7. Community-based services
7.1 Residential care
Residential care refers to care provided to residents of approved residential aged-care facilities.
The introduction of the proposed medicine may defer or accelerate a person’s admission to a residential care facility, thereby affecting the weekly level of care required for the new resident. The actual level of care affected will vary according to the level of dependency of the particular resident on admission to the residential care facility. Similarly, the proposed medicine may vary the level of dependency for a person already in a residential care facility, and, in turn, vary the level of care required for their support. In either case, the effects should be included in the economic evaluation of the medicine.
Residential care is categorised according to the Aged Care Funding Instrument (ACFI). The ACFI is based primarily on the resident’s dependency (need for care) rather than on care planning or care provided by an aged-care facility.
The ACFI consists of 12 care need questions. Diagnostic information about mental and behavioural disorders, and other medical conditions is also collected. Information from the ACFI is used to categorise residents as having low, medium or high care needs in each of the following care domains:
- activities of daily living
- behaviour
- complex health care.
Information and resources for conducting an ACFI assessment are available from the department’s website. Daily ACFI subsidy rates are available from the department’s website. In addition to the government subsidy, all residents pay at least a basic daily care fee, indexed quarterly. For the latest value of the basic daily care fee, contact the Aged Care Information Line on 1800 500 853 or visit the department’s website.
Assess which resident categories would be affected by use of the proposed medicine or its main comparator, and the extent of any variation expected on the resident’s level of dependency. Calculate the number of days affected by the therapies. The unit of measurement is the sum of the appropriate daily ACFI subsidy rate and the basic daily care fee.
If the ACFI category is unknown, the subsidy paid for a resident will be the sum of the amounts payable for the three care domains (activities of daily living + behaviour + complex health care). Where the effects are spread uniformly across all categories, use the average across all categories. Use clinical judgment when selecting the appropriate ACFI category relevant for the economic evaluation, and justify the selection.
7.2 Home care
A home care package is a coordinated package of care designed to help an older person with complex care needs to remain living in their own home. There are four levels of home care package – Level 1 receives the lowest subsidy, and Level 4 receives the highest subsidy. Care recipients may also be eligible for a number of supplements. The home care subsidy is paid as a daily rate, depending on the level of package the care recipient receives. Home care funding is not determined by care type.
The introduction of the proposed medicine may defer or accelerate eligibility for a home care package, or affect the level at entry, depending on the assessed care needs of the individual. Similarly, the proposed medicine may vary the level of dependency for a person who already receives a home care package, which may vary the level of care required for their support. An individual’s care plan may need to be renegotiated to direct more funds towards particular care types, such as medicines administration, resulting in a reduction of other care types. Alternatively, the individual may need to pay additional fees to access services beyond those available through package funds.
If the variation in dependency is significant, a reassessment may be required, which may result in eligibility for a different package level (either higher or lower) or referral to a different type of care, such as residential care.
An external assessment by an Aged Care Assessment Team determines the level of package at entry. A further assessment is required if the care recipient’s care needs change to the extent that they need a different package level or enter residential care.
Assess the extent of any variation expected on the care recipient’s level of dependency relating to the proposed medicine or its main comparator. The unit of measurement is the sum of the appropriate daily home care subsidy rate plus the basic daily care fee.
Information about current rates of home care subsidy and supplements is available from the department’s website.
In addition to the subsidy, many care recipients pay a basic daily care fee. The basic daily care fee is separate from the income-tested care fee (which is used to substitute a portion of the daily government subsidy). Information about current home care fees is available from the department’s website.
7.3 Home nursing
Home nursing services are those provided by qualified nursing personnel at the patient’s home or residence. These do not include nursing services provided in residential care or in a hospital – these are included in ‘Residential care’ (Subsection 7.1) and ‘Hospital services’ (Section 6), respectively.
The introduction of the proposed medicine may increase or decrease the number or duration of home nursing visits required. Unit costs for nursing under the Commonwealth Home Support Programme (CHSP) may vary across the states and territories; the CHSP estimated the national cost in 2016 at $91.83 per hour.
Use clinical judgment to determine the number and duration of services likely to be affected in this category, and justify their assessment in the submission.
7.4 Ambulance services
The introduction of the proposed medicine may increase or decrease the use of ambulance services. If this is relevant to an economic evaluation, the unit of measurement is each trip taken or avoided. Costs for ambulance services can be obtained from the quarterly statistics reports of the Australian Prudential Regulation Authority. Use the latest quarterly data from the ‘All states combined’ report, and divide the total cost of services by the total number of services, to obtain the mean cost per service. Specify the date of the quarterly data used in the submission.
7.5 Other community-based services
The introduction of the proposed medicine may affect a wide range of community-based health services other than those listed elsewhere in this manual. Examples of such services are Meals on Wheels and Community Health Services.
However, it is often difficult and expensive to identify all these services, and quantify the effects of a proposed medicine on them. Thus, these types of services have not usually been included in economic evaluations. However, these issues may be considered in the context of the social or community effects of the proposed medicine other than effects already recognised in the economic evaluation. This information is not necessarily expressed in monetary terms, but may supplement the economic evaluation by ensuring that all effects of the proposed medicine on the provision of resources are recognised and considered.
