Changes to Aged Care in Australia and Chronic Oedema Screening

From July 2024, the home support assessment and the comprehensive assessment will be combined to form the integrated assessment tool. At this stage, funding of at-home aged care programmes will remain the same. The diagram below shows these changes. 

The integrated assessment tool (IAT) will replace the National Aged Care Screening and Assessment Form (NSAF) to assess people wanting to access government-subsidised aged care.

The tool will enable the assessment workforce to collect more complete information and have the flexibility to record the individual story of each older person and their carers.

The tool will promote quality of assessment by ensuring:

• assessors follow minimum standards for assessments.
• assessments are consistent and standardised so that people with the same needs access the same services.
• assessors tailor service recommendations and referrals to each person’s needs
• assessors work in partnership with the older person accessing care to set goals and plan care, with a focus on reablement.
• older people and their families only have to tell their story once.

The IAT will be implemented by health professionals as well as non-health professionals, depending on the individual’s needs. The assessment aims to be face-to-face unless there is a reason it can’t be. For low-level needs, not all of the sections of the IAT will be included.

The integrated assessment tool (IAT) has 13 sections, as shown in the diagram below. Section 7, physical, personal health and frailty is relevant to chronic oedema.

Ref: https://www.health.gov.au/our-work/single-assessment-system-for-aged-care/assessment-tool 

In section 7 the question about any major skin conditions( diagram below) is where chronic oedema will be screened. This is a base question which is mandatory to complete. Therefore, regardless of the level of care the person may need, or whether the assessor is a health professional or not, this question must be completed. The assessor will complete the following:

• Ask the person if they have a history of swelling in their feet and ankles.
• Observe the feet and ankles for the presence of swelling.
• Where possible, perform a 10 second pitting test, which involves pressing the thumb on the top of the foot and behind the ankle bones on both feet. Observe if a dent is created.
• If swelling is observed or a dent is created, a referral to a health professional is instigated for further assessment and management.

Ref: https://www.health.gov.au/our-work/single-assessment-system-for-aged-care/assessment-tool

The inclusion of chronic oedema screening is an important step. Hopefully, it will facilitate both early intervention and management and provide a way to obtain data on the prevalence of chronic oedema in the ageing population.

July 2025

In July 2025 home care packages and short-term restorative care will be replaced by support at home (diagram below). The Commonwealth home support programme will remain the same. A new funding model will be introduced with 11 budget levels that cover all clients. Clients can be re-assessed into higher levels as they age. Reasonable prices and client fees will be set by the government. Providers will invoice for services after they are delivered. Extra funds will be available for rural and remote areas. The client will still have a single provider. Details about the 11 budgets and funding for chronic oedema management are not yet available. There will also be a new assistive technology and home support modification scheme. It is hoped that compression garments will be included as part of this scheme.

No earlier than July 2027

Commonwealth home support programme will join the support at home home which will mean there will be a single program for care in the home. Participants can choose to have a single provider or access services from multiple providers. There will be the same funding model across all providers and a single assistive technology & home modification scheme.