Application Form

Strengthening Virtual care Capability in Residential Aged Care Homes

Western NSW PHN is inviting Expressions of Interest (EOI) from eligible Residential Aged Care Homes (RACH's) across Western and Far West NSW to participate in the Strengthening Virtual Care Capability in Residential Aged Care Homes initiative.

Residential aged care homes play a critical role in supporting the health and wellbeing of older people. In regional, rural and remote communities, access to timely healthcare services can be challenging due to workforce shortages, distance and service availability. Virtual care provides an opportunity to improve access to clinical services, support earlier intervention and reduce avoidable hospital transfers, while enabling residents to receive care in a familiar environment.

This initiative builds on learnings from the 2023 Telehealth Grants and aims to strengthen virtual care capability by providing fit‑for‑purpose equipment and targeted workforce capability support. The focus is on embedding virtual care into everyday workflows and building staff confidence and capability to use digital health tools safely and effectively.

Successful applicants will receive virtual care equipment supplied at no cost, along with workforce capability support delivered through a time‑limited Community of Practice for nominated Virtual Care Champions in 2026. The Community of Practice will focus on skill development, shared learning and practical implementation to support the routine use of virtual care.

Support is provided as equipment and workforce capability support only and does not include direct funding.

Applications will remain open until 5:00pm, Monday 13 April 2026.

Instructions

This application includes five sections and will take approximately 15-20 minutes to complete.

Please complete all sections of the form.

Section 2 is a questionnaire comprising 22 questions that ask about your current use of virtual care, available equipment, and any challenges experienced. The questions are used to understand service context, validate need, and provide insight into the current state of virtual care to inform planning and evaluation. They are not assessed as standalone criteria.

This application form should be completed by the Residential Aged Care Manager or an authorised delegate. By submitting this form, you confirm that you are authorised to apply on behalf of the Residential Aged Care Home.

Successful applicants will be required to enter into a contract with WNSW PHN prior to receiving the equipment.

Definitions

Applicant Residential Aged Care Home (RACH) means the individual Australian Commonwealth‑funded residential aged care service submitting this Expression of Interest

Approved Provider / Organisation means the legal entity approved under the Aged Care Act 2024 that operates the Applicant Residential Aged Care Home.

Initiative means the Strengthening Virtual Care Capability in Residential Aged Care initiative delivered by Western NSW Primary Health Network (WNSW PHN), which is a time‑limited activity and not an ongoing program.

WNSW PHN means the Western NSW Primary Health Network.

MPS means a Multi‑Purpose Service operated by NSW Health.

Virtual Care Champion means a staff member of the Residential Aged Care Home who helps lead telehealth use, joins Community of Practice sessions in 2026, and is the main contact for support and coaching.

Residential Aged Care Home Details (Authorised Contact)

This person must be the Residential Aged Care Manager or an authorised delegate submitting this application.

Residential Aged Care Home / Service name: *

Trading Name of the Residential Aged Care Home / Service name (if applicable):

Do you have an ABN? *

Yes No

ABN: *

Are you registered for GST? *

YesNo

If Other, please specify *

Street address *Street address line 2

City *

State *

Postcode *

Briefly describe your organisation (no more than one paragraph) *

APPLICATION CONTACT DETAILS

In this section, you are asked to provide the contact details of your organisation’s authorising officer and/or key contact person for this application. The authorising officer is the person authorised to sign a funding agreement on behalf of your organisation, should your application be successful.

Authorised Person’s name: *

Authorised Person's Position title: *

Authorised Person's Phone Number : *

Authorised Person's Email Address *

Virtual Care Champion Details (Mandatory Participation Requirement)

Each participating Residential Aged Care Home must nominate at least one Virtual Care Champion. This person will lead local implementation and participate in program onboarding, coaching, and Community of Practice activities throughout 2026. At least one Virtual Care Champion is required; more than one may be nominated.

Virtual Care Champion – name: *

Position / role within the service: *

Work email address: *

Work phone number: *

If nominating more than one Virtual Care Champion, please provide details for any additional Virtual Care Champion as an attachment to the application form.

Mandatory Eligibility Criteria for Residential Aged Care Homes

Please confirm Residential Aged Care Home (RACH) eligibility by ticking all applicable boxes. Applications that do not meet all mandatory eligibility criteria will not be considered.

Mandatory Eligibility Declaration

By submitting this Expression of Interest, the applicant Residential Aged Care Home confirms that it: *

Is an Australian Commonwealth-funded Residential Aged Care Home operating within the Western NSW Primary Health Network (WNSW PHN) region, excluding Multi-Purpose Services (MPS) operated by NSW Health.Operates in accordance with applicable legislative and regulatory requirements under the Aged Care Act 2024 (and any applicable transitional provisions). Is not currently subject to any investigation, sanction or suspension by the Aged Care Quality and Safety Commission or any other relevant regulatory authority that would preclude participation in this initiative.Has no outstanding enforcement action, compliance notices requiring remediation, or serious breaches under the Aged Care Act 2024 (including any applicable transitional provisions) that would preclude participation in this initiative.

Eligibility Basis

The Residential Aged Care Home meets at least ONE of the following eligibility criteria: *

The service has not previously applied for the 2023 WNSW PHN Telehealth Grants. The service previously participated in the 2023 WNSW PHN Telehealth Grants and confirms that approximately 50% or more of residents currently access healthcare services via virtual care, including GP and/or allied health consultations.The service is participating in a formally approved virtual care research, evaluation, or quality improvement project, conducted under appropriate ethics and/or governance authorisation (e.g. universityled or health system–endorsed initiatives such as the Sydney University WoundView Project), and demonstrates a need for additional virtual care equipment to support participation.

Eligibility- Virtual Care Uptake

At the time of application, does your service meet the eligibility requirement that approximately 50% or more of residents currently receive healthcare via virtual care (e.g. telehealth video or phone consultations)?

YesNo

By selecting “Yes”, the applicant confirms that this statement is true to the best of their knowledge at the time of application.

Note: This eligibility declaration is separate from the baseline assessment, which captures resident numbers and virtual care uptake to establish a shared starting point for the initiative.

Clarifying Note – Virtual Care Research Participation

Applications approved on the basis of virtual care research participation are intended to ensure that Residential Aged Care Homes are able to participate in relevant virtual care research projects.

Equipment will be provided as a standard virtual care equipment package in line with the initiative. Equipment packages will not be split or partially allocated.

Program Participation Requirements

Residential Aged Care Home confirms and agrees that ; *

Commits to nominating at least one Virtual Care Champion, providing their work email address, and supporting their active participation in Community of Practice sessions throughout 2026.Acknowledges that the authorised manager or delegate submitting this Expression of Interest is responsible for enabling the Virtual Care Champion’s attendance and participation. Agrees to complete a mandatory Digital Health Maturity Assessment with WNSW PHN during latter half of 2026.Consents to the use of aggregated or deidentified virtual care utilization data for program monitoring, reporting, and evaluation by WNSW PHN, including reporting to the Department of Health, Disability and Aging.

End of mandatory eligibility criteria section.

Selection of Virtual Care Equipment

There are seven virtual care equipment options available for this EOI to support different care settings and workflows. These include powered and nonpowered medical carts that can be used with a tablet, laptop or all-in-one computer.

Please review the options and choose (tick) one (1) option in the online application form that best meets your residents’ virtual care needs and workflows for virtual care delivery. Additional information is available via the links shown in the images below.

Note:Images are examples only and the final cart setup may vary.

Option A : Battery Powered Cart : Height adjustable cart, Adjustable monitor arm, All-in-One computer Keyboard & Mouse, Handheld HD General Exam Camera, Microphone Speakerphone, Rear storage basket, Optional single drawer, Lithium Iron Phosphate battery located in base of cart.

Option B: Battery Powered Cart : Height adjustable cart, All-in-Onecomputer, Patient facing camera on telescopic pole, Keyboard & Mouse, Handheld HD General Exam Camera, Speakerphone, Single drawer, Power-Cell cart battery-requires mounting on rear of cart.

Option C : Battery Powered Laptop Cart : Height adjustable cart, Laptop computer, Keyboard & Mouse, Handheld HD General Exam Camera, Microphone Speakerphone, Rear storage basket, Optional single drawer, Lithium Iron Phosphatebatterylocatedin base of cart.

Option D: Laptop cart: Height adjustable cart, Laptop computer, Patient facing camera on telescopic pole, Keyboard & Mouse, Handheld HD General Exam Camera, Speakerphone& Single drawer.

Option E: Laptop Cart: Light duty medical cart, Height adjustable, Laptop computer, Handheld HD General Exam Camera & Microphone Speakerphone.

Option F: Tablet Cart: Lightweight mobile tablet cart - weighted base, Articulated arm- tablet height adjustment, 360 degree rotating tablet mount, Tablet computer, Utility box, Handheld HD General Exam Camera, Microphone Speakerphone& Optional-Worksurface or keyboard traywith wirelesskeyboard & mouse.

Option G: Tablet Cart: Lightweight Mobile tablet cart, Tablet computer, Patient facing HD Camera,
Wireless keyboard & mouse, Handheld HD General Exam Camera& Speakerphone.

End of section.

Please proceed to Virtual Care Baseline & Readiness Assessment

Virtual Care Baseline & Readiness Assessment (EOI)

Please answer the following questions based on your current practice. Your best estimate is sufficient.

Connectivity and Digital Readiness

Q1. Does your current WiFi connection reliably support video consultations (e.g. telehealth) without frequent interruptions? *

YesSometimesNo

Q2. Can your WiFi support multiple simultaneous video consultations or devices at the same time? *

YesSometimesNo

Q3. Do WiFi coverage issues (e.g. blackspots or weak signal) currently limit your ability to deliver virtual care in your facility? *

No – WiFi coverage is adequate Yes – the issue has been resolved or is being addressed Yes – the issue remains due to funding, infrastructure, or resource constraints

Q3a. if yes, briefly describe the issue and whether it could be resolved with additional support (e.g. access points, extenders, cabling). (Optional- one sentence)

Resident Participation and Support Needs

Q4. When delivering virtual care to residents, does your facility experience challenges supporting certain residents to participate effectively? (Select all that apply) *

No – virtual care works well for most residents Residents with higher clinical or care needs require additional support Cognitive, communication, or sensory needs present challenges Some residents or families require additional support or reassurance Cultural considerations influence engagement (including for First Nations residents, where applicable) Not applicable – our facility does not currently use virtual care

Q4a. If yes, briefly describe the main challenges or additional support required. (Optional – one sentence)

Existing Virtual Care Equipment- Current Use

Q5. Please list the virtual care equipment currently used for resident consultations (including quantities). Example: 2 laptops, 1 telehealth cart, 3 tablets. *

Current Model of Care Delivery

Q6. How are General Practitioner (GP) services delivered to residents? *

Mostly virtual Mostly onsite A combination of virtual and onsite Not currently available

Q7. How are Allied Health services delivered to residents? *

Mostly virtual Mostly onsite A combination of virtual and onsite Not currently available

Telehealth Platforms and Providers

Other (please specify):

Q10. How is virtual care currently used in your service? (Select all that apply) *

Q11. How would you describe your service’s current level of confidence and capability with virtual care? (Select one)

High – well established Moderate – some use Low – limited or ad hoc use Very low – little or no experience

Q12.What are the main barriers to using virtual care in your service? (Select up to three) *

Staff confidence or training Access to suitable devices or equipment Internet connectivity or bandwidth Resident digital capability or cognitive impairment Privacy or consent concerns Lack of clinical workflows or guidance Limited external provider availability Not currently a priority No significant barriers

Q13.What types of support would be most helpful to strengthen virtual care capability in your service? (Select all that apply)

Staff training and upskilling Clinical usecase guidance Equipment or device support Connectivity support Community of practice / shared learning Technical troubleshooting support Change management and workflow support Not required at this time

Existing Virtual Care Equipment-Available Devices

Q14. What virtual care equipment does your service currently have access to for resident consultations? (Select all that apply) *

Desktop computer (with webcam) Laptop / notebook Tablet (e.g. iPad, Android tablet) Smartphone Telehealth or virtual care cart (mobile unit) Fixed virtual care workstation (e.g. large screen with camera) None currently available Other (please specify in below text box)

Other (please specify): ______________________

Q15. When smartphones are used for consultations in your service, how are they typically used? (Select one)

Phone calls only (audio) Video consultations Both phone and video consultations Not sure

If smartphones are not used for consultations, please skip this question.

Resident Numbers and Demand

Q16 . Total number of residents in your Residential Aged Care Home: *

Q17. Approximately how many residents currently require or regularly use virtual care services? (Estimate acceptable) *

Trend in Virtual Care Usage

Q18. Over the past 6 months, has the proportion of residents receiving virtual care: *

Increased Stayed about the same Decreased Unsure

Q18a. If increased or decreased, briefly note the main reason(s).(Optional – one sentence)

Q18b. Optional estimates: Number of residents with at least one virtual consult in the last 30 days (if known):

Q18c. Optional estimates: Number of residents with at least one virtual consult in the same period 6 months ago (if known) :

Remote Monitoring and Diagnostic Devices

Q19. Do you currently use any remote monitoring or diagnostic devices for virtual care? (e.g. BP monitors, pulse oximeters, ECG devices, digital stethoscopes, examination cameras)

Yes – please list below No

Q19a. If Yes, please list the remote monitoring or diagnostic devices currently in use *

Q20. If you do not currently have these devices but have residents or clinicians who would benefit from remote monitoring, please describe your needs below. (Optional )

Workforce Capability and Leadership

Q21. Are staff trained to provide and support virtual care services? *

Yes – most staff are trained and confident Some staff are trained Limited or no staff training

Q21a. If some or limited, please specify relevant roles or numbers (optional). (Example: 3 Registered Nurse and 1 Enrolled Nurse are confident delivering virtual care.)

Virtual Care Research Participation

Q22. If applicable, briefly describe any current or approved virtual care research, evaluation, or quality improvement project your organisation is participating in, including the project (name or brief description), lead organisation; and why additional virtual care equipment is required to support participation. Response limit: 60–75 words

I confirm the information provided in the above Q22. is current at the time of application and relates to a formally approved project.

End of questionnaire.

Please proceed to declaration and consents.

DECLARATION

This section must be completed by an authorised representative of the organisation submitting the application.

By submitting this Expression of Interest, the applicant Residential Aged Care Home confirms and agrees that it:

Is an Australian Commonwealth-funded Residential Aged Care Home and operates in accordance with applicable legislative and regulatory requirements under the Aged Care Act 2024, including any applicable transitional provisions. *

Operates a Residential Aged Care Home within the Western NSW Primary Health Network (WNSW PHN) region and is not a Multi-Purpose Service (MPS) operated by NSW Health. *

Meets at least ONE of the eligibility pathways selected in Section 2 (Eligibility Basis) at the time of submission and can provide supporting evidence if requested by WNSW PHN. *

Where eligibility is based on virtual care uptake, confirms that statements regarding approximately 50% or more of residents receiving healthcare via virtual care are accurate to the best of its knowledge at the time of application. *

Is not currently subject to any investigation, sanction or suspension by the Aged Care Quality and Safety Commission or any other relevant regulatory authority that would preclude participation in this initiative. *

Has no outstanding enforcement action, compliance notices requiring remediation, or serious breaches under the Aged Care Act 2024 (including any applicable transitional provisions) that would preclude participation in this initiative. *

Agrees to participate in the Virtual Care Initiative in accordance with program requirements, including: nominating at least one Virtual Care Champion supporting participation in Community of Practice sessions and associated coaching activities using the equipment to support residents to access virtual consultations with relevant clinicians *

Acknowledges that equipment packages offered through the initiative are fixed, will be funded and procured by WNSW PHN, must be maintained in good working order, and will be returned to WNSW PHN within eight (8) weeks of delivery if the organisation elects not to proceed. *

Agrees to complete required digital health and baseline assessments and consents to the collection, secure storage, use and reporting of aggregated or deidentified data for the purposes of program monitoring, evaluation, reporting and audit by WNSW PHN, including reporting to the Australian Government Department of Health, Disability and Ageing in accordance with applicable privacy and records management requirements. *

All information provided in this application is true and accurate to the best of the applicant’s knowledge at the time of submission *

Conflict of Interest Declaration

The applicant Residential Aged Care Home confirms that:

The applicant Residential Aged Care Home declares that it has no actual, potential or perceived conflicts of interest that could reasonably be seen to influence its participation in this initiative.The applicant Residential Aged Care Home declares that it does have an actual, potential or perceived conflict of interest. If yes, please describe the nature of the conflict and any relevant context.

Please outline the nature of the conflict, parties involved (if applicable), and any relevant context.

Final Declaration and Consent

I declare that the information provided in this Expression of Interest (EOI) application is true, accurate and complete to the best of my knowledge. *

I confirm that I am a senior representative with operational responsibility for the Residential Aged Care Home, or an authorised delegate acting with the authority of the Organisation, and that I am authorised to submit this Expression of Interest on its behalf. *

I consent to the collection, use and disclosure of information contained in this application for the purposes of assessment, program delivery, administration, monitoring, evaluation, reporting and audit in relation to the Strengthening Virtual Care Capability in Residential Aged Care (2026) initiative. *

I have read, understood, and agree to the EOI Guidelines, should this application be successful. *

I understand that all information will be handled in accordance with the Privacy Act 1988 (Cth), relevant funding deed obligations, and WNSW PHN records management and information security requirements. *

I acknowledge that external reporting and evaluation activities will be conducted using aggregate data only, to ensure the confidentiality of individual Residential Aged Care Homes, and that information may be shared with relevant government agencies or authorised third parties where required for program delivery, compliance or audit purposes. *

I acknowledge that ownership of virtual care equipment provided under this initiative will transfer to the Residential Aged Care Home upon delivery and acceptance, subject to participation obligations and recovery provisions outlined in this Expression of Interest and the Participation Agreement.
*

I acknowledge that providing false or misleading information may result in this application being deemed ineligible. *

I declare that the applicant Residential Aged Care Home is financially viable and has the organisational capacity to accept, maintain and appropriately use the equipment and capability support provided under this initiative for its duration.

*

I understand that Expressions of Interest will be screened for eligibility and available capacity, and that decisions regarding eligibility or participation are final.
*

I understand and accept that information provided in this application will be stored by WNSW PHN in various formats, including hard copy and or electronic. *

I confirm that this application does not seek to duplicate existing support, equipment, or capability assistance received for the same purpose through other programs or initiatives, and is not intended to replace routine service delivery or ongoing operational costs.

*

I agree to contact WNSW PHN should I become aware of any changes to information contained in this application. *

I understand that this application does not create a legal or binding commitment. *

If the application is successful, I acknowledge that:
- The applicant Residential Aged Care Home will be asked to sign a Participation Agreement with the WNSW PHN;
- The applicant Residential Aged Care Home will be required to provide information or attestations, as requested by WNSW PHN, to confirm appropriate use of the virtual care equipment and participation in initiative activities;
- The applicant Residential Aged Care Home will provide reports to the WNSW PHN in accordance with their Participation Agreement; and
- The organisation agrees to maintain adequate insurance for the duration of this Participation Agreement and provide WNSW PHN with proof when requested. *

I understand if the conditions of the Participation Agreement are not complied with:
- The WNSW PHN will recover the equipments allocated; and
- The WNSW PHN may terminate the Participation Agreement with the applicant. *

I have read the WNSW PHN General Participation Conditions *

Applicant Signature *

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Name *

Position *

Date: *

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