This Mid-Term Review report analyses the targets, performance to date and key issues associated with the Younger People in Residential Aged Care (YPIRAC) Program. The Program is a joint initiative of Commonwealth, State and Territory Governments to provide accommodation and support to younger people with disability living in or at risk of admission to residential aged care (RAC).
Overall, the Review has found that the Program is having a positive impact on a large number of younger people living in or at risk of admission to RAC. State and Territory Governments have undertaken varying approaches to the Program's implementation reflecting the different local policy and legislative contexts in which they operate.
A Council of Australian Governments (COAG) initiative, the Program commenced with the signing of Bilateral Agreements between the Australian Government and States and Territories over several months from August 2006 to January 2007. The Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) coordinates the Program nationally. An overall target net reduction of between 425-689 people in the number of younger people in RAC over five years has been established.
The Program seeks to meet three objectives:
- Program Objective One: Move younger people with disability currently accommodated in RAC into appropriately supported disability accommodation, where it can be made available and if this is what clients choose.
- Program Objective Two: Divert further admissions of younger people with disability who are at risk of admission to RAC into more appropriate forms of accommodation.
- Program Objective Three: Enhance the delivery of Specialist Disability Services to those younger people with disability who choose to remain in RAC or for whom RAC remains the only available suitable supported accommodation option.
The evaluation questions set for the Mid Term Review are:
- Were the Bilateral Agreements underpinning the Program designed to allow the objectives for the Program set out by COAG to be met?
- How is the Program being implemented in each State and Territory as set out in the Bilateral Agreements and what are the challenges and issues impacting on the Program?
- To what extent will the funding available to States and Territories meet the demand for support required by the YPIRAC initiative?
The methodology as outlined in the terms of reference for this review included:
- Liaising with the government departments in each State and Territory responsible for implementing the YPIRAC Program to collect the required information
- Undertaking an analysis of that information
- Reviewing the Program against the evaluation questions.
This Mid Term Review has taken place within a context of:
- Implementation of the Program commencing at different times in each jurisdiction, due to Bilateral Agreements being concluded within a period between August 2006 and January 2007;
- An initial emphasis being placed on the conduct of functional needs assessments of those people in the initial target group, being people aged under 50 years and currently in RAC.
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Mid Term Review - Findings
This Review finds that the Program is expected to meet its targets over the five years of the Program.
- Were the Bilateral Agreements underpinning the Program designed to allow the objectives for the Program set out by COAG to be met?
Given the limited evidence available regarding the YPIRAC Program target group, Bilateral Agreements made a number of assumptions regarding Program targets and timeframes based on the best evidence available at the time of the Program inception. The inaccuracy of some of these early assumptions, particularly in relation to the levels of YPIRAC client needs and the cost in providing support services, have created challenges for some jurisdictions. A number of jurisdictions have renegotiated their targets and/or the timing of funding to reflect the actual experience in implementing the Program. The Department of FaHCSIA has supported the review of targets and funding arrangements as needed.
- How is the Program being implemented in each State and Territory as set out in Bilateral Agreements and what are the challenges and issues impacting on the Program?
There have been initial delays in meeting forecast targets with some jurisdictions significantly underperforming in meeting targets for Program Objective One and Program Objective Two for the initial three years of Program implementation. This underperformance can be attributed to delays in assessing the needs of the target group, the development or modification of capital programs and contacting and/or engaging clients, particularly in rural and remote locations. The initial funding allocations in some jurisdictions underestimated the large number of high need clients and therefore the costs associated with providing support services.
Jurisdictions have benefited greatly from the flexibility in the Program design. Jurisdictions have been able to prioritise Program Objective Two, define target groups and allocate funding to reflect their policy, legislative and service delivery environments. This has allowed for the development of the Program in different ways across jurisdictions – ensuring that Program implementation is efficient and reflective of local contexts.
Some jurisdictions have built on existing government structures and service delivery models to implement the Program in genuine 'joined-up' government settings. These approaches reflect the complexity of the Program's operating environment and the necessary overlaps across the health, disability, housing, community services and aged care portfolios. These are good practice implementation approaches that will support sustainable outcomes for clients beyond the five year cycle of the Program.
Given the complexity of the Program in responding to so many varying individual needs of clients and their families, many jurisdictions have implemented productive partnerships with non-government organisations who have the expertise and service infrastructure to support the client-group. This has produced efficiencies across the Program
Significant progress has been achieved nationally in providing genuine individualised alternatives to inappropriate RAC for younger people with disability, in a flexible and tailored service environment. This has been achieved through the development of strategic partnerships across/within governments and with the non-government sector, in a complex service interface between health, housing, aged care, disability, community services.
Jurisdictions have developed strong informal and information sharing networks across the Program nationally, sharing experiences and resources in an environment of cooperation. This is producing efficiencies across the Program nationally, reducing the likelihood of duplication, and ensuring that solutions to common problems are shared.
- To what extent will the funding available to States and Territories meet the demand for support required by the YPIRAC initiative?
Overall, data indicates that the Program target to achieve a national net reduction in the number of YPIRAC by between 425-689, is likely to be achieved within five years, as per original Program forecasts. This conclusion is based on data provided by jurisdictions, analysis of the net number of YPIRAC in 2006 and 2008, and the percentage of Program funding that is still to be provided to each jurisdiction. Despite early delays in meeting these targets, and particularly the inconsistency of actual targets in relation to those forecast across each of the Program Objectives, nationally, a net reduction of 149 people aged under 50 years living in residential aged care was achieved.1 Of particular importance is that 296 (51%) clients were relocated, or have agreed to be relocated from RAC, as part of the YPIRAC Program and 125 (21.5 %) were deemed at risk from entry into RAC2.
These findings are particularly interesting given that most jurisdictions have indicated relatively slower progress towards achieving targets for Program Objective One, as capital works have not been completed at this stage of implementation and the large number of diversions reported as part of Program Objective Two. Many jurisdictions will be unable to achieve their five year targets until years four and five, as the development of capital, which takes significant time, is finalised.
There is significant unmet need of YPIRAC, both in the under 50 years target group, and particularly the 50-65 years target group. While the Program will make a positive contribution to this previously neglected group, many YPIRAC will continue to have significant needs that cannot be met within current funding allocations.
This Mid-Term Review has concluded that jurisdictions have made significant positive progress in implementing the Program to date. There is a body of quantitative and qualitative data to support the conclusion that the Program is having a very positive impact on younger people with disabilities who either reside in, or are at risk of entering, RAC.
Whilst overall Program targets will be achieved, these may not represent the anticipated distribution of clients across Program Objectives, as outlined in the Bilateral Agreements.