Table 10.1: Most Relevant International Residential Care Systems – New Zealand Auditing of Funding Country Payment level determination Mandated Care funding tool Care Classification levels Review of needs Claims New Pre-entry – External Assessor None Four facility External Assessor None Zealand classifications and DHBs fund residential care. interRAI is done pre and post Facility must complete Facility assessor related funding types. entry. NH inter-RAI within 21 requests review if DHBs determine the level of care Rest home. days post admission and resident has higher needed by having NASC teams interRAI used for MDS and to Hospital care. facility can dispute the care need than facility conducting assessments using the promote care planning not Specialist dementia allocated home type type can manage. community inter-RAI. (Valid for used for funding. care with locked unit level. Local Health Body Considering using the facility accommodation. Visit from an External (DHB) - NASC assessor This model provides a transparent completed interRAI – RUGs Psychogeriatric care Assessor determines determines if move and consistent assessment ADL but concerned it may associated with decision. approved. approach. increase payments due to hospital care. inflated ratings Facility asks for home Assessments and judgement by interRAI completed type review using NASC teams assigns resident to one Considering moving to and DHB has access interRAI & NASC of four care levels. interRAI and RUGs for not to all data. determines outcome, only needs but funding Each care level attracts one flat may require visit. The assessment. payment amount. decision to move to a Providers have indicated that higher-level care facility the length of time to is made in consultation complete the interRAI with facility staff. assessments and the efforts Higher care facilities are to regularity repeat the often on the same assessments is a significant campus as lower level resource demand. options.
Table 10.1: Most Relevant International Residential Care Systems – New Zealand Country Payment level determination Mandated Care funding tool Care Classification levels Review of needs Auditing of Funding Claims New Zealand Pre-entry – External Assessor DHBs fund residential care. DHBs determine the level of care needed by having NASC teams conducting assessments using the community inter-RAI. (Valid for This model provides a transparent and consistent assessment approach. Assessments and judgement by NASC teams assigns resident to one of four care levels. Each care level attracts one flat payment amount. None interRAI is done pre and post entry. interRAI used for MDS and to promote care planning not used for funding. Considering using the facility completed interRAI – RUGs ADL but concerned it may increase payments due to inflated ratings Considering moving to interRAI and RUGs for not only needs but funding assessment. Providers have indicated that the length of time to complete the interRAI assessments and the efforts to regularity repeat the assessments is a significant resource demand. Four facility classifications and related funding types. Rest home. Hospital care. Specialist dementia care with locked unit accommodation. Psychogeriatric care associated with hospital care. interRAI completed and DHB has access to all data. External Assessor Facility must complete NH inter-RAI within 21 days post admission and facility can dispute the allocated home type level. Visit from an External Assessor determines decision. Facility asks for home type review using interRAI & NASC determines outcome, may require visit. The decision to move to a higher-level care facility is made in consultation with facility staff. Higher care facilities are often on the same campus as lower level options. None Facility assessor requests review if resident has higher care need than facility type can manage. Local Health Body (DHB) - NASC assessor determines if move approved.
acfi_review_report_part_2_main_report.docx