By Una Sandeman, Lifestyle Lead Anglicare Southern Qld Metro South Community
This is my personal experience with the introduction of My Aged Care and the Commonwealth Home Support Program.
The arrival of My Aged Care (MAC) and the Commonwealth Home Support Program (CHSP) in 2015 had everyone in the Aged Care industry waiting apprehensively for the 1st of July 2015 to arrive. This was going to be one of the biggest changes many in the industry would have seen since the introduction of HACC. It would also be the beginning of the changes to come over the next 4 years.
It was hard to know what to expect and having been in the industry for 26 years I decided that it is easier to accept change than to fight it. After reading as much as I could about the new system and what possible changes lay ahead I made the decision to encourage my Lifestyle team to embrace these changes with a positive attitude. With the government having a strong focus on Restorative, Wellness and Enablement models of practice I could see opportunities ahead for the diversional therapy profession. I asked my team of diversional therapist and lifestyle assistants to look at this change as a chance to grow our profession and recognition as our expertise lies in wellness and enablement practice. At that time I did not realise how great the opportunity would be that lay ahead of us for recognition of my beloved profession …Diversional Therapy.
I know that to many who read this and to those who have been challenged by the new MAC and CHSP systems and processes I am sure you may feel it is strange for me to say how excited I was and continue to be about the introduction of MAC and CHSP particularly after I read the CHSP manual for the first time back in 2015. I am very aware of all the concerns and teething problems that have arisen for clients, carers and service providers but as with all change there is always a settling in time and adjustments required by all, one can focus on the problems or one can look at the opportunities the second option is the one I chose.
Recognition for our profession
Having worked in the industry in Australia since 1989 and working in the diversional therapy field since the early 90’s I am well aware of the ongoing struggle with our profession not being taken seriously. So you can imagine how I felt when I read the CHSP manual and there it was in black and white Diversional Therapy listed as a sub type along with the physiotherapist, occupational therapist, speech pathologist, dieticians, etc under the Allied Health Service type. This is where I saw the greatest opportunity, finally a chance for diversional therapists to be recognised in their own right.
A little about me. I am, like many diversional therapists who have struggled to get recognition for our profession but not one day goes by that I have not felt proud and passionate about my chosen profession. I lead a community service lifestyle team at Anglicare in Brisbane with 4 diversional therapists and 10 lifestyle assistants and many volunteers. We provide numerous programs in the community and also at a respite centre where our programs improve quality of life and encourage enablement and independence. The referrals from MAC for Allied Health (diversional therapy), social support groups, centre-based respite and in-home flexible respite service types are covered by our programs. The diversional therapist completes a biopsychosocial admission assessment, develops care plans, designs programs and completes reviews for all clients who are referred for these services.
How did I manage to achieve getting referrals for diversional therapy? I believe it is all about relationships and understanding that when change occurs it will usually affect everyone involved in some way, even those driving or implementing the change. Those working in the My Aged Care screening department and the regional assessors (RAS) were all new in 2015 along with the processes so like service providers they too were learning to cope with the new system and also trying to learn about the services that are provided out in the community. So this meant they didn’t always have a clear understanding of what the role of a diversional therapist is. Taking the time to speak with MAC staff who were completing the initial screening of clients and getting to know our local regional assessors (RAS) so they had a clear understanding of our services and the role of the diversional therapist made an enormous difference. Asking questions of the referees when MAC referrals received by my team were unclear, requesting diversional therapy referrals if they didn’t come through, showing empathy when people became flustered and explaining to those who didn’t know what a diversional therapist role consists of has led to ongoing diversional therapy referrals for my team. Those RAS assessors and ACAT assessors who know our service and what we do are now including diversional therapy referrals when referring for the above service types that our DTs cover.
You may ask ‘Why did I insist on having these referrals for diversional therapy, when we were already getting the referrals for the service types listed above?’
It is important to note that the service types I listed above (social support group, centre-based respite, in-home flexible respite) are all referred to my team. This means all these clients are assessed and reviewed by a diversional therapist, not nurses, not OTs, not physios but by diversional therapy professionals. They complete all the admission to service requirements, ongoing services, reviews and this is what makes the difference to the clients’ wellbeing so I believed they deserved the recognition for this. We recognise all the other professions so it is now our turn to be part of this and we all have the opportunity to do this, I encourage all diversional therapist who work in the community to go forward and promote yourselves as you now have the platform to work from.
What this means for my team and my service.
This means recognition for the diversional therapist, a very proud moment and one I didn’t think I would see in my working career.
It means our service can now claim outputs under allied health service type for the work the diversional therapist do with the clients.
I ask you all why wouldn’t we take this opportunity? What is holding you back?
Below are actual referrals received by my diversional therapist
I still get excited every time I see these referrals coming through and this has happened since July 2015
Centre-based respite
Allied Health and Therapy Services (Diversional Therapy) N/A Referral code given to client
Types: MAC Referral received by ASQ
Subject: 22/09/2016: MAC Referral RECEIVED for AH Diversional Therapy/Minor Home Maint/Ho
Date: 22/09/2016
22/08/2016: MAC Referral RECEIVED for AH Diversional Therapy/Minor Home Maint/Home Maintenance
Types: MAC Referral received by ASQ
Subject: 16-AUG-2016: MAC Referral RECEIVED for Diversional Therapy, Group Social Support
Date: 16/08/2016
16-AUG-2016: MAC Referral RECEIVED for Allied Health and Therapy Services: Diversional Therapy, Social Support Group
Client Records: NSAF, HSA and SP attached
Types: Additional Service Subtype Referral
Subject: Additional Service Subtype Referral
Date: 21/09/2016has been referred for the following additional subservice type [Allied Health – Diversional Therapy]. This service will commence on [asap)
Below is an extract from The Commonwealth Home Support Program Manual 2015
| Objective | To provide services that restore, improve or maintain frail, older people’s health, wellbeing and independence. |
| Service type description | Allied health and therapy services focus on restoring, improving, or maintaining older people’s independent functioning and wellbeing. This is done through providing a range of clinical interventions, expertise, care and treatment, education including techniques for self-management, technologies including telehealth technology, advice and supervision to improve people’s capacity.The focus of these services is assisting older people to regain or maintain physical, functional and cognitive abilities which support them to either maintain or recover a level of independence, allowing them to remain living in the community. Non-clinical services, including some diversional and preventative therapies, may be provided to clients under this service type, however, these must be complementary supports for the client and not delivered in isolation from the focus of this service delivery.Allied Health and Therapy Services funded under the Commonwealth Home Support Programme include (but are not limited to):• podiatry• occupational therapy• physiotherapy• social work• formal counselling from a qualified social worker or psychologist• speech pathology• exercise physiology• nutritional advice from an Accredited Practising Dietitian or a qualified nutritionist• ATSI Health worker• diversional therapy• other allied health and therapy services.This list of services is not exclusive and grant recipients are not expected to provide all the activities listed.There are two models of service provision for this service type available depending on intensity. These are additional service sub-types to those listed above.Grant recipients must indicate which (or both) of the models they are able to deliver, and which specific allied health or therapy they will provide under that model.It is anticipated that grant recipients will be able to deliver both models.1) Ongoing Allied Health and Therapy servicesGrant recipients can deliver one or more of the services in the list above (exactly which services are delivered by the provider will need to be identified). These services are of an ongoing or episodic nature, are delivered on an individual or group basis and provided at a low intensity or frequency, with a maintenance or preventative focus, for example regular podiatry for a client with diabetes and group exercise classes.2) Restorative Care servicesGrant recipients can deliver a time-limited, allied-health led approach to service delivery that focuses on older clients who can make a functional gain after a setback. These may be one to one or group services that are delivered on a short-term basis which are delivered by, or under the guidance of an allied health professional.Their goal will to be to increase the independence of clients. They will target people who can make a functional gain after a setback, who are at risk of a preventable injury, or who need other allied health led services to maintain independence.In implementing restorative care services, grant recipients must:• conduct an initial assessment of the client to establish a baseline from which progress or maintenance of function can be evaluated. This assessment must identify goals and must include the development of an individual plan for each client• use measurable, objective, quantitative and qualitative indicators and record results associated with therapeutic goals or desired outcomes which include the client‘s functional ability: on entry, atreview and at discharge• complete an outcome assessment documenting achievement or progress made against identified client goals prior to discharge for each client. |
| Out-of-scope activities under this service type | Specialist post-acute care and rehabilitation services are out-of-scope and must not be purchased using Commonwealth Home Support Programme funding. |
| Service delivery setting e.g. home/centre/clinic/community | Services may be delivered in a client’s home, a clinic, at a day centre, a group environment or other community setting. |
| Legislation | Grant recipients must adhere to any relevant Commonwealth and/or state/territory legislation or regulations. |
| Output measure | Time (recorded in hours and minutes as appropriate).Type of care (identify which model/s will be delivered i.e. Ongoing Allied Health and Therapy Services and/or Restorative Care Services). |
| Staff qualifications | Allied health providers must meet their respective accreditation and registration requirements and operate within the scope of practice of their particular regulated or self-regulated body. For example, speech pathologists funded under the Commonwealth Home Support Programme must hold the Speech Pathology Australia Certified Practising Speech Pathologist credential.Depending on the respective accreditation and registration requirements, this may permit activities being undertaken by assistant allied health professionals or less qualified staff. |