within a three month period from the date of
        the approval.


        Approval to delay commencement of service:
        If an approved applicant is no t ready to take up a place because they need to
        undergo transition programs, locate housing or complete modifications a place
        may be held in reserve for the applicant for a period of up to six months from the
        approval. If the place has not been taken up af ter six months it should be
        provided to another priority client. However the original approval remains in
        principle and the next available vacancy will be offered to this client.


        Approval to maintain an approved place for an agreed period beyond three
        months must be sought in writing. The delegated DADHC officer will approve the
        additional time if:
             the applicant is taking all possible action to achieve commencement, and
             transfer to the waiting list is likely to jeopardise or discourage commencement
              (eg where public housing requires a guarantee of support and has a date for
              completion).


        Where an applicant is unable to commence due to lack of a service provider,
        nominal approvals should be extended unless all possible options have been
        exhausted. DADHC officers should assist in identifying appropriate service provider
        options and provide information and support to the client and/ the case coordinator.


        Withdrawal of application:
        Applications will be withdrawn from the waiting list:


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                at the request of the applicant;
                where applicants have reached the ineligible age of 65 before being offered
                 an approved place;
                where applicants are unable to be contacted and every attempt has been
                 made to locate the current where-abouts of the applicant;
                if the client moves interstate;
                if a re-assessment, carried out because there has been a change in
                 circumstances or support needs before commencement or a delay in time,
                 identifies that the applicant is no longer eligible or viable.


        DADHC will acknowledge withdrawals in writing.


        Ineligible Applicants:
        Where the Department determines that an applicant is ineligible or that the Program
        is not a viable service for the applicant, the DADHC delegated Officer should advise
        the applicant of the decision.


        Applicants not eligible for Attendant Care include those who:
               live in a funded group home or other funded residential accommodation;
               are aged under 16 years or over 65 years;
               live or plan to live in another State or Territory
               have a high level of need such that they are unable to ma nage their Attendant
                Care service; require registered nurses to provide the specialised care; need
                high level intervention from psychiatric or drug/alcohol dependency supports; or
                have acquired brain injury that results in significant cognitive deficits;
               are unable or likely to be unable to take up an approved package within six
                months of the package being approved.




        Where eligibility can be considered:
        Applicants can be considered if:
                they require more than 34 hours personal care per week and have sustai nable
                 informal support available to supplement care needed over the medium to long
                 term
                they require more than 34 hours of personal care support per week and can
                 afford to pay for the additional support needed


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               they are using other DADHC funded services, provided ACP is not being used to
                top up service types that are not funded in an ACP package such as Respite
                Care, out-of home Accommodation Support or ATLAS/PSO
               they agree to allow DADHC to review the terms of settlement for any
                damages/compensation paid for their injury and recover or charge the cost of
                care as appropriate

        Action following approval of an ACP place:

       Where an applicant has been approved for an ACP place the procedures are:
             DADHC advises the applicant of the approval of their application, t he conditions
              which must be agreed to by the applicant accepting an Attendant Care place,
              and the service providers eligible to deliver Attendant Care services
             Approved applicants discuss their service provision with one or more eligible
              providers, choose an appropriate service provider and notify DADHC of their
              choice together with their acceptance of the conditions of funding
             DADHC advises the selected service provider and forwards a copy of the
              assessment so that service provision can be established
             The chosen service provider negotiates service delivery, administrative
              arrangements, recruitment of staff and training of staff with the approved
              applicant and then notifies DADHC of the commencement date for service
              delivery
             DADHC completes procedures for commencement of funding to the service
              provider.
        In determining the above the delegated Officer should have regard to the following:
             that the reasons cited by the organisation for declining the referral are clearly
              understood;
             that consultation with the consumer may be necessary;
             whether alternative Service Providers are willing to provide services to the
              consumer;
             the implications of the decision for the relationship between the Department
              and the Service Provider
             that the decision and decision making process are clearly documented and
              available for review, appeal or Freedom of Information request.


        Once the decision has been made by the delegated Officer DADHC will need to
        advise the Service Provider of the decision. Under the contract, organisations are
        bound- to comply- with the delegated Officer's decision.

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       Conditions for accepting an Attendant Care place:
       To accept a position on the ACP, it is necessary that the applicant:
             has read and understood the Attendant Care Program Guidelines Nov 2003;
             notifies the Department of any Compensation/Damages Claim that has been/will be
              lodged and the status of that claim;
             informs the Department of the outcome of any Compensation/Damages Claim and
              allows the Department to view the Terms of Settlement of successful claims so that
              an appropriate payment can be determined for services received; and
             agrees to replace any Personal Care services funded by DADHC, that the applicant is
              currently receiving, with the Personal Care services to be funded through the
              Attendant Care Program;
             notifies the Department as soon as possible of the chosen ACP service provider so
              that the service can begin as soon as possible (within three months from the date of
              the letter.

        Action following approval to vary number of approved hours of service delivery:
        After a re-assessment if an increase or decrease in the number of approved hours
        is recommended and approved the procedures are:
             DADHC advises the consumer of the outcome of the review, including any
              variation to approved hours
             DADHC advise the Service Provider of the outcome of the review, including
              any variations made
             DADHC completes procedures for variation of funding to the
              service provider.




        SECTION 6             –     PRIORITY SETTING


        The purpose of this section is to outline the criteria to be used to establish priority for
        allocation of places in the, where there are more applicants than places and waiting
        lists are required.

        Primary Categories:

        When applications are received they are ranked into the following categories. These
        categories are considered to be in descending order of priority. However where places
        are limited final decisions about priority will be made having regard to the factors
        affecting level of priority outlined below.

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        The primary categories are:
              1. applicants in nursing homes, lo ng term hospital beds including
                 rehabilitation units, aged or disability hostels and aged 16-50 years;
              2. applicants living at home, whose support needs have increased and/or
                 the available supports are no longer sustainable, are aged 16 -50
                 years and where placement in nursing home, hospital or congregate
                 care is the only option;
              3. applicants living at home, whose support needs have increased and/or
                 the available supports are no longer sustainable, are aged 51 -65
                 years and where placement in nursing home, hospita l or congregate
                 care is the only option;
              4. applicants in nursing homes, long term hospital beds including
                 rehabilitation units, aged or disability hostels and aged 51-65 years;

        Priority factors
        Within the above categories, the following factors should be flagged and considered in
        order to determine a greater or lesser priority for limited available places on the
        Program.
         1.      level of current support or need
                     applicants whose personal care support need is greater than 15 hours per
                      week
                     applicants who have been managing with community support services but
                      whose condition has worsened and they are unable to manage within the
                      limits set by existing support services
                     applicants who have been managing in the community but whose situation
                      has now been flagged by DADHC regional management as in urgent need
                      of support
                     applicants who are currently receiving their extra supports through
                      unsustainable interim funds or services
                     applicants who will be discharged from hospital/nursing home to live on
                      their own without family or partner support
                     applicants who are living on their own whose condition has deteriorated
                     applicants who need to live on their own as current situation is
                      unsatisfactory and who require extra support to do so
                     applicants whose family support person who assists with care is elderly, in
                      ill health, has a disability, has died, has moved away or is now required to
                      work in order to support the family

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           2. readiness
                    applicants whose modified/accessible housing or accommodation is ready
                     or likely to be ready within a four month period
                    applicants whose essential equipment is in place or being provided
                     through spinal PADP
                    applicants whose rehabilitation in a spinal unit or transition unit is
                     completed or likely to be completed within a three month period
                    applicants whose access to other essential support services such as
                     community nurse, shopping, additional domestic assistance, complex case
                     coordination support has been negotiated or is being put in place
            3. personal situation
                  applicants who are the parent of young children
            4. date of application
                  applicants whose current status has been flagged as urgent and whose
                   application was received first
            5. lesser priority
                  applicants aged over 60 years who have been assessed as suitable for
                   nursing home placement
                  applicants who are receiving sustainable support from other funded services
                  applicants who are receiving sustainable support from a combination of
                   funded services and informal supports
                  applicants whose assessed personal care needs are greater than 34 hours
                   per week and the supplementary support sources are likely to be
                   unsustainable and/or a different service model is more appropriate
                  applicants where the assessor has identified risks and concerns regarding
                   the suitability or capacity of the ACP for that applicant.




         SECTION 7          -        TRANSITION AND STARTUP FUNDING


        Transition assistance:

        Transition assistance is focused on the specific needs of the approved applicant
        which arise from his/her disability and need to be met for successful transition to
        independent living in the community; and can include training programs, home
        modifications and aids and equipment. Transition programs are undertaken after
        assessment has indicated that such assistance is necessary.


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       Description:
        Aids and equipment provided as part of a transition program may incl ude
        wheelchairs, hoists, shower chairs, special kitchen equipment ie microwave ovens,
        and other special purpose equipment. Transition assistance may also include
        independent living programs and similar training.

       Amount provided:
        The recommended limit per client is $5,000.

       Eligibility:

        In order to qualify for additional equipment or other specialised transition assistance
        transition needs must be identified by an Occupational Therapist or other appropriately
        qualified person, identified at or near the entry to the Program and must not be available
        through PADP (or available within a reasonable time).


        Start-up assistance:
        This assistance is provided on a one -off basis so that clients who have been living in
        nursing home/hospital/hostel for significant periods can meet the costs of moving
        into the community (eg bond money, basic furniture and household goods).


       Description:
        Assistance may be given for such items as:
              removal expenses;
              bonds (eg phone, electricity, housing, furniture);
              soft furnishings;
              linen and bedding;
              electrical appliances;
              kitchen utensils;
              crockery;
              food supplies; and
              cleaning goods.


        Amount provided:
        The recommended limit per client is $3,000.




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        Eligibility:
        In order to qualify for start-up assistance clients should satisfy all of the fo llowing
        criteria:
               have been a nursing home/hospital/hostel resident;
               be dependent on a Commonwealth pension as their major source of income;
                and
               have no other means of arranging or purchasing household requirements
                which are essential to their move to the community or will substantially
                increase their quality of life.
        Note: Existing clients may receive this assistance if they can demonstrate genuine
        need.

       Procedures for claiming Transition and Start up Assistance:

                A request for assistance (giving descriptio ns of items required, costs and
                 quotes should be forwarded to the appropriate DADHC Officer who will
                 prepare a submission to the delegated fficer for approval of a one -off
                 payment
                Start up and Transition assistance will be paid to the service provider
                The service provider will arrange with the service user for the payment of the
                 goods
                The service provider should acquit the payment and the use of the funds in
                 the normal way.




        SECTION 8             -      SERVICE PROVISION

        Consumer control:
        The Program aims to maximise cons umer control and independence.               This can
        include the consumer locating, interviewing, screening, hiring, training, managing
        and firing his/her attendant carers. These responsibilities can be shared with the
        service provider. The extent of shared responsibility will be determined by the
        consumer in consultation with the service provider.

        Training of carers:

        The Program does not prescribe any minimum qualification level or any particular
        type of formal training for attendant carers. However, it is expected that appropriate


Attendant Care Program                                                             Page 18
        training will be provided or arranged by the service provider and/or by the service
        user to suit the particular situation of each person taken on by the service provider
        as a client. Service providers are also responsible for meeting the requirements of
        Occupational Health and Safety legislation.


        Service providers must ensure that basic competencies are either a pre-requisite of
        the employment conditions or provided through training. The service user will be
        involved in the training of sp ecific carers as much as possible.

        Training will include the basic skills necessary for the carer to perform personal care
        tasks in a competent manner, without risk to the health and well-being of the
        consumer or themselves (e.g. lifting, basic first aid, hygiene, etc.),as well as the way
        tasks are to be performed to suit the needs and preferences of the consumer.


        Health Care:

        Any on-going health care needs must be able to be met in the community (e.g. by a
        local doctor, hospital out-patients department, visiting nurse, etc.) Acute admission to
        a hospital in the case of an emergency would not preclude eligibility for the Program.

        Use of attendant care hours:

        Attendant care hours should only be used for providing direct personal assistance to the
        service user as outlined in the service specification. See Section 2 for the Service Types
        and Service Activities allowed under Attendant Care.

       Assistance with tasks which are not "personal care or related”:
        A service user may use attendant care flexibly for allowable tasks that may vary
        from time to time. The service user may negotiate with attendants to undertake
        these tasks within their allocated hours. A service user may also, from time to time,
        use other supports, such as relatives or friends, for some assessed personal care
        and related tasks. The consumer may then negotiate with attendants to provide
        other assistance within remaining allocated hours, to a maximum of four hours per
        week.


        Such support does not include child care, work in a family busi ness, providing
        personal care or other personal assistance to household members other than the
        approved client, or professional services, such as home modifications, carpet
        laying or plumbing.


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        Attendants can accompany a consumer on holiday if they agree to this arrangement
        and there are additional hours saved to cover the period involved. No additional
        funds will be provided to cover travel costs or extra penalty rates for that period.

        Saving of hours:

        If service users use fewer than their app roved attendant care hours (eg if
        friends/relatives assist with some tasks) they may carry these hours over from
        week to week and use the attendant care hours at a later date.


        Service users may carry over a maximum of 50 hours from one financial year to t he
        next. Service users who regularly under-use the approved number of hours and
        consistently carry over unused hours each year should be reviewed by DADHC to
        ascertain whether the level of support being provided to them is still appropriate.

        Hours unused due to hospitalisation:
        If a consumer is admitted to hospital or in respite he/she may not save hours during
        the period of hospitalisation.
        Consideration will, however, be given to paying the organisation to keep one or
        more attendants "on retainer" for a nominal amount of hours per week, in order to
        prevent the client having to start with new attendants on returning home from
        hospital. Attendants on retainer should continue to support the client as appropriate
        (eg visiting the client in hospita l, keeping the home habitable, gardening etc) for the
        amount of hours paid. Please note that personal care tasks should not be
        continued while the service user is a temporary in-patient in a hospital; in respite
        care or other funded supported accommodation service.

        Pooling of hours:

        Service users in the Program may, if they choose, arrange with other Attendant
        Care Program consumers to pool some or all of their hours in order to maximise
        attendant care assistance (eg for meal preparation etc). Service users who live in
        the same household do not have to pool any of their hours but may do so if they
        wish. Regardless of whether service users choose to pool hours they will be
        assessed individually in regard to their independent requirements. Attendant Care
        should not be used to top up funding of an organisation to operate a funded
        Accommodation Support facility.




Attendant Care Program                                                            Page 20
        Clients not requiring service temporarily:
        When an approved service user ceases to need the approved ACP support because
        there is a temporary improvement in their condition; a temporary deterioration in their
        condition such that they have moved into a full care placement; they have gone
        overseas temporarily; they choose to use available informal supports to support
        them, and also, there is the likelihood that support will again be needed at some time
        in the future, the client should be kept on the Program.


        When it is known or becomes evident that such a situation will continue for a
        considerable length of time, such as three months or more, the service provider is
        required to notify DADHC to suspend funding. After three months the situation will
        be reviewed by DADHC. An ACP place cannot be kept open for a period greater
        than six months. If appropriate, qualified advice on the indi vidual's prognosis
        should be sought in order to determine whether they should continue to be kept
        on the Program.

        Initial attendant training hours:
        An allocation of initial attendant training hours can, if needed, be allocated to
        approved service users on the Program. Service users assessed as needing at least
        15 hours of care per week may be allocated 25 hours. Application must be made in
        writing to DADHC by the service provider who will need to justify the request as
        being outside their normal responsibility to appoint and train staff with basic levels of
        competency.


        This allocation can only be made once for a service user.


        Up to 20% of training hours can be used for recruitment purposes. Provision of
        training hours need not necessarily oc cur prior to the commencement of a service
        user and organisations may use some of these training hours on an ongoing basis if
        they choose.


        Training of replacement attendants and any additional ongoing training should be
        covered within the approved attenda nt care hourly rate.

        Initial transition hours:
        25 initial transition hours can, if needed, be allocated to newly approved service
        users on the Program. These hours can only be allocated once and should be used

Attendant Care Program                                                             Page 21
        within one month of the consumer moving out of the nursing home, hospital or
        congregate facility and recruiting carers.


        These hours may be used for attendant care assistance directly related to the
        service user‟s transition from the institution to community living and could be used
        for such things as opening bank accounts, shopping, unpacking, training in the use
        of new equipment and community orientation.

        Emergency Hours:

        Each service user may be allocated one emergency hour per week to cover ongoing
        training, emergency respite and holiday supplementary hours. Thus each service
        user is entitled to up to a maximum of 52 emergency hours per financial year.


        These hours are in addition to initial transition/training hours and any "banked" hours
        saved by service users up to the maximum of 50 hours.


        Emergency hours can, if needed, be anticipated by service users before they have
        actually accumulated.


        Unused emergency hours do not accumulate over financial years as service users
        will be re-credited with emergency hours every year.


       Funds accumulated by service providers in their aggregated Attendant Care service
       funds when service users under-use hours or when they are in hospital may be used
       for an average level of emergency hours per client per year. Service providers may
       request more funds from DADHC for this purpose, if needed.


        Adjustments to the payments to service providers for emergency hours should
        occur through the normal acquittal process following the end of a financial year.




        SECTION 9          -      ELIGIBLE SERVICE ORGANISATIONS


        There are a number of service providers who are approved as “eligible” to provide
        Attendant Care services. From time to time the Department may seek to increase the
        number of service providers to ensure geographical coverage and choice for


Attendant Care Program                                                           Page 22
        approved service users. From time to time DADHC will seek to expand the number of
        eligible providers in order to fill geographic or expertise gaps or to deal with the need to
        increase service capacity.


        This list of eligible providers is sent to each newly approved applicant so that they may
        discuss service provision and arrangements for managing the Program, choose a
        provider that suits their needs and has the capacity to provide their service and then
        negotiate service delivery.


        Organisations must:
               Be financially viable so that public funds can be accounted for and to
                ensure the security and continuity of services provided to recipients of
                Attendant Care
               have the management and administrative structures in place to
                administer payments made quarterly in advance based on the number
                of agreed hours for each approved person referred to the service and
                provide a cost effective service
               demonstrate commitment to the Principles and Objectives of the NSW
                Disability Services Act and if appropriate the Home and Community
                Care Act and conform to the Service Standards derived from this
                legislation
               demonstrate capacity to develop an appropriate service model and
                deliver ACP services as outlined in the Service Specification
                (SECTION 2)
               demonstrate capacity to meet service users need s
               assist recipients to have maximum control of their attendant care
                arrangements. This       means     that the    recipient will be actively
                encouraged and assisted to be involved in the individualised training
                of their attendant carer(s), selection of their attendant carer(s), and
                management of their daily care arrangements
               consult fully with the consumer over choice of attendants and give an
                undertaking to ensure consumer participation in all aspects of this
                process
               ensure emergency attendant care arrangements for each service user,
                so that a service user is not left without a service




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               implement sound access and equity strategies are in place to provide
                equitable access for the specified target group including Aboriginal
                people, Torres Strait Islander people, people from culturally and
                linguistically diverse communities and people living in geographically
                isolated areas
               negotiate a contribution towards costs of care with service users
                ensuring policies and procedures are in place for those service users
                who do not have the capacity to pay. Care above the hours approved
                under the Program will need to be negotiated between the organisation
                and the service user and payment may then occur
               notify DADHC if a service user receives damages or compensation as a
                result of their injury. DADHC will review the settlement conditions for
                these service users and may request payment for service provision
               recognise the privacy and independence of service users of attendant
                care. This means that a service provider will not use attendant care in
                such a manner as to restrict or hinder the independence of a service
                user.    It also means that a service user‟s self determination will be
                respected in all areas relating to their attendant care arrangements
               provide attendants with appropriate training or co-operate in arranging
                such training.    Where the service user wishes this should involve
                supporting service users in the training of their attendants.    It is also
                aimed at the occupational health and safety of the attendants as well as
                the comfort and safety of recipients. The training could include such
                aspects as lifting, transfers, first aid and hygiene
               assist the service user in the development of peer support or service
                support networks in order to ensure access to any other required
                support. This means that an organisation should actively encourage a
                service user to link with other people, organisations, case-coordination
                support and services in order to have their needs met . In practical terms
                this will require knowledge of informal, special and generic services
                accessible to the service user and provide information and assistance to
                the service user on how to access these
               submit financial and statistical returns to DADHC as required under
                the Funding Agreement. This means that services wi ll be accountable
                for grants made to them in relation to attendant care and that
                acquittals and payment adjustments will be on a quarterly basis in line


Attendant Care Program                                                                 Page 24
                with the rest of the DADHC. Organisations are also required to
                promptly notify DADHC of issues that will result in a variation to their
                funding such as the death of a service user or the move of a service
                user into a more supported model of care




        SECTION 10          -      FINANCIAL PROCEDURES


        General funding arrangements:

        Funds available from the Attendant Care Program can be paid only to
        organisations which have been approved as „eligible‟ Attendant Care service
        providers under Section 6 of the DSA.


        The rate payable to organisations per hour for Attendant Care service provision is
        standard across all service providers and is negotiated from time to time by
        DADHC in line with notional unit costs for the provision of these services. The
        hourly rate includes payment to attendants, workers compensation insurance,
        associated administrative costs (including coordinator salaries or part salaries)
        and ongoing costs for training of attendants. Payments to organisations are to be
        made quarterly in advance, according to the approved hours of attendant care for
        service users using that service organisation.

        Financial monitoring principles for the Attendance Care Program:

        Allocation of funds to service providers should be monitored in dollars, hours and
        places. The monitoring of commitments should include the calculation of full year
        costs. The expenditure of funds available in each year will depend on:
               the actual number of hours allocated per service user weekly
               variation in hours consumed e.g. due to under-use because of temporary
                absence from the Program
               variation in hours due to approved augmentation of hours for some service users
               the number of emergency hours used by service users
               service users entering or leaving the Program.


        Allocation of new places
        An allocation of a new place will be made, within Departmental budget allocations, using
        priority categories and factors for consideration, where:


Attendant Care Program                                                            Page 25
                  a vacancy has become available as an existing service user has withdrawn; or
                  additional places are made available with a budget allocation.




        Commitment of funds
        Each allocation of a place commits recurrent funds from the actual date the approved
        applicant commences receiving service according to the following:
                  number of allocated hours per week x number of weeks remaining in the year x
                   the agreed hourly rate; and
                  number of allocated hours per week x 52.14 weeks x the agreed hourly rate, for
                   each subsequent year.


        Variation to approved hours:
        Where there are approved variations to allocated hours (i.e. a change to approved
        hours due to a review following a re-assessment) committed funds for each financial
        year should be adjusted from the date the variation is approved.


        Where a consumer of the Attendant Care Program ceases to use the Program either
        permanently, or for a period (e.g. due to hospitalisation), funding commitments to the
        Service Provider should be adjusted accordingly.


        Interstate transfers of service users:
       The Attendant Care Program is portable across New South Wales but is not portable
       across State and Territory boundaries. Under the interstate portability protocol
       “Moving Interstate: Assistance to People with Disabilities and their Carers”, signed
       by Disability Ministers and Disability Administrators of each State and Territory, the
       following arrangements were agreed:
                 individuals seeking to move interstate may access that State or Territory‟s
                  service system through transparent demand management processes based
                  on relative priority of need;
                 individuals may register their demand for service prior to any planned move;
                 where the move is urgent, unplanned or due to circumstances beyond the
                  control of the individual, the State of Origin agrees to give consideration to the
                  transfer of funds for up to 12 months to enable time for the transition to be
                  organised; and


Attendant Care Program                                                                Page 26
             the State of Origin agrees to contact DADHC counterparts in other States to
              assist in facilitating the request for service in that State.


          Change of service provider:
          Service users may change service providers if they wish in order to negotiate
          arrangements regarding aspects of service delivery that better suit their needs.


          Procedures to follow include:
                  The service user contacts and discusses their service with any of the
                   „eligible‟ service providers and determines whether or not the organisation
                   can meet their needs and has the capacity to provide their service
                  Once a service provider is chosen the service user notifies the current
                   service provider and DADHC of their intention to change
                  DADHC contacts the service provider and sends a copy of the service
                   user‟s assessment to the new organisation to assist with establishing
                   service
                  The relinquishing service provider and the new service provider negotiate
                   an end date for service and a commencement date for service
                  DADHC is notified in writing by the relinquishing service provider of an
                   end date for service
                  DADHC is notified in writing of a commencement date for service
        DADHC follows procedures to effect the variation in funding and notifies both
        organisations of the variation and the effective dates.

        Payments to attendants:

        Service organisations will be responsible for all payments of salaries, allowances to
        attendants, workers compensation, relevant insurances and taxation. Terms and
        conditions of employment, pay periods and method of payment will be determined by
        the organisation.


        The organisation will need to arrange with the service user a suitable method for
        return of the time sheets or other records of hours to meet its own payment
        deadlines for processing wages.




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