Use of and satisfaction with Community Aged Care Packages in the eastern suburbs of Sydney

8

Australasian Journal on Ageing, Vol 26 No 1 March 2007, 8–14© 2007 ACOTA

DOI: 10.1111/j.1741-6612.2007.00188.x

88Blackwell Publishing Asia

Research

Evaluation of Community Aged Care Packages

Use of and satisfaction with Community Aged Care Packages in the eastern suburbs of Sydney

Marlene Thomas, Brian Woodhouse and Jenny Rees-Mackenzie

Prince of Wales Community Aged Care, South Eastern Sydney and Illawarra Area Health Service, Randwick, New South Wales, Australia

Yun-Hee Jeon

Australian Primary Health Care Research Institute, College of Medicine and Health Sciences, Australian National University, Canberra, Australian Capital Territory, Australia

Objective:

The pilot study aimed to examine the accessibility and the flexibility of the Community Aged Care Package (CACP) program, and provide recommendations for further improvement.

Method:

Data were collected using structured interviews with 80 CACP recipients, and mail surveys with nine service coordinators of CACP services. Descriptive statistics and

χ

2

analysis were used for quantitative information, and thematic analysis for qualitative data.

Results:

CACPs were utilised more frequently and for longer periods by clients with English-speaking backgrounds and those living alone. The average level of client satisfaction with CACP was high, over 62% rating extremely satisfied. Participants expressed concerns related to CACPs including inflexibility, lack of communication between service providers and other health services, poor continuity and quality of care, inadequate funding, problems with recruitment, retention and support for staff.

Conclusion:

While the clients’ overall satisfaction levels were rated high, qualitative information suggested a need for improvement of the current delivery of the CACP program.

Key words:

aged, community health services, consumer satisfaction, health services accessibility.

Introduction

Driven by the notions of assisting older people to remain intheir own home as long as possible and potentially increasingcost effectiveness in service delivery, care in the community ispertinent to this growing population which is projected to risefrom 12% (2.2 million) in 1996 to 16% (3.5 million) in 2016[1]. One of the strategies implemented to manage the expectedincrease in future demand for aged care services is the provi-sion of Community Aged Care Packages (CACPs), which wereintroduced in 1992–1993. Promoting the policy of Ageing-In-

Place, and individually tailored to each client, CACPs aredesigned to provide coordinated community care services forclients who would otherwise be eligible for low-level (hostel)residential care [2]. Research has shown, however, that CACPsserve a less dependent sector of the frail and disabled agedpopulation than those who are eligible for low-level residentialcare [3].

There are 859 organisations offering CACPs in Australia,providing over 24 000 packages at any one point in time. TheCommonwealth Government’s target has been to have at least10 CACP places per 1000 people aged 70 years and over(except for Aboriginal and Torres Strait Islander peoples, forwhom the target is different), and the availability is set toincrease to 18 CACPs by 2006 [4].

An extensive electronic database search using CINAHL,ProQuest Health & Social Sciences, APAIS Health, AustralianFamily and Society Abstracts, Pre-MEDLINE, MEDLINE,EMBASE and EBM Reviews indicates that there has beenno research on how CACP recipients (clients) perceive theirpackages. Are they fulfilling clients’ needs? What could beimproved for them? How do we redress this gap in the knowledgeabout the accessibility of these packages and their flexibility inmeeting the individual needs of clients? It is essential to gaugethe effectiveness of the package from the recipients’ point ofview [5]. Matching service provision with recipients’ needs isparamount in efficient stewardship of scarce resources. Thesequestions prompted the first author (MT) to identify particularissues of need in the community among people receivingCACPs in her area of practice, located within the SouthEastern Sydney Area Health Service. It was also recognisedthat the CACP service providers in the region needed anopportunity to voice their issues and concerns.

The residential population of South Eastern Sydney AreaHealth Service (approximately 781 445) represents 12% of theNSW population, with a high proportion of overseas-bornresidents (31%), which is 8% higher than the State level [6].The Area has a higher proportion of people aged 65 and olderthan the state average. The proportion of people living aloneamong those aged 65–74 years is 21.9% of all in that age-groupfor SESAHS and 20.9% for NSW, while for those aged 75 andover, it is 38.7% and 37%, respectively [7]. People living alonemay be socially isolated; social ties are said to reduce morbidityand mortality from various causes, and to influence help-seekingbehaviour [8]. Social isolation may be an even greater problemfor older people from non-English speaking backgrounds,especially those without strong ethnocultural communities to

Correspondence to: Dr Yun-Hee Jeon, The Australian National University. Email: [email protected]

aja_188.fm Page 8 Monday, January 29, 2007 11:33 AM

E v a l u a t i o n o f C o m m u n i t y A g e d C a r e P a c k a g e s

Australasian Journal on Ageing, Vol 26 No 1 March 2007, 8–14

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© 2007 ACOTA

lobby on their behalf. This is particularly problematic for olderpeople who find their second language (i.e. English) abilitiescontracting as they age [9]. Furthermore, the presence of aco-resident is associated with lower levels of and differenttypes of services used [3].

In 2000–2001, the study, independent of the service providersand their funding body, was conducted to give voice to theCACP recipients and particularly to those clients from culturalgroups who may be marginalised from mainstream services.The overall aim of the study was to shed light on the accessi-bility and the flexibility of CACP by focusing on client satisfac-tion and deficits in CACP provision. The objectives of thestudy were:

• To survey CACP recipients to determine the extent of theiruse of the service and what they perceive as most usefulto them

• To survey CACP service providers to determine theconstraints under which they operate in providing the service

• To employ the survey findings to provide recommendationsto improve CACPs

Method

This was a descriptive pilot study using both quantitativeand qualitative methods to gain information on the use andprovision of CACPs in two municipalities of the easternsuburbs of Sydney. Permission to conduct the study was gainedfrom the South Eastern Sydney Area Health Services ResearchEthics Committee.

The service providers were recruited from those agencies thatmanaged CACPs in the chosen areas. Inclusion criteria for theclients were: those in receipt of a CACP and living in those twomunicipalities. As an employee of the community health centrein the research site the first author had access to the healthrecords of the client population, hence was able to review theall relevant records to identify possible participants for thestudy. Clients with moderate to severe dementia were excludedbecause of their inability to give informed consent and beinterviewed. Receipt of a CACP was confirmed by telephoningthe individual client.

Three questionnaires were developed to collect the informa-tion on the views of people receiving CACPs, one forthose who live alone, one for those who live with others, andone for the CACP service providers. The questionnairesfor the clients were trialled with 10 CACP recipients, notall of whom were Australian born, and revised in consultationwith representatives from the service organisations, carers/families of clients and the researchers. The client question-naires included demographics, areas and amounts of assist-ance provided under the CACP program, their socialcontacts and activities, and their satisfaction with theservice. These were administered by the researchers and,when required, with assistance of health-care interpreters.Using structured open-ended questions, the questionnairefor the CACP service coordinators was designed to examine

the areas of service they provided, the flexibility and wayservices were provided as well as challenges they encoun-tered. The questionnaire was mailed to service providersand coordinators so that they could complete it whenconvenient.

Quantitative data were entered and analysed using SPSS 12.0software. Descriptive statistics and

χ

2

analysis were used: toidentify client and service provider characteristics, and theextent of CACP utilised/provided, the clients’ level ofsatisfaction with the service, and factors associated withservice utilisation and satisfaction. Information derived fromstructured, open-ended questions was entered into Microsoft

®

Word and analysed initially by the first author using ‘copy,cut and paste’ functions according to the techniques ofthematic analysis [10]. Once the common issues related to theflexibility and challenges with the provision of CACP wereidentified they were integrated and organised into mainthemes. The description of these was then reviewed, modifiedand refined at a team level (all authors).

Results

Demographic information of client participants (

N

= 80)

Of 80 participants, 29 (36.2%) were living in households ofmore than one person. Fifty-four (67.5%) were women, and70 (87.5%) were aged 75 and over. Forty-three (53.8%) wereAustralian born and 49 (61.3%) spoke English as a preferredlanguage at home.

Types and amount of assistance under the CACP program

Table 1 provides information about characteristics of clients’utilisation of CACPs. When data were further examined using

χ

2

analysis the following were found significant:

1

People whose main language spoken at home was Englishwere more likely to rate a higher number of CACPdays (

χ

2

= 15.23, 2 d.f.,

P <

0.01), and more likely toreceive other support services (

χ

2

= 7.03, 1 d.f.,

P <

0.01)when compared with those who did not speak English athome. Similarly, Australian-born clients were more likelyto rate a higher number of CACP days (

χ

2

= 10.14, 2 d.f.,

P <

0.01).

2

When compared with those who were serviced by ethnic-specific organisations, clients who received a CACP pro-gram from the non-ethnic services more frequently usedthe program (

χ

2

= 10.03, 2 d.f.,

P <

0.01), and were morelikely to use other support programs (

χ

2

= 6.86, 1 d.f.,

P <

0.01).

3

Clients living alone were more likely to rate a highernumber of services provided when compared with clientswith co-resident (

χ

2

= 6.67, 2 d.f.,

P <

0.05).

In terms of the types of help clients received through CACPs,cleaning, shopping and laundry services were most frequentlyused, and services such as home maintenance, gardening andmedication supervision were least used by the clients. SeeFigure 1.


T h o m a s M , J e o n Y - H , W o o d h o u s e B

e t a l

.

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Social contacts and activities

When asked about their social contact with family and/orfriends:

1

Seventeen clients said their family/friends visited once ortwice a month and 11 said they had no visit or few timesa year for special occasions only. Only 24 clients had fre-quent outings (weekly or more often) with their family/friends.

2

Emails and letters were rarely used by the clients asmeans of social contact, whereas over 81% made frequenttelephone calls to their family/friends.

3

While 70.6% of the 51 clients living alone were unable togo out unassisted, only 14 of those homebound receiveda social outing service through CACPs.

4

Forty-two of the total participants were engaged in someform of social activity, mostly religious activity (43%) andday-away group/bus outing (40%).

5

Compared with clients aged 80 and over, those agedbetween 65 and 79 years were more likely to attend activ-ities (

χ

2

= 4.98, 1 d.f.,

P <

0.05), and more likely to go outwith family and friends (

χ

2

= 7.8, 2 d.f.,

P <

0.05).

See Table 2 – Clients’ social contacts and activities for furtherdetails.

Client satisfaction

Using a 1–10-point Likert scale, the average level of clientsatisfaction with CACPs was rated high (mean = 8.61,SD = 1.76), with over 62% rating extremely satisfied (9–10).Chi-squared analysis showed no correlations between the levelof satisfaction and other variables such as age, sex, co-residents, language, country of origin and amount and typeof services. However, the clients also expressed frustrationswith the services, relating to ‘lack of flexibility’ (e.g. prescrip-tive and rigid timetables not always suitable for the clients,and no gardening service available), ‘unsatisfactory serviceprovided by care workers’ who were often refusing tocomplete certain tasks quoting occupational health andsafety (OH&S) issues and ‘lack of continuity of care/service’ caused by frequent staff change. See Table 3 for furtherdetails.

Findings from service providers questionnaire (

N

= 9)

Each of nine CACP organisations nominated one person toparticipate in the survey. Five of the service providers werespecifically funded to provide ethno-specific CACPs and twomanaged housing-linked CACPs, designed for those living indesignated rental housing developments or private renters.One service provider managed predominately dementia-specific CACPs but also managed a small number of frail agedCACPs. As shown in Table 4, the service providers highlighted

Table 1: Characteristics of clients’ utilisation of Community Aged Care Packages (CACPs)

Clients’ service use (N = 80) No. (%)

Service providerNon ethnic specific service 46 (57.5)Ethnic specific service 34 (42.5)

Number of households with dual CACPs 4 (5)Length of time receiving CACP

0–3 months 1 (1.3)4–12 months 23 (28.8)More than 12 months 56 (70)

Number of services per person1–3 33 (41.3)4–6 38 (47.5)7–9 9 (11.3)

Receiving weekend services (yes) 8 (10)Number of days receiving CACP

1–2 days 40 (50)3–4 days 28 (35)5 or more than 5 days 12 (15)

Amount of service per week (hour)3 or less than 3 hours (small) 15 (18.8)More than 3–6 hours (medium) 54 (67.5)More than 6 hours (large) 11 (13.8)

Frequency of service plan discussionMonthly 32 (40)3–6 monthly 26 (32.6)PRN (when necessary) 8 (10)Don’t know 13 (16.3)Never 1 (1.3)

Receive any other services (yes) 27 (33.8)

Figure 1: Number of clients using an individual service component.




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© 2007 ACOTA

problems/issues similar to what the client participantshad raised, for example ‘limited capacity for flexibility’,‘challenges with recruitment and retention and support forstaff’ and ‘communication breakdowns’, between CACPservices and the acute care sector, and between the clientand the provider, which essentially hindered the provisionof quality and continuity of care. ‘Insufficient funding’ inparticular was seen as highly problematic impacting on thewhole of the service and the capacity to provide a morecomprehensive client-centred and flexible service. Thisoften left service providers with a sense of frustration.

Discussion

Over 52% of the client participants were active and involvedin community activities and 29.4% were able to go out alone.Approximately two-thirds received frequent visits fromfamily or friends and did not feel socially isolated. Culturallyand linguistically diverse clients were less likely to useCACPs or other community care services; however, theywere not much different from English-speaking clients interms of their levels of satisfaction, social contacts andactivities.

Clients’ level of dependency may be linked with receipt ofpersonal care assistance. Only 17.5% of clients aged 75 andover (20% aged 65 and over) received personal care assistance,significantly lower than national data reported in the 2002Community Aged Care Census [11], where 55.1% of clientsbetween 75 and 79 years and 56.3% between 80 and 84 yearsrequired showering/bathing, a major personal care component.The CACP often assists the carer/co-resident with practicalhousehold tasks, not necessarily the personal care of theregistered client. However, the proportion of those receivingpersonal care remained lower than the national data, with only21.6% of clients who lived alone receiving personal care.These findings are supported by Gibson and Mathur’s study[3], which found that 24% of CACP clients received personalcare assistance compared with 54% of hostel residents. Gibsonand Mathur [3] concluded that CACP clients were less dependentthan hostel residents. Two important questions emerge: whetheror not current CACPs are targeting the right population and infact function as an alternative to low-level residential care; andwhether a systematic assessment of client needs and eligibilityof the service has been conducted. This is a critical issue inachieving equitable access to and allocation of home careresources [12,13].

This study also found that although the clients’ overall satis-faction levels were rated high, this did not necessarily reflecttheir experience. When given an opportunity to make a com-ment at the end of the questionnaire, many clients expresseddissatisfaction with the quality of care they received, especiallyin relation to domestic assistance. However, most had chosennot to complain to the service coordinator, not an uncommonfinding among older care recipients [5]. Cooper and Jenkins [5]

Table 2: Clients’ social contacts and activities

Frequency of social contacts and activities No. (%)

Number of visits by family/friends (N = 80)Rarely to none 11 (13.8)Less frequent (1–2 per month) 17 (21.3)Frequent (weekly or more) 52 (65)

Number of telephone contacts by family/friends (N = 80)Rarely to none 4 (5.0)Less frequent (1–2 per month) 11 (13.8)Frequent (weekly or more) 65 (81.3)

Number of outings with family/friends (N = 80)Rarely to none 47 (58.8)Less frequent (1–2 per month) 9 (11.3)Frequent (weekly or more) 24 (30)

Number of email contacts with family/friends (N = 80)Rarely to none 74 (92.5)Frequent (weekly or more) 6 (7.5)

Number of letter contacts with family/friends (N = 80)Rarely to none 75 (93.8)Frequent (weekly or more) 5 (6.3)

Number of face-to-face contacts (visits and outings) withfamily/friends (N = 80)

Rarely to none 6 (7.5)Less frequent (1–2 per month) 18 (22.5)Frequent (weekly or more) 56 (70)

Number of non–face-to-face contacts (letter, email and telephone) with family/friends (N = 80)

Rarely to none 4 (5.0)Less frequent (1–2 per month) 11 (13.8)Frequent (weekly or more) 65 (81.3)

Able to go out alone (yes) (N = 51) 15 (29.4)Social activities (N = 80)

Attend any form of social activities (movies, picnics, play, etc.) 42 (52.5)Attend day-away group/bus outings 17 (21.3)Attend senior citizens club 3 (3.8)Attend religious activity 18 (22.5)Attend community activity (structured, funded) 10 (12.5)

Table 3: The main issues raised by clients

Main issues Summary of clients’ comments

Lack of flexibility • Service provider’s inability to allow extra time for certain activities, such as shopping and attending doctor’s appointment when clients’ scheduled CACP times did not coincide with their medical appointment. No gardening was available.

• CACPs following a fairly prescriptive pattern (2-hour blocks of time, two to three times weekly) hence could not transport clients to medical appointments outside of the scheduled CACP times.

Unsatisfactory service provided by workers

• Care workers using a variety of excuses, in particular occupational health and safety issues, to minimise the amount and type of tasks they would complete, for example, not moving small items (vases, photos, etc.) when dusting, or not lifting shopping from the trolley onto the supermarket check-out counter. For example, ‘I am tired of being told, ‘we are not allowed to do that, any lifting of even small objects’.

• Clients’ frustration at having to tell the care worker what to do each time they come to the home.Lack of continuity of care/service • Familiarity and trust take some time to develop and clients who had experienced many staff changes in a short period of

time felt quite upset with this situation. For example, ‘You just get used to one person and they are gone’.

CACP, Community Aged Care Package.



e t a l

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reported that home care clients were often afraid to give staffnegative comments about the service they received becausethey worried about the ramifications such as the loss of currentservice. A particular caution therefore should be exercisedwhen interpreting information generated by client satisfactionsurveys conducted by researchers who are affiliated with serviceproviders [14].

While positive client responses about services that are notcompletely satisfactory can be explained by this fear, othercommon reasons include: respondents’ tendency to giveanswers that are more socially desirable and agree with pos-itive statements without thoroughly examining the questionbeing asked; being overly grateful for receipt of services with-out examining the quality and thus having low expectations;and also as a result of developing personal attachment to careworkers [5]. Discrepancies between clients’ high satisfactionratings and their perceived problems with the CACPs areareas to be addressed in the future. Without gaining a truepicture of the clients’ experiences of CACPs, it will be difficultto meet their needs and improve current CACP services. Thefindings support the literature, indicating there is a need toestablish an effective communication channel between theservice provider and the client.

A recurring theme concerned staffing arrangements and thequality of care provided. The clients did not like havingfrequent change-overs of care workers, making it difficult forthem to adjust to constant changes, and the service providershad difficulty maintaining a workforce sufficiently skilledto meet the individual clients’ needs. The staffing issue isultimately linked to funding available for CACPs and thelow salary paid to care workers. The current baseline wagefor community care workers ranges between $A13.97 and$A15.37 per hour, plus travel allowance (for the use of owncar) [15]. Hence, the relatively low salary and the need to useprivate transport may be the main factors for the difficulty inrecruiting staff. This is a particular concern for CACP serviceproviders in Sydney where a significant shortage of perma-nent nursing and personal care staff exists in the aged andcommunity services [16]. In terms of quality of care, thefindings suggest that there is a need to develop and maintain

avenues for better communication between the serviceproviders and local health-care services, in particular mentalhealth services. In doing so, continuity of care will be morelikely maintained.

Staff training is another important area to be improved. Oneparticular area of concern was related to care workers’ misuseof OH&S regulations as they sometimes appeared to be tooconcerned about their own safety. From the clients’ perspectivethis was viewed as care workers using the regulations as an‘excuse’ for not doing certain tasks, resulting in frustration andeven resentment among the clients. While one of the purposesof this regulation is to provide safe environment for bothclients and care workers [17], it is possible that care workersdid not have sufficient understanding of the regulation to applyin their care practice, indicating a need for further education ofcare workers about the OH&S regulation and their interpre-tation. Service providers felt that additional educationalopportunities should be offered to care workers, not only toenhance their skills but to demonstrate the value and respectthat management had for them to improve their job satisfac-tion. Lack of support and training for home care workers hasbeen recognised as a barrier to the provision of quality care anda factor that affects their self- esteem and attitude towards theirwork [18].

The Australian government continues to increase spending onAged Care [19], however, at the grassroots level of service pro-vision, the CACP service providers identify a lack of funding asa major factor in the quality and quantity of service they areable to provide. In this study the CACP coordinators expresseda wish to expand/enhance the service offered to clients but feltconstrained by financial capacity as they had reached the limitsof funding. The issue that needs clarifying is the boundary/limitation to spending available, compared with the clients’expectation of service. If the government’s aim is to supportolder people in their own home through CACPs rather thanlow-level residential care, the funding will need to be sufficientto provide the necessary range and flexibility of service thatclients expect. Older people living in a low-level care facility havedifferent concerns than people living in their own home, forexample gardening and home maintenance. According to the

Table 4: The main issues raised by service providers

Main issues Summary of service providers’ comments

Limited capacity for flexibility • Limited capacity to provide flexible service because of limited funding, strict service guidelines, high expectation from clients and inadequate staffing.

Challenges with staffing and support for staff

• Attracting staff willing to work with older people and retaining staff in the workforce are difficult because of inadequate salary budgeted for care workers.

• Additional difficulty in recruiting workers of ethno-specific CACPs who have relevant knowledge and skills in the area.• No staff development training available for care workers apart from mandatory courses, indirectly hindering the

provision of quality care.• Service providers’ own need for support from their management in terms of individual professional development.

Communication breakdowns • Communication breakdowns existing at several points on the care continuum: around hospital admission and discharge in acute care settings, in particular dealing with mental health services; and between the client and the provider.

Insufficient funding • Clients’ needs were not always met because of limited funding.• Inability to offer more flexible and comprehensive services, for example social and group activities, health promotion

and prevention, and gardening/lawn mowing.

CACP, Community Aged Care Package.




13

© 2007 ACOTA

CACP guidelines [2], gardening, such as weeding, lawnmowing and removal of rubbish, is listed as one of the carecomponents of a CACP. However, gardening was one of theleast frequently accessible/utilised services in this study becauseof its limited availability. Is ‘gardening’ the act of maintaininga safe environment, or, does this involve a more pro-activeparticipation such as cutting off dead flowers, weeding orplanting in order to make the garden look more presentable?Service providers in this study also advocated for more garden-ing, lawn mowing and handyman services for their clients;however, they were unable to do so because of financialconstraints. This issue clearly indicates the need for refiningthe current model for CACPs in terms of what they purportto provide and what clients expect to receive within a limitedbudget allocation. It needs to be understood that olderpeople living at home are frequently more concerned abouttheir environment than their own needs, as demonstratedin this study.

In conclusion, the study findings provide insight into howCACPs have been managed and received in the Sydney easternsuburbs, from the perspective of service providers and clients.The study highlights the gaps and barriers that interferewith provision of flexible services, and offers recommenda-tions that can be used to improve the CACP program in thearea of Sydney. While findings need to be viewed with caution,since the survey was conducted in two municipalities of Sydneyeastern suburbs, it is the first of its kind to consider issuesrelating to the use and provision of CACPs from a consumerperspective. Further research is strongly recommendedto explore the issues raised in this pilot and to ensuregeneralisability.

Based on the findings of this study, it is recommended that:

1

Communication links between acute care services andcommunity service providers be strengthened.

2

A client feedback process be set-up so that clients have amechanism to make a complaint or express a concernwithout being identified or having their right to privacyand service compromised.

3

A review of the current CACP service model and guidelinesincluding eligibility criteria and definitions of services becarried out to target the right population and improve theflexibility and accessibility.

4

A budget review be conducted to assess current care workerssalaries and ongoing educational expenses for staff (careworkers and service coordinators). Adequate funding andstaffing need to be synchronised in order to achieve theflexibility desired.

It is hoped that the findings and the recommendations will beused to inform service providers in light of ‘A New Strategyfor Community Care: The Way Forward’ [19], which aims toprovide additional support of $A13.7 million over 4 years forquality assurance and monitoring across CACPs, ExtendedAged Care Packages in the Home and the National Respitefor Carers Program.

Acknowledgements

The study was partially funded by the South East Health’sMulticultural Health Unit to employ bilingual health workersto assist with interviews with culturally and linguisticallydiverse participants. Dr Dale Gietzelt assisted with the designof the study and ethics application. We would like to extendour thanks to Prince of Wales Community Health Services andProfessor Lynn Chenoweth, Director of the Health and AgeingResearch Unit, for their support for nursing research.

Key Points

•

Clients of CACPs are concerned about lack offlexibility of the service, poor quality and continuityof the care/service.

• Communication breakdowns, between CACPservices and the acute care sector, and between theclient and the provider, pose a significant barrier tothe effective provision of CACPs.

• A review of budget and the CACP guidelines (e.g.eligibility criteria and definitions of services) need tobe carried out to maximise potential of CACPs.

• More attention should be given to recruitment andretention issues, and support for staff.

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15 Office of Industrial Relations, NSW Department of Commerce. AwardsOnline; Charitable sector, aged and disability care services (State)Award 2003. http://www.industrialrelations.nsw.gov.au/awards/index.html.

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http://www.industrialrelations.nsw.gov.au/awards/

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Documents

Use of and satisfaction with Community Aged Care Packages in the eastern suburbs of Sydney