Commonwealth of Australia
Aged Care Act 1997
Classification Amendment Principles 1998 (No. 1)
I, WARWICK leslie SMITH, Minister for Family Services, make the following principles under subsection 96-1 (1) of the Aged Care Act 1997.
Dated	1998.

Minister for Family Services
____________
1.   Name of principles
1.1   These principles are the Classification Amendment Principles 1998 (No. 1).
2.   Commencement
2.1   Section 11 is taken to have commenced on 1 October 1997.
2.2   The remainder of these principles commence on 1 November 1998.
3.   Amendment
3.1   The Classification Principles 19971 are amended as set out in these principles.

4.   Section 9.3 (Definitions)
4.1   Definitions of adjusted fee government nursing home, date of transfer, Hetti Perkins Nursing Home, hostel and transferred place:
Omit the definitions.
Note   Omit the note after section 9.3, substitute:
“Note: Definitions in Act
A number of expressions used in these principles are defined in the Aged Care Act 1997 (see Dictionary in Schedule 1), including: 
•	aged care
•	approved provider
•	care
•	classification level
•	extended hospital leave
•	flexible care service
•	residential care
•	residential care service
•	respite care
•	Secretary.”.
5.   Part 2 (Exclusion of care recipients)
5.1   Divisions 2 and 3:
Omit the Divisions.
6.   Part 3 (Progressive application of Parts 4 to 9 to excluded care recipients)
6.1   Omit the Part.
7.   Section 9.17 (Appraisal procedures)
7.1   Section 9.17:
Omit “The”, substitute “(1)     The”.
7.2   After subsection 9.17 (1), insert:
“(2)	The appraiser must take the steps in Table 3 for a care recipient from the first day when the care recipient enters the residential care service.
“(3)	However, for Questions 9 to 16 in Part 1 of Schedule 1, the appraiser should not include care needs of the care recipient for the period of 7 days starting on the first day when the care recipient enters the residential care service.
“(4)	Subsection (3) does not apply if section 9.23 applies to allow an appraisal to be made over a shorter period.”.
8.   Section 9.19 (Classification levels — care that is not provided as respite care)
8.1   After subsection 9.19 (2), insert:
“(3)	If a care recipient is a hostel care resident who, immediately before 1 November 1998, was not classified under Division 2 of Part 3, as in force before that day, the care recipient is taken to have a rating of A for each question in Part 1 of Schedule 1.”.
9.   Section 9.23 (Circumstance and shorter period)
9.1   Section 9.23:
Omit “If”, substitute “(1)     If”.
9.2   After subsection 9.23 (1), insert:
“(2)	However, if the care recipient was provided with care by an organisation approved under section 15.8 of the Flexible Care Subsidy Principles 1997, the appraisal may be made:
	(a)	if the care recipient was provided with care for a continuous period of 10 days — over the period of 10 days; or
	(b)	if the care recipient leaves the organisation before receiving care for a continuous period of 10 days — over the period that the care recipient was provided with care by the organisation.”.
10.   New Part 6A
10.1   After Part 6, insert:
“Part 6A — When classifications take effect
9.23A	Purpose of Part (Act, s 26-1)
	“This Part specifies the period within which the Secretary must receive an appraisal of the classification of a care recipient who enters care between 1 October 1997 and 31 December 1997 in order to determine when the classification takes effect.
9.23B	Appraisals received within the appropriate period
“(1)	This section only applies if the day on which provision of care to a care recipient began between 1 October 1997 and 31 December 1997.
“(2)	A classification of a care recipient (other than a classification in relation to care provided as respite care) is taken to have had effect from the day on which provision of the level of care specified in an appraisal to the care recipient began, if the appraisal is received by the Secretary within 3 months after the day on which provision of the care to the care recipient began.”.
11.   Part 7 (When classifications take effect)
11.1   Omit the Part heading, substitute:
“Part 7 — When respite care classifications take effect”.
12.   Part 8 (When classifications cease to have effect)
12.1   After section 9.29, insert:
“Division 3 — Expiry date for classification of care recipient — extended hospital leave
9.29A	Purpose of this Division (Act, s 27-1)
	“This Division specifies the expiry date for a classification of a care recipient who takes extended hospital leave.
9.29B	Expiry date for a classification of a care recipient — extended hospital leave
“If a care recipient takes extended hospital leave that ends after what would, apart from this section, have been the expiry date under section 27-1 of the Act, the expiry date for the classification of the care recipient is the day on which that leave ended.”.
13.   Part 9 (How classifications are renewed)
13.1   After section 9.35, insert:
“Division 4 — Reappraisal period — expiry date of classification occurs in certain circumstances
9.36	Purpose of this Division (Act, s 28-3)
	“This Division specifies the reappraisal period for a care recipient where the expiry date for classification of the care recipient occurs in certain circumstances.
9.37	Reappraisal period for classification if expiry date occurs in certain circumstances
“(1)	The reappraisal period mentioned in subsection (2) applies where the expiry date of a classification of a care recipient occurs:
	(a)	while the care recipient is on leave from a residential care service; or
	(b)	within 1 month after the residential care service recommenced providing residential care to the care recipient after that leave ended.
“(2)	The reappraisal period is the period of 2 months beginning on the day on which the provision of residential care to the care recipient through the residential care service recommenced.”.

14.   Schedule 1 (Appraisal procedures)
14.1   Omit the Schedule, substitute:
	SCHEDULE 1	Section 9.17
APPRAISAL PROCEDURES
PART 1 — MATTERS TO CONSIDER IN APPRAISING A CARE RECIPIENT
Guidelines for the interpretation of resident classification scale questions
The resident classification scale is a relative resource allocation instrument
The resident classification scale consists of 20 questions, each having 4 ratings.  The allocation of the 20 ratings, based on the assessed care needs of each care recipient, results in a score which places them on a nationally consistent scale, relative to all other people living in residential aged care facilities throughout Australia.
The elements in the resident classification scale have been selected as those elements of care that best discriminate between relative care needs.  Therefore, the resident classification scale provides a ranking, ranging from people with the highest care needs to those with the lowest care needs.
Using the Questions
Although the description for recording A for most questions is summarised as ‘No assistance’ or ‘Not applicable’, this does not, in general, mean that no care is given.  It may mean that ‘minimal care’ is given.  The weightings have been zero rated for statistical reasons since the scale is designed to measure relative care need.
The requirements of the B, C and D ratings are minimums for attaining that level.  Where a care recipient’s care needs are above the minimum for that rating, that will remain the applicable rating if they do not meet the criteria of the higher rating.
Where questions list examples, they are listed as an indicative guide and are not exhaustive.
The scale has been developed, and the weights calculated, to reflect supervision, observation, support, prompting and encouragement in the provision of care as well as physical assistance.  It incorporates the need for continuing assessment and the monitoring and review of care plans.
The resident classification scale is completed against a clearly defined and documented plan of care which has been based upon an assessment of the care needs of the care recipient.  The care needs will have been documented and the care plan will state what services are to be provided to meet these care needs.
Volunteers/purchased services
The resident classification scale takes into account care provided by volunteers or purchased at market rates by the facility for provision to care recipients.  If the care recipient meets the cost of any service then the facility cannot claim for that service.  Similarly, where services are provided by a government-funded service (either State or Federal) at a subsidised rate, or for free, they cannot be claimed for through the resident classification scale.

Q1	Communication
This question refers to the degree of assistance that the care recipient needs in communicating with staff, relatives and friends, and other care recipients, for whatever reason.  It measures the additional effort taken by staff to facilitate effective communication where care recipients have:
•	hearing loss not remedied by aids (or where there is resistance to the use of an aid);
•	visual impairment not remedied by spectacles or contact lenses;
•	speech impairments;
•	language difficulties (for example, care recipients with little or no English proficiency who do not live in their ethno-specific environment);
•	comprehension problems which contribute to communication difficulties.
It also takes into account the effort involved in cleaning and fitting hearing aids, spectacles and lenses.
If the care recipient has no difficulty with communication, record A.
If the care recipient requires assistance with cleaning and fitting of aids, record B.
If facility staff are required to spend additional time listening, speaking slowly and clearly, encouraging the care recipient to communicate or occasionally use non-verbal cues, record C.
If the care recipient requires assistance from facility staff on almost all occasions to communicate by translating or interpreting, or non-verbally — for example, signing, or using communication aids including talking boards or computers, record D.

Ratings	Q1	Communication	
No difficulty	A	Requires no assistance.	
Some difficulty	B	Requires assistance with cleaning and fitting of aids.	
Major difficulty	C	Requires additional time listening, speaking slowly and clearly, encouraging communication or occasionally using non-verbal cues.	
Extensive difficulty	D	Requires assistance to communicate by translating or interpreting;
OR
Requires communication by non-verbal means on almost all occasions.	

Independence — self-care
This section relates to independence in the activities of daily living.
Q2	Mobility
This question refers to the degree of assistance required by a care recipient with regard to mobility.  This includes:
•	assistance with walking on a one-to-one basis, including the provision of supervision, encouragement or physical support;
•	assistance in the use of mobility aids, including wheel chairs and walking frames;
•	assistance with moving to and from chairs, wheelchairs, beds or toilets.
Moving care recipients to and from beds and chairs etc is covered in this question.
Extensive manual handling for maintenance of skin integrity, eg frequent changing of the position of a chairfast or bedfast care recipient, is covered in Question 18.
If the care recipient usually changes location independently, record A.
If the care recipient requires assistance from staff for transfers or if the care recipient needs to be accompanied or supervised when walking, record B.  Supervision includes escorting and directing for purposeful mobility.
If the care recipient is unable to walk, or the care recipient self wheels or is wheeled by staff, and has no other assistance that would merit a D rating, record B.
If the care recipient requires assistance from staff for transfers and also needs to be accompanied or supervised when walking, record C.  If the care recipient does not need to be accompanied or supervised when walking except over wet patches on, say, a bathroom floor, this would be insufficient to satisfy the requirements for a C rating.
If the care recipient requires considerable assistance or encouragement from staff in order to maintain mobility, record D.
If the care recipient requires staff to use lifting equipment, including lifting straps, to assist with location change or, where the use of lifting equipment is not feasible, more than 2 staff would be required for transfer, record D.

Ratings	Q2	Mobility	
No assistance	A	Usually independent.	
Some assistance	B	Requires assistance from staff for transfers;
OR
Needs to be accompanied or supervised when walking.	
Major assistance	C	Requires assistance from staff for transfers;
AND
Needs to be accompanied or supervised when walking.	
Extensive assistance	D	Requires major assistance (as above) and encouragement from staff in order to maintain mobility;
OR
Requires lifting equipment for transfers.	

Q3	Meals and drinks
This question refers to the degree of assistance that the care recipient requires with eating and drinking.
If the care recipient eats and drinks independently, only requiring observation, record A.
The clinical nursing aspects of tube feeding are covered in Question 18.
In this question:
limited individual assistance means setting up to enable the care recipient to manage independently.  This may include some prompting but no other assistance.
individual assistance means prompting and assisting with eating for some elements of the meal, for example, starting or finishing off the meal.
one-to-one individual assistance means one-to-one individual assistance with eating and drinking.  This means full assistance with eating or encouraging the care recipient to maintain independent function.

Ratings	Q3	Meals and drinks	
No assistance or not applicable	A	Eats and drinks independently, observation only.	
Some assistance	B	Requires limited individual assistance.	
Major assistance	C	Requires individual assistance with eating or drinking.	
Extensive assistance	D	Requires one-to-one individual assistance with all meal time activities.	

Q4	Personal hygiene
This question refers to the degree of assistance that the care recipient requires with showering and washing, dressing and undressing, and personal hygiene, including all grooming activities and the routine application of moisturisers for dry skin.
If the care recipient attends to his/her personal hygiene independently, record A.
If the care recipient has difficulty with these activities and requires staff to spend time to enable him/her to shower and wash, dress and undress and complete his/her grooming, record B, C or D depending on the degree of assistance given.
In this question, where staff are required to encourage or persuade the care recipient on a one-to-one basis to optimise self care function, record D.  This includes where a care recipient requires extensive support to enable him/her to be able to see to his/her own personal hygiene requirements.
If 2 staff are required to carry out most activities, record D.
In this question:
requires assistance with some activities means that the care recipient is able to shower or wash self under supervision, or to complete some activities without assistance but requires limited help with others — for example, fastening buttons, cleaning teeth, putting on shoes.
requires staff to carry out most activities means that the care recipient can only complete limited aspects of personal hygiene — for example washing of face or hands, or combing of hair, and staff complete the rest of the tasks associated with personal hygiene.
optimise self care means that the care recipient is as independent as is practicable in seeing to his/her own personal hygiene requirements.

Ratings	Q4	Personal hygiene	
No assistance	A	Attends to personal hygiene independently.	
Some assistance	B	Requires assistance with some activities.	
Major assistance 	C	Requires 1 staff to carry out all activities.	
Extensive support	D	Requires staff to encourage or persuade the care recipient on a one-to-one basis to optimise self care function;
OR
Requires 2 staff to carry out most activities.	

Q5	Toileting
This question refers to the degree of assistance that the care recipient requires to use a toilet.  This includes any kind of toilet such as a commode, urinal, bedpan or a continence sheet (kylie or bluey) used for a planned episode of evacuation of the bowel or bladder.
This question covers the interventions required to assist the care recipient:
•	to use the toilet;
•	to attend to personal hygiene related to the toileting function;
•	to adjust clothing.
If the care recipient attends to toileting independently or if the care recipient cannot use any kind of toilet, record A.
Note that the care of catheters and colostomies are covered in Question 18.  However, toileting aspects associated with a care recipient who has a catheter or a stoma bag, for example emptying drainage bags, personal hygiene and adjusting of clothing, are covered in this question.
For a care recipient with a catheter or a colostomy, emptying a drainage bag and the associated adjustment of clothing and attending to personal hygiene, record B.
When assessing ability to use the toilet, do not include location change that is assessed in Question 2. 
In this question:
setting up means preparing the care recipient who then uses the toilet and attends to personal hygiene.  It may require positioning the care recipient on the toilet.
some assistance means minor adjustment of clothing.
major assistance means that staff spend time and effort in encouraging and persuading the care recipient to be independent as far as he/she is able, rather than the staff undertaking the activities.
extensive assistance means that staff are required to carry out all activities related to the toileting process.

Ratings	Q5	Toileting	
No assistance or not applicable	A	Attends to toileting independently or cannot use any kind of toilet.	
Some assistance	B	Requires setting up and some assistance.	
Major assistance	C	Requires staff to encourage and persuade care recipient to optimise self-care function.	
Extensive assistance	D	Requires staff to carry out all activities.	

Q6	Bladder management
This question relates to continence of urine and maintenance of continence of urine and the reduction of incontinence.
If the care recipient maintains continence independently and needs no program to remain continent, record A.
If the care recipient is able to remain continent of urine or have incontinence reduced, only because of the care provided by the staff, record B, C or D.
If the care recipient would be occasionally incontinent and his/her continence is supported by prompting only, or by using continence aids, record B.
If the care recipient is frequently incontinent and this cannot be improved by a continence program and continence aids such as pads, or urinary drainage systems are used at all times and are the only procedures used, record C.
If the care recipient is frequently incontinent and this cannot be improved by a continence program and, for behavioural or other reasons, he/she cannot use continence aids, record C.
If the care recipient would be frequently incontinent, but his/her continence level is optimised through an individualised continence program, record D.
A continence program is based on an individualised assessment of the continence state, with planning, implementation and evaluation guidelines.  A program means more interventions than pads only, or prompting only — for example, maintaining adequate fluid intake, bladder retraining, habit training or scheduled toileting, and be drawn from information in the care recipient’s continence assessment.
In this question:
prompting means reminding a care recipient to go to the toilet.
bladder retraining means progressive lengthening or shortening of toileting intervals.
habit training means using a flexible toileting schedule based on care recipient’s pattern of incontinence.  Reinforcement techniques may be used.
scheduled toileting means toileting to a fixed schedule while care recipient is awake.
occasionally incontinent means once a day or less.
frequently incontinent means twice or more a day.

Ratings	Q6	Bladder management	
Not applicable	A	Continent of urine.	
Some support	B	Would be occasionally incontinent but continence supported by prompting only;
OR
Wears external continence aids occasionally.	
Major support	C	Wears continence aids at all times related to frequent incontinence that cannot be improved by a continence program;
OR
Incontinent but, for behavioural or other reasons, cannot use continence aids.	
Extensive support	D	Would be frequently incontinent but has an individualised continence program in place to optimise continence level.	

Q7	Bowel management
This question relates to continence of faeces and maintenance of continence of faeces and the reduction of incontinence.
Stoma care (including colostomy care) is covered in Question 18.  Routine emptying of colostomy drainage bags, personal hygiene and adjustment of clothing are covered in Question 5.
If the care recipient maintains continence of faeces independently and needs no program to remain continent, record A.
If the care recipient is able to remain continent of faeces, or to have incontinence reduced only because of the care provided by the staff, record B, C or D.
If appropriate appliances such as pads are the only procedure used, record B.
If the care recipient is on a bowel management program for the prevention of constipation, record C.  A bowel management program includes monitoring and recording bowel activity, and may include any of the following:
•	maintaining adequate fluid intake;
•	laxatives and aperients;
•	stool softeners or fibre supplements;
•	high fibre diet;
•	suppositories or enemas;
•	exercise or massage.
If the care recipient would usually be incontinent but has an individualised continence program in place to optimise his/her continence level, record D.  For this care recipient, a bowel management program may also be in place.
A continence program is based on an individualised assessment of the continence state, with planning, implementation and evaluation guidelines.  A program means more interventions than pads only, or prompting only — for example, individualised habit training or scheduled toileting, and be drawn from information in the care recipient’s continence assessment.
In this question:
prompting means reminding care recipient to go to the toilet.
habit training means using a flexible toileting schedule based on a care recipient’s pattern of incontinence.  Reinforcement techniques may be used.
scheduled toileting means toileting to a fixed schedule while care recipient is awake.

Ratings	Q7	Bowel management	
Not applicable	A	Continent of faeces.	
Some support	B	Wears continence aids at all times related to frequent incontinence that cannot be improved by a continence program.	
Major support	C	Constipation is prevented or continence level maintained by a bowel management program.	
Extensive support	D	Would usually be incontinent but has an individualised continence management program in place to optimise continence level.	

Q8	Understanding and undertaking living activities
This question relates to the care recipient’s ability to remember, understand, plan for, initiate and perform general living activities, and to react appropriately to information provided.
If the care recipient has no difficulty with understanding and undertaking living activities, record A.
If the care recipient requires staff to assist him/her to remember, understand, plan for, initiate and perform activities such as deciding whether or not and when to initiate activities such as eating, drinking, grooming and personal hygiene or with whom to initiate social interaction, record B, C or D, according to the level of support required.
If the care recipient needs cues, reminders to understand and react appropriately and can do so for a short period, record B.
If the care recipient has major difficulty remembering and understanding information, and requires frequent repetition and reminding to undertake and complete most activities, record C.
If the care recipient cannot remember and understand information and needs to be assisted to perform all living activities, or is unable to respond to any prompts for physical or cognitive reasons, record D.

Ratings	Q8	Understanding and undertaking living activities	
No difficulty	A	Understands and undertakes living activities independently.	
Some difficulty	B	Needs cues or prompting to initiate, undertake or complete living activities.	
Major difficulty	C	Has major difficulty ascertaining, initiating, undertaking or completing most living activities and requires repetition and reminding.	
Extensive difficulty	D	Cannot undertake living activities and needs to be shown or have explained every time;
OR
Unable to respond to any prompts.	

Behaviour
This section, which contains Questions 9 to 14, relates to a care recipient’s care needs in addition to support for daily living activities, caused by the care recipient’s behaviour.
Ratings are related to staff time and effort in overcoming or reducing the impact of the behavioural problems.  Ratings should be based on interventions implemented to prevent or reduce this occurrence.  Examples of interventions are vigilant observation, mechanisms to distract the care recipient at times or in circumstances where there is an assessed risk of the behaviour occurring, or special behavioural programs.  The interventions should be individually tailored for the care recipient.
The need for the intervention must previously have been determined during assessment and recorded as needing monitoring (for B), or monitoring and supervision (for C or D).  Interventions are designed to prevent recurrence or reduce the level of the behaviour.
If the care recipient has no behavioural problems, record A for these questions.
If the resident requires monitoring because of irregular and short-lived occurrences of the behaviour and the interventions are required to be implemented only for these occurrences, record B.
If interventions are implemented for a period of time and then relaxed, but monitoring and supervision for recurrence are required, record C.
If supervision and intervention are required daily, record D.
In this section:
monitoring means being aware of the circumstances in which the care recipient has engaged in the behaviour in the past and observing the care recipient, to be aware when similar circumstances occur, so that the appropriate intervention may be taken to prevent the recurrence of the behaviour.
supervision means ensuring that specific situations or triggers which are likely to give rise to the behaviour do not occur, or are managed in ways to minimise the likelihood of occurrence.
daily means during a twenty four hour period.
An example of monitoring only and therefore a B rating is when a care recipient becomes agitated during stormy weather.  The staff would be aware when stormy weather occurred or was forecast and take special care during that time to reassure and calm the care recipient until the stormy weather passed.  There is little likelihood of the need for an intervention beyond the duration of the storm.
An example of monitoring for recurrence leading to supervision on less than a daily basis and therefore a C rating is when a care recipient becomes physically aggressive after he or she is visited by a particular relative.  The care recipient may need to be supervised after the departure of the relative but, after a few days, the need for supervision would be reduced until it was not required until the next visit.

Q9	Problem wandering or intrusive behaviour
This question relates to the care recipient wandering, absconding or, while wandering, interfering with other people or their belongings.  This may include a care recipient who makes repeated attempts to leave the facility or someone who goes uninvited into any areas within or outside the facility where his/her presence is not welcome or is not appropriate — for example, kitchens or other care recipients’ rooms.  It may also include a care recipient who wanders into areas resulting in staff spending time seeking, finding and guiding the care recipient back to his/her proper location or someone who goes into another room and takes things from drawers or cupboards.
Note that this question does not cover circumstances where a care recipient, through verbal disruption, noisiness or physical aggression, interferes with or disrupts other persons in the facility.  These are covered in Questions 10 and 11.
The rating should be based on the effort required to put in place interventions that are taken to prevent potential re-occurrence.
The need for the intervention must previously have been determined during assessment and recorded as needing monitoring (for B), or monitoring and supervision (for C or D).  Interventions are designed to prevent recurrence or reduce the level of the behaviour.
Monitoring the behaviour of all care recipients, as a matter of course, to ensure they do not wander into other care recipients’ rooms or interfere with others or others’ belongings, would not justify a rating other than A.  However, a B, C or D rating would be justified where a care recipient, for example, has been assessed previously as having wandered into other care recipients’ rooms causing a disturbance or taking items not belonging to him/her.  The rating would, therefore, be appropriate when there is a likelihood of re-occurrence and staff are required to observe the care recipient and to put in place an intervention to prevent him/her from wandering into someone else’s room.
A D rating would be appropriate where a care recipient is assessed as being likely to wander or interfere with others or others’ belongings at any time of the day or night (this behaviour would have been documented previously) and an intervention is in place to manage this potential occurrence.
If the resident requires monitoring because of occasional, irregular and short‑lived occurrences of the behaviour and the interventions are required to be implemented only for these occasional occurrences, record B.
If interventions are implemented intermittently, for a period of time and then relaxed, but monitoring and supervision for recurrence are required, record C.
If supervision and intervention are required daily, record D.
In this question:
monitoring means being aware of the circumstances in which the care recipient has engaged in the behaviour in the past and observing the care recipient, to be aware when similar circumstances occur, so that the appropriate intervention may be taken to prevent the recurrence of the behaviour.
supervision means ensuring that specific situations or triggers which are likely to give rise to the behaviour do not occur, or are managed in ways to minimise the likelihood of occurrence.
daily means during a twenty four hour period.

Ratings	Q9	Problem wandering or intrusive behaviour	
Not applicable	A	Does not require monitoring.	
Occasionally	B	Requires monitoring but not regular supervision.	
Intermittently	C	Requires monitoring for recurrence and then supervision on less than a daily basis.	
Extensively	D	Requires monitoring for recurrence and supervision on a daily basis.	

Q10	Verbally disruptive or noisy
This question includes abusive language and verbalised threats directed at a care recipient, visitor or member of staff.  It also includes a care recipient who indulges in behaviour that causes sufficient noise to disturb other people.  That noise may be either, or a combination of, vocal or non-vocal noises such as rattling furniture or other objects. 
The rating should be based on the effort required to put in place interventions that are taken to prevent this potential re-occurrence.
The need for the intervention must previously have been determined during assessment and recorded as needing monitoring (for B), or monitoring and supervision (for C or D).  Interventions are designed to prevent recurrence or reduce the level of the behaviour.
Monitoring the language of all care recipients, as a matter of course, would not justify a rating other than A.  However a B, C or D rating would be justified where a care recipient has previously been assessed as having been verbally disruptive, for example, around meal times, requiring staff to ensure that he/she is attended in the manner most likely to avoid or reduce this outcome.
The rating would not be justified merely because all metallic items that can be clanged together have been removed.  The rating would be appropriate where a care recipient has previously been assessed as, for example, making significant degrees of noise and the objects used to create that noise are modified by staff intervention to reduce the degree of noise created. 
If the care recipient requires monitoring because of occasional, irregular and short-lived occurrences of the behaviour and the interventions are required to be implemented only for these occasional occurrences, record B.
If interventions are implemented intermittently, for a period of time and then relaxed, but monitoring and supervision for recurrence are required, record C.
If supervision and intervention are required daily, record D.
In this question:
monitoring means being aware of the circumstances in which the care recipient has engaged in the behaviour in the past and observing the care recipient, to be aware when similar circumstances occur, so that the appropriate intervention may be taken to prevent the recurrence of the behaviour.
supervision means ensuring that specific situations or triggers which are likely to give rise to the behaviour do not occur, or are managed in ways to minimise the likelihood of occurrence.
daily means during a twenty four hour period.

Ratings	Q10	Verbally disruptive or noisy	
Not applicable	A	Does not require monitoring.	
Occasionally	B	Requires monitoring but not regular supervision.	
Intermittently	C	Requires monitoring for recurrence and then supervision on less than a daily basis.	
Extensively	D	Requires monitoring for recurrence and supervision on a daily basis.	

Q11	Physically aggressive
This question includes any physical conduct that is threatening and has the potential to harm a care recipient, visitor or member of staff.  It includes, but is not limited to, hitting, pushing, kicking or biting.
The rating should be based on the effort required to put in place interventions that are taken to prevent this potential re-occurrence.
The need for the intervention must previously have been determined during assessment and recorded as needing monitoring (for B), or monitoring and supervision (for C or D).  Interventions are designed to prevent recurrence or reduce the level of the behaviour.
Monitoring the behaviour of all care recipients, as a matter of course, would not justify a rating other than A.  However a B, C or D rating would be appropriate where a care recipient has previously been assessed, for example, as having been physically disruptive around bedtime requiring staff to implement interventions.  The rating would also be appropriate if an intervention was put in place to modify the behaviour of the care recipient at times or in circumstances where there is a higher risk of physical aggression.
If the care recipient requires monitoring because of occasional, irregular and short-lived occurrences of the behaviour and the interventions are required to be implemented only for these occasional occurrences, record B.
If interventions are implemented intermittently, for a period of time and then relaxed, but monitoring and supervision for recurrence are required, record C.
If supervision and intervention are required daily, record D.
In this question:
monitoring means being aware of the circumstances in which the care recipient has engaged in the behaviour in the past and observing the care recipient, to be aware when similar circumstances occur, so that the appropriate intervention may be taken to prevent the recurrence of the behaviour.
supervision means ensuring that specific situations or triggers which are likely to give rise to the behaviour do not occur, or are managed in ways to minimise the likelihood of occurrence.
daily means during a twenty four hour period.

Ratings	Q11	Physically aggressive	
Not applicable	A	Does not require monitoring.	
Occasionally	B	Requires monitoring but not regular supervision.	
Intermittently	C	Requires monitoring for recurrence and then supervision on less than a daily basis.	
Extensively	D	Requires monitoring for recurrence and supervision on a daily basis.	

Q12	Emotional dependence
This question is limited to the following behaviours:
•	active and passive resistance other than physical aggression;
•	attention seeking;
•	manipulative behaviour;
•	withdrawal.
This question does not relate to group activities which are covered in Question 15.
This question applies to one-on-one interventions required to respond to, manage and alleviate demanding behaviours or resistance to other necessary care activities.  Such interventions include considerable additional personal attention to calm the care recipient after visitors depart or carefully scheduled activities designed to distract the care recipient when he/she is at particular risk of adopting these behaviours.  The rating should be based on the effort required to implement the interventions to prevent the potential re-occurrence of the behaviour.  It also applies to one-on-one intervention to manage withdrawal or depression.
The need for the intervention must previously have been determined during assessment and recorded as needing monitoring (for B), or monitoring and supervision (for C or D).  Interventions are designed to prevent recurrence or reduce the level of the behaviour.
If the care recipient requires monitoring because of occasional, irregular and short-lived occurrences of the behaviour and the interventions are required to be implemented only for these occasional occurrences, record B.
If interventions are implemented intermittently, for a period of time and then relaxed, but monitoring and supervision for recurrence are required, record C.
If supervision and intervention are required daily, record D.
In this question:
monitoring means being aware of the circumstances in which the care recipient has engaged in the behaviour in the past and observing the care recipient, to be aware when similar circumstances occur, so that the appropriate intervention may be taken to prevent the recurrence of the behaviour.
supervision means ensuring that specific situations or triggers which are likely to give rise to the behaviour do not occur, or are managed in ways to minimise the likelihood of occurrence.
daily means during a twenty four hour period.

Ratings	Q12	Emotional dependence	
Not applicable	A	Does not require monitoring.	
Occasionally	B	Requires monitoring but not regular supervision.	
Intermittently	C	Requires monitoring for recurrence and then supervision on less than a daily basis.	
Extensively	D	Requires monitoring for recurrence and supervision on a daily basis.	

Q13	Danger to self or others
This question covers high risk behaviour which includes behaviour requiring supervision or intervention and strategies to minimise the danger.  Examples of such behaviour include unsafe smoking habits, walking without required aids, leaning out of windows, self-mutilation and suicidal tendencies.
This question is about behaviour and does not apply where a care recipient has a medical condition that might lead to injury, for example, through fitting or loss of consciousness.  It does not apply to a range of behaviours which might in the longer term be considered as damaging or health reducing such as smoking generally or non-compliance with a specialised diet.  It applies where there is an imminent risk of harm.
This question excludes acts of physical aggression that are covered in Question 11.
The rating should be based on the effort required to implement interventions to prevent this potential occurrence.
The need for the intervention must previously have been determined during assessment and recorded as needing monitoring (for B), or monitoring and supervision (for C or D).  Interventions are designed to prevent recurrence or reduce the level of the behaviour.
Monitoring the behaviour of all care recipients, as a matter of course, would not justify a rating other than A.  However a B, C or D rating would be appropriate where a care recipient has previously been assessed as, for example, endangering themselves or others requiring staff to supervise the care recipient to identify when this may re-occur and then take preventive action.
If the care recipient requires monitoring because of occasional, irregular and short-lived occurrences of the behaviour and the interventions are required to be implemented only for these occasional occurrences, record B.
If interventions are implemented intermittently, for a period of time and then relaxed, but monitoring and supervision for recurrence are required, record C.
If supervision and intervention are required daily, record D.
In this question:
monitoring means being aware of the circumstances in which the care recipient has engaged in the behaviour in the past and observing the care recipient, to be aware when similar circumstances occur, so that the appropriate intervention may be taken to prevent the recurrence of the behaviour.
supervision means ensuring that specific situations or triggers which are likely to give rise to the behaviour do not occur, or are managed in ways to minimise the likelihood of occurrence.
daily means during a twenty four hour period.

Ratings	Q13	Danger to self or others	
Not applicable	A	Does not require monitoring.	
Occasionally	B	Requires monitoring but not regular supervision.	
Intermittently	C	Requires monitoring for recurrence and then supervision on less than a daily basis.	
Extensively	D	Requires monitoring for recurrence and supervision on a daily basis.	

Q14	Other behaviour
This question covers behaviour not already covered in Questions 9 to 13 that requires staff to spend time and effort in addition to support for daily activities.
Examples of behaviour to be included in this question are not given as it is intended as a ‘catch all’ for any other behaviour not covered by Questions 9 to 13.
The rating should be based on the effort required to implement interventions to prevent this potential re-occurrence.
The need for the intervention must previously have been determined during assessment and recorded as needing monitoring (for B), or monitoring and supervision (for C or D).  Interventions are designed to prevent recurrence or reduce the level of the behaviour.
Monitoring the behaviour of all care recipients, as a matter of course, would not justify a rating other than A.  However, a B, C or D rating would be appropriate where a care recipient has previously been assessed as, for example, exhibiting a certain behaviour requiring staff to ensure the care recipient is supervised or employ an intervention to avoid that behaviour occurring.
If the care recipient requires monitoring because of occasional, irregular and short-lived occurrences of the behaviour and the interventions are required to be implemented only for these occasional occurrences, record B.
If interventions are implemented intermittently, for a period of time and then relaxed, but monitoring and supervision for recurrence are required, record C.
If supervision and intervention are required daily, record D.
In this question:
monitoring means being aware of the circumstances in which the care recipient has engaged in the behaviour in the past and observing the care recipient, to be aware when similar circumstances occur, so that the appropriate intervention may be taken to prevent the recurrence of the behaviour.
supervision means ensuring that specific situations or triggers which are likely to give rise to the behaviour do not occur, or are managed in ways to minimise the likelihood of occurrence.
daily means during a twenty four hour period.

Ratings	Q14	Other behaviour	
Not applicable	A	Does not require monitoring.	
Occasionally	B	Requires monitoring but not regular supervision.	
Intermittently	C	Requires monitoring for recurrence and then supervision on less than a daily basis.	
Extensively	D	Requires monitoring for recurrence and supervision on a daily basis.	

Q15	Social and human needs — care recipient
This question relates to the care recipient’s need for support other than physical care.
The time and effort taken by staff to give guidance and emotional support to the care recipient are covered in this question.
The care recipient’s social, cultural and religious needs, and chosen lifestyle preferences are covered in this question.
The management of withdrawal due to depression is not covered in this question.  This is covered in Question 12.
Activities which are part of a program claimed for in Question 19 or 20 are not covered in this question.
The time taken to give guidance and emotional support to relatives and friends of the care recipient is not covered in this question.  This is covered in Question 16.
For routine, in-house group activities such as watching television, playing bingo, group singing and craftwork, record A.
Examples of activities covered in this question are:
•	conversation and board games (individual activities); 
•	reading to the visually impaired;
•	group activities requiring one or more staff with a group of care recipients including outings, attendance at church and escorting groups to clinics; 
•	accompanying a care recipient to external appointments.
For extensive (more than 30 minutes on each day) one-on-one recreational, social, cultural or religious activities, including providing counselling or support for palliative care and highly disabled care recipients, record D. 
In this question:
some minor support means the care recipient is assisted by staff to participate in a group activity, other than routine, in-house activities, at least once a week, or in a one-to-one activity at least once in a 21 day period.  In this case, record B.
major support means the care recipient is assisted by staff to participate in a group activity, other than routine, in-house activities, on at least a daily basis, or in a one-to-one activity at least weekly.  In this case, record C.
extensive support means staff dedicate at least 30 minutes a day for the above activities in a one-on-one situation with the care recipient.  In this case, record D.

Ratings	Q15	Social and human needs — care recipient	
No support	A	Requires no specific support.	
Some support	B	Requires some minor support.	
Major support	C	Requires major support.	
Extensive support	D	One-on-one support for activities for more than 30 minutes daily.	

Q16	Social and human needs — families and friends
This question relates to activities related to the care recipient, involving one or more staff members interacting with families, friends, or the community.  The activity may or may not involve the care recipient.
Guidance and other activities not related to the care recipient are not covered in this question.
Activities such as giving guidance and emotional support, care planning, legal or guardianship matters, cultural and religious matters are covered in this question.  This would include support to family and friends where the care recipient requires such care as palliative care, a continence program, management of problem behaviours and care for increasing dementia.
Community is used in this question to refer to community groups such as church groups, social groups and groups or bodies of cultural significance to the care recipient.  It does not refer to linkages with medical professions — for example, doctors, dentists, podiatrists, etc.
In this question:
some means less frequently than weekly.
major means at least weekly, but not daily.
extensive means support on a daily basis.

Ratings	Q16	Social and human needs — families and friends	
No support	A	Requires no specific support.	
Some support	B	Requires support less frequently than weekly.	
Major support	C	Requires support weekly or more often.	
Extensive support	D	Requires support daily or more often.	

Q17	Medication
This question refers to medication(s) administered on a regular basis.  Infrequent, or less than weekly, administration of oral analgesic medication(s) is not covered in this question.
Injections such as an influenza vaccination or a multi-vitamin injection are not covered in this question.
This question assumes that administration of medication(s) will be carried out in accordance with requirements in relevant State/Territory legislation.
This question includes prescribed eye and ear drops, nebulisers, metered aerosols, turbuhalers, canisters and inhalers, the application of transdermal medication patches, other topically applied prescribed medication(s) and rectally or vaginally administered prescribed medication(s).
This question excludes intravenous infusions which are covered in Question 18.  However, intravenous drug administration through a cannula or hypodermic are included in rating D.
This question excludes aperients, which are covered in Question 7.
In this question, if a care recipient would have a B rating, but he/she is resistant to medication administration, for example, because of dementia, and staff are required to spend time and effort in giving significant encouragement (greater than prompting and reminding), record C.
In this question:
assist means giving the correct medication(s) to the care recipient, in the correct manner and at the appropriate times, and ensuring that medication(s) is ingested.
administer means providing physical assistance so that the care recipient completes the ingestion or taking of prescribed medication(s).
a controlled drug means a schedule 8 drug.  In some States this may be called a dangerous drug.  In some States or Territories, this may include schedule 4D drugs where there is a legal requirement for the recording and storage of schedule 4D drugs to be the same as for schedule 8 drugs.

Ratings	Q17	Medication	
No assistance	A	Care recipient self-manages medication.	
Some assistance	B	Requires staff to give medication to the care recipient, the care recipient takes the medication him/herself and staff confirm that the medication has been ingested.	
Major assistance	C	Requires staff to administer and assist with the taking of prescribed medication;
OR
Care recipient is resistant to medication administration, and staff are required to give significant encouragement (greater than prompting and reminding).	
Complete assistance	D	Requires daily administration of a controlled drug;
OR
Requires staff to administer subcutaneous (s/c), intramuscular (i/m) or intravenous (i/v) drug at least daily.	

Q18	Technical and complex nursing procedures
This question relates to technical and complex nursing procedures.  The following lists of procedures are indicative and not exhaustive.
This question assumes that procedures in list 1 will be carried out in accordance with requirements in relevant State/Territory legislation.
LIST 1 includes:
•	maintenance of skin integrity, including changing of position of a chairfast or bedfast care recipient;
•	eye care other than eye drops which are covered in Question 17;
•	assistance with nebulisers, metered aerosols, turbuhalers, canisters and inhalers;
•	oral hygiene (excluding cleaning teeth which is covered in Question 4);
•	blood pressure measurement;
•	blood sugar measurement;
•	simple wound dressings; 
•	tube feeding and cleaning of tube following feeding;
•	catheter care other than insertion or removal of a catheter, including perineal/penile toilet and change of drainage bag;
•	stoma maintenance, including replacement of stoma bags and wafer maintenance;
•	oxygen therapy where the supply of oxygen is continuous and has been prescribed by a medical practitioner, or where the care recipient is capable of self-managing oxygen;
•	implementation of a pain management or palliative care program (more than regular or ‘prn’ analgesic);
•	care and fitting of prosthesis;
•	anti-embolic stockings.
Note that if (say) assistance with a nebuliser is given twice a day and care and fitting of a prosthesis is given twice a day and blood pressure is measured once a day, then the total is 5 procedures daily.
For procedures such as dressings, anti-embolic stockings and prosthesis, the putting on (say) at the beginning of the day is 1 procedure and the taking off at (say) the end of the day is 1 procedure.  For an occasion of removal and immediate replacement, this occasion is 1 procedure.  For an occasion of removal and replacement where replacement is not immediate, for example removal before a shower and replacement after a shower, removal is 1 procedure and replacement is 1 procedure.
If a procedure or procedures from list 1 total 1 to 3 times daily, record B.
If a procedure or procedures from list 1 total 4 to 6 times daily, record C.
If a procedure or procedures from list 1 total more than 6 times daily, record D.
If a combination of procedures from lists 1 and 2 totals more than 6 times daily, record D.
This question assumes that procedures in list 2 will be carried out by a registered nurse or other health professional appropriate to the particular procedure, based on initial and ongoing assessment, planning and management of the care recipient’s care by a registered nurse.  Examples include medical practitioners, stoma therapists, physiotherapists, speech pathologists or qualified practitioners from palliative care teams.
LIST 2 includes:
•	establishment and supervision of a complex pain management or palliative care program including monitoring and managing any side effects;
•	insertion, care and maintenance of tubes including intravenous and naso‑gastric tubes;
•	establishing and reviewing a catheter care program, including the insertion, removal and replacement of catheters;
•	establishing and reviewing a stoma care program;
•	complex wound management;
•	suppositories;
•	risk management procedures relating to acute or chronic infectious conditions;
•	special feeding for care recipients with dysphagia (difficulty with swallowing);
•	suctioning airways;
•	tracheostomy care;
•	enema administration;
•	oxygen therapy which requires ongoing supervision due to variable need; 
•	dialysis treatment.
Note that if (say) suctioning of airways is carried out twice a day and special feeding is carried out twice a day and an enema is given once a day, the total is 5 procedures daily.
If a procedure or procedures from list 2 total 1 to 3 times daily, record C.
If a procedure or procedures from list 2 total more than 3 times daily, record D.
If a procedure or procedures from lists 1 and 2 total more than 6 times daily, record D.

Ratings	Q18	Technical and complex nursing procedures	
No assistance	A	No procedures are provided.	
Some assistance	B	A procedure or procedures from list 1 totalling 1 to 3 procedures daily.	
Major assistance	C	A procedure or procedures from list 2 totalling 1 to 3 procedures daily;
OR
A procedure or procedures from list 1 totalling 4 to 6 procedures daily.	
Extensive assistance	D	A procedure or procedures from list 2 totalling more than 3 procedures daily;
OR
A procedure or procedures from lists 1 and 2 totalling more than 6 procedures daily.	

Q19	Therapy
This question relates to therapy provided to care recipients where the facility provides the therapy, or the facility pays for the therapy, and the therapy is documented as a care need.  The therapist should meet the requirements for full membership of the therapist’s national or state body OR be a registered nurse for physical therapy.  The therapies include:
•	physiotherapy;
•	physical therapy developed by registered nurses, for example:
	passive movements for unconscious or severely disabled care recipients;
	techniques such as pelvic floor exercises to promote continence;
•	occupational therapy;
•	diversional therapy;
•	speech therapy.
Music therapy and aromatherapy are not claimed for in this question, but are covered in Question 20.
The therapist’s role is to individually assess the care recipient’s need for the therapy and to develop a personalised therapy plan.
The program does not need to be implemented by the therapist, but may be implemented by a staff member at the direction of the therapist.  However, it is the role of the therapist to regularly evaluate, by assessment, the effectiveness of the therapy program. 
If the care recipient requires no therapy, record A.
If a therapy program is provided 1 or 2 times a week, record B.  This might be to maintain the care recipient’s existing level of function.
If a therapy program is provided 3 or more times a week, but not daily, record C.  This might be to improve, or to minimise, loss of the care recipient’s existing level of function, correct a deficit, or, in the case of physiotherapy, maintain or minimise loss of joint range of movement or prevent contractures.
If a therapy program is provided in either daily blocks, or 3 or more times a week in large blocks of time (at least 30 minutes duration), record D.
Therapy provided by different categories of therapists are added together to determine the frequency of the provision of therapy.

Ratings	Q19	Therapy	
No support	A	No therapy required.	
Some support	B	Therapy provided 1 or 2 times a week.	
Major support	C	Therapy provided 3 times a week.	
Extensive support	D	Therapy program provided either daily or at least 3 times a week in large blocks of time.	

Q20	Other services
This question relates to services provided to care recipients where the facility provides the service or the facility pays for the service and the service is documented as a care need.  These services are services other than those covered in Questions 1 to 19.  These include, but are not restricted to, services provided by:
•	psychologist;
•	dietitian;
•	podiatrist;
•	social worker;
•	music therapist;
•	aromatherapist.
The provider of these services individually assesses the care recipient’s need for the service and develops a personalised plan for the provision of the service(s).  The program may be implemented by other staff.  However, it is the role of the provider to regularly evaluate, by assessment, the effectiveness of the program. 
If the care recipient requires no other services, or services less frequently than weekly, record A.
If other services are provided 1 or 2 times a week, record B.
If other services are provided 3 times or more a week, but not daily, record C.
If other services are provided daily record D.
Services provided by the above providers are added together to determine the frequency of the provision of services.

Ratings	Q20	Other services	
No support	A	No other services required.	
Some support	B	Other services provided 1 or 2 times a week.	
Major support	C	Other services provided 3 or more times a week but not daily.	
Extensive support	D	Other services provided daily.	
PART 2 — SCORES TO BE APPLIED TO THE APPRAISAL

Column 1
Question	Column 2
Question description	Column 3
Level of support	Column 4
Score	
				
Q1	Communication	A	0.00	
		B	 0.28	
		C	 0.36	
		D	 0.83
	
Q2	Mobility 	A	0.00	
		B	 1.19	
		C	 1.54	
		D	 1.82
	
Q3	Meals and drinks	A	0.00	
		B	 0.67	
		C	 0.75	
		D	 2.65
	
Q4	Personal hygiene	A	0.00	
		B	 5.34	
		C	14.17	
		D	14.61
	
Q5	Toileting	A	0.00	
		B	 5.98	
		C	10.65	
		D	13.70
	
Q6	Bladder management	A	0.00	
		B	 2.22	
		C	 3.82	
		D	 4.19
	
Q7	Bowel management	A	0.00	
		B	 3.32	
		C	 5.72	
		D	 6.30

Q8	Understanding and	A	0.00	
	undertaking living	B	 0.79	
	activities	C	 1.11	
		D	 3.40
	
Q9	Problem wandering or	A	0.00	
	intrusive behaviour	B	 0.80	
		C	 1.58	
		D	 4.00
	
Q10	Verbally disruptive or	A	0.00	
	noisy	B	 1.19	
		C	 1.75	
		D	 4.60
	
Q11	Physically aggressive	A	0.00	
		B	 2.34	
		C	 2.69	
		D	 3.05
	
Q12	Emotional dependence	A	0.00	
		B	 0.28	
		C	 1.50	
		D	 3.84
	
Q13	Danger to self or others	A	0.00	
		B	 1.11	
		C	 1.54	
		D	 1.98
	
Q14	Other behaviour	A	0.00	
		B	 0.91	
		C	 1.82	
		D	 2.61

Q15	Social and human	A	0.00	
	needs — care	B	 0.95	
	recipient	C	 1.98	
		D	 3.01

Q16	Social and human	A	0.00	
	needs — families	B	 0.28	
	and friends	C	 0.55	
		D	 0.91
	
Q17	Medication	A	0.00	
		B	 0.79	
		C	 8.55	
		D	 11.40
	
Q18	Technical and complex 	A	0.00	
	nursing procedures	B	 1.54	
		C	 5.54	
		D	 11.16
	
Q19	Therapy	A	0.00	
		B	 3.64	
		C	 6.10	
		D	7.01
	
Q20	Other services	A	0.00	
		B	 0.71	
		C	 1.46	
		D	2.93
	
NOTE
1.  Classification Principles 1997 notified in the Commonwealth of Australia Gazette on 29 September 1997.