# Aged Care Assessment and Audit Pathway — Topic Map > **Purpose:** End-to-end map from the first sign you need care, through NASC assessment, funding, choosing a provider, and understanding audit reports. > **Key contact:** Health NZ / Te Whatu Ora — 0800 855 066 | Your local NASC provider --- ## 1. Entry Point: GP or Self-Referral to NASC ``` START: You or a family member needs help with daily living, health, or safety concerns │ ├─► GP consultation │ ├─► GP can refer directly to NASC (Needs Assessment & Service Coordination) │ └─► GP can also arrange community health services (district nursing, etc.) │ ├─► Self-referral to NASC │ └─► Anyone can contact their local NASC directly │ └─► Find via Health NZ website or call 0800 855 066 │ └─► Hospital discharge └─► Hospital social worker or discharge planner can refer to NASC ``` **What to expect on first NASC contact:** - A NASC coordinator will collect basic information (name, age, health conditions, living situation) - They will schedule a face-to-face assessment (usually in your home or current residence) - Urgent cases are prioritised --- ## 2. NASC Assessment Process ### What is interRAI? The **interRAI** (International Resident Assessment Instrument) is the standardised assessment tool used by all NASC assessors in New Zealand. It is a comprehensive, evidence-based tool that evaluates: - Medical conditions and diagnoses - Cognitive function (memory, decision-making) - Physical function (mobility, personal care, meal prep) - Mental health (depression, anxiety, behaviour) - Social supports and living environment - Nutritional status - Continence - Skin condition - Medication management **The assessment is:** - Conducted **face-to-face** by a trained NASC assessor (usually a nurse or allied health professional) - Takes approximately **60–90 minutes** - Includes discussion with the older person **and** family/whānau/carer where appropriate - **Free of charge** to the person being assessed ### Care Needs Level Determined | Level | Description | Typical Outcome | | --------- | ------------------------------------ | ----------------------------------------- | | Low | Some support needed with daily tasks | Home support services, community services | | Medium | Regular support needed | Home support package, day programmes | | High | Full-time care likely required | Residential care assessment | | Very High | Complex medical/nursing needs | Hospital-level or psychogeriatric care | --- ## 3. Care Options Determined ``` NASC ASSESSMENT COMPLETE — care needs level assigned │ ├─► Low to medium needs ────► HOME SUPPORT PATHWAY │ Continue at home with: │ • Home care (personal care, housework, meals) │ • District nursing / community health │ • Day programmes and social support │ • Carer support for family caregivers │ └─► See: 04 Home Care and Community Support folder │ └─► High to very high needs ──► RESIDENTIAL CARE PATHWAY Move to an aged residential care facility └─► Continue to Section 4 below ``` --- ## 4. Residential Care Levels | Level | Description | Typical Resident | | ------------------------------ | ----------------------------------------------- | ------------------------------------------------------------------------------------ | | **Rest Home** | Personal care, supervision, some nursing | Frail elderly needing help with daily activities but not complex medical needs | | **Hospital (Continuing Care)** | 24-hour nursing, medical oversight | People with complex medical needs, post-surgery, chronic conditions | | **Dementia Care** | Secure environment, specialist dementia support | People with Alzheimer's or other dementia, may be at risk of wandering | | **Psychogeriatric Care** | Specialist mental health for older people | Older adults with severe mental health conditions (often with challenging behaviour) | --- ## 5. Funding Pathway: RCS Application ``` NASC confirms residential care needed │ └─► APPLY FOR RESIDENTIAL CARE SUBSIDY (RCS) └─► Work and Income — 0800 552 002 │ ├─► FINANCIAL ASSESSMENT │ ├─► ASSETS ≤ $291,825 (single 65+)? │ │ └─► → FULL RCS │ │ • Subsidy paid to provider │ │ • You keep $56.58/wk personal allowance │ │ • Your NZ Super goes towards care cost │ │ │ ├─► ASSETS > $291,825? │ │ ├─► → RESIDENTIAL CARE LOAN (RCL) │ │ │ • Interest-bearing, secured against property │ │ │ • Repaid from estate after death │ │ │ • You still keep $56.58/wk │ │ │ │ │ └─► → SELF-FUND (if you choose not to take RCL) │ │ │ └─► ASSETS under limit but own home? │ └─► Home is exempt for first 12 months │ (extendable if spouse/dependent remains) │ └─► INCOME ASSESSMENT └─► All income (incl. NZ Super) goes towards care └─► Only $56.58/wk personal allowance retained ``` **Key forms needed:** - Medical certificate (from NASC/GP confirming care need) - Financial declaration (assets, income, property) - Application for RCS (Work and Income) --- ## 6. Provider Selection: How to Find and Compare ``` Funding approved or in process — now choose a provider │ Step 1: Find certified providers ├─► Health NZ website — certified provider search ├─► Eldernet — comprehensive directory └─► Word of mouth / local knowledge │ Step 2: Check audit reports ├─► Go to Health NZ audit report search ├─► Search by facility name or location ├─► Read the latest full audit report │ └─► Key things to look for: │ • Certification period (4 yrs = good; 1 yr or provisional = concerns) │ • Number and severity of non-compliances │ • Areas of non-compliance (clinical care? staffing? environment?) │ • Follow-up from previous audits └─► Compare 2–3 facilities before deciding ``` --- ## 7. Certification and Audit: How It Works ### Audit Types | Audit Type | Frequency | Announced? | Purpose | | ----------------------- | ----------------------- | ------------------ | ----------------------------------------- | | **Certification audit** | Every 1–4 years | Yes | Full assessment for certification/renewal | | **Surveillance audit** | Annual or more frequent | Can be unannounced | Check ongoing compliance | | **Provisional audit** | As needed | Yes | New facilities or after major changes | ### Standards Assessed Audits measure compliance against **Health and Disability Services Standards (NZS 8134:2021)**: - **Clinical care** — nursing, medical oversight, medication management - **Staffing** — qualifications, ratios, training - **Food and nutrition** — quality, choice, special diets - **Infection control** — cleanliness, outbreak management - **Resident rights** — dignity, privacy, advocacy - **Safety and environment** — building, equipment, hazard management - **Governance** — management, policies, complaints handling ### How to Find and Understand Audit Reports ``` Step 1: Visit Health NZ website ├─► health.govt.nz → Find an audit report └─► Search by facility name │ Step 2: Open the latest audit report PDF │ Step 3: Look for the CERTIFICATION RECOMMENDATION ├─► "Certified for 4 years" = excellent ├─► "Certified for 2–3 years" = minor issues ├─► "Certified for 1 year" = significant concerns └─► "Provisional certification" = serious issues │ Step 4: Review NON-COMPLIANCES ├─► Look at how many and severity ├─► Check if clinical care was flagged └─► See if previous issues were resolved │ Step 5: If concerned about quality ├─► Discuss with facility manager ├─► Contact Health NZ ├─► Contact Health & Disability Commissioner (HDC) └─► Use Nationwide Health & Disability Advocacy Service ``` --- ## 8. Cross-References ### Within this folder (02 Aged Residential Care) | File | Relevance | | ------------------------------------------------------------------------ | ------------------------------------------------------ | | `2026 - Health NZ - Web Capture - Rest Home Certification and Audits.md` | Full detail on audit types, standards, finding reports | | `2025 - Health NZ - Meeting with Aged Care Commissioner.md` | Current issues and reform context | | `2025 - Ombudsman - OPCAT Aged Care Monitoring Report.md` | National monitoring findings | | `2025 - HDC - Annual Report.md` | Complaints trends in aged care | | `2025 - HQSC - Annual Report.md` | Quality and safety data | ### Other folders | Folder | Relevance | | -------------------------------------- | ------------------------------------------------- | | **05 Funding and Subsidies** | RCS, RCL, Accommodation Supplement details | | **04 Home Care and Community Support** | Home support pathway (alternative to residential) | | **03 Retirement Villages** | If needing independent living + care | ### Key contacts | Who | Role | Contact | | -------------------------------- | -------------------------------------- | ------------------------ | | NASC | Needs assessment & referral | Local NASC provider / GP | | Work and Income | RCS, RCL, financial assessment | 0800 552 002 | | Health NZ (Te Whatu Ora) | Certification, audits, provider search | 0800 855 066 | | Health & Disability Commissioner | Complaints about care quality | 0800 11 22 33 | | Advocacy Service | Free support for complaints | 0800 555 050 | | Aged Care Commissioner | Oversight of aged care sector | Via Health NZ | --- > **Note:** Asset and income limits update annually (1 April). Figures shown are for a single person 65+. Check current rates with Work and Income for couples and those aged 50–64.