National Review of Community Transport under the Commonwealth HACC Program:

National Review of Community Transport under the Commonwealth HACC Program: Final Report March 27 th 2014 Prepared for: Department of Social Services

Executive Summary Introduction The Review of Community Transport has primarily sought to provide the Commonwealth with sufficient information about HACC Community Transport to support the development of more efficient and effective common arrangements for transport in the Commonwealth Home Support Program (CHSP). HACC Community Transport within this review included HACC Community Transport (Service Group 7), HACC Community Transport embedded in other HACC services and HACC-like transport arrangements. The review has provided the Commonwealth with information about the current arrangements for transport that include HACC Community Transport or arrangements that affect the design and delivery of HACC Community Transport services. This information was primarily provided through six evidence gathering activities that included: a literature review; data analysis; National discussions in all States and Territories and in regional centres; website questionnaires for providers and client/carer/representatives; jurisdictional mapping and sector consultations. These activities resulted in the production of five reports producing an evidence base and accompanying analysis. The HACC Community Transport Review reports are: Literature Review Data Analysis Report National Discussion Summary Report (developed from 15 individual site reports) Website Questionnaire Report Jurisdictional Mapping Report The evidence and analysis presented in these reports has supported the development of the fundamental steps detailed in this report. The adoption of the proposed fundamental steps detailed in this report will support the development of common arrangements within CHSP Transport and produce greater effectiveness and efficiencies. These proposals have been developed with sensitivity to the context within which HACC Community Transport is delivered and included consideration of the Commonwealth Government s commitment to reducing unnecessary red tape. Key Themes arising from Review Activities Demand The growth demand for HACC Community Transport will be significant over the next 15 years (+64.9% in the 65+ years population by 2026). The growing demand for transport will put significant pressure on the entire health and aged care systems and the plethora of alternate transport programs and arrangements that are focused on the HACC target population. The demand for additional HACC Community Transport services is being driven by the growth of the population 65 years and over and the increasing number of older people choosing to age in the community (Commonwealth policy supports this choice). Key factors within this population that impact on the growth in demand for transport include: The prevalence and impact of dementia The increasing support requirements related to the activities of daily living as people age ii

The high demand for health services as people age Reduced access to family carers These demands will only add to the operational pressures impacting on service providers which include: Costs outstripping the growth in Government funding Uncertainties regarding the future source of funds required to replace vehicles More State regulation affecting transport operations of community transport providers leading to increased costs Ageing and reducing pools of volunteers The Complex Range of Transport Services HACC Community Transport (Service Group 7) operates within a complex environment. This environment includes: embedded transport in other HACC programs, other Commonwealth Aged Care and Carers programs, alternate State Transport schemes, Non-Emergency Medical transport services and other Commonwealth programs that include embedded transport. Within the HACC program transport is delivered as either a unique service type (which includes transport reablement activities) or as an enabler of other HACC programs. Transport is where the client is transported rather than where support worker travels to the client. HACC service types other than HACC Community Transport (Service Group 7) identified as having significant embedded transport includes: Social Support Respite Domestic Assistance and Personal Care (particularly in Victoria) Volunteer Coordination and Linkages Aged Care (Victoria Only) Centre-based Day Care (excluding Western Australia) Case Management and Coordination The review has also found that transport is embedded in other programs that will form part of the new CHSP program: Assistance with Care and Housing for the Aged (ACHA), National Respite for Carers Program (NRCP) and Day Therapy Centres (DTC). The Commonwealth Home Care Packages (HCP) program also intersects with HACC Community Transport. HCP providers purchase services from HACC Community Transport and other transport services and will do so with increasing frequency as the Home Care Package program is expanded. It is worth noting that HCP clients are estimated to be using a quantum of transport equivalent to the current HACC Community Transport (Service Group 7). In addition to these programs there are other transport programs such as: Local Government transport schemes Transport provided by clubs The COAG Closing the Gap transport scheme Subsidised Public Transport Schemes Taxi Transport Subsidy Scheme (all States and Territories) Fuel Card (Western Australia rural areas)/cars for Communities (Tasmania) There is an increasing demand for non-emergency medical transport in the HACC Community Transport program resulting in a negative impact on the availability of transport to support other aspects of the activities of daily living. There are multiple factors impacting on the demand for non-emergency medical related transport in HACC and more broadly which include: iii

Reducing or static resources being provided by Health Services for transport Increased length of life and rapidly increasing population of very old people (85+) with resultant proportionally higher demand for health services Increased demand for transport to renal dialysis Increasing impact of initiatives that are supporting older persons to age in the community Increasing incidences of health and specialist services being retracted to larger population centres Shortages of General Practitioners (GPs) particularly in regional and rural Australia While HACC Community Transport supports eligible older people to access GPs, Specialist and Health Services there are also other schemes that provide alternate options to access health services. These transport schemes include: Patient Assisted transport Non-Emergency Patient Transport Schemes Other Health Service Transport arrangements/programs The significance of these findings is to appreciate that HACC Community Transport clients are, in many cases, choosing from a menu of transport options and they are doing so to meet their individual support and social needs. The complex system of multiple programs, varied eligibility and assessment criteria is leading to duplication of services, inequity and gaps in service delivery. Models of HACC Community Transport The key models and approaches used in the delivery of HACC Community Transport are: The Victorian model: is an approach that has been led through a philosophy enshrined in policies and guidelines. This approach considers transport as an enabler of other HACC programs rather than a designated service type The Transport for NSW model: which administers about 70% of HACC Service Group 7 transport (trips) in NSW through brokered arrangements to a network of Community Transport providers Community Transport Services Tasmania: which is the only State-wide single provider model; the model uses volunteer coordinators and drivers supporting the transport needs of the HACC target group and the wider needs of transport disadvantaged people in an integrated and coordinated approach Community Passenger Networks (CPNs): which operate in South Australia primarily providing information, coordination, brokered transport services and transport services as a last resort Service Clusters: this is the most common approach used in Australia; in this model the provider delivers a range of HACC services (and/or other Aged Care services) Specialist Community Transport Providers delivering a cluster of transport services to persons who are transport disadvantaged iv

Carers Community Transport is accessed by carers who are currently not able to be reported in HACC Community Transport (Service Group 7) outputs. There is an opportunity to review this practice and include carers in the CHSP target group. Commonwealth Funded Aged Care The key issues, considerations and implications related to the other Commonwealth funded programs are: DTC, HACC (all service types other than Service Group 7), ACHA and NRCP have embedded transport in the programs as an adjunct to or enabler of the service. As CHSP folds these programs into the overall program there are opportunities to consider how services may be able to make better use of HACC Community Transport infrastructure, expertise and services to respond to some of the embedded transport needs. This should include the relationship of the carer to CHSP Transport as the National Respite for Carers Programs becomes part of CHSP The significant growth of Home Care Packages over the next ten years will challenge the service system but also provide opportunities for HACC Community Transport service providers to increase capacity and scale. An increase in capacity and scale may support greater effectiveness and efficiency. In responding to the community transport needs of Home Care Package clients, clear policy guidelines will be required Residential Aged Care clients are likely to have a diminished capacity to use CHSP Transport into the future. A primary transport service for this cohort is likely to be non-emergency patient transport Workforce and Organisation Structure The structure of the workforce and organisations delivering HACC Community Transport is an important consideration with regard to appreciating the capacity of service providers to scale up to meet future demand, the capacity to enact reforms and the capacity to achieve common arrangements. Organisations responding to the Website Questionnaire (793 organisations) reported the following workforce structure: 1,367 full-time paid administration/coordination staff and drivers 4,905 part-time paid administration/coordination staff and drivers 9,819 volunteer administration/coordination staff and drivers It should be noted that these organisations may be only referring to staff deployed in the delivery of HACC Community Transport not their entire organisation. Some HACC Community Transport organisations operate with no paid staff at all. 63% of HACC Community Transport is provided by organisations that on average have one part-time staff member in administration/coordination and one part-time driver. On average 5.9 volunteers make up the rest of these services workforce. Client Impacts: related to the current system Clients of HACC Community Transport may have an array of other transport options from which they can choose. Client choice and behaviour may dictate which of these options are chosen; this includes HACC Community Transport. Client choice may also be limited due to the information available to the client and the confusing eligibility criteria. The array of transport options and differing client contributions add to the complication of the system within which HACC Community Transport operates. In rural and remote locations the options may be significantly limited however this varies depending on the jurisdiction and/or remoteness. v

Service Providers Impacts: related to the current system HACC Community Transport services have developed across jurisdictions according to State/Territory HACC policies/philosophies, the Territory/State s geography, legislative differences and parallel funding arrangements. These dissimilarities have led to significant operational differences that indicate that developing common arrangements under the new Commonwealth Home Support Program will need to be achieved incrementally and with great sensitivity to current State and Regional arrangements. Service providers rely on community goodwill and volunteers and therefore providers will need to be able to embrace and work with these key stakeholders to achieve service improvements and common arrangements. The small size of the majority of service providers means that there will be limited resources available for planning, change management and policy development. Funders Considerations: related to the current system The small size of the majority of service providers presents a case for Government to develop community development positions at a regional level that can work with service providers and guide change processes. These processes will need to draw on and secure the ongoing involvement of key stakeholders at a grassroots level. Overall Implications: related to the current system There are a number of service improvements and opportunities that will support the development of common arrangements that would be beneficial to clients, providers and Government. These improvements and opportunities in the short to medium term (18 months to 3 years) need to focus on fundamental elements of the program. These elemental steps are detailed in Towards Common Arrangements. Towards Common Arrangements The review found that was insufficient data available to reasonably determine the models/options that will best meet the needs/requirements of clients, providers and Government within CHSP Transport. As a precursor to making these determinations a fundamental set of measures are proposed. These measures require immediate attention to ensure that more significant reforms can be achieved as CHSP is implemented. Urgency for Action The urgency for action is also driven by very significant drivers of demand for CHSP Transport. A key finding of the HACC Community Transport Review is the significant future demand for additional HACC Community Transport services which is being driven by the growth of the population 65+ years and by the increasing number of older people choosing to age in the community. Fundamental Measures The fundamental measures proposed to facilitate opportunities for improvements impacting on clients, service providers and Government in the short to medium term (18 to 36 months) are as follows: Clearly define the purpose of Community Transport within the CHSP including planning for an increased number of clients in the future, particularly clients with dementia and other special needs and supporting and encouraging a wellness approach in the CHSP, including transport Clarify the role of the CHSP Transport in providing non-emergency medical transport to clients vi

Consider funding issues such as block funding arrangements, how capital items are funded, and whether there is scope to introduce a different basis of unit pricing in CHSP Transport Define what data should be collected to effectively support, monitor and evaluate CHSP Transport Maintain, support and develop the volunteer base Support and develop coordination functions, potentially across planning regions, to enable service providers to work together and to assist service providers to develop their capacity These measures have been developed with sensitivity to the context within which HACC Community Transport operates. This includes a mosaic of programs, substantial reliance on volunteers and community goodwill and a large number of very small HACC community service providers. Definition of HACC Community Transport Any definition for CHSP Transport will build on the main purpose and eligibility of the CHSP. CHSP will support clients to maintain independent living in the community and promote healthy ageing. A definition for CHSP Transport should be written in plain English and include the following aspects: Direct and indirect transport service Embedded transport where transport is an enabler to other service types within the CHSP Transport should be accessible to people (carers) escorting CHSP clients where this support is required Services that support transport reablement and independence. The following elements should also be considered in a definition of CHSP transport: CHSP Transport purposes could include: social contact and support local health appointments (e.g. General Practitioner, dentist, allied health) and health services that maintain/strengthen health status shopping and banking (activities of daily living) religious and cultural observances Possible exclusions: non-emergency medical transport which includes outpatient services such as oncology, renal dialysis and other hospital based treatments. Direct and indirect: direct transport services are those where the ride in the vehicle is provided by a worker or a volunteer. Indirect transport services include rides provided through vouchers or subsidies 1 Independent living in the community. Transport reablement: services focused on maximising the client s capacity or regaining skills related to travel independence Travel: transport services provided to the client or carer/travel companion where they are travelling in the vehicle CHSP Transport should include: non-assisted/assisted transport and planned (group) and on-demand (individual) services 1 Commonwealth HACC Program Manual, 2012, Commonwealth of Australia, Chapter 3 page 6 vii

Transition Activities The following section considers implementation and transition steps that may be considered if the report findings and proposals are adopted. CHSP Manual Transition Activities: CHSP Transport definitions, prescribed services and measures will be detailed in the CHSP Manual including a process/cycle of sector input utilising the communication and transition support Communication and transition support Transition Activities: A number of parallel activities will help facilitate change and refine CHSP Transport arrangements within this complex and often under resourced environment, these include: Recognition from all parties involved in the review that this report represents a starting place for change and that improvements and actions will be refined and tested over the next three years Develop a Coordination and Development function operating within each aged care planning region to assist the sector to develop the capacity required to execute the changes, to ensure that changes are sensitive to local operating conditions and to develop forums for communicating with providers within each aged care planning region Establishing ongoing communication with an industry working group to facilitate the changes such as working with Commonwealth in achieving the changes required with respect to non-emergency medical transport, broader advocacy and actions required to reduce the growth demand for CHSP Transport through a wide range of transport reablement initiatives Providing participants in the HACC Community Transport Review and other stakeholders with feedback and information on the outcomes of the review and ongoing updates on the progress being made Scope of CHSP Transport Transition Activities: the transport component of all of these programs will be reported by providers. This will require new units of measure, data collection and data analysis/reporting. It may also require this reporting to be a requirement of the DSS contract with providers. Providers will need to consider their capacity (software, vehicles and staff) to support the increased scope of services. Transport Reablement Transition Activities: New Transport Reablement service definitions will be written to support the detailing of prescribed Transport Reablement services. Transport reablement will require new reporting outputs to be developed. These outputs will be included in new contracts. Providers delivering these reablement services under current contract with DSS will require adjustments to be made to their contracts. Additional research is required to identify a broad range of effective reablement programs and measures. Carers Transition Activities: Policies and guidelines relating to the subsidy paid and fee contribution (if any) for the carer and/or travel escort will need to be developed. Providers will need to consider their capacity (vehicles and staff) to support the increased scope of services. viii

Non-Emergency Medical Transport Transition Activities: State and Territory Governments and their respective health services will need to accept their responsibility to fund the burgeoning need for non-emergency medical transport for outpatient and specialist appointments for people in the CHSP target population including the unique issues in rural and remote Australia State and Territory Governments and their respective health services may be able to form contracts with existing HACC Community Transport providers to continue to provide transport that is HACC like to the client group who are currently accessing non-emergency medical transport that will be excluded from CHSP Transport Commonwealth and State and Territory Governments may be able to consider new options particularly in rural and remote locations to develop joint or integrated arrangements to utilise the same infrastructure for CHSP Transport and non-emergency medical transport for specialist services and outpatients Commonwealth and the respective State and Territory Governments will need to address operational issues in other programs and schemes that are resulting in clients favouring or requiring the support of HACC Community Transport for nonemergency medical transport to access specialists and outpatient services Providers will need to be given the flexibility to transition clients to alternate transport schemes or to continue to support existing clients over a number of years depending on the client s willingness and capacity to transition. Providers will need to be funded to continue to support current clients who can t or won t transition to another program during the transition period Unit Cost Transition Activities: Undertake research to develop a matrix of costs. Building on this review quantify the extent of volunteer involvement and community support and the economic benefits of volunteer and community contributions. The amount of cross subsidisation should also be considered in appreciating the real costs. These activities should be undertaken in parallel with the development of a uniform client contribution schedule and the development of new reporting measures. Future contracts developed by DSS with providers will be crafted taking into account the matrix of costs as a benchmark. Data Collection and Reporting Transition Activities: Apply the new units of measure to all new contracts developed for CHSP including programs with an embedded transport component. Incorporate the new measure into the MDS and require existing contracts to report transport and where relevant the component of their service that is transport (currently embedded in the service) using the new standard measure. This process will be aided through the use of technology. The coordination and development function proposed in this review will be well positioned to foster the adoption of technology by providers. DSS through HACC Service Group 8 2 could consider a grant scheme to support this proposal. Supporting the Volunteer Base Transition Activities: Engage with local communities and organisations (particularly focusing on under resourced organisations) through the proposed coordination and development function to create communication, feedback cycles and guidance to adopt the changes. This activity is calculated to ensure that goodwill is maintained 2 Service types included in Service Group 8 include; building the evidence-base, development and service interventions and Sector support and development. ix

and that change occurs in a manner that is sensitive to the grassroots practices and needs of clients. This engagement and communication will be aided by the proposed role of the coordination and development function in facilitating coordination and networking. Coordination and Networking Transition Activities: Within planning regions and/or sub regions (as required) develop transport focused networks and forums. These will be used to maximise the use of existing infrastructure and to aid the significant changes related to non-emergency medical transport proposed through this review. It is considered that the use of alternate travel programs and the capacity of those programs will be subject to significant variation at a local level, particularly in rural and remote areas. The local networks, aided by the leadership of the development and coordination function, will provide a vital link in facilitating change and providing feedback to DSS. x

Contents Executive Summary... ii Contents... xi Tables... xii Figures... xii 1 Introduction... 1 1.1 Acknowledgements... 1 1.2 Authors... 1 1.3 Scope of the National HACC Community Transport Review... 1 1.4 About this Report... 2 1.5 Methodology... 3 1.5.1 Project Plan... 3 1.5.2 Feedback process... 3 1.5.3 Project activity methodologies... 4 2 Context... 6 2.1 Commonwealth HACC Program... 6 2.2 Commonwealth Home Support Program... 7 2.3 Growing Demand for Community Transport Services... 7 2.4 Commonwealth HACC and other transport services... 11 2.4.1 Aged Care Transport Programs... 11 2.4.2 Other Transport Schemes and Arrangements... 12 2.4.3 Non-Emergency Medical Transport... 13 2.5 Other Commonwealth Aged Care and Carers Programs... 14 2.6 Other factors impacting HACC Community Transport... 18 2.6.1 Organisational dynamics... 21 2.6.2 Reducing the Demand for Community transport... 21 2.7 Summary... 22 3 Towards Common Arrangements...23 3.1 The purpose of Community Transport; Definition... 24 3.2 The role of the CHSP in non-emergency medical transport... 28 3.3 Funding and capital... 30 3.4 Data Collection and Reporting... 36 3.5 Supporting the volunteer base... 40 3.6 Coordination and networking... 42 4 Transition...45 4.1 CHSP Manual... 45 4.2 Communication and transition support... 45 4.3 Scope of CHSP Transport... 46 4.4 Transport Reablement... 46 4.5 Carers... 46 4.6 Non-Emergency Medical Transport... 47 4.7 Unit Cost... 48 4.8 Data Collection and Reporting... 48 xi

4.9 Supporting the Volunteer Base... 48 4.10 Coordination and Networking... 49 Tables Table 1: 65+ years Population 2011 and 2026 by Jurisdiction... 8 Table 2: 85+ years Population 2011 and 2026 by Jurisdiction... 8 Table 3: Home and Community Care Program Estimates... 11 Table 4: Commonwealth Home Support Program Estimates... 12 Table 5: Other Commonwealth Aged Care Programs Estimates... 12 Table 6: Consolidated Findings: Estimates... 12 Figures Figure 1: Project Map... 3 Figure 2: Support Arrangements for persons with dementia... 9 Figure 3: Hospital separations by age and sex per 1,000 of the population... 10 Figure 4: Other transport accessed by HACC Community Transport Clients... 20 Figure 5: What Clients like about HACC Community Transport... 20 Figure 6: Cost Elements of HACC Community Transport... 32 Figure 7: The average client fees by distance... 35 Figure 8 : Paid and volunteer staff driving and supporting clients... 40 xii

1 Introduction In 2013 Verso Consulting Pty Ltd was contracted by the Commonwealth Department of Social Services to review community transport delivered under the Commonwealth Home and Community Care (HACC) Program. The National Review of Community Transport under the Commonwealth HACC Program is one of several reviews that are being undertaken in the context of the development and implementation of the new Commonwealth Home Support Program (CHSP). Other reviews include Service Group 2 (Assessment, Client care coordination, Case management and Counselling/support, information and advocacy (client/carer); Service Group 5 (Home Modifications, Goods and Equipment, Home Maintenance and Formal linen service); and Service Group 6 (Meals). Each review will seek to identify further detail on the current operational arrangements including the diversity of funding and service delivery models utilised across Australia, with the aim of determining how these contribute to the objectives of the new Commonwealth Home Support Program. The outcomes of the National Review of Community Transport will inform the development of a more consistent, efficient and effective approach to providing transport services under the Commonwealth Home Support Program. 1.1 Acknowledgements Verso Consulting would like to acknowledge the input and expertise from the Community Transport Review Sub-Group throughout all the phases of the National Review of Community Transport. We would also like to acknowledge the input and advice received from the overarching Commonwealth Home Support Program Advisory Group. Further to this, Verso acknowledge the members of the Department of Social Services for their input and assistance as well as the dedication of service providers, clients, family carers and representatives in providing information during the National Discussions and Website Questionnaires. 1.2 Authors The National Review of Community Transport Services under the Commonwealth HACC Program Report was developed from these research reports and authored by: Doug Faircloth (Director) Verso Consulting Pty Ltd Allison Knight (Senior Consultant) Verso Consulting Pty Ltd The Data Analysis, Website Questionnaire, Jurisdictional Mapping, National Discussion and Literature Review reports included contributions from multiple members of Verso Consulting s team, which included: Doug Faircloth, Sue Faircloth, Allison Knight, Marita Sealy, Dr Bob Noakes and Germanus Pause. 1.3 Scope of the National HACC Community Transport Review The HACC Community Transport Review seeks to identify the delivery of HACC Community Transport and subsequent service implications to inform the way transport services operate under the new Commonwealth Home Support Program. Within this 1

remit the Department has sought to appreciate transport delivered under Service Group 7 and transport delivered as part of other HACC programs whether direct or indirect. The requirements of the HACC Community Transport Review also included, seeking information regarding HACC like transport services and the interaction with the Commonwealth Aged Care programs. 1.4 About this Report This Final Report draws together key themes based on the findings from a number of data gathering activities within the National Review of Community Transport. The data gathering activities consist of: A Literature Review comprising a review of international and Australian literature covering Transport, wellbeing and reablement; Changing client need and transport requirements; Existing service models and trends including responsive practice approaches; Costs associated with community transport; Utilisation of volunteers; Special needs groups; and Interface with other transport services A Data Analysis utilising data from the Master HACC funding from the Portal Database (HACCTRANS040 Report 3/07/2013), Western Australia and Victoria indicative data based on a 70:30 split for 2012 to 2013 (DoHA 8/07/13), CASPER database 2013, HACC DoHA AC Review of Government Services (ROGS) 2013 data, Minimum Data Set (MDS) Annual Bulletins 2010-11, ABS Census 2011, and Customised population projections prepared by ABS for DoHA 2008 National Discussions held across Australia between 17th October and 14th November 2013 to gain input into information gaps identified through the Literature Review and Data Analysis. Discussions were held in capital cities and regional centres with Service Providers and Clients/Carers/Representatives. There were 303 Service Provider participants and 48 Client/Carer/Representative participants Website Questionnaires were tailored to Service Providers and Clients/Carers/Representatives building on information gaps identified through the Literature Review and Data Analysis. They were hosted on the Commonwealth s Living Longer Living Better website during the period of 17th October to 14th November 2013. Hard copy questionnaires were also developed to enhance accessibility for clients and carers. There were 798 Service Provider responses and 1,930 Client/Carer/Representative responses (900 completed online, 1,030 completed in hard copy) Jurisdictional Mapping which consolidated the main findings from the Data Analysis, National Discussions and Website Questionnaires to illustrate State/Territory differences and similarities in their provision of HACC Community Transport services and identify the wide range of other HACC-like transport services available to older people Verso Consulting also undertook face to face and telephone consultations and received email submissions from the sector. This Sector contribution included the input provided by the Community Transport Review Sub-Group members severally and individually, State Government bodies and other organisations. In all National Discussions Verso provided contact details and issued an open invitation for additional inputs to organisations and individuals. Responses included the provision of documents, reports and emails that supplemented to face to face and telephone consultations. Records of the consultations were maintained. These inputs were used to support/clarify the aggregation of evidence from the other activities and to confirm the veracity of findings 2

1.5 Methodology 1.5.1 Project Plan The completion of the National Review of Community Transport and its project activities has been undertaken in line with the project plan (below). Figure 1: Project Map 1.5.2 Feedback process Verso Consulting utilises a comprehensive feedback process to ensure that activities respond to the needs and purpose of the project. We have worked in partnership with the Department of Social Services and the Community Transport Review Sub- Group within a framework of Active Learning. Our Active Learning Model fosters a peer approach to service reviews, and enables the achievement of service and practice improvements within a spirit of partnership and shared learning. Active Learning is a unique consulting method developed by the Verso Team. It builds on the theories of Action Learning 3 and Action Research 4. Active Learning is particularly useful to support stakeholder engagement and collaboration through planning processes with a clear reference to shared principles. 3 Revans, R.W. (1980), Action Learning: New Techniques for Management, Blond & Briggs, London, United Kingdom 4 Kemmis, S. and McTaggart, R. (eds) (1988), The Action Research Reader, 3rd Edition, Deakin University Press, Geelong, Australia 3

1.5.3 Project activity methodologies As each of the project activities had a different purpose, a range of methodologies have been utilised throughout the National Review of Community Transport. A summary of each methodology is provided below, although a more comprehensive description of each activity methodology is included within each activity report. Literature Review In order to comprehensively respond to 23 research questions covering the themes identified in section 1.3 of this report, a Document Register was developed utilising documents and resources provided by the Department of Social Services and the Community Transport Review Sub-Group. Verso Consulting sourced material from international journals to gain an international perspective on mobility and older people, as well as material from the Victorian Transport Library. Grey literature gained through Verso Consulting s industry experience and research was also considered. Data Analysis A key aspect of the methodology used in the development of the Data Analysis Report was the identification of the data s limitations. These limitations include inconsistent datasets from Western Australia and Victoria due to the continuing provision of HACC services in those states under a State/Commonwealth partnership, and Northern Territory information being provided in a consolidated form across all HACC Service Groups. The Data Analysis Report utilises a wide range of data sources to gain an indication of HACC Community Transport services across Australia. National Discussions The National Discussions comprised 22 National Discussions at 15 locations across Australia with Service Providers and Clients/Carers/Representatives in capital cities and one rural/regional location in all States/Territories (with the exception of the Australian Capital Territory). The site locations in rural and regional settings provided additional opportunities to sample distinct regional issues from inland, coastal and remote Australia. A range of resources were developed to guide the discussions which focussed on information gaps identified within the Literature Review and Data Analysis. Individual Site Reports were developed documenting the National Discussions which identified key themes for inclusion in the National Discussion Summary Report. Website Questionnaires In partnership with the Department of Social Services and the Community Transport Review Sub-Group, questionnaires for Service Providers and Clients/Carers/Representatives were developed to respond to key information gaps identified within the Literature Review and the Data Analysis activities. The Service Providers and Clients/Carers/Representatives questionnaires were promoted through a range of activities including the Departments internal HACC contact databases with emails sent to all HACC and Aged Care Package providers, industry relationships developed by the Community Transport Review Sub-Group, links embedded in Participant Packs sent to registered participants attending the HACC Community Transport National Discussions, and phone calls made by Verso Consulting to encourage service providers to attend the National Discussion; these calls were also used to promote the completion of the questionnaires. In addition to the internet-based Client/Carer/Representative questionnaire, a hard copy Client/Carer/Representative questionnaire was developed and circulated to a 4

wide range of service providers and client peak organisations as well as all service providers who registered to attend the National Discussions. On completion of the questionnaire period, the data was compiled by the Department of Social Services and sent to Verso Consulting for analysis. Hard copy Client/Carer/Representative questionnaires were inputted into the database to ensure that all responses were analysed. Jurisdictional Mapping Multiple data sources were used in the development of the Jurisdictional Mapping Report. The information and data sources included the Literature Review, Data Analysis Report, National Discussions, Website Questionnaires, and ABS Census 2011. A web-search was also conducted around legislation and industry standards and other community transport programs. Sector Consultations Throughout the review processes Verso Consulting also sought input from the sector. This included the input provided by the Community Transport Review Sub-Group members severally and individually, State Government bodies and other organisations. These organisations included but are not limited to: the Council of Social Service of New South Wales (NCOSS), TransitCare Queensland, LINK Community Transport (Vic), Community Transport Services Tasmania (CTST) and Transport Development and Solution Alliance (QLD) who provided Verso Consulting with additional insights. 5

2 Context 2.1 Commonwealth HACC Program The Commonwealth HACC Program identifies seven Service Groups to ensure that older people living in the community are supported. These are: Service Group 1: Domestic assistance, Personal Care, Social Support, Respite Care and Other meals services Service Group 2: Assessment, Client care coordination, Case management and Counselling/support, information and advocacy (client/carer) Service Group 3: Nursing care and Allied health care Service Group 4: Centre-based day care Service Group 5: Home modifications, Goods and equipment, Home Maintenance and Formal linen service Service Group 6: Meals Service Group 7: Transport Service Group 8: Building the evidence-base, Development and service interventions and Sector support and development The Commonwealth HACC Program provides basic maintenance, support and care services for frail older people (aged 65+ and Aboriginal or Torres Strait Islander people aged 50+) to assist them to remain in their homes according to their choice. The guiding principles 5 of the Commonwealth HACC Program are to: Promote each client s opportunity to maximise their capacity and quality of life Provide services tailored to the unique circumstances and cultural preference of each client, their family and carers Ensure choice and control are optimised for each client, their carers and families Emphasise responsive service provision for an agreed time period and with agreed review points Support community and civic participation that provide valued roles, a sense of purpose and personal confidence Provide appropriate workforce training and development The aims and objectives 6 of the Commonwealth HACC Program are to: Provide a comprehensive, coordinated and integrated range of basic maintenance, support and care services for frail older people and their carers Support these people to be more independent at home and in the community, thereby enhancing their quality of life and/or preventing or delaying their admission to long term residential care Provide flexible, timely services that respond to the needs of these people As at December 2013, HACC services were provided under the Commonwealth HACC program in all states and territories, except Victoria and Western Australia. In those 5 Commonwealth HACC Program Manual, 2012, Commonwealth of Australia, page 2 6 Commonwealth HACC Program Manual, 2012, Commonwealth of Australia, page 3 6

states, services are provided through jointly funded state and Commonwealth HACC programs. In May 2013, Victoria agreed to transition to the Commonwealth HACC program from 2015 due to agreements encompassing the implementation of National Disability Insurance Scheme (NDIS). In August 2013, as part of the negotiations regarding the NDIS, the Western Australian Government agreed to commence negotiations on implementing a transition of HACC services for older people to Commonwealth responsibility from 2016-17. 2.2 Commonwealth Home Support Program The National Review of Community Transport sits within a wider review of a range of HACC Service Groups including Service Group 2 (Assessment, Client care coordination, Case management and Counselling/support, information and advocacy (client/carer); Service Group 5 (Home modifications, Goods and equipment, Home Maintenance and Formal linen service); and Service Group 6 (Meals). These reviews will inform the program design for the Commonwealth Home Support Program (CHSP) which will bring together four distinct programs: the Commonwealth HACC Program, National Respite for Carers Program (NRCP), Day Therapy Centres (DTC) Program, and Assistance with Care and Housing for the Aged (ACHA) Program. The new CHSP is due to commence on 1 July 2015. 2.3 Growing Demand for Community Transport Services The demand for additional HACC Community Transport services is being driven by the growth of the population 65+ years (as detailed in table 1 and table 2), and the increasing number of older people choosing to age in the community and policy that supports this choice including Home Care Packages. Key factors within this population that impact on the growth in demand for transport include: The prevalence and impact of dementia The increasing support requirements related to the activities of daily living as people age The high need for health services as people age Reduced access to family carers Other community aged care programs (e.g. home care) The total number of Commonwealth Home Care Packages is expected to grow significantly over the next decade, doubling from approximately 67,000 packages currently to a forecast of 140,000 packages by 2021-22. This change will place additional demands on the community transport programs and systems including HACC Community Transport. Growth of the HACC Target Population The population of persons 65+ years has been used in Table 1 to capture the majority of the HACC target population. Table 1 excludes Aboriginal and Torres Strait Islander people aged 50-64 years, as there is no reliable population projection data to support proportional growth estimates. The data predicts high growth within the 65+ years population over the next 15 years of 64.9% with significant increases in all jurisdictions. 7

Table 1: 65+ years Population 2011 and 2026 by Jurisdiction Jurisdiction 2011 65+ Population 2026 65+ Population Estimate Growth % NSW 1,037,165 1,653,000 59.3 VIC 765,637 1,250,171 63.3 QLD 584,163 1,009,077 72.7 WA 281,832 539,711 91.5 SA 260,678 392,459 50.6 TAS 82,986 128,357 54.7 ACT 38,653 70,448 82.3 NT 17,538 26,164 49.2 National 3,068,652 5,059,387 64.9 Source: ABS 2011 census and ABS Age Population Projections: 2013 preliminary revision The population 85+ years; an indicator of high support needs The 85+ years data has been used in this table to capture the population with the highest usage of HACC Community Transport, aged care services in general and health services. The data predicts high growth over the next 15 years of 58.3% with significant increases in all jurisdictions. Table 2: 85+ years Population 2011 and 2026 by Jurisdiction 2011 85+ Population 2026 85+ Population Estimate Growth % NSW 139,733 223,800 60.2 VIC 104,994 162,154 54.4 QLD 69,799 113,175 62.1 WA 34,215 62,645 83.1 SA 38,155 51,365 34.6 TAS 10,245 15,083 47.2 ACT 4,829 8,461 75.2 NT 693 1,680 142.4 National 402,683 638,363 58.3 Source: ABS 2011 census and ABS Age Population Projections: 2013 preliminary revision The prevalence and impact of dementia The ABS Australian Social Trends December 2012 reported that 80.1% of people identified as having dementia or Alzheimer s disease in 2009 said that they needed to be driven by someone else in a private vehicle or taxi to travel from home. The pie chart included in this section details the support arrangements of people living with dementia. The finding is that most people (66%) living with dementia who are 65+ years are living in the community; the balance are living residential aged care (34%). Current research indicates the prevalence of dementia follows an exponential growth pattern as age increases. Alzheimer s Australia report that Dementia prevalence rates are relatively low until the age of 70 years and over, where prevalence rates start to increase rapidly, indicating the increased risk of developing dementia due to age. 7 A study by the Australian Institute of Health and Welfare found Among 7 Dementia Across Australia: 2011-2050, Deloitte Access Economics for Alzheimer s Australia, 2011, p 14 8

Australians aged 65 and over, almost 1 in 10 (9%) had dementia, and among those aged 85 and over, 3 in 10 (30%) had dementia 8. The finding is that the prevalence of dementia may be a significant predictor of the need for HACC Community Transport this is particularly so with the estimated 58.3% growth of the 85+ years population over the next 15 years. Figure 2: Support Arrangements for persons with dementia Sources: Developed from data extracted from the Australian Institute of Health and Welfare 2012. Dementia in Australia. Cat. no. AGE 70. Canberra: AIHW; Residential aged care in Australia 2010 11 A statistical overview; AIHW September 2012 and Casper Database 2013 Increasing support requirements There is increasing support requirements related to the activities of daily living as people age (which includes support related to dementia). At 70 years of age 23.0% of people reported in the 2011 census that they need assistance for the core activities; 47.7% of 85+ years population report a need for assistance 9. The key finding is that core activity limitations rise sharply as people age. Therefore there will be increasing demands for HACC Community Transport to support the activities of daily living due to the significant increase in the 85+ years population over the next 15 years. The high demand for health services as people age The demand for health services rises exponentially as people age as illustrated by the hospital separations data detailed in figure 3. The finding is that the significant increased requirement to access health services will drive increasing demand for nonemergency medical transport including transport to General Practitioners (GPs), allied health services, specialist consultations and outpatient services. 8 Australian Institute of Health and Welfare 2012. Dementia in Australia. Cat. no. AGE 70. Canberra: AIHW 9 ABS 2011 Census of Population & Housing 9

<1 1 to 4 5 to 14 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85+ Figure 3: Hospital separations by age and sex per 1,000 of the population 16 14 12 Females Males 10 8 6 4 2 0 Source: Australian Institute of Health and Welfare 2009. Australian hospital statistics 2007 08. Health services series no. 33. Cat. no. HSE 71. Canberra: AIHW Reduced access to family carers The productivity commission noted that reduced access to family carers will place added pressure on the formal aged care system into the future. The Data Analysis Report developed as part of this review demonstrates that as people age they have reduced access to carers. The significant increase in the 85+ years population and the reducing availability of carers will result in higher demand for alternate transport options to support older persons to maintain the activities of daily living. Summary The growth demand for HACC Community Transport will be significant over the next 15 years. The growing demand for transport will put significant pressure on the entire health and aged care systems and the plethora of transport programs and arrangements detailed in section 2.4 including HACC Community Transport. There is a high risk that transport responsibilities will be subject to cost shifting across jurisdictions and Commonwealth departments and programs as demand exerts ever increasing pressures. The National Discussions provided evidence of these dynamics with a particular concern regarding the degree to which HACC Community Transport is supporting non-emergency medical transport at the expense of other essential roles for HACC Community Transport. Under the growth pressures, highlighted in the findings of this review, there may be a failure to produce the optimum results for Government, service providers and clients. This is particularly so due to the large range of transport programs with different client contributions, differing goals and different auspice but ostensibly the same client group. Factors that require careful consideration include how a sector so dependent on volunteers and services delivered by small community organisations will be able to respond to this unprecedented demand. These demands will only add to the operational pressures impacting on service providers which include: Costs outstripping the growth in Government funding Uncertainties regarding the future source of funds required to replace vehicles More regulation affecting transport used by community transport providers leading to increased costs Ageing and reducing pools of volunteers 10