Final Report on RREF 2001 - Department of Health

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Part B: Development of Options for a Revised RREF Resource issues: Focusing on resource issues, participants in the Round 2 consultations acknowledged that it was important that VHC resources were used to the best advantage, and that fuller take up would be realised by January 2002 when funding under any revised RREF would come into effect. Making an adjustment for the veteran population in the RREF base population was also seen as an incentive for providers to maximise take up of VHC among eligible clients. A further reason for excluding veterans eligible for VHC was that this population is very unevenly distributed and if no adjustment was made, it was argued that providers in areas with large veteran populations would be able to “double dip” with access to HACC funds and VHC funds, while those in areas with fewer veterans would be penalised. Given that the RREF is essentially concerned with resource allocation, and VHC provides additional resources for HACC type services, and taking account of the time interval to implementation of any revised RREF, it is proposed to subtract eligible veterans from the RREF base population. Modelling has proceeded on this basis, but there will be opportunity to review the adjustment for the VHC eligible population when any new RREF is implemented. As the numbers of veterans eligible for VHC will change from year to year, this data will have to be updated annually and there will be opportunity for further review. Three further considerations are: ! Deduction of the eligible veteran population after the doubling of the frail aged in Base 3 has the effect of discounting by 50% and so allows for some continuing use of HACC services by veterans who are eligible for the HVC. ! Under a continuation of the current RREF some adjustment would be made for VHC clients and funding. ! The veteran population is now ageing rapidly and the population excluded from the RREF base populations will need to be updated annually with data from DVA. 6. Other issues Shortfall in Residential Care The Options Paper presented initial options that included the shortfall in residential care in the RREF as a need variable. The shortfall in each LGA was measured as the difference between the operational beds and the number of beds that the LGA should have on the basis of the target ratio of 90 beds per 1000; most of the shortfall comprises hostel places. A number of conceptual and practical issues that posed difficulties in dealing with the shortfall in this way were however noted. The alternative of taking the residential care shortfall into account in the base population was then considered, but many of the same problems remained. Three sets of issues were identified in the Options Paper and in the Round 2 Consultations. <strong>Final</strong> <strong>Report</strong> July 2001 28
Part B: Development of Options for a Revised RREF Measurement and apportioning of shortfall to LGAs: • Almost half the LGAs had an excess of residential care places, 32 out of 78, and only 13 had a shortfall in excess of 20 per 1000. This skewed distribution and whether to take the shortfall into account as a ratio per 1000 population aged 70 and over, or as an absolute number, posed problems for scaling as a need variable. • There were also difficulties in measuring the shortfall as the difference between operational beds and the target ratio at any one time, given a considerable degree of flux in the sector at present. With a large number of approvals in principal in existence, the rate at which AIPs come on stream is critical, but is not known with any certainty and when blocks of around 30 beds come on stream at a time, the impact on the shortfall is marked, and occurs in a short time. • The shortfall is extremely uneven geographically, with some LGAs having persisting shortfalls while others have beds in excess of the ratio. While no penalty would be imposed for excess beds, only a small number of LGAs would receive a medium to high weighting on this need variable and so it make only a small contribution to overall need weighting. • Difficulties were encountered in obtaining timely data on actual operational beds from the Commonwealth for comparison with the target numbers. Impact of shortfall on HACC • A detailed analysis was made of several factors related to how the residential care shortfall affected the need for HACC services and how this variable should be included in the RREF. These factors included whether high and low care should be separated; whether CACPs should be included: the distribution of the shortfall across LGAs; whether shortfalls in some LGAs were balanced by excess provision in adjacent LGAs; and difficulties in projecting on the basis of existing shortfalls as approved beds coming into operation in the next five years will be concentrated in areas of greatest shortfall. • While the shortfall of beds has a pronounced impact in the LGAs concerned, it is evident that excess beds in some LGAs may balance shortfalls in some adjoining LGAs, but not in all cases, but this effect cannot be readily taken into account. “Excess” beds arise mostly in LGAs where public sector facilities are located, and these facilities have regional roles. Averaging levels of provision across groups of LGAs or regions would reduce local deficits and even out provision across the region, but it is difficult to apportion “excess” places across regions in accord with actual use. • The shortfall is taken into account in the base population options that adjust for the frail aged. Base 3 especially makes a significant adjustment by doubling the moderately, severely and profoundly handicapped living in the community, hence LGAs with more frail aged people in the community due to a shortfall of residential care places gain most. The base populations also make these adjustments on the basis of the LGA in which the individual actually resides. <strong>Final</strong> <strong>Report</strong> July 2001 29
Page 1 and 2: FINAL REPORT REVIEW OF THE RELATIVE
Page 3 and 4: STEP 3: OPTIONS FOR SCALING NEED VA
Page 5 and 6: ABBREVIATIONS AND NOTE ON TERMINOLO
Page 7 and 8: ACKNOWLEDGEMENTS An exercise as ext
Page 9 and 10: EXECUTIVE SUMMARY The Review of the
Page 11 and 12: Executive Summary All regions will
Page 13 and 14: Executive Summary Beyond the detail
Page 15 and 16: Executive Summary 9. The planning a
Page 17 and 18: PART A: BACKGROUND AND SCOPE OF THE
Page 19 and 20: Part A: Background and Scope of the
Page 31 and 32: PART B: DEVELOPMENT OF OPTIONS FOR
Page 33 and 34: Part B: Development of Options for
Page 39 and 40: Final Repo
Page 43: Part B: Development of Options for
Page 59 and 60: Step 4: Options for weighting need
Page 65 and 66: Profiles of Need Variables Part B:
Page 81 and 82: Part C: Outcomes In the initial mod
Page 83 and 84: Part C: Outcomes 5.3 FURTHER ISSUES
Page 85 and 86: Part C: Outcomes Step 6: Outcomes o
Page 87 and 88: Part C: Outcomes • The Northern a
Page 89 and 90: Part C: Outcomes By way of illustra
Page 91 and 92: Part C: Outcomes The outcomes of th
Page 93 and 94: Part C: Outcomes 7.4 FURTHER ISSUES
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Four features of the revised outcom
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Part C: Outcomes The adjustment for
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Part D: Achieving Equity in the HAC
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Unit cost structure The unit cost s
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Part D: Achieving Equity in the HAC
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APPENDIX 1.1 continued Commonwealth
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APPENDIX 1.4: SUBMISSIONS RECEIVED
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Frequently Asked Questions A number
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DACS • 2.5% of children in the 0-
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LGA Median H’hold Inc. YLD Lang o
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Department of Human Services 1999b.
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Final Report on RREF 2001 - Department of Health

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