2016-17 AGED CARE APPROVALS ROUND

PART D - SHORT-TERM RESTORATIVECARE PLACES

2016-17 & 2017-18

Organisation name: (if approved provider, insert approved provider name)
Service name:

Please select the state/territory and the aged care planning region in which the

Short-Term Restorative Care places are sought

State/Territory / Select oneNSWVICQLDSAWATASACTNT / Aged Care Planning Region

The Aged Care Planning Region name must align with the state or territory where places are being sought. Aged Care Planning Region names and boundaries are available at the following link.

If your organisation is notapproved as a provider of Flexible Care, have you completed and submitted the application for Approval as an Approved Provider of Flexible Care?

YesNo

Form Instructions

If you are applying for Short-Term Restorative Care places only you must complete:

  • Part A – Aged Care Application form once for your organisation
  • Part D – Short-Term Restorative Care Places application form for each service for which you are seeking an allocation of short-term restorative care places in the selection Aged Care Planning Region.

If you are seeking an allocation of residential aged care places for this service in addition to an allocation of Short-Term Restorative Care places, you must complete a

Part B – Residential Aged Care Places application form.

Only attachments specifically requested should be included with your application. Additional attachments provided will not be considered during the assessment process.

Detailed information about completing this application form is included in the 2016-17 Aged Care Approvals Round (ACAR) Essential Guide.

Part D – Short-Term Restorative Care Places

Section 1 – Service Details

1.1Service Information

Is this an existing aged care service? / Select oneYesNo
If yes, what type of service/s do you currently provide?
Approved Provider ID
RAC Service ID (existing service only)

1.2 Service Address

Street number
Street name
Street type
Suburb/town
State/territory / Select oneNSWVICQLDWASATASACTNT
Postcode

1.3 External Accreditation

If allocated STRC places, will you seek to have this service fall under the definition of an externally accredited service?
If yes, complete the questions below. / Select oneYesNo
What accreditation is in force with respect to the service?
Which body issued this accreditation?
Is the body that issued the accreditation a government, or non-government body? / Select oneYesNo
Mandatory attachments / Please attach to your application a copy
(a)your service’s current Accreditation Certificate from the accrediting body (if date and period of accreditation is not included on the certificate these must also be provided);
(b)the service’s most recent accreditation report; and
(c)any conditions of your accreditation.
Part D – Short-Term Restorative Care Places
Section 2 – Short-Term Restorative Care Places Sought

INSTRUCTIONS

Before completing this section, you must refer to Chapter 5of the 2016-17 ACAR Essential Guide.

You must enter the maximum and minimum number of places you are seeking for this service in this Aged Care Planning Region in each financial year, together with the date by which your proposed service will be able to commence Short-Term Restorative Care delivery.

You may also note the SA3 geographic locations you intend to target within the Aged Care Planning Region.

2.1 Number of places sought in this Aged Care Planning Region.

2016-17
Target SA3
Geographic Locations
(if any) / Number of Places / Date of Commencement^^
Maximum / Minimum
2017-18
Target SA3
Geographic Locations (if any) / Number of Places / Date of Commencement^^
Maximum / Minimum

2.2 What care setting do you propose to deliver the Short-Term Restorative Care places?

In a home setting

In a residential care setting

A combination of both a home setting and residential care setting

Part D – Short-Term Restorative Care Places
Section 3 – Service Proposal

3.1 Provide a detailed description of the model of service delivery your service proposes to adopt to meet the objectives of the Short-Term Restorative Care Programme, including:

how your service proposes to deliver care in a home care setting or a residential care setting, or a combination of both settings

how the proposed setting(s) will be able to meet client needs

if, when and how it will transition care recipients between care setting

This form is approved under paragraph 13-1(c) of the Aged CareAct 1997.

Word limit 750

This form is approved under paragraph 13-1(c) of the Aged CareAct 1997.

3.2 Describe how your service proposes to source the additional capacity it requires to commence Short-Term Restorative Care service delivery on the dates you have provided under Section 2.1 of this form.

This form is approved under paragraph 13-1(c) of the Aged CareAct 1997.

Word limit 750

This form is approved under paragraph 13-1(c) of the Aged CareAct 1997.

3.3 Describe how your service proposes to use linkages to the community or communities in which you propose to provide Short-Term Restorative Care (including linkages to primary care and other service providers), and how these linkages will support a multi-disciplinary approach to care delivery.

This form is approved under paragraph 13-1(c) of the Aged CareAct 1997.

Word limit 750

This form is approved under paragraph 13-1(c) of the Aged CareAct 1997.

How many hours did your organisation take to complete this ACAR Short-Term Restorative Care Places application?

This form is approved under paragraph 13-1(c) of the Aged CareAct 1997.