Program 2.4: Veterans’ Community Care and Support

Objective

To effectively manage community programs to support veterans to remain independent in their homes.

Overview

Veteran community care and support programs include Veterans’ Home Care, community nursing, HomeFront, Veterans’ Home Maintenance Line, community care grants, carer and volunteer support and day clubs.

The objective of these programs is to support veterans to remain independent in their homes, and improve their quality of life and health. The veteran community is ageing, and increasingly requires higher levels of service. The provision of these services helps to delay entry into residential aged care and maximises independence.

The 2010–11 estimate for Veterans’ Home Care includes funding for social assistance.

A total of 1,750,500 Veterans’ Home Care services were provided to approximately 71,000 clients (29% of the veteran treatment population). Community nursing services were provided to approximately 31,000 clients (13% of the veteran treatment population).

Program 2.4 also includes the provision of the Australian Government subsidy for entitled veterans and war widows and widowers living in residential aged care facilities.

Expenditure on community nursing is expected to progressively increase for some years, given increasing need and complexity.

Expenses

  2010–11 PBS
(million)
Estimated actual
2010–11
(million)
Outcome
2010–11
(million)
Administered $1,379.1 $1,447.1 $1,447.6
Departmental $21.8 $24.1 $25.0
Total resources $1,400.9 $1,471.2 $1,472.6

Key performance targets: Community nursing and Veterans’ Home Care

  2010–11 PBS Estimated actual
2010–11
Outcome 2010–11
Price: Unit cost per card holder $89 $92 $97

Deliverables

Veterans’ Home Care

The Veterans’ Home Care Program is designed to assist veterans, war widows and widowers who wish to continue living independently in their own home and their local community, but who need a small amount of practical help. The program provides domestic assistance, safety-related home and garden maintenance, personal care and respite care.

To ensure services are of a high quality, a contract and quality management framework, together with post-payment monitoring, is in place for both Veterans’ Home Care and community nursing.

DVA contracts assessment agencies to assess the needs of veterans, war widows and widowers and coordinates the delivery of services by contracted providers on the basis of assessed need. The program currently has 191 contracts for assessment and service provision and provides support services to approximately 71,000 eligible beneficiaries.

In 2010–11, approximately 73,000 veterans, war widows and widowers were assessed for services compared with 77,314 in 2009–10. Of those approved to receive services during the year:

  • 90% were approved for domestic assistance
  • 27% were approved for home and garden maintenance services
  • 4% were approved for personal care
  • 14% were approved for respite care services.

(These figures add up to more than 100% as people may be approved for more than one service type.)

The program provided up to four services to those who were assessed and approved for assistance. Table 38 shows the percentage of clients approved for one or more services for the past five years.

Table 38. Percentage of clients approved for one or more Veterans’ Home Care services 2006–11

Number of services Percentage of clients
  2006–07 2007–08 2008–09 2009–10 2010–11
One 73.4% 73.2% 72.4% 69.9% 68.5%
Two 23.6% 23.7% 24.5% 26.8% 28.2%
Three 2.8% 2.9% 2.8% 3.1% 3.1%
Four 0.2% 0.2% 0.2% 0.2% 0.2%

Veterans, war widows and widowers assessed by the agencies were also referred, as appropriate, to other Repatriation Commission programs, such as the Rehabilitation Appliances Program, HomeFront and community nursing. They were also referred, as appropriate, to external services provided by Commonwealth, state and territory governments, such as delivered meals, social support or community aged care packages.

The 2010–11 average cost of services (including in-home respite care) per veteran, war widow and widower was approximately $1,410 compared with $1,405 in 2009–10. The average age of people approved for services was 84 years compared with 83 years in 2009–10 and 2008–09.

In 2010–11 a total of $10.5 million was spent on assessment and coordination by agencies: $79.1 million on domestic assistance, personal care and home and garden maintenance services; and $23.3 million on in-home respite services. Table 39 shows a comparison of expenditure on these services for the past five years.

Table 39. Comparison of expenditure on Veterans’ Home Care services 2006–11

  2006–07
(million)
2007–08
(million)
2008–09
(million)
2009–10
(million)
2010–11
(million)
Assessment and coordination $9.4 $10.5 $10.5 $10.7 $10.5
Domestic assistance etc. $69.1 $72.1 $77.0 $80.1 $79.1
In-home respite $20.4 $21.1 $21.2 $24.2 $23.3

As of 1 May 2011, a new social assistance service for participants in the Coordinated Veterans’ Care Program was also made available through Veterans’ Home Care. Following a general practitioner referral and assessment by a contracted agency, social assistance can be provided to veterans, war widows and widowers identified by their GP as socially isolated. Social assistance is a short-term intensive service (generally up to 12 weeks) to assist people to become more socially active and engaged in community activities.

DVA consults with the community care sector through the Veterans’ Home Care Reference Group, which met twice during 2010–11. Key consultation included discussion on implementation and performance of the revised assessment instrument, the Coordinated Veterans’ Care Program social assistance new service type, the review of the program guidelines and factsheets and the impact of the Carer Recognition Act 2010 on the program and providers.

To ensure services are of a high quality, a contract and quality management framework, together with post-payment monitoring, is in place for both Veterans’ Home Care and community nursing.

Community nursing services

The Community Nursing Program is designed to meet clinical and/or personal care needs by providing access to community nursing services. This program assists veterans, war widows and widowers to continue living in their own homes and to avoid early admissions to hospital or residential care. In 2010–11 DVA spent $117.5 million on community nursing services, a decrease of 0.17% on the $117.7 million spent in 2009–10.

In 2010–11, 31,122 card holders received community nursing services, a 1.7% increase from
2009–10. Average cost for services per veteran, war widow and widower in 2010–11 was $3,777 compared with $3,319 in 2009–10. (Note that community nursing data is subject to provider claiming time lags; therefore these figures may be subject to revision.)

The majority (97%) of DVA-contracted community nursing services are paid through a set schedule of item numbers and fees (Schedule of Fees). The remainder are paid through the exceptional case process managed by DVA’s Exceptional Case Unit, which contracts specialist clinical nurse consultants with a range of expertise in generalist nursing, wound management, palliative care and gerontology to undertake this role.

As part of ongoing consultation with contracted providers, DVA established the Community Nursing Reference Group comprising 16 service provider representatives. This group, which meets twice a year, plays an integral part in the continuing development and improvement of the program, including advising on industry-wide issues, developments in nursing standards and best practice, and workforce and provider issues within the industry. It also provides feedback on proposed enhancements to community nursing policy and procedures.

The Community Nursing Clinical Advisory Committee (formerly known as the Community Nursing Industry Advisory Committee) represents peak nursing bodies. It advises DVA on clinical issues and provides feedback on proposed clinical enhancements to the program.

On 1 May 2011 the Coordinated Veterans’ Care Program commenced for Gold Card holders with chronic conditions and complex care needs. Care coordination under this program may be provided by either a practice nurse or a community nurse from a contracted provider. Community nurses will work closely with GPs, participants and their carers to coordinate care using the plan prepared by the GP.

Residential care

Residential aged care services

The Repatriation Commission provides an Australian Government subsidy for entitled veterans, war widows and widowers living in residential aged care facilities. In 2010–11, $1.2 billion was paid compared with $1.1 billion in 2009–10. As at 30 June 2011, there were around 25,000 entitled veterans, war widows and widowers in long term residential aged care compared with 25,273 in 2009–10.

Most residents in aged care facilities have to pay daily care and accommodation fees. However, the Commission pays these fees for all former prisoners of war (POWs) and Victoria Cross recipients. In 2010–11 the Commission paid $2.9 million in daily care fees for former POWs, the same as in 2009–10. No income test applies to the payment of daily care fees for former POWs and Victoria Cross recipients.

Community packaged care

Since August 2009 DVA has paid the fees, including income tested fees, which former POWs and Victoria Cross recipients are liable to pay for Australian Government Community Aged Care packages, Extended Aged Care at Home packages and Extended Aged Care at Home Dementia packages. In 2010–11 we paid $68,303 for community packaged care for former POWs.

Business activity

Grants-in-aid

On 1 July 2009 the Grants-in-Aid Program, including the annual allocation of $145,000, was amalgamated with Building Excellence in Support and Training (BEST) grants. However, it remains a distinct element within that broader program. BEST reporting is included under Program 1.4.

Grants-in-aid assist national level ex-service organisations with administration costs such as travel on DVA associated business, office equipment and government liaison undertaken on behalf of the veteran community. To be eligible, an organisation must be a national representative body, have direct links to the ex-service community and have objectives which aim to benefit the welfare of its members.

In 2010–11, ten national ex-service organisations applied for and received $139,00 grants-in-aid funding.

Community care grants

Veteran and Community Grants provide funding for projects that support a healthy, quality lifestyle for members of the veteran community and assist them to remain living independently in their own homes. Grants are also available for initiatives that reduce social isolation, support carers and improve access to community care services. Included are Community Care Seeding Grants, Joint Venture Grants and Joint Venture Day Club Grants.

Funding is available for projects that will become sustainable and financially viable, or for one-off projects that have an ongoing health benefit for the veteran community. Grants are not intended to provide for ongoing financial assistance. Applicants must be an ex-service organisation, community-based organisation or private organisation that can demonstrate the ability to contribute to the welfare of members of the veteran community through the project.

In 2010–11 a total of $2.4 million was provided to 205 applicants compared with $3.5 million and 247 applicants in 2009–10.

Day clubs

Day clubs provide an opportunity for members of the veteran community to integrate, socialise and participate in wider mainstream community activities. The clubs aim to ease social isolation and promote general health and wellbeing by providing the opportunity to participate in a variety of activities in a group setting.

The day clubs program operates through cooperation between DVA and a partner organisation, usually an ex-service organisation. In 2010–11 there were 153 day clubs located throughout Australia, and over 6,000 active members and volunteers who regularly attended club activities. Day clubs receive initial funding from DVA and are supported by contracted community support advisers located in each DVA state office.

Veterans’ Home Maintenance Line

The Veterans’ Home Maintenance Line is part of a program to assist members of the veteran community to remain living independently in their own homes for as long as possible. The toll-free telephone service provides property maintenance advice and referral to reputable tradespeople. It can also arrange home inspections to identify current or possible future maintenance problems.

The combined number of calls received from the Veterans’ Home Maintenance Line and the HomeFront line was approximately 99,000 in 2010–11 compared with 64,000 in 2009–10. Expenditure for the year totalled $336,700 ($338,760 in 2009–10). The top five requests were for plumbers, household handypersons, and electrical, gardening and roofing services.

HomeFront

HomeFront is a falls and accident prevention program that provides entitled persons with a free annual home assessment and financial assistance (subsidy) towards the cost of recommended aids and minor home improvements that will reduce the risk of falls and accidents. Around 34,000 entitled persons received HomeFront services in 2010–11 compared with 30,000 in 2009–10. Expenditure totalled $10.6 million ($8.7 million in 2009–10). The program is available to Gold and White card holders.

Carer and volunteer support

The contracted National Carer Support Service began in September 2009 and continued to expand its reach to the states and territories in 2010–11. The service promotes and supports the health and wellbeing of carers of veterans, or veterans who are carers, through the development of information, resources, capacity building, representation and relationship building. A total of $346,000 was spent for the year, with 12 seminars and presentations held across the country and the production and distribution of a DVD titled Men Care Too!.