Access and Support Services
Working with My Aged Care and Regional Assessment Services
To take effect from 1 August 2016 FINAL DRAFT
14 July 2016 Version 4 FINAL DRAFT

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From 1 July 2016 people seeking access to services under the Commonwealth Home Support Program (CHSP) for the first time need to contact My Aged Care to discuss their needs and have a client record created. Existing clients whose needs have changed significantly and who need additional support will also need to register with My Aged Care.

This information sheetprovides guidelines for Access and Support (A&S) services on how to work with Regional Assessment Services (RAS) to support their clients to access to CHSP services.It will also assist other CHSP providers to understand how A&S service can assist people through My Aged Care.

What is Access and Support?

A&S services play a key role in supporting access to services and improved service responses for people who may be disadvantaged due to their diversity characteristics. A&S services often support people at various stages throughout the client pathway.

A&S aCHSP funded activity under ‘specialised support services’ and is currently a funded activity of the Victorian HACC Program for Younger People.The percentage of A&S services targeted to peopleaged under or over age 65 (under or over age 50 for Aboriginal people) will depend on each agency’s Commonwealth and State A&S funding split.

Theseguidelines describe the role of A&S services in supporting new clients to access CHSP services through My Aged Care.

People eligible for Access and Support services

People accessing A&S services must be:

•seeking aged care services such as CHSP

•have a diversity characteristic and face barriers to accessing services or staying in services because they:

–are unsure about how to communicate their need for assistance

–have little or no knowledge about aged care services

–have little or no experience in using aged care services

–are not aware of their eligibility for aged care services or lack confidence to find out if or how aged care services could potentially help them

–think that services may not understand their needs or respect their preferences[1].

A&S has a key focus on the CHSP special needs groups:

•People from Aboriginal and Torres Strait Islander communities

•People from culturally and linguistically diverse CALD backgrounds

•People who live in rural and remote areas

•People who are financially or socially disadvantaged

•Veterans

•People who are homeless, or at risk of becoming homeless

•People who are lesbian, gay, bisexual, transgender and intersex

•People who are care leavers

•Parents separated from children by forced adoption or removal[2].

A&S also takes into account other diversity considerations such as people living with dementia, age, gender, faith and spirituality.

Some A&S eligible people may need relatively low level care, while other people may need higher levels of care. Regardless of their level of need, to receive support from an A&S worker, the person must be experiencing barriers to accessing aged care services as a result of their diversity. If a person has high care needs but no barriers to access because of their diversity characteristics, it is not the role of an A&S worker to assist them.

It is the responsibility of the A&S service to determine the priority of a person to receive support from an A&S worker. Not all people seeking CHSP services will be eligible or a priority for A&S services.

A&S role in the client pathway

CHSP eligible people may seek A&S support, or may be identified as needing A&S support, for part of or throughout the client pathway. The role of A&S services is to:

  • use assertive outreach to identify people who may be eligible for CHSP services
  • support the person to make contact with the My Aged Care contact centre, and through the registration and screening process
  • support the person through the RAS assessment and supportplanning process, and
  • support the person until they are familiar with the CHSP service.

A&S services also provide secondary consultation to agencies on request to support service providers to improvetheir service responses to targeted communities.

RASs are encouraged to meet with the A&S service to understand the A&S service catchment area, the A&S service target group (eg Aboriginal, CALD, dementia) and the issues for potential clients from the particular target group around accessing assessment and/or services.

My Aged Care

The table below shows the client pathway through My Aged Care and the roles and responsibilities of both the RAS and A&S services at each step in the process.

Contact Centre: registration and screening

•The A&S service prepares the client for contact with the My Aged Care contact centre by explaining the screening and assessment processes.This may include informing the client that they can nominate the A&S service as their regular representative on the contact centre action plan.
•The A&S service can organise an interpreter through Telephone Interpreter Services (TIS), if required, in readiness for the phone call to the contact centre OR alternatively, the A&S worker can request My Aged Care to organise this.
•The A&S service supports the client to make the phone call to the contact centre,with the client’s consent, and helps them understand and answer the questions.
•The contact centre registers the client and creates a client record with the A&S servicenominated,with the client’s consent,as theirregularrepresentative.
•The contact centre commences a National Screening and Assessment Form (NSAF) and develops an action planwhich includes the role of the A&S service,at the client’s request.
•The contact centre sends an electronic referral for a home supportassessment.
If the person’s preference is NOT to register through the Contact Centre, the Regional Assessment Service can register the person using the assessor portal in My Aged Care. (Section 3.1.2: My Aged Care RAS Guidelines). See home support assessment below.

RAS: home support assessment(if an A&S service has been nominated by the client to assist them)

•The RAS receives areferral from My Aged Care with the A&S worker nominated, with the client’s consent, as theclient’s regular representative.
•The RAS contacts the A&S service to discussthe client’s particular circumstances and to identify suitable dates for a client home support assessment. The assessment date would take into consideration the assessor, client and the A&S worker’s schedule.
•The A&S service contacts the client and/or carer to inform them of the assessment and to find out their preferred date/time for the assessment.
•The RAS organises a face to faceinterpreter through the Victorian Interpreting and Translating Service (VITS), if required.
•The RAS conducts a client face to face assessment with the A&S servicein attendance.
•The RAS develops a support plan that includes the role of the A&S service,if requestedbythe client.
•The RAS refers the client to a CHSP service provider for service provision. The RAS also refers the client to the A&S service.
•Where the client needs several services the RAS will be the key coordination point for My Aged Care linking services support.
Special circumstances - Facilitated Registration
The facilitated registration process streamlines the registration, screening and assessment process.
•The A&S service, together with the client can ring the RAS and request a Facilitated Registration if this is what the person prefers.
•Facilitated registration means that the RAS will register the client at the face to face assessment visit.
•In consultation with the Regional Assessment Service assessor the A&S servicearranges the assessment date and place and attends the assessment with the client.
•The RAS organises the face to face interpreter using VITS.
•The Regional Assessment Service creates a Support Plan and sends a referral to the relevant CHSP provider(s)and to the A&S service.
Access to the client’s aged care client record
A&S workers need to read the client’s aged care client record in order to provide the appropriate support. A&S agencies need to ensure that their A&S workers have the appropriate access to the person’s registration and assessment information through My Aged Care.

CHSP provider: service provision

•The CHSP service provider acceptsthe electronic referral from a RAS. The A&S service is identified in the clients support plan as the client’s regular representative.
•The CHSP service provider liaises with the A&S service about suitable dates for a client service level assessment, with consideration of the CHSP provider schedule (including other CHSP service providers on the support plan), the A&S service schedule and the availability of the client and their carer (if needed).
•The A&S service contacts the client to explain the service level assessment process and to find out the client’s preferred date for the service levelassessment.
•The CHSP service provider organises a face to faceinterpreter through the Victorian Interpreting and Translating Service (VITS), if required.
•The CHSP service provider service conducts a service level assessment with the A&S service in attendance, then enters the client service information on the client record on the My Aged Care provider portal.
•The A&S servicesupports the client until they are settled into CHSP services.
Client discharge from Access and Support
When the A&S service discharges the client, consideration should be given to changing the person who is nominated as their regular representative on the client record. The A&S servicemay not be appropriate as the person’s representative once the client is discharged.

Refer to the following page for a diagram showing the Access and Support and My Aged Care pathway.

Heather Russell

Manager Service Development

HACC and Assessment Unit

Further information: My Aged Care:

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Access and Support services: Working with My Aged Care and RAS (with client consent)

*TIS = Translating and Interpreting Service (Commonwealth)

*VITS = Victorian Interpreting and Translating Service

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[1]Diversity planning and practice in HACC services in Victoria: a practice guide for HACC A&S roles, Sept 2013

[2]Commonwealth Home Support Programme manual, 2015