Southern District Health Board (SDHB)
Guidelines for Aged Care Residential Facilities (ACRF)
Request for Subsidised High Cost Wound Dressings
1. Purpose: To meet the intent of the Aged Residential Hospital Specialised Services
Agreement clause D18.3 Provision of Dressing Supplies:
a) You must provide all dressings and supplies used in treatments. These must be of an
appropriate standard, as determined by a Registered Nurse, to meet the need of the
Subsidised Resident.
b) If both of us agree that a Subsidised Resident needs, for more than one week,
wound dressings, the daily cost of which, excluding your staff costs, is more than
20% of the maximum price specified in clause C2.1;
i.
You must pay the full cost of the dressings for the first week of use and an amount
equal to 20% of the maximum price specified in clause C2.1 for the second and any
subsequent week of use; and
ii.
we will pay the balance of the cost of such dressings for the second and any
subsequent week of use.
1.2 Agreement: The Southern DHB and ACRF will use these guidelines to fulfil the requirements
of Clause D18.3 of the ARRC Agreement.
If the dressing/s or suitable substitute is not available from the ACRF supplier the Southern
DHB will assist in sourcing the dressing/s and the ACRF will be responsible for reimbursing
the Southern DHB in accordance with the subsidy.
2. Inclusion Criteria:
 The resident is a long-term DHB Subsidised Resident of Age Related Residential Care
o The resident is not a short term care resident (eg respite)
o The resident is not a palliative care patient
o The resident is not funded by ACC or MOH
o The resident is not funded under the SHB Long Term Support/Chronic Health
Conditions agreement
o The resident is not eligible for the cost to be funded under another funding stream
(eg ACC medical misadventure)
 Wound has been assessed by the DHB wound care Nurse Specialist and the treatment plan
has been agreed.
 Wound treatment greater than seven days
 Dressing cost is greater than 20% of the bed-day rate for the resident per week
 Advanced high-cost primary and secondary wound care products. Examples include topical
negative wound therapy, larvae therapy requiring four or more pots per treatment, or
multiple or large wound requiring high-number of dressings.
2.1. Subsidised Resident Calculation Guide: (bed day rate will vary by TLA, this is an example):
Bed Day Rate & 20% Value
Subsidised Resident Area
Bed Rate (exc
20% Value of
7-Day x 20%
GST)
Bed Day Rate
Value
Psychogeriatric Specialised Hospital
$202.83
$40.57
$283.96
Continuing care
$177.11
$35.42
$247.94
Dementia Unit
$145.57
$29.11
$203.80
Rest Home
$103.80
$20.76
$145.32
3. Exclusion Criteria
 Staff costs associated in performing wound care
 Standard dressing consumables such as dressing packs, scissors, tapes, gloves, bandages,
gauze squares, combines, cleansing solutions, etc
 Pressure reducing/relieving devices
4. Process:
 Resident identified by ACRF or Southern DHB
 Resident and wound assessed by Southern DHB Wound Specialist; this can be achieved by
physical or telecommunication methods.
 Wound reassessment will occur not less than every 2-weeks by physical or
telecommunication methods.
 The ACRF is responsible for notifying the Southern DHB Planning & Funding HOP Portfolio
Manager (sharon.adler@southerndhb.govt.nz) and Wound Service if the resident is
transferred to another facility, when treatment is no longer required, or if the resident dies.
Note: You may not invoice for any period when the resident is not resident in your facility.
ACRF Resident identified with wound potentially requiring high-cost dressings for > one-week
Resident identified by ACRF
Resident identified by Southern DHB
Referral to Southern DHB Wound Service for Assessment & Approval
Otago site: Emil Schmidt
Southland site: Mandy Pagan
Declined Referral
Accepted Referral (meets set criteria)
Wound Service notifies relevant referrer & SDHB Wound Service notifies relevant referrer &
Planning & Funding HOP Portfolio Manager
Planning & Funding HOP Portfolio Manager.
Wound Service maintains resident / wound
follow-up at least every 2-weeks until high-cost
treatment is not required.
4.1. Referral Form:
Southern District Health Board (SDHB) Referral for Approval of High-Cost
Wound Dressings
Refer to the Southern DHB Application Guideline for Aged Care Residential Facilities (ACRF)
Request for Subsidised High Cost Wound Dressings
ACRF:
Address:
Resident Name:
Resident NHI:
GP:
Level of Care (tick)
□Psychogeriatric
□Continuing care
□Dementia Unit
□Rest home
Wound/s Type (tick and circle where relevant)
□Pressure Injury. Stage: 1, 2, 3, 4, unstageable or suspected deep tissue injury.
State location:
□Surgical wound. State location:
□Skin tear/laceration. State location:
□Leg ulcer. State aetiology if known:
□Diabetic foot ulcer
□Burn. State location:
□Other State:
Wound/s Duration:
Wound/s Dimensions (if more than two wounds attached additional form):
Wound Depth cm:
Wound Depth cm:
Wound Width cm:
Wound Width cm:
Wound Length cm:
Wound Length cm:
Specify Individual Dressing Required & Cost Per Dressing:
Primary (in contact with the wound) dressing/s required:
Size of dressing/s:
Cost per individual dressing: $
Number of dressings required per dressing change:
If Applicable:
Secondary (in contact with the primary dressing) dressing/s required
Size of dressing/s:
Cost per individual dressing: $
Number of dressings required per dressing change:
Dressing frequency:
Total dressing cost per day: $
High Cost Dressing recommended by:
Estimated Duration of High-Cost Dressing:
Manager Name & Signature:
Manager Contact Number:
Date completed:
Please send this completed form to the appropriate Southern DHB Wound Care Service for
Consideration. Recommend to telephone the Service re pending referral.
Emil Schmidt – email:
Mandy Pagan – email:
emil.schmidt@southerndhb.govt.nz
mandy.pagan@southerndhb.govt.nz
Fax:
Fax:
Telephone: extension:
Telephone: 03 2181949 extension: 8100
Postal address:
Postal address: Southern DHB, PO Box 828, Kew
Road, Invercargill, 9812
SOUTHERN DHB SECTION:
Date Referral Received by Wound Service:
□Referral Declined reason:
□Referral Accepted:
Clinical Nurse Specialist Signature:
Date Approved:
ACRF Notified of Decision: Y or N
FORWARD TO PLANNING & FUNDING DEPARTMENT FOR PROCESSING
Attn: Sharon Adler
Health of Older People Portfolio Manager
Planning & Funding
Southern District Health Board
Private Bag 1921
Dunedin 9054
sharon.adler@southerndhb.govt.nz
Developed July 2013 - For Review July 2014