Mid-Term Review, Younger People in Residential Aged Care (YPIRAC) Program 

• 3.1  AIHW NMDS reports
• 3.2  Summary of jurisdictional program implementation as reported in the 2006/07 and 2007/08 progress reports
• 3.3  Australian Capital Territory
• 3.4  Progress towards Program targets
• 3.5  Queensland
• 3.6  New South Wales
• 3.7  Northern Territory
• 3.8  South Australia
• 3.9  Tasmania
• 3.10  Victoria
• 3.11  Western Australia
• 3.12  Contextualising Program achievements to date

The ongoing progress monitoring of the YPIRAC Program is supported by the YPIRAC National Performance Monitoring, Evaluation and Reporting Framework.

The Framework outlines agreed performance indicators and data sources for measuring the effectiveness, efficiency and appropriateness, in meeting each of the Program objectives across jurisdictions.

• Performance reporting is drawn from a number of sources, including:
• The YPIRAC Program (NMDS)
• Jurisdictional bi-monthly reporting
• Jurisdictional implementation plan progress reports
• Financial acquittals.

In June 2007 FaHCSIA engaged the AIHW to establish the YPIRAC Program NMDS. As part of this, the AIHW has submitted two reports outlining the findings of the analysis of the YPIRAC Program NMDS in 2006/07 and 2007/08.

In addition to interviews with jurisdictional representatives and the circulation of supplementary questions, this Mid-Term Review has been informed by the AIHW NMDS reports, the jurisdictional bi-monthly reporting and the progress reports.

This chapter provides a summary of national program and jurisdictional data extracted from the AIHW NMDS reports and jurisdictional bi-monthly reporting and progress reports.

3.1 AIHW NMDS reports

In developing the NMDS a trial period was established during the 2006/07 period allowing jurisdictions to comment on the NMDS.

A number of issues were identified during the trial period, which required changes to data definitions and categories in the 2007/08 period, including:

• Refining the definitions of ‘YPIRAC service user’ and ‘YPIRAC assessment’
• The addition of ‘YPIRAC client monitoring’ as a service type
• Deletion of a number of redundant items in relation to service use, including service users’ support needs and reasons why alternative accommodation was not offered

These changes, in addition to normal teething issues in the frequency and quality of data collected, has made the comparison between 2006/07 and 2007/08 NMDS difficult.

For the purpose of providing a summary snapshot of the YPIRAC Program national achievements to date, and client group characteristics, the AIHW 2007/08 report has been used.

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3.1.1 Overall achievements as reported by the AIHW 2007/08 Report

As reported in the AIHW 2007-08 NMDS report, a total of 580 people received services funded by the YPIRAC Program during the 2007–08 period.

Of the 580 service users:

• 579 were offered one or more of YPIRAC assessment, individual care planning and client monitoring during the reporting period. There were 578 service users who accepted these offers and 577 who received a service under the Program.
• Around half (51%) had agreed to move from a RAC setting to alternative accommodation.
• 22% were considered ‘at risk’ of entry to RAC.
• 23% of service users were to remain in or enter RAC, while accessing additional support services.
• 2.2% were to remain in a RAC facility without additional services.
• 2.1% of YPIRAC service users had a target group that was not stated/unknown.

The following table from the AIHW 2007-08 NMDS analysis provides a snapshot of YPIRAC service users, age groups and target groups by jurisdiction for the 2007-08 period. Of the 580 services users:

• Victoria has the largest number of clients who have agreed or have been moved from RAC to alternative YPIRAC funded accommodation and support (99 people), followed by New South Wales (94 people)
• Queensland has the largest number of clients who have been identified as being at risk of entry into RAC (49 people), followed by Victoria (24 people) and South Australia (21 people)
• New South Wales has the largest number of YPIRAC who remain in, or enter RAC, with additional YPIRAC Program support (56 people), followed by Victoria (39 people)

Table 3 – YPIRAC service users, age group and target group by State/Territory 2007-08

State/Territory									Total
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	No.	%
<50 years
Group 1	83	82	34	20	18	3	2	3	245	42.2
Group 2	2	20	38	13	20	3	5	4	105	18.1
Group 3	46	36	9	-	7	8	-	3	109	18.8
Group 4	4	-	2	1	5	-	-	-	12	2.1
Not stated	-	12	-	-	-	-	-	-	12	2.1
Total <50 years	135	150	83	34	50	14	7	10	483	83.3
50-64 years
Group 1	11	17	6	6	6	3	2	-	51	8.8
Group 2	-	4	11	2	1	-	2	-	20	3.4
Group 3	10	3	6	2	1	-	2	1	25	4.3
Group 4	1	-	-	-	-	-	-	-	1	0.2
Not stated	-	-	-	-	-	-	-	-	-	-
Total 50-64 years	22	24	23	10	8	3	6	1	97	16.7
All service users
Group 1	94	99	40	26	24	6	4	3	296	51.0
Group 2	2	24	49	15	21	3	7	4	125	21.6
Group 3	56	39	15	2	8	8	2	4	134	23.1
Group 4	5	-	2	1	5	-	-	-	13	2.2
Not stated	-	12	-	-	-	-	-	-	12	2.1
Total	154	174	106	44	58	17	13	11	580	100.0

Note: YPIRAC target groups:
Group 1 Agreed to or has moved from residential aged care to alternative YPIRAC funded accommodation and support
Group 2 deemed ‘at risk’ of entry into residential aged care
Group 3 Remain in or enter residential aged care with additional disability support services
Group 4 Remain in or enter residential aged care without additional disability support services.

Source: AIHW 2009, p 6

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3.1.2 Characteristics of service users

Of the total number of YPIRAC service users in 2007-08,

• 83% were aged under 50, reflecting the Program’s priority focus at a national level.
• Those aged 40 to 49 years accounted for more than half of all service users (54%).
• Around 14% of all male service users were aged less than 30 years, compared with 5.8% of females.
• 42 were of Aboriginal and/or Torres Strait Islander origin (7.2%).  The proportion of Indigenous service users varied across State/Territory jurisdictions, from 73% of all YPIRAC service users in the Northern Territory, to zero in Tasmania.

Around half (53.1%) of YPIRAC Program clients had more than one significant disability.  The primary disability groups of YPIRAC service users in 2007-08 were:

• Acquired Brain Injury (ABI) (46.4%)
• Neurological (26.7%)
• Physical (16.6%).

3.1.3 Types of services accessed by YPIRAC Program clients

Of the 580 service users:

• 30% received accommodation support.  This includes the provision of services to enable a client to remain in their existing accommodation or to move to more appropriate accommodation.
• 26% received community access support.  This includes services designed to provide opportunities for clients to gain and use their abilities to maximise their social independence, such as self-help and social skills programs, cooking classes and recreational activities (e.g. trips to art galleries).
• 23% accessed community support services.  This includes services needed for a client to live in a community setting such as therapy, behavioural/specialist intervention and counselling. 
• 2.8% received respite services.  This includes the provision of support to allow for short term breaks for families and other voluntary care givers and can be delivered in the client’s own home, or in respite homes or centres.  Crisis respite can also be provided.
• 99.7% accessed other services.  This includes advocacy, information and alternative forms of communication, YPIRAC assessments, YPIRAC client monitoring.

The most commonly accessed community support services were:

• Therapy support (16%)
• Case management, local co-ordination and development (12%).

Within the community access group, the service type most commonly received were:

• Other community access (18%)
• Learning and life skills development (7.8%).

Transport services were accessed by 14.5% of service users.

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3.2 Summary of jurisdictional program implementation as reported in the 2006/07 and 2007/08 progress reports

This section provides a summary of the activities and progress towards targets by each jurisdiction for the initial two years of Program implementation, 2006/07 and 2007/08.

Information has been collated from jurisdiction progress reports provided in August 2007 and August/September 2008.

The Implementation Progress Reports written by the various State and Territory jurisdictions for 2006-2007 were presented in a number of formats, ranging from detailed discussions to summaries and tables.  One of the challenges in presenting this information is the fact that there were no specific reporting requirements, thus allowing States and Territories to forge their own direction in their Implementation Plans.  The documents written by the various jurisdictions generally provided a summary of their progress and achievements with regard to young people in RAC.  Some jurisdictions addressed key issues such as governance, communication strategies, planning and assessment, service development, enhancement within RAC and diversion whilst others focused on specific State and Territory agreed outputs.

As a consequence of the difference between the Implementation Plan Progress Reports across the States and Territories for 2006-2007, the Implementation Plan Progress Reports for 2007-2008 were more streamlined and based on a standard template.  These documents provided a detailed analysis of the outcomes achieved for young people with disability residing in or at risk of entering RAC.

In general, the Implementation Plan Progress Reports of 2007-2008 demonstrated that each jurisdiction is committed to ensuring sustainable and long-term options are developed to ensure younger people living in or at risk of entering RAC have appropriate accommodation and support options in the community.

Key milestones across the States and Territories in 2007-2008 included progress against projected targets; assessment processes in place; assessments undertaken, and the number of people assisted across the three objectives of the program (i.e. number of care plans), activities relating to the transition to new care options and the development of new and long term care options.

Furthermore, there has been successful management of:

• Ongoing care in new or existing arrangements.
• The development and progress of capital works.
• Development of protocols with ACATs and other agencies.
• Application of quality assurance measures and activities associated with measuring quality of life for the target group.
• Activities associated with the development of responses to people of diverse cultural backgrounds and Aboriginal Torres Strait Islanders, and communication or consultation strategies.

3.2.1 Implementation tools

Overall, all jurisdictions have undertaken significant work to ensure measures to support implementation processes, such as guidelines and assessment tools, are in place for the Program.

Overall, activities and processes undertaken to support Program implementation by States and Territories can be best categorised as follows:

• Stakeholder engagement - including consultation/focus groups with peak organisations and service providers, engagement with clients and advocates, and the development of communication strategies.
• Development of governance structures – including the use of existing internal working groups or the establishment of expert working groups or steering committees.
• Development of data collection systems – involving the establishment of processes to collect required information and the use of tools such as quality of life indicators to assess progress.
• Assessment/in-take processes – including the development of assessment processes to identify clients ‘at risk’ of entering residential aged care; frameworks to identify priority clients; the development of a logic for the allocation of Program funding across the jurisdiction, and the development of protocols/arrangements with ACATs or ACAS (Aged Care Assessment Service) to ensure consistency in the identification and/or assessment of clients.
• Identification and engagement of service providers to deliver the Program – collaboration with other agencies such as housing or health departments to support the delivery of services or development of capital works, and expressions of interest/tendering process to engage new service providers to deliver services and build capital.

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3.3 Australian Capital Territory

The Australian Capital Territory YPIRAC Program experience has been shaped by:

• The comparatively small number of YPIRAC Program clients and targets (n=12).
• The fact that due to its geographical size, Program clients are likely to be located in centralised locations, in reasonable proximity to each other, and existing service structures.

As per the summary information presented below, the first two years of the YPIRAC Program in the Australian Capital Territoryfocused on the development of Program architecture, processes and key networks to support future Program implementation.  This included negotiations with ACATs regarding client assessment and referral Protocols.

Table 4 – Australian Capital Territory: Summary of YPIRAC Program highlights (2006/07 and 2007/08)

Australian Capital Territory Program highlights for year one (06/07)…

• Communication activities implemented, including: Completion of communication strategy, contacted all YPIRAC under 55 years.
• Planning and assessment activities including: Establishment of an advisory committee, development of transition plans, eligibility criteria, priority for service criteria, advocacy support, and processes to review decisions and privacy and confidentiality.
• PO2 activities: Initial negotiations to develop a YPIRAC-ACT and ACAT Protocol to ensure that younger people at risk of entry into RAC are assessed by the YPIRAC Program.

Australian Capital Territory highlights for year two (07/08)…

• Continued planning and assessment activities including: Finalised assessment tool for clients to record their desires regarding the Program.
• Continued PO1 activities: Tender for capital works conducted and architect appointed.
• Continued PO2 activities: Undertook an application and assessment process including defining the eligibility criteria, prioritising of applicants, assisted with planning and linking to appropriate services, and allocated resources above the required targets for PO2.
• Continued PO3 activities: Undertook an application process, supported and assisted individuals with planning and linking to appropriate services, and allocated resources.

3.4 Progress towards Program targets

When considering the progress towards Program targets in the Australian Capital Territory, it is important to note that the overall five-year target was 12 people – four in each PO.

It should be noted that due to the small number of people with a disability (who meet the YPIRAC eligibility) under 50 years, the priority target group in the ACT includes people 55 years and under.

Jurisdiction	Target to June 2009 - PO1	Achievement at December 2008 – PO1	Target to June 2009 - PO2	Achievement at December 2008 - PO2	Target to June 2009 - PO3	Achievement at December 2008 – PO3
Australian Capital Territory	0	1	0	7	0	5

3.5 Queensland

As per the summary information presented below, the first two years of the YPIRAC Program in Queenslandfocused significantly on the development of Program architecture, processes and key networks to support future Program implementation.

Early investment in communication activities with Program stakeholders, identification of Program partners and the establishment of planning and assessment processes provided a strong foundation for the Program implementation, particularly:

• The development of a suite of client assessment tools and aid in selecting accommodation and support options:
  • Preliminary Assessment Skills and Functioning Tool Report - focus on client history, medical history, physical functioning, and cognitive skills.
  • Options Planning Report- focus onclient and family identifying daily client support requirements.
  • Client Profile Tool – focus on identifying client-focussed goals as discussed with client, family and networks.
  • Risk Assessment Tool – focus on identifying levels of client transitioning within the community. This helps service providers assess the resource intensiveness/staffing demands that will be required to meet client needs.
  • Person Centred Mapping Tool - focus on indentifying the client’s desires and aspirations, important relationships and places, likes and dislikes, and the choices they would like to make.
• Development of Younger People with Disability in RAC Eligibility and Assessment Policy and, Younger People with Disability in RAC Prioritisation Policy and criteria for identifying people ‘at risk’ of entry into RAC.

The Program initial focus has been on the development of strategic partnerships with non-government organisations to build alternative accommodation options for Program clients, and identify suitable community-based service providers to provide support clients living outside of RAC.

Table 5 – Queensland: Summary of YPIRAC Program highlights (2006/07 and 2007/08)

Queensland Program highlights for year one (06/07)…

• Communication activities implemented, including: YPIRAC Program information package and invitations sent to 320 YPIRAC or younger people at risk of entry into RAC.
• Planning and assessment activities including: Funding provided to the Brain Injury Association of Queensland to establish the Assessment and Options Planning Service and conduct 200 assessments over two years. The assessment of YPIRAC Program clients is supported by a suite of various tools and aims to determine the client’s disability support and health care needs and identify suitable Program options.
• PO1 Activities: Allocation of recurrent and non-recurrent funding to Wesley Mission Brisbane and Youngcare to develop a 16 bed apartment complex for YPIRAC Program clients who have high or complex. This component of the Program is called the Integrated Living Model.
• PO2 Activities: Development and tendering for service providers to implement three support models - Living with Family and Network Supports Model, Living Independently Model, and Shared Supports Model. The Living with Family and Network Supports Model represent a collaborative approach between the person’s carers and formal support services to develop sustainable care arrangements.

Queensland highlights for year two (07/08)…

• Continued communication activities: YPIRAC Program information package and information sent to target group who had not responded to initial invitation. Contact was also made with 17 YPIRAC who had been admitted into RAC since July 2006. Direct correspondence was also sent to Directors of Nursing in RAC where clients had not responded to initial correspondence seeking their support in promoting the Program. Follow up phone calls were also made.
• Continued planning and assessment activities: Development of additional tool - Person Centred Mapping Tool which indentifies the clients needs, desires and aspirations, important relationships and places, likes and dislikes, and the choices they would like to make. Finalisation of guidelines for the assessment of people considered to be ‘at risk’ of entry into RAC. Discussion with Queensland Health regarding the development of a Protocol with ACATs to avoid the admission of younger people into RAC prior to the client being considered by the YPIRAC Program.
• Continued PO1 activities: Operation of two accommodation and support options commenced. Negotiations also commenced with two additional non-government organisations for the construction of accommodation options.
• Continued PO2 activities: Service providers were selected through a tender process to deliver support under Living with Family and Network Supports Model, Living Independently Model, and Shared Supports Model.

3.5.1 Progress towards Program targets

The table below provides a quantitative summary of the Queensland YPIRAC Program progress towards meeting its targets. Data reflects the Program-focus to date on PO1 and PO2.  Further achievements in PO1 are expected as construction of accommodation options is completed.

Jurisdiction	Target to June 2009 - PO1	Achievement at December 2008 – PO1	Target to June 2009 - PO2	Achievement at December 2008 - PO2	Target to June 2009 - PO3	Achievement at December 2008 – PO3
Queensland	35-43	25	36-44	35	6-12	0

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3.6 New South Wales

As per the summary information presented below, the first two years of the YPIRAC Program in New South Walesfocused on the development of Program architecture, processes and key networks to support future Program implementation. Early investment in communication activities with Program stakeholders, identification of Program partners and the establishment of planning and assessment processes provided a strong foundation for the Program implementation.

Early investment in communication activities with Program stakeholders, identification of Program partners and the establishment of planning and assessment processes provided a strong foundation for the Program implementation.

During the initial two years of the Program New South Wales undertook various procurement processes to identify service providers to assist in Program activities under PO1 and PO3.  In relation to PO2, Enable NSW was provided funding to procure, supply and maintain equipment for at least 50 YPIRAC Program clients.

Table 6 – New South Wales: Summary of YPIRAC Program highlights (2006/07 and 2007/08)

New South Wales Program highlights for year one (06/07)…

• Communication activities implemented, including: Communication strategy finalised, Program information line established, application packs sent to all YPIRAC under 50 years, and follow-up of non-respondents.
• Planning and assessment activities including: Program staff recruited, expert working group and internal reference group convened, Program policies and guidelines developed including Complaints & Appeals Guidelines and Assessment Package and Support Planning Procedures and  Guidelines, data base for management of client records established, assessment methodology and prioritisation tools developed, and training of assessors.
• PO1 activities: Commenced procurement of services to establish three new supported accommodation places in the Hunter Region, and the provision of ten accommodation places in the Sydney metropolitan area.
• PO2 activities: YPIRAC Program – ACAT Protocol progressed to ensure at risk client group is identified as early as possible and referred to YPIRAC Program for assessment.
• PO3 activities: Commenced procurement of services to purchase six specialist disability support packages for people remaining in RAC.

New South Wales highlights for year two (07/08)…

• Continued communication activities: Further application packs distributed to Program clients, information on advocacy services and Program fact sheets distributed.
• Continued PO1 activities: Completion of four bedroom house and transition of clients to this new accommodation.  Additional procurement process will be undertaken in September-December 2008 with an expected 100 new accommodation places created.
• Continued PO2 activities: Funding provided to Enable NSW to procure, supply and maintain equipment for at least 50 applicants.
• Continued PO3 activities: Procurement process completed for the In-reach packages to enhance specialist service delivery to YPIRAC. Funding provided for 50 In-reach packages by four service providers.

3.6.1 Progress towards Program targets

As will be discussed in the following sections of the report, there have been some initial delays in New South Wales completing capital works to relocate Program clients (PO1) and in establishing strategic partnerships to divert clients from entering RAC. (PO2). With the completion of procurement processes as part of PO1, and the appointment of Enable NSW (PO2), it is expected that performance data for the January 2009 – June 2009 period will indicate significant progress in the implementation of PO1 and PO2.

In considering the New South Wales performance over the initial two years of the Program it is important to note that the Bilateral Agreement was not formally accepted until December 2006. Effectively the reporting period 2006/07 only represents six months of Program activity.

Jurisdiction	Target to June 2009 - PO1	Achievement at December 2008 – PO1	Target to June 2009 - PO2	Achievement at December 2008 - PO2	Target to June 2009 - PO3	Achievement at December 2008 – PO3
New South Wales	44-88	2	19-36	2	65-100	199

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3.7 Northern Territory

The Northern Territory YPIRAC Program experience has been shaped by:

• The comparatively small number of YPIRAC Program clients.
• The fact that many of these clients are in various regional areas, making the provision of YPIRAC Program services highly decentralised.

As per the summary information presented below, the first year of the YPIRAC Program in the Northern Territory focused on recruiting YPIRAC Program staff, developing the capacity of the sector, for example through the training of ACATs, and conducting assessments of all YPIRAC clients.

The rapid assessment of all clients within the first year of the Program has allowed the Program to be implemented in a very targeted and resource effective manner.  For example, the initial focus in Darwin was only in relation to home modifications (PO2), given that the only YPIRAC Program client in Darwin preferred to live in the family home.  The number of clients (n=3) in Alice Springs on the other hand who preferred to relocate to a purpose-modified facility, supported the modification of a group home for the specific needs of the YPIRAC Program target group.

Northern Territory: Summary of YPIRAC Program highlights (2006/07 and 2007/08)

Northern Territory Program highlights for year one (06/07)…

• Communication activities implemented, including: Contact was made with all YPIRAC Program target group and consent obtained for assessment as part of the Program.  Partnerships with key stakeholders such as the Aged Care Advocate and Adult Guardians at the local level.
• Planning and assessment activities including: Guidelines and Protocols for the Northern Territory YPIRAC Program were finalised.  Recruitment of staff to conduct individual assessments of YPIRAC Program clients was completed, and all assessments were conducted.  Reports were prepared on clients based on a Comprehensive Behavioural Analysis. Data collection tools to assess Program impacts were also developed.
• PO1 activities: Negotiated with Territory Housing for the modification of one alternative group home for YPIRAC Program.
• PO2 activities: Developed assessment tools to identify younger people at risk of entry into RAC. The Northern Territory ACAT Manual was updated to reflect the new tools and processes for diverting younger people from entry into RAC, and training was provided to ACATs. Tenders for alternative care options were made available to community sector.
• PO3 activities: Tenders for alternative care options were made available to community sector.

Northern Territory Program highlights for year two (07/08)…

• Continued planning and assessment activities: Finalised a range of tools to assess client needs, including Disability assessment, Disability Report, Individual Support Plan (immediate needs) and, Disability Support Plan (long term).
• Continued PO1 activities: Group home established in Alice Springs.
• Continued PO2 activities: One client provided funding to return to family home with specialist equipment, home modifications, and additional support services.
• PO3 activities: Services funded for clients in Tennant Creek and Katherine RAC

3.7.1 Progress towards Program targets

The table below provides a quantitative summary of the Northern Territory YPIRAC Program progress towards meeting its targets.  PO1 and PO2 targets for the period ending June 2009 were met by December 2008, and PO3 targets are likely to be met within the specific timeframe.

Jurisdiction	Target to June 2009 - PO1	Achievement at December 2008 – PO1	Target to June 2009 - PO2	Achievement at December 2008 - PO2	Target to June 2009 - PO3	Achievement at December 2008 – PO3
Northern Territory	2-3	2	1	6	4	3

3.8 South Australia

The South Australian YPIRAC Program, Young People in Nursing Homes Project, achieved significant outcomes in its initial two-years of implementation.

Through the development of a comprehensive Program framework in the very early stages, clear guidance was provided in relation to the assessment of Program clients, eligibility criteria and processes to implement the Program under each PO.  This allowed for the rapid access to Program clients, stakeholders and implementation of strategies.

While the majority of jurisdictions focused their initial efforts on different POs, the South Australian Program has managed to achieve significant outputs across all three POs.

South Australia: Summary of YPIRAC Program highlights (2006/07 and 2007/08)

South Australia Program highlights for year one (06/07)…

• Communication activities implemented, including: Initial contact made with YPIRAC client group, consumer consultation and workshops.
• Planning and assessment activities including: Steering committee convened, Program framework developed - including eligibility criteria, and client assessment process and tools, including My Life-My Plan. .
 
• PO1 activities: Clients relocated to more appropriate accommodation as per year one targets.  Commenced development of six to seven cluster sites to accommodate up to 50 people and 13 individual accommodation options in regional/remote areas.
• PO2 activities: Clients diverted to more appropriate accommodation exceeding year one targets.  Development of process to purchase, maintain and distribute equipment to facilitate relocation to home or other community based accommodation.
• PO3 activities: Clients provided enhancement packages as per year one targets.

South Australia Program highlights for year two (07/08)…

• Continued planning and assessment activities: Communication plan developed and implemented.
• Continued PO1 activities: Two cluster sites to accommodate seven clients have been completed. Construction of remaining cluster sites commenced, completion due July 2009. Working towards acquiring additional land for development of new cluster sites.
• Continued PO2 activities.
• Continued PO3 activities.

3.8.1 Progress towards Program targets

The table below provides a quantitative summary of the South Australian YPIRAC Program progress towards meeting its targets.  As previously mentioned, significant progress has been made towards achieving targets across all three POs.

Jurisdiction	Target to June 2009 - PO1	Achievement at December 2008 – PO1	Target to June 2009 - PO2	Achievement at December 2008 - PO2	Target to June 2009 - PO3	Achievement at December 2008 – PO3
South Australia	24	17	14	19	17	8

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3.9 Tasmania

The Tasmanian YPIRAC Program experience has been shaped by:

• The comparatively small number of initial YPIRAC Program clients and targets under 50 years (n=14).
• The fact that many of these clients are in various regional areas, making the provision of YPIRAC Program services decentralised.

While the initial two years of implementation focused on the development of Program frameworks, guidelines and processes, given the small number of the YPIRAC Program target group, initial assessments of all clients were completed.

It is worth noting that given the Program has not scheduled the development of alternative accommodation (PO1) until year three, clients were more likely to be referred for enhancements (PO3) until the facilities are completed and they are relocated.

Table 9 – Tasmania: Summary of YPIRAC Program highlights (2006/07 and 2007/08)

Tasmanian Program highlights for year one (06/07)…

• Communication strategy implemented, including: Development and implementation of communication strategy.  Contacted all YPIRAC Program clients under 50 years, their families or advocates.
• Planning and assessment activities including: recruitment of Program staff, purchased assessment tool developed by the Summer Foundation for Victoria, majority of assessments completed, and reference network established.
• PO1 activities: Commenced to plan for a capital development program to be implemented in year three of the Program.  Held initial consultations with service providers regarding the most appropriate accommodation models.
• PO2 activities: Development of Protocol with ACATs to assist in the identification of younger people at risk of entering RAC.
• PO3 activities: Provided services to a number (three) of YPIRAC. These included Community Access services such as day programs, specialised equipment and access to health professionals.

Tasmanian Program highlights for year two (07/08)…

• Continued communication activities: Accommodation forum was held to discuss the criteria for the development of capital –this included attendance by some of the proposed residents, disability service providers and the Program’s steering committee. Program Information sessions were also held with peak bodies, and fact sheets produced for Program staff and clients.
• Continued planning and assessment activities: Staff attended training sessions regarding transition planning, key Program staff completing training at TAFE regarding transition planning.
• Continued PO1 activities: A site has been selected for the new accommodation service and an architect appointed.
• Continued PO2 activities: An at risk scale for entry to RAC was developed in conjunctions with RAC to assist in the prioritisation of clients.
• Continued PO3 activities.

3.9.1 Progress towards Program targets

The table below provides a quantitative summary of the Tasmania YPIRAC Program progress towards meeting its targets.

In considering the Tasmanian performance over the initial two years of the Program it is important to note that the Bilateral Agreement was not formally accepted until December 2006, with recruitment of a Program manager completed in January 2007.

Effectively the reporting period 2006/07 only represents six months of Program activity.

Jurisdiction	Target to June 2009 - PO1	Achievement at December 2008 – PO1	Target to June 2009 - PO2	Achievement at December 2008 - PO2	Target to June 2009 - PO3	Achievement at December 2008 – PO3
Tasmania	0	1	3	3	16	15

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3.10 Victoria

As per the summary information presented below, the first two years of the YPIRAC Program in Victoria, my future my choice, focused significantly on the development of Program architecture, processes and key networks to support future Program implementation.  The delivery of planning and assessment, alternative living options and enhancement supports also commenced during this period.

Early investment in communication activities with Program stakeholders, identification of Program partners and the establishment of planning and assessment processes provided a strong foundation for the Program implementation.

To facilitate the planning and assessment process:

• Eight planning organisations have been engaged to work with YPIRAC Program clients and their families in the development of their individual plans across the State.
• An independent advocacy service has been established (Action for Community Living) to provide support to Program clients unable to communicate their preferences or with no family/support network to represent them.

In addition, the Program has invested in early communication with ACAS and the acute and health and rehabilitation sector to ensure coordination of stakeholders across the continuum of entry into RAC and short and long term care.  As part of this a diversionary strategy (PO2) has been developed to ensure the efficient diversion of younger people at risk of entry into RAC.  This includes criteria for defining and assessing clients ‘at risk’ of entry into RAC.

Table 10 – Victoria: Summary of YPIRAC Program highlights (2006/07 and 2007/08)

Victorian Program highlights for year one (06/07)…

• Communication strategy implemented, including: Communication with all YPIRAC, their families, RAC services, peak bodies and community service organisations, newsletters, and establishment of Program hotline, website and email address.
• Planning and assessment activities including: Planning and assessment framework developed by the Summer Foundation, all Victorian YPIRAC offered opportunity to participate in Program planning and assessment, independent advocacy service established (Action for Community Living), central stakeholder panel established to consider individual plans and allocate resources, complaints process established.
• PO1 activities: Service providers have been identified to provide innovative support services for 46 people with moderate to high care needs. Commenced development of a new facility-based service for 10 people with high-level support needs and associated clinical care needs to be located in the inner urban area,  and the expansion of a neurological service to provide for additional three places
• PO2 activities: Diversionary strategy developed to minimise the number of new admissions of younger people to RAC, criteria to identify ‘at risk’ Program population of entry into RAC, enhanced communication between Program and ACAS, and with acute and health and rehabilitation sector.

Victorian Program highlights for year two (07/08)…

• Continued communication activities: Summary of Program planning and assessment process was published - Younger people in residential aged care, Support needs, preferences and future directions report.
• Continued planning and assessment activities: Assessments completed for the majority of Program clients who had consented to Program participation, regional process established to facilitate direct contact and information dissemination, process finalised for verification of final individual plans (including review of proposed costing, implementation, monitor and review).
• Continued PO1 activities: Funding allocated for the development of seven new services for 46 people, with expected completion by December 2010.  The first of these services opened in February 2008.  Planning is underway for a further 47 accommodation support places
• Continued PO2 activities.
• PO3 activities: Focus on purchasing additional disability supports to help the Program client meet their personal goals and improve the quality of their life.  Outcomes for these clients include increased ability to participate in social and recreational activities, enhanced opportunities to develop and/or maintain family and friendship networks, and the purchase of items such as attendant care support, equipment and therapy.

3.10.1 Progress towards Program targets

The table below provides a quantitative summary of the Victorian YPIRAC Program progress towards meeting its targets.  In relation to the underperformance of PO1, it is important to note that seven new services to accommodate up to 46 people are expected to be completed by December 2010.

Jurisdiction	Target to June 2009 - PO1	Achievement at December 2008 – PO1	Target to June 2009 - PO2	Achievement at December 2008 - PO2	Target to June 2009 - PO3	Achievement at December 2008 – PO3
Victoria	71	19	15	41	20	119

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3.11 Western Australia

The Western Australian YPIRAC Program experience has been particularly unique due to a number of jurisdictional specific factors:

• The YPIRAC target group was known to the government and services/programs were already in place to support their needs. The Combined Application Process (CAP) tool for example, to assess younger people at risk of entry to RAC, had been in use for over seven years.  This allowed for the Program to commence implementation comparatively quickly, particularly in supporting people as part of PO2.  In this context, existing processes and arrangements with service providers were maximised and YPIRAC Program clients benefited from minimal delays in accessing services.
• Despite the Program establishing strategic partnerships with service providers to remodel existing capital for the YPIRAC Program in the first two years, delays have occurred due to the increased demand for building services resulting from the mining boom.  Access to building contractors has therefore been limited.

Table 11 – Western Australia: Summary of YPIRAC Program highlights (2006/07 and 2007/08)

Western Australia Program highlights for year one (06/07)…

• Communication strategy implemented, including: Initial contact letters, Program information and Registration of Interest (RoI) information was forwarded to all known YPIRAC in Western Australia.  Correspondence was also sent to the Chief Executive Officers and Directors of Nursing of relevant RAC facilities encouraging promotion of the YPIRAC Program.
• Planning and assessment activities including: Initial interview and assessment process has been developed. In addition, an existing tool, the CAP, has been used to assess younger people ‘at risk’ of entry into RAC.  The tool has been in operation in Western Australia for over seven years.  16 service providers expressed interest in providing services as part of the YPIRAC Program.
• PO1 activities: One service provider was engaged to redevelop existing accommodation to support 10-15 YPIRAC Program clients.  An additional redevelopment to accommodate 10-12 YPIRAC clients will commence once a suitable provider is identified.  Both redevelopments are expected to be completed by years four and five of the Program.  Initiated negotiations with the Western Australian Department of Housing to build fully accessible housing options, it is expected that a total of nine units will be remodelled for YPIRAC Program clients.
• PO2 activities: Given the CAP tool was in use, PO2 has been the initial Program focus.  Funding has been used to assist YPIRAC Program clients remain in their home.
• PO3 activities: Initial identification of specialist services.

Western Australia Program highlights for year two (07/08)…

• Continued communication activities: All YPIRAC have been contacted and provided an opportunity to participate in the Program.  Particularly targeted potential Aboriginal Program clients in the North West of Western Australia.  Aboriginal Liaison Officers have been visiting regional and remote communities to discuss the Program.
• Continued planning and assessment activities including: Planning process developed and ensures that key stakeholders are involved in the assessment of each individual to develop care plans are developed for each client.  Development of Protocols with ACATs completed.
• Continued PO1 activities: Three facilities are expected to be completed by 2008/09, of these, one will have a focus on Huntington’s disease and one on ABI.  Two additional accommodation facilities have been identified, and will be completed by 2010.
• Continued PO2 activities.
• Continued PO3 activities.

3.11.1 Progress towards Program targets

The table below provides a quantitative summary of the Western Australian YPIRAC Program progress towards meeting its targets.  In relation to the underperformance of PO1, it is important to note the unique challenges presented by the shortage of building contractors.  Given a number of facilities are well into construction, and the progression of arrangements with the Department of Housing to remodel existing accommodation for the needs of YPIRAC Program clients, it is likely that the PO1 targets will be achieved within the initial five-years of the Program.

Jurisdiction	Target to June 2009 - PO1	Achievement at December 2008 – PO1	Target to June 2009 - PO2	Achievement at December 2008 - PO2	Target to June 2009 - PO3	Achievement at December 2008 – PO3
Western Australia	12	3	18	16	24	11

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3.12 Contextualising Program achievements to date

As noted in the summaries presented in this chapter, jurisdictions have accomplished a significant amount during the initial two years of Program implementation, particularly given that this Program represents the first nationally coordinated approach to respond to the needs of YPIRAC.

Many of the early Program achievements focused on the development of local processes and frameworks to support the implementation of the Program, and better understand the needs of the target group.  This early investment has been an important step in ensuring a coordinated response to the complexity of the YPIRAC Program – which demands a jurisdictional response across the aged care, health, housing and community services sectors, both within government and the non-government sectors.

While much of the analysis presented in the forthcoming chapters has focused on answering key questions such as whether the net reduction targets will be achieved, the successful completion of these goals can be largely attributed to the early investment in establishing the required service and policy architecture across each jurisdiction.

3.12.1 Program funding

Given the importance of setting up the initial jurisdictional service and policy infrastructure, the majority of jurisdictions (n=6), will access 62 per cent of their Program funding only in the last two years of the Program (2009/10 and 2010/11).

The rationale for this funding structure reflects the early jurisdictional investment in understanding the needs of the client group, and responding to many of the early assumptions reflected in the Bilateral Agreements.  This has been an important step in ensuring the future success of the Program.

In this context, while the analysis in forthcoming chapters considers whether the Program targets will be achieved within existing funding allocations, this Mid Term Review cannot address whether the funding available will be sufficient to meet the demand for support required by the YPIRAC target group for a number of reasons, namely:

• Analysis has focused only on 2006-07 and 2007-08 data.
• No itemised financial data in relation to the cost of providing services has been made available.
• Given only two years of implementation have taken place, it is too soon to assess the cost per client, and whether allocated amounts will be adequate. Jurisdictions have reported they will be able to meet targets within current funding allocations.

These are all important issues that will be better addressed in the five-year evaluation should access to sufficient itemised financial data be made available by jurisdictions.

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