Recommendations 11 - 15
That the Minister for Families, Housing, Community Services and Indigenous Affairs and Minister for Department of Health and Ageing direct their Departments to review the adequacy of case management or care coordination for carers and care receivers using community care, aged care, disability and community mental health services.
Adequacy of case management and care coordination for carers
As set out in response to Recommendation 4, the Commonwealth Government has undertaken to propose that relevant ministerial councils develop a national carer recognition framework. The Commonwealth Government will request that ministerial councils consider the adequacy of case management and care coordination in assisting carers in their caring role as part of the development of this framework.
Adequacy of case management and care coordination for care receivers
The Commonwealth Government agrees to examine the adequacy of case management and care coordination for disability services in the context of the National Disability Agreement. The Commonwealth Government has agreed with State and Territory Governments to give priority to developing a national framework for service planning and access. The framework will focus on providing a person‑centred approach to service delivery and simplifying access to specialist disability services, including through an examination of case management and care coordination approaches for people with disability and their carers.
The Council of Australian Governments’ National Action Plan on Mental Health (2006–2011) includes a new care coordination flagship program. This initiative involves a coordinated system of linking care between clinical and non-clinical services for people with severe mental illness. The new system is designed to build on existing coordination arrangements for people with severe and persistent mental illness and complex multi‑agency needs who are most at risk of falling through the gaps in the service system.
Case management is already an integral aspect of the services provided to aged people under the Commonwealth Government’s Community Packaged Care programs.
Further, case management for aged people, people with disabilities and their carers is provided as a specific service type under the jointly funded Home and Community Care Program. This service type comprises active assistance from a formally identified agency worker who coordinates the planning and delivery of a suite of services to the individual client.
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That the Minister for the Department Families, Housing, Community Services and Indigenous Affairs extend the National Disability Advocacy Program to:
- provide family advocacy services which better recognise the role of carers providing individual advocacy on behalf of, and with, care receivers; and
- provide formal advocacy for carers in their own right when this is required.
The Commonwealth Government, through the Department of Health and Ageing, provides funding to Carers Australia for a Carer Information and Support Service. The 2009-10 allocation for this program is more than $3.2 million. Individual carer advocacy is undertaken, where necessary, as part of the support provided to carers through this service.
The focus of the National Disability Advocacy Program is to protect the interests of the person with disability in line with the Disability Services Act 1986. It assists people with disability to overcome barriers that impact on their daily lives and their ability to participate in the community. Given this, it would not be appropriate to extend the National Disability Advocacy Program to provide formal advocacy services for carers in their own right.
The National Disability Advocacy Program includes a family advocacy stream. Family advocates work with parents, family carers and family members, on behalf of the person with disability, on a short‑term, long‑term or issues-specific basis. Ten agencies are funded under the National Disability Advocacy Program to provide family advocacy services. In 2008‑09 this funding equated to five per cent of total funding for the program.
Counselling, information and advocacy for carers of aged people and people with disabilities is provided as a specific service under the Home and Community Care Program. In 2007-08, around 15,000 carers accessed this service through the Home and Community Care Program.
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That the Minister for Health and Ageing review arrangements for systemic carer advocacy provided through Carers Australia and the network of state and territory Carer Associations.
The review should examine the extent to which arrangements for systemic advocacy represent the diversity of carer groups and consider whether these arrangements might need to be extended or reformed.
The Commonwealth Government, through the Department of Health and Ageing, currently funds Carers Australia to advocate for, and promote the interest of, carers with government, business, community sectors and other interested parties. The Commonwealth Government agrees to review its funding arrangements for systemic carer advocacy.
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That the Attorney-General, in conjunction with the Minister for Families, Housing, Community Services and Indigenous Affairs and the Minister for Health and Ageing, investigate whether the National Privacy Principles and the Information Privacy Principles, and equivalent provisions in state and territory privacy and mental health legislation, adequately allow carers to be involved in the treatment of the individuals for whom they care.
The Minister for Families, Housing, Community Services and Indigenous Affairs and the Minister for Health and Ageing promote to health and community care providers the importance of involving carers in the treatment and services for those receiving health and community care services.
AGREE IN PART
The Commonwealth Government agrees with this recommendation in part and is already undertaking significant work to investigate whether the National Privacy Principles and the Information Privacy Principles allow carers to be involved in the treatment of the people for whom they care; and to promote the importance of involving carers in the treatment and services for those receiving health and community care services.
In responding to this recommendation the Commonwealth Government notes that the Privacy Act and relevant regulation and policy are now the responsibility of the Cabinet Secretary, not the Attorney General.
National Privacy Principles and the Information Privacy Principles
The Australian Law Reform Commission considered the National Privacy Principles and Information Privacy Principles as part of its comprehensive report on Australian privacy laws, For Your Information: Australian Privacy Law and Practice, which was released in August 2008.
The Australian Law Reform Commission recommended that the provisions allowing disclosure of health information be revised to include an express provision to allow disclosure to a person who is primarily responsible for providing support or care to an individual.
The Commonwealth Government is responding to the Australian Law Reform Commission’s report in two stages with recommendations on creating a single set of privacy principles and reforming protections for health information to be considered in the first stage. It is anticipated that the Government will release a first stage response before the end of November 2009 and exposure draft legislation outlining the proposed reforms in early 2010.
Any reform in this area allowing carers to be involved in the treatment of the care receivers must be balanced with the need to uphold the rights of care receivers, including the right to live independently and the right to privacy as articulated in the United Nations Convention on the Rights of Persons with Disabilities.
Equivalent provisions in state and territory privacy and mental health legislation
The Australian Law Reform Commission also recommended that the states and territories apply the proposed new unified privacy principles to their public sector organisations and agree that the Commonwealth regulate the private sector, including the private health sector.
The Australian Law Reform Commission’s recommendations concerning the adoption of nationally consistent privacy laws, including relevant parts of mental health legislation, will be addressed through further consultation with the states and territories.
The Commonwealth Government will, through relevant ministerial councils, recommend that State and Territory Governments investigate whether their privacy and mental health legislation adequately allow carers to be involved in the treatment of the individuals for whom they care.
Promoting the importance of involving carers in treatment and services
The Commonwealth Government has also undertaken significant work to promote the need to involve carers in the treatment of, and services for, those receiving Commonwealth Government health and community care services.
The Commonwealth Government developed a Charter of Rights and Responsibilities for Community Care, to apply to Commonwealth Government funded programs under the Aged Care Act 1997 from 1 October 2009. The charter will include provisions for care recipients’ representatives to participate in decisions relating to care in situations where there is limited capacity, and for carers to be recognised as important partners in the decision making processes relating to care.
The National Respite for Carers Program, Community Packaged Care Programs and Residential Respite Program guidelines support and reinforce the importance of involving a person’s carer, family or other nominated representative in the assessment, design and delivery of the services the person receives.
The Commonwealth Government’s revised Australian National Mental Health Standards focus on several key principles for carers, including the right of nominated carers to be involved in the treatment of the care recipient, recognition of the important role played by carers in the care recipient’s life, and recognition that participation by carers is integral to the development, planning, delivery and evaluation of mental health services.
The Mental Health Respite Program, Personal Helpers and Mentors Program and Mental Health Community Based Program guidelines outline the importance of involving care recipients, their carers and families in service design and delivery.
The Fourth National Mental Health Plan (2009-2014), endorsed by all Health Ministers, also states that families and carers should be informed to the greatest extent consistent with the requirements of privacy and confidentiality about the treatment and care provided to the consumer, the services available, and how to access those services.
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That the Attorney-General promote national consistency and mutual recognition governing enduring powers of attorney and advanced care directives to the Standing Committee of Attorneys-General.
The Commonwealth Government agrees to continue to promote national consistency and mutual recognition of arrangements for enduring powers of attorney through the Standing Committee of Attorneys‑General. The Australian Health Ministers’ Advisory Council, an advisory body to the Australian Health Ministers’ Conference, is currently progressing the development of nationally consistent guidelines for advanced health care directives.
While legislation and regulation in this area is primarily a matter for State and Territory Governments, the Commonwealth Government will promote national consistency and mutual recognition through relevant committees.
The Commonwealth Government also notes work will be progressed in this area in response to the recommendations of the House of Representatives Standing Committee on Legal and Constitutional Affairs report Older people and the law.
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