In February 1997, Commonwealth and State/Territory government officials responsible for the Home and Community Care Program (HACC Officials) commissioned the Australian Institute of Health and Welfare (the Institute) to undertake developmental work on a national HACC Minimum Data Set. The Home and Community Care (HACC) Program assists frail older people, younger people with disabilities, and their carers by providing support and assistance to those living at home or in the community. It aims to prevent premature or inappropriate institutionalisation, by providing appropriate home- and community-based services. The HACC program is jointly funded by the Commonwealth and State and Territory Governments.
The need for a review of HACC data requirements arose in response to several developments. The program had grown rapidly since its inception in 1985, with expenditure in 1995–96 two and a half times greater than it was in 1985–86 in real terms (AIHW 1995, 1997). There were a number of changes in the administration of the HACC program over recent years, and in the broader policy environment in which the program operates. In addition, various reviews and reports had pointed to the need for better data in the HACC program.* HACC Officials agreed that improvements in the quality and reliability of HACC data were necessary to ensure program accountability and to assist with planning and monitoring of the program.
The existing data collections (the HACC Service Provision collection, the HACC User Characteristics collection and the Community Options Project collections) had provided much needed data on home-based care over the last decade. They suffered, however, from some major limitations which increasingly impinged on the policy appraisal and planning processes as home-based care became a larger and more central part of the national aged care service system. Most importantly, these data do not provide comprehensive answers to questions such as:
- How many people receive HACC services?
- How much HACC service is provided in a particular region?
- What ‘package’ of care does an ‘average’ HACC client receive?
- What is the dependency profile of the HACC client population?
- What does it cost to support a ‘high dependency’ HACC client?
The proposed new national database for HACC was intended to make it possible to answer such questions, and to this end HACC Officials emphasised that the new MDS should be client-centred and have an outputs/outcomes focus rather than a focus on processes or inputs. The development of such a database was made difficult, however, by the nature of the HACC program itself. While jointly funded by the Commonwealth and State/Territory Governments, the program is managed at the State/Territory level. There are approximately 4,000 service delivery outlets across Australia, some of which are part of a large organisation such as Home Care in New South Wales or Silver Chain in Western Australia, while others are small stand-alone agencies staffed by only one or two persons. The agencies provide a wide range of services, including home help, community nursing, allied health care, delivered meals, transport, personal care, respite care, centre day care, home maintenance, home modification, social support, information, advocacy, formal linen services, training and development. Clients can, and often do, access services from more than one agency in the same episode of care. Usage of computers and computer-based data systems varied from the sophisticated to the non-existent. Taken together, these factors constituted some serious difficulties to be overcome in developing a new MDS capable of providing the required information for policy appraisal, accountability and planning purposes.
* The Efficiency and Effectiveness Review of the Home and Community Care Program: Final Report (DHSH 1995), Home But Not Alone (House of Representatives Standing Committee on Community Affairs 1994), and Everyone’s Future (H&CS 1993).