• 4.1 Overview
• 4.2 The complexity of the YPIRAC Program
• 4.3 The Bilateral Agreements
• 4.4 Program strengths and challenges
• 4.5 Mid Term Review – discussion of conclusions

4.1 Overview

This chapter provides analysis and discussion of the Program strengths and challenges based on data provided by jurisdictions and the literature review undertaken for the project. Central to the analysis is an understanding of the complexity of the interface between health, aged care, disability services, community services and housing in which the YPIRAC Program is based. Overall, the Program has met an important and tangible need for many younger people with disability. It is expected that by the conclusion of the five year Program, the net reduction target of between 425-689 in the number of YPIRAC will have been achieved. However, despite the Program meeting the target, a significant demand for services for YPIRAC will remain. This is particularly the case for clients with very high needs and for those in rural and remote locations. Overall, the Program implementation to date has been successful in achieving a number of important outcomes:

For clients and their families

• It has provided genuine individualised alternatives to inappropriate RAC for younger people with disability in a flexible and tailored service environment.

From a service delivery perspective

• It has facilitated the development of partnerships by governments, across jurisdictions and with the non-government sector to enable the delivery of community-based care options or enhancement services to YPIRAC, and the development of purpose-built or modified facilities.

From a policy perspective

• It has set a benchmark for servicing arrangements in complex environments and collated critical data to inform the development and delivery of Programs targeting younger people with disability nationally and across individual jurisdictions.

4.2 The complexity of the YPIRAC Program

While the circumstances of YPIRAC had been previously known to governments and the service sector, this Program represents the first nationally coordinated attempt to respond to the complex needs of this highly vulnerable and neglected group.

The establishment of the Program included the development of:

• Program Objectives
• Bilateral Agreements
• Targets
• Action Plans
• Financial allocations.

These were based on the best evidence available at the commencement of the Program. A certain number of assumptions were made in relation to:

• The overall net reduction in the number of YPIRAC that will be achieved and at what stages of the five year Program cycle.
• The capacity of jurisdictions to influence the net number of YPIRAC through this Program.
• The levels of funding that will be required to achieve targets under each of the POs.
• The number of clients that will choose to participate in the Program and how well they perceive it to meet their needs.
• The capacity of the community-sector to deliver services to younger people often with high levels of disability and complex or associated health conditions.

Discussion in this chapter will explore the implications of these assumptions and their impact on the findings of the Mid-Term Review. This chapter explores the assumptions and application of the Bi-lateral Agreement, the strengths and challenges of the Program structure and design, and draws conclusions regarding the Program’s current progress toward its stated objectives.

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4.3 The Bilateral Agreements

The Bilateral Agreements reflect all the Program assumptions outlined above. This Review has found that despite best efforts, a number of assumptions in the structure of the Bilateral Agreements had limited validity. Table 12 describes the key Program assumptions and the actual experience of jurisdictions.

Table 12 – Program assumptions, delivery and impacts on Program outcomes

Assumption	Program delivery	Impact on outcomes to date
The tasks and timelines involved in setting up the Program in each jurisdiction.	Lack of sector-wide experience in supporting younger people with disabilities, particularly high need clients, in community settings. Lack of accurate and timely information regarding clients. Although time consuming, the importance of face-to-face contact with the clients and their families has been emphasised as important to program set up by jurisdictions.	Delays in recruitment due to skill shortages. Skill gaps remain in relation to supporting transition planning and responding to the changing health needs of clients, particularly those with degenerative conditions. A time lag has been experienced between client assessment and service availability due to delays in service development.
The level of client need would be evenly split across the four levels of support – low, medium, high and very high	The experience in most jurisdictions to date is that the majority of the YPIRAC target group have high or very high needs. In Victoria this has been estimated as being as much as 75 per cent of the target group. Similarly, in 2005, it was estimated that of the Queensland YPIRAC population, 81.5 per cent have high care needs. As expected, high care needs result in the need for service provision 24 hours a day, to assist people with showering, dressing, toileting, eating and mobility. For community based services, a range of equipment is needed to service the needs of high support needs clients. The Summer Foundation (2007) estimated that 52 per cent of the Victorian YPIRAC research sample utilised five or more items of specialised equipment.	Significant challenges are faced in finding appropriate support arrangements for clients with high support needs. Increased cost in the provision of services limits the number of clients the Program can assist.
The cost of providing care for each client.	South Australia for example has indicated that in its initial modelling the individual provision of services was budgeted at $80,000 on average per client. Given the unexpected number of high need clients the actual cost is $100,000-$120,000 per client. Queensland and Western Australia have also reported that to ensure cultural sensitivity in the delivery of the YPIRAC Program to Indigenous clients and their families, significant investments in travel to remote communities has been undertaken. Whilst this has been crucial in responding to cultural, linguistic and historical needs of Indigenous clients, the long travel distances between communities have resulted in increased Program costs.	Tasmania and the ACT Program budgets were ‘re-phased’ by negotiation with the Commonwealth Government to achieve a different allocation over the five years of the Program across each PO to better match Program objectives and targets. The overall allocation did not change. The Program will not be able to respond to the needs of all YPIRAC. Significant service demand will remain for the under 50 years target group, even when the Program meets its targets after five years. Issues of service-capacity will remain a challenge in the delivery of services to rural and remote clients.
The targets that will be achieved under each PO and at what stages.	All jurisdictions experienced delays in commencing the Program as they developed procedures, guidelines and engaged stakeholders. Jurisdictions also experienced delays in developing or modifying facilities, and establishing service delivery arrangements with providers. Not all targets have been met to date.	In most instances, overall targets will be met by year five but not within the specified milestone time frames for the early phase of the Program. Queensland and Tasmania renegotiated their targets across the five-year Program (although the overall number of people to be assisted did not change). Victoria and Western Australia indicated the possibility of renegotiating its targets.

4.3.1 Use of Bilateral Agreements

The use of Bilateral Agreements for the Program engages the relevant agencies across levels of government and jurisdictions. They are a necessary tool for these purposes. Bilateral Agreements do not necessarily provide jurisdictions with the flexibility to easily change targets and milestones under each PO as the Program evolves because of the manner in which they require renegotiation with relevant Ministers to afford changes.

However, any potential negative impacts on Program flexibility through the use of Bilateral Agreements have been mitigated, through good management by the Commonwealth by:

• The flexible approach of FaHCSIA in renegotiating targets and the timing of funding to better reflect the actual challenges in Program implementation. This has been a particularly important component of the Program to date.
• The five-year timeframe for the initiative which allows jurisdictions to ‘catch-up’ on delays in meeting targets overtime.

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4.4 Program strengths and challenges

In considering the achievements and implementation experience of jurisdictions to date, this Mid-Term Review has sought to identify Program strengths and challenges to inform future directions for the next three years of implementation. The implications of these are further explored in the following chapter of this report.

4.4.1 Program Strength – Flexibility in Program design

Flexibility for jurisdictions

The support by the Australian Government for the jurisdiction’s to approach implementation consistent with local service systems and policy context has enabled creative solutions to be developed to respond to the needs of individuals and local circumstances. The flexibility within the Program structure has allowed jurisdictions to balance their focus on each of the POs differently, at varying stages of the Program. This has been a critical success factor as the social and economic situations across jurisdictions are diverse.

For example:

In Queensland...

• Significant advances were made in the development of capital in the early stages of the Program. Accommodation to support up to 34 people has been built or modified in Brisbane, Gold Coast and Far North Queensland, with further facilities expected to be completed in Brisbane and the Sunshine Coast in 2009.

In the Australian Capital Territory...

• The initial focus was on the completion of a five-bedroom home to accommodate four clients, plus an additional room for families.

In Western Australia...

• The overheated economy as a result of the mining boom made access to contractors to build or modify facilities a lengthy waiting process. The focus has therefore been on developing services to divert people from entering RAC.

In the Northern Territory...

• The Northern Territory Emergency Response (NTER) resulted in many people moving in and out of their homes and communities. This delayed the start of the Program, as invitation letters sent to many younger people with disability, their family or guardian were never received.

In New South Wales...

• The initial focus has been on PO2 and PO3 through the development of In-Reach and In-Home packages which offer recreational and diversional therapy and allied health services such as physiotherapy.

In Tasmania...

• The provision of transport has been identified as a significant issue for clients wanting to access allied health services, respite or attend social functions. Taxi fares have therefore been a common component of some aspects of the Program.

The different context and priorities across jurisdictions has provided, and will continue to provide, useful learnings to be shared and potential overall efficiencies for the Program. Representatives from Victoria have for example visited Queensland as part of good practice information sharing on the Queensland experience in developing capital provisions. The plans developed by Queensland for purpose designed and built housing have also been shared across jurisdictions.

A further example of the flexibility afforded to jurisdictions is the different role negotiated for ACATs/ACAS across the Program. Traditionally, ACATs/ACAS conduct assessments to facilitate entry into RAC across all jurisdictions. Their involvement in the Program is therefore crucial, either in supporting the assessment of younger people with disability, or referring younger people with disability to the YPIRAC Program for assessment. This process will be critical to the success of the Program following the initial five year funding period.

For example:

In Victoria...

• The Program is providing an opportunity to strengthen relationships with ACAS. An existing Protocol between disability services and ACAS has been enhanced to ensure the unique needs of younger people with disability are reflected.

In Tasmania...

• ACATs are an integral part of the Program; they conduct the client assessments as they would with any other person that may enter RAC.

National guiding principles for the assessment and coordination of services by ACATs :

• It is noted that a set of national guiding principles for the assessment and coordination of services by ACATs is currently being finalised. The guidelines will promote national consistency in the role of ACATs, including the assessment of the needs of younger people at risk of entry into RAC.
• Given the important role ACATs could have in the YPIRAC Program, either as assessors or in referring younger people at risk of entry into RAC, the national formalisation of their role will be an important step in embedding the consideration of the needs of younger people with disability into their practice.

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Flexibility in service provision

Reflecting the complexity of the target group including age, medical condition, living arrangements, individual and family desires and geographic constraints, the flexibility of the Program structure has allowed jurisdictions to tailor responses to individual needs.

Jurisdictions have invested significant time and resources into the development of tools to collate narratives to understand the needs and desires of clients and their families. This will result in the delivery of services that are tailored to the specific needs and desires of clients.

For example:

In Victoria...

• The individualised nature of the Program is best communicated by its title, my future my choice

In South Australia...

• My Story, an assessment component designed to capture detail about clients, who they are and what they would like, and is completed with each YPIRAC Program participant.

In Western Australia...

• The Program aims to understand what individuals want for themselves and their future as a key component of the initial assessment. There is a significant focus on collecting qualitative data about lifestyle aspirations.

In the Northern Territory...

• Narrative reports have been identified as being enormously helpful in implementing the Program.

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4.4.2 Program strength – innovative delivery across governments and NGOs

Joined-up services

A further benefit of the Program’s flexibility is that it has allowed for jurisdictions to engage with and across their own government agencies and service delivery contexts to meet the needs of the Program. The complexity of the YPIRAC Program and its overlap across the health, disability, housing and aged care portfolios of State/Territory governments, has highlighted the need for an increase in coordination in responding to the needs of this target group.

This is likely to result in long-term sustainable change to the way State/Territory Government departments consider their role in supporting younger people with disability.

For example:

In Victoria...

• Step up/step down Programs attached to acute hospitals allow time for a client to stabilise, in the case of degenerative disease progression, or recovery from trauma of injury, prior to making premature decisions about placement into RAC. This delay provides an opportunity to demonstrate the potential benefit of having access to rehabilitation services and living in community settings rather than RAC. This is an important strategy given that in Victoria, 65 per cent of YPIRAC come from a hospital or rehabilitation setting.

In New South Wales...

• A one-off grant was provided to NSW Health to respond to the equipment requirements of clients being diverted away from RAC and into community settings.
• Work is also underway with Housing NSW to ensure relevant services are able to work towards rehousing clients in the most appropriate facilities.
• Clients are also screened by referral and intake team tools to determine whether they are eligible for other community-based services and Programs.

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Strategic Partnerships

The Program structure has also allowed for the establishment of strategic partnerships with non-government organisations and peak bodies to facilitate the implementation of the Program across jurisdictions. This is particularly important in acknowledging the complexity of the service infrastructure that is required to support younger people with a range of disabilities. Engaging with peak bodies and service providers that have specialist understanding of different conditions enables the Program to develop tailored responses to individual needs.

For example:

In South Australia...

• The YPIRAC Program has worked in partnership with other government and non government organisations to access capital works and build a range of supported accommodation cluster sites across the State.

In Queensland...

• Partnership with non-government organisations has resulted in the contribution of land, funding and expertise to support capital development and improvement work being conducted as part of the YPIRAC Program.

In New South Wales...

• The YPIRAC Program Working Group has included the Younger People in Nursing Home National Alliance, Brain Injury Association, Aged Care Association of Australia and Aged and Community Services Association of NSW and ACT, to support the provision of expert advice in the development and ongoing implementation of the Program. Funding has also been provided to the Multiple Sclerosis Society for the Continuous Care Pilot, to support people with degenerative neurological conditions remain living in the community longer, and reduce the likelihood of entry to residential aged care . The project is being managed by the Multiple Sclerosis Society of NSW.

In Victoria...

• The Continuous Care Project to support people with degenerative neurological conditions remain living in the community longer and reduce the likelihood of entry to RAC is being managed by the Multiple Sclerosis Society of Victoria.

In the ACT...

• A strategic relationship with the National Brain Injury Foundation has facilitated the transfer of an YPIRAC Program client into their service.

The Program strengths and achievements to date have been delivered with effective Australian Government support in Program design, management, coordination and administration. This has enabled the jurisdictions to flexibly respond to their own contexts and to develop innovative service delivery arrangements to meet client needs.

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4.4.3 Challenge - Setting and meeting Program targets

This section frames the analysis of this Mid Term Review and underpins the recommendations for the future of the Program, which are outlined in the following chapter.

The challenges include factors outside of the Program control which impede their capacity to meet targets, specific constraints in regional and remote locations and the challenges of planning for clients with long-term, complex support needs.

Limited information about the client group, their circumstances and needs

At the commencement of the Program it was difficult to accurately establish targets given that most jurisdictions had little experience with, and knowledge of the YPIRAC client group, their current circumstances and their needs and wants. Necessarily - there were some assumptions made at the beginning of the Program which then formed the basis for the establishment of targets.

Given the limited knowledge of the YPIRAC target group, the targets set out in the Bilateral Agreements represent a ‘best guess’ as was stated by one of the jurisdictions.

Clients in the Program have varying levels of support needs. Some jurisdictions when forecasting Program costs for example, made assumptions that the client group would be evenly split across the four levels of support – low, medium, high and very high. In reality the majority of clients have either high or very high support needs.

Because of this limited knowledge at the beginning of the Program, most jurisdictions did early Program planning; undertaking research and consultation to enable them to better understand stakeholder needs.

For example, in Tasmania and Victoria, the Summer Foundation was engaged to develop profiles of the YPIRAC client group and identify their experience, social and medical needs and conditions, to further inform the development of YPIRAC Program.

Varying needs across age ranges and geographies

While the initial priority focus of the Program is people under 50 years old, there are a significant number of potential service users aged 50 to 65 years and in some jurisdictions people under 30 years that also require Program support. In most jurisdictions, the Program has been unable to cater for demand outside the priority age focus of the Program.

For example the Northern Territory indicated that many clients under the age of 30 (as opposed to those aged under 50 years), have significant support needs, and there was a need for the Program to consider prioritising this younger under 30 age cohort. By contrast, a 2005 Queensland study (2005, 7) found that of the under 50 years old YPIRAC Program target group, 73.7 per cent of YPIRAC were between 40-49 years, with 4.3 per cent under the age of 30 years.

In addition, the majority of jurisdictions indicated that while the five year Program targets will be achieved this will still leave an unmet need for a large number of YPIRAC.

Meeting targets in the early stages of the Program

Across jurisdictions the Program is mostly referring clients to new service arrangements or accommodation. At the beginning phase of the Program there is inevitably a time lag between assessment and the availability of places. Delays in finalising capital works in most jurisdictions have proved to be a particular challenge when diverting or relocating clients.

The time lag in the availability of services and facilities is particularly problematic when dealing with clients that have degenerative conditions and changing needs over the waiting period. It should be noted that additional assessments and client reviews are necessary when dealing with this client group, which can have impacts on timeliness of service delivery.

Jurisdiction specific challenges in achieving net reductions

While it is expected that overall the national net-reduction of YPIRAC clients will be achieved over the five years of the Program, jurisdictions have indicated that they have limited control over additional younger people entering RAC. Much of this relates to jurisdictional specific criteria or conditions which may contribute to increases in the YPIRAC population. Some examples are outlined below:

• In South Australia and Victoria, not all YPIRAC are eligible for the Program. Under the Victorian Disability Act (2006) there are a number of YPIRAC who do not have a disability (as defined) and are therefore not part of the Program.
• In these situations YPIRAC have a mental illness but no associated or co-existing disability, or were compensable clients. It is estimated that up to 6 per cent of the Victorian YPIRAC target group falls under this category.
• In Queensland and South Australia, some of the Aboriginal Nursing Homes that have clients in the YPIRAC Program are not classified as Commonwealth funded homes. Therefore any diversion of clients from these is not considered in the overall net reduction of clients.

In Victoria, there are four residential care services known as ‘specialist RACs’. These target younger people with needs such as mental illness, neurological, slow stream rehabilitation, or drug or alcohol related ABI. At October 2008, 18% (or 36 people) of the 202 people aged less than 50 were living in these specialist RACs. The capacity to achieve an overall net reduction in this circumstance is hampered as these services are considered in the overall RAC data, but as soon as a young person is supported to exit or diverted as part of the YPRAC Program, the specialist RAC fills the vacated spot with a new younger person.

• Jurisdictions have reported that many YPIRAC are not willing to relocate. This is particularly the case in regional areas, as this would result in many clients moving away from their families and support networks. In Victoria for example, up to 43 percent of YPIRAC had not consented to participation in the YPIRAC Program, either due to the fact that they are happy with current arrangements, or did not respond to invitations. Similarly almost 50 per cent of YPIRAC had indicated after their initial assessment that they did not want to relocate.
• Jurisdictions have reported difficulty in predicting the target group at risk of entering RAC. As part of meeting PO2, it is important to be able to plan for provisions for future Program recipients and future resource requirements.

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Regional and remote areas

There are significant challenges in responding to the needs of YPIRAC in rural and remote areas. The challenges include the following:

• Many regional areas are sparsely populated with insufficient critical mass of clients and services to cost effectively deliver community-based accommodation or services.
• The YPIRAC Program responds to varying medical conditions, disabilities and changing needs of many high support need clients. Even in larger regional areas where more than a number of YPIRAC Program clients may be based, developing a cost-effective, individually tailored delivery model can be very challenging.
• In many instances clients express a preference for placements in locations where they grew up or are familiar with. These are often not available in regional and remote areas. Clients therefore remain in RAC because of lack of alternatives.

There have been some innovative responses to these challenges within the Program. In Queensland, clients supported under the YPIRAC Program in remote areas share arrangements with clients supported under other funding Programs. Each funding Program contributes a proportion of funding based on their client needs. Similarly in Victoria in some instances, YPIRAC and older carer Programs combine funding to create a more sustainable pool of service delivery for a larger client group.

The YPIRAC Program Victorian model has also funded a support person to implement the Program regionally. The support person is responsible for direct communication with Program clients and their families, as well as the coordination of support packages.

4.4.4 Challenges – Planning future service delivery

Clients with high-level complex needs require security in their support arrangements which have to be able to respond to their current and future needs. This places demands on Program capacity for continuity of service, planning for ‘whole of life’ as well as for key transitions and changing rehabilitation, health and other support service needs.

Program continuity

Service users are concerned that the lack of recurrent funding beyond the initial five-years of the Program will place their support arrangements at risk in the future. This is of particular concern for people who are currently settled in RAC who are being asked to considering relocating, as their current arrangements appear to provide them with future security.

Linked with this Program, managers indicate that service users have expectations of recurrent funding. Currently, there is a lack of information about exit strategies to support clients should on-going funding not be available.

Furthermore, Program managers have found that the lack of clarity around recurrent funding has also contributed to a high turnover of YPIRAC Program staff. In NSW for example, all YPIRAC Program appointments are made on a temporary basis. In Tasmania, the YPIRAC Program manager position has been held by three different people.

It is noted that the Bilateral Agreements contain a provision of ongoing funding, should a five-year evaluation support the Program’s overall success and cost-effectiveness.

Transition planning

Transition planning has been defined by jurisdictions in a number of different ways:

• Transition from RAC to new accommodation: The need to provide equipment and support to families and clients as they relocate from hospital or RAC into their homes or new accommodation.
• Transition necessitated by increasing support needs: The need to develop Program responses to assist clients as their support needs increase, particularly in relation to degenerative illnesses. This may require them to re-enter RAC.
• Transitions required by changing needs over time: The need for the Program to respond to different medical conditions, support needs or client desires, that may develop during their lives.

The Summer Foundation report into YPIRAC in Victorian found that of the research participants, 58 per cent had entered RAC due to an increase in their needs and 16 per cent had been cared by someone who was no longer able to care for them. Seventy-seven per cent of YPIRAC had four or more medical conditions, with 52 per cent utilising five or more items of specialised equipment (2007, 17-100).

In Queensland, the YPIRAC Program has developed strategies to assist with managing transitions by taking a continuum of care approach to enable the Program to respond to the changing needs of clients throughout their life course. Similarly Victoria has developed strategies such as the Continuous Care Project with the MS Society to manage degenerative neurological conditions and delay as much as possible entry or re-entry into RAC.

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Rehabilitation

In their analysis of the YPIRAC Program initiative, Foster, Fleming and Tilse (2007) identified people with ABI as the single largest category of YPIRAC, accounting nationally for 30 per cent of clients. Reporting by jurisdictions supports this.

Foster et al (2007, 314) argue that supporting people with ABI requires harnessing the interface between health, rehabilitation and disability support services and identifies this as a key challenge for the YPIRAC Program. They argue that the YPIRAC Program should place people with ABI and their families inside of and with clear access to the health and rehabilitation systems and specialist frameworks that have been designed to promote recovery for this population. Rehabilitation is currently outside the scope of the YPIRAC Program.

The importance of an ongoing rehabilitation regime in managing many complex conditions is well understood within the Program. The need for increased Program focus on this has been identified by some jurisdictions as an important future challenge for the Program.

4.4.5 Challenge - communicating the complexity of client needs and the service delivery context

As with all government programs, there are demands on jurisdictions to report quantitative achievements and data on clients to enable confidence in program achievements and expectations about efficiency and accountability. Reporting by governments is therefore less likely to include qualitative information that may be available regarding programs, including information which demonstrates the texture and the challenges of program implementation. However, it is acknowledged that the opportunity to consider qualitative outcomes will be addressed in formal program evaluations and reviews.

This document, through the use of examples seeks to contribute to this qualitative understanding.

4.5 Mid Term Review – discussion of conclusions

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. While most jurisdictions reported initial delays in developing processes, recruitment and capital works, it is expected that the impact of these will be contained to the first two years of Program implementation. These provide the necessary Program building blocks for future delivery. These foundations will support meeting Program placement targets over the five years of the Program.

4.5.1 Current progress toward the objectives

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 POs, a net reduction of 149 YPIRAC had been achieved (see table 13).

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 RAC.

These findings are particularly interesting given that most jurisdictions have indicated relatively slower progress towards achieving targets for PO1, as capital works have not been completed at this stage of implementation and the large number of diversions reported as part of PO2.

Table 13 –net reduction in YPIRAC 2006-2008

	NSW	VIC	SA	QLD	WA	TAS	NT	ACT
No. of YP in RAC (0-49 yrs old) in 2008	336	209	55	179	58	11	6	4
No. of YP in RAC (0-49 yrs old) in 2006	391	221	60	244	65	15	7	4
Decrease (2006 to 2008)	-55	-12	-5	-65	-7	-4	-1	0

Source: Australian Institute of Health and Welfare, YPIRAC Program Final Report on the 2007-08 Minimum Data Set, Table 5.2
(N.B. this data includes young people with disability in residential aged care who have died or aged out of the Program)

As previously noted, jurisdictions have indicated that they expect further achievements in the next Program period, particularly as capital works are finalised. This is supported by the percentage of total Program funding that will be provided to jurisdictions in the final two years of the Program – in most cases 62% of Program funding is yet to be provided (see table 14).

Table 14 – Program Funding

Jurisdiction	Funding provided in 2006-07	Funding provided in 2007-08	Funding provided in 2008-09	Total remaining funding ($) to be provided in 2009-10 and 2010-11	Percentage of total Program funding to be provided in 2009-10 and 2010-11
NSW	$1,332,422	$4,663,477	$9,326,954	$25,316,018	62
VIC	$987,746	$3,457,111	$6,914,222	$18,767,172	62
QLD	$782,503	$2,738,759	$5,477,518	$14,867,488	62
SA	$301,714	$1,055,998	$2,111,995	$5,732,558	62
WA	$397,012	$1,389,543	$2,779,085	$7,543,232	62
TAS	$95,103	$194,166	$1,031,250	$1,580,130	54
NT	$39,838	$139,433	$278,865	$756,921	62
ACT	$253,798	$540,744	$367,511	$779,655	40

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When looking at the individual performance of jurisdictions to date, for example, (see table 15), it is evident that in some instances there appears to be underperformance, particularly around PO1.

It was originally anticipated that by the conclusion of the 2008-09 financial year, between 188-241 people would have been relocated from RAC (PO1). At the December 2008 reporting period however, the total number of YPIRAC relocated was 70.

For example:

In New South Wales...

• Original forecast to relocate between 44-88 people by June 2009, had achieved 2 relocations by December 2008.

In Victoria...

• Original forecast to relocate 71 people by June 2009, had achieved 19 relocations by December 2008.

In Western Australia...

• Original forecast to relocate 12 people by June 2009, had achieved 3 relocations by December 2008.

In South Australia...

• Original forecast to relocate 24 people by June 2009, had achieved 17 relocations by December 2008.

In Queensland...

• Original forecast to relocate between 35-43 people by June 2009, had achieved 25 relocations by December 2008.

Jurisdictions have indicated that in the fourth and fifth year of the Program, they expect a significant increase in the number of clients relocated from RAC. Much of this delay has been attributed to the development and/or modification of capital provisions.

Further progress towards achieving original targets will make a significant numerical contribution towards achieving an overall net reduction nationally.

Table 15 – PO1 and PO2 achievements as reported by Jurisdictions in the December 2008 reporting period

	NSW	VIC	SA	QLD	WA	TAS	NT	ACT
PO1	2	19	17	25	3	1	2	1
PO2	2	41	19	35	16	3	6	7
Total	4	60	36	60	19	4	8	8

This Review notes that:

• 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. Table 16 provides a summary of the current progress towards achieving forecast objectives.
• While overall Program targets will be achieved, these may not represent the anticipated distribution of clients across PO1, PO2 and PO3, as outlined in the Bilateral Agreements.
• Jurisdictions have very limited control over the factors that influence younger people entering RAC and whilst forecast targets, at this stage are likely to be achieved, these cannot be guaranteed due to a range of previously discussed factors outside the control of the Program.

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Table 16 – Current progress towards objectives

Priority Objective and focus	Desired Program outcome	Current progress toward the objective
One – Relocation of current younger people in RAC care facilities.	Net reduction in numbers of younger people in RAC.	Limited number of service users choosing to relocate. In particular jurisdictions, up to 50% of service users have indicated that they will not be relocated Initial delays in the development of and modification of capital provisions. It is expected that targets will be met by years four and five.
Two – Diversion of younger people at risk of entering RAC	Reduction in new service users entering residential aged care therefore preventing a net increase in new admissions of younger people into RAC. Net reduction in numbers of younger people in RAC.	High success in service user engagement with overachievement in this target area by many jurisdictions. Given the large number of clients with high and very high needs, this has attracted higher costs that those initially anticipated. To ensure service provision in remote or rural areas, Program funding in these instances has often been combined with other Programs.
Three – Supporting younger people in RAC.	Supporting younger people in RAC to enhance quality of life outcomes	High success in service user engagement and a range of strategies to enhance quality of life.

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