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Protocol about Younger People with Disability in, or at Risk of Entering, Residential Aged Care
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Intent of YPIRAC protocol
In almost all circumstances, the placement of younger people with disability in residential aged care (YPIRAC) is not a preferred option, especially for people aged under 50 years.
This protocol aims to prevent the admission of younger people with disability to residential aged care, except in exceptional circumstances.
Scope of YPIRAC protocol
This protocol applies to policies and procedures within the Department of Human Services (DHS).
The target group is people under 65 years of age (50 years for Aboriginal Australians) who are:
- eligible for services through Disability SA and
- in, or at risk of entering, residential aged care
This protocol is underpinned by a range of operational guidelines.
Categories of YPIRAC protocol
This protocol refers to categories of unmet need within Disability SA. These are:
- Category 1 (Critical): homelessness or immediate danger of actual harm to self/others.
- Category 2 (Evident): risk of homelessness or harm to self/others.
- Category 3 (Potential): deteriorating health and/or ability of person or carer.
- Category 4 (Non-urgent): meeting the need would improve the person's current situation.
Background of YPIRAC protocol
National YPIRAC Program
Between 2006 and 2011, the national Younger People in Residential Aged Care (YPIRAC) program was delivered by all states and territories to progress three objectives:
Diversions: To divert younger people with disability at risk of entering residential aged care into more appropriate accommodation and support;
Exits: To move younger people with disability currently in residential aged care into appropriate supported disability accommodation, where such accommodation is available and the person chooses to move; and
Enhancements: To enhance the delivery of specialist disability services to those younger people with disability in residential aged care.
While the primary focus of the initiative was on those aged less than 50 years, the program targeted all people with disability aged under 65 years in, or at risk of entering, residential aged care.
YPIRAC in South Australia
The South Australian YPIRAC program focused on the development of 'cluster' accommodation sites. This maximised the number of younger people with disability with high and complex needs supported through the program, while promoting individual choice and control within these settings. Eight sites were established under the program, providing accommodation for 46 people.
The national YPIRAC program concluded in June 2011. Ministers across all jurisdictions have committed to maintaining effort consistent with the objectives of the program.
Principles of YPIRAC protocol
The following principles underpin the department's responses to the YPIRAC cohort:
- People with disability have the right to be able to determine their own best interests, including the right to exercise informed choice and engage as equal partners in decisions that will affect their lives, to the full extent of their capacity.
- People with disability have the right to available and appropriate assistance and support that will enable them to maximise their capacity to exercise choice and control, and realise their potential.
- People with disability have the right to participate in and contribute to the social, cultural, political and economic life of the community on an equal basis with others.
- Residential aged care services are designed specifically to meet the needs of frail older people, and are not oriented to provide for the needs of younger people with disability.
- Younger people with disability in, or at risk of entering, residential aged care, should have access to specialist disability accommodation and support services that are appropriate to their needs.
- Disability SA should only refer younger people with disability to aged care services when all disability service options have been exhausted and no other services more appropriate to meet the person's needs are available.
DHS responses to achieve YPIRAC objectives
- For Disability SA clients under 65 years of age, residential aged care is considered only when all age-appropriate, community-based options have been explored and it is evident that these options are not appropriate or available. Disability SA case managers document the options that have been explored through individualised, person-centred planning processes involving the person with disability and their family or carers.
- Following this planning process, residential aged care may be the clear preference of the person with disability and/or their family or carers. Where this is the case, this is clearly documented.
- Access to supported accommodation for younger people with disability at risk of entering residential aged care requires referral to Disability SA's Accommodation Placement Panel (APP). The APP is the central mechanism within Disability SA for diverting younger people with disability from residential aged care. APP monitors clients who are registered as Category One on the Disability SA unmet needs register and matches these clients with supported accommodation vacancies across the State.
- A Disability SA client under 65 years of age who is at risk of entering residential aged care is registered as Category One on the unmet needs register.
- People with disability under 50 years of age in or at risk of entering residential aged care are prioritised across all categories of the unmet needs register, in addition to children and young people under the Guardianship of the Minister and Aboriginal and Torres Strait Islander peoples.
- Vacancies arising within accommodation services developed under the national YPIRAC initiative are filled by those on the unmet needs register who meet the YPIRAC criteria.
- Younger people with disability may be at risk of entering residential aged care from hospital due to an increased need for supports or services. In these circumstances, they may be eligible for Disability Transition to Community (DTC) funding which supports the safe and timely discharge of people with disability from public acute care settings to appropriate supported accommodation in the community. Requests for DTC funding are processed through the APP, with funding allocation decisions made jointly by DHS and SA Health representatives.
Conditions for Aged Care Assessment Team (ACAT) referral:
- For each referral of a younger person with disability at risk of entering residential aged care, the APP considers the documentation submitted outlining the options already explored with the person with disability and their family or carers. Where the APP confirms that all community-based supports and accommodation options have been exhausted, the APP may approve and facilitate referral to ACAT.
- Referrals through the APP of a younger person with disability for an ACAT assessment require approval by the Director, Community Services.
- Where the person with disability is aged under 50 years, additional approval by the Director is sought prior to a referral to ACAT being actioned. The Director is provided with a summary of the client situation and advised that no alternative options are available.
- Subject to client consent, the Disability SA case manager provides relevant documentation, including needs assessments and plans, to ACAT.
- Where ACAT receives a referral for a Disability SA client from a source other than Disability SA, ACAT is requested to refer back to Disability SA to ensure the usual approval and planning processes occur prior to ACAT assessment.
- Best practice in assessing a younger person with a disability involves joint assessment by ACAT and Disability SA. Where joint assessment is not possible, a 'case conference' approach involving the person and their family or carers and all relevant services may be initiated by Disability SA.
- The APP meets weekly but approval for referral to ACAT can be fast tracked in urgent circumstances. Fast-tracking means that APP approval for an ACAT assessment can be received within two working days. At least three of the following criteria must be met for fast tracking to be approved:
- Client aged 59 years or over or, if Aboriginal or Torres Strait Islander, 45 years or over.
- ACAT have indicated that the person's needs could be met by a residential aged care facility, including those relating to behaviour.
- The client has had a rehabilitation assessment and is not eligible for rehabilitation.
- The client has a rapidly deteriorating condition.
- The client has requested to move into residential aged care.
In partnership with Disability SA regional offices, the APP is also responsible for reviewing and responding to the needs of younger people with disability in residential aged care who wish to move.
- Category One priority on the unmet needs register is accorded to:
- Any person with disability under 50 years of age in residential aged care, regardless of choice.
- Any person with disability between 50 and 65 years of age in residential aged care who wishes to move to more suitable community-based supported accommodation.
- Category four (non-urgent) on the unmet needs register is accorded to any person between 50 and 65 years of age in residential aged care due to choice.
- All unmet needs are reviewed periodically.
Younger people with disability in residential aged care are encouraged to access age-appropriate community activities and maintain family and social relationships
Young People in Residential Aged Care Evaluation Report. This report outlines the findings from a small South Australian study that explored the effect of the Young People in Residential Aged Care (YPIRAC) program on clients.