The Complex Care Program provides support for medically complex and fragile children and young people who require frequent hospital admissions and or are technology dependent at home.  There are different tiers of support reflecting the nature of the health care needs.

To be eligible for complex care all of first four criteria AND either or both of criteria five and six need to be met.

1. Chronicity

This child’s condition is expected to be present for twelve months.

2. Complexity

Complex problems are not the same as complicated problems. There are components that interact and are not independent and predicting response and progress may be difficult.
Diseases are present in different organ systems that impact each other in unpredictable ways or social factors impact significantly on health and care provision.

There should be a need for ten medical appointments in twelve months, involving three or more specialty teams dealing with different organ systems. (This can be predicted at initial enrolment). If psychosocial complexity: defined as significant difficulties in areas of carer health, geographical isolation or disability has impacted on children accessing appropriate care this can also be considered when looking at the appointment numbers.

3. Instability

This child has had, or is predicted to need, emergency department presentations

Consider the child’s condition or interventional care need and how that could increase the potential for an emergency admission, for example: Does this child have an indwelling device that could increase their risk of infection or have a condition that could require sudden unexpected medical attention, eg epilepsy 

4. Functional limitation

This child’s condition impacts on their participation in independent age-appropriate activities.

Note: For an infant, please think of their potential for functional limitation.

Does this infant’s condition impact their ability to be cared for by others

Or does this child’s interventions affect their mobility or ability to undertake activities?

5. Fragility

The child has or is expected to have frequent and or prolonged hospital admissions. 

If they have had at least three overnight admissions or a total of 30 or more inpatient days in the last six months or this is predicted to occur in the next six months then they will meet this criteria.

6. Intensity

This child has an interventional health care need and requires a technology or a procedure in their home. Eg Intensive bathing for EB patients and severe skin conditions, TPN, Tracheostomy, Ventilation (both continuous and overnight), Nasojejunal Tube.

What is not considered technology dependence?

• PEG feeds alone
• Suctioning alone
• Presence of a stoma 

Children who are eligible for complex care will undergo an initial needs assessment to ascertain the level of support required.

There is a scoring system that looks at the critical health care needs which is incorporated into the referral form and assigns an initial Tier of support.

Children eligible for Tier one (the highest level) support undergo additional assessments of additional health care needs and family capacity to determine the in-home home health care support needs and allocation.