SINGLE ASSESSMENT SYSTEM (SAS), CARE MANAGEMENT, & HOME CARE NQIs PART II

Part 1 of the NQIs conversation

I’ve recently spent some time digging into the Integrated Assessment Tool (IAT) that replaced the National Screening & Assessment Form (NSAF) back in July of this year. The IAT will be used as part of the incoming Single Assessment System (SAS) from December 9th which replaces the current split Aged Care Assessment Team (ACAT) and Regional Assessment Service (RAS) arrangement. The SAS will be the gatekeepers to funding approvals and support plans right across the aged care continuum including CHSP, HCP, STRC, Residential Respite, Residential Permanent, and Support At Home (S@H) and its various embedded funding programs and schemes once it goes live (hopefully not before Jan 1 2026 but that's a whole different article).

On paper, these changes look to be net positive and will hopefully result in a slightly less complicated introduction to aged care for older Australians and reduced waiting times for assessment.

I do however have concerns with how the proposed S@H program design will incorporate the IAT and SAS.

Based on what has been released to date it would appear that:

• There will be reduced flexibility at the care recipient / provider level to adjust service care plans which would instead require inbound My Aged Care (MAC) referrals so that the SAS could perform a ‘review’ and adjust the support plan or funding approvals. This could potentially create all sorts of issues with older Australians accessing timely care if there is a backlog in the review process.

• Whilst opening up the assessor pool should be good from a waiting time perspective the jury is still out as to whether this will potentially dilute the quality of the assessment and support planning process and create inconsistencies in funding approval methodology. If two different assessors can assess the same care recipient and come up with wildly different funding approvals and support plans then that is a problem.

(On the above point, I am led to believe that during the IAT trial they were looking at decision support algorithms for delegates to assign funding but I haven’t seen any evidence that is being applied from Dec 9th to date).

• With the proposed capped reduction in Care Management funding coupled with the currently proposed role scope of Care Partners I am also concerned that providers will be heavily relying on the SAS and Support Plan and will not be performing the same levels of additional ongoing screening, assessment, and care planning review that is foundational to well-coordinated, safe, and quality care. Case Management / Care Management is the foundation that supports care and should be performed (and funded appropriately) at the provider level.

On the flip side of the coin are what I see as some real opportunities for how the home care sector could potentially leverage the IAT and SAS including:

1. Creating Government to Business (G2B) Application Programming Interface (API) functionality so that the digital IAT and Support Plan can be shared across systems in both directions and maintained in accuracy. But rather than hiding it within the MAC portal how about it being front and centre in the care recipients My Health Record so that the primary care sector has clear visibility of who they need to be coordinating discharge planning and ongoing care arrangements with.

2. We could also utilise the following embedded validated tools which are within the IAT as part of the home care National Quality Indicators (NQIs) data set:

-          Frailty (Frail Scale)

-          Physical Function (DEMMI)

-          Continence (RUIS & RFIS)

-          Social Connection (GSGL / DSSI)

-          Psychological Wellbeing (PHQ-4 / GDS)

-          Cognition (GP-COG / KICA)

We have the opportunity to capture the above validated data points at the beginning of the aged care journey for every older Australian entering home care. If we then periodically maintained these tools (aka. reassess) we could then:

• Monitor the effectiveness of the current funding approvals and support plan in meeting the care recipient assessed needs.

• Adjust the care recipients funding approvals and support plan to meet older Australians changing assessed needs.

• Use these validated tools as part of a home care NQI data set not as a way of ranking providers, but instead as a way of monitoring the care needs of the home care sector and ensuring there is sufficient resourcing and skills to support the system.

• Use the NQIs as a way of adjusting the funding recommendation algorithm.

Keen to hear others thoughts on the incoming Single Assessment System and your experience with the Integrated Assessment Tool, the proposed Care Management model, and how we could potentially better utilise the IAT data set.