The Australian National Aged Care Classification (AN-ACC) (Australian Government Department of Health and Aged Care 2023a) was introduced by the federal government in October 2022 as part of a plan to reform and improve aged care services for older Australians. 

This change means that residents living in aged care facilities now have their funding assessed by an independent assessor. The AN-ACC assessment determines the level of funding a provider receives to provide care and services to a resident based on their classification and other factors, including location.

Separately from the AN-ACC model, the federal government has also brought in legislation introducing mandated care minutes for some staff members, including nurses, which came into effect in October 2023 (Australian Government Department of Health and Aged Care 2023b). 

This new funding model does not specify the amount of allied health input a resident should receive and allied health staff input was not included in the mandatory care minutes. However, the new model did expand the scope for physiotherapy in that treatments are no longer determined by the funding model.

The APA has worked collaboratively with other peak bodies, including Allied Health Professions Australia, to advocate for physiotherapists in the aged care sector. 

This has been driven by APA National President Scott Willis in his meetings with members of parliament as well as by the state and national committees of the APA Gerontology group through our involvement with the National Aged Care Alliance. 

We explained our role in providing exceptional care for residents living in aged care, which contributes to the ability of facilities to meet the national Aged Care Quality Standards and to address the quality indicators. 

Our stance is that physiotherapists are essential in residential aged care and should therefore have mandated care minutes.

Feedback from the front line

Following the implementation of the AN-ACC, feedback from physiotherapists working in residential aged care has been mixed. 

Providers are no longer bound to specific therapy inputs and there have been a number of reports of reductions in physiotherapy services and hours in this setting. 

Other significant workforce impacts have also been noted. 

A survey conducted by Allied Health Professions Australia (Allied Health Professions Australia 2022) within six weeks of the implementation of the AN-ACC highlighted the following: 

• one in eight respondents had lost their job
• thirty-seven per cent of respondents reported that their clinical role or employment had changed and 43 per cent of those respondents reported that their hours had reduced
• thirty per cent indicated that they expected to cease working in residential aged care.

The notable reduction in allied health staffing is concerning. 

The ability to provide 1:1 physiotherapy hours has decreased in many facilities, accompanied by an increase in group programs and in the use of allied health assistants and personal trainers to conduct exercise classes. 

Some residents are reported to have experienced a decline in both their mobility and their independence. 

However, against a backdrop of COVID-19 lockdowns, which continue to limit face-to-face physiotherapy, these statistics are difficult to obtain.

For those physiotherapists remaining in the aged care sector, a feeling of increased autonomy was reported alongside the ability to now provide evidence-based, exercise-centred treatments. 

Anecdotally, this change has improved engagement, quality of life and the overall mobility of residents. However, a glaring inequity has evolved whereby not all residents will be able to receive this care under the new funding. 

The previous funding model enabled physiotherapists to treat residents up to four times a week—for some, this may have now ceased or been reduced. 

It was reported in one case that this led to a deterioration in a resident’s mobility, with the resident predominantly resting in bed and developing incontinence. 

This is a clear example of the potential for adverse outcomes when allied health input is not provided.

Some residents may choose to access physiotherapy privately or through Medicare chronic disease management plans but not all can afford or organise such services. 

There is currently a requirement in the Aged Care Act 1997 under the ‘Care and services—to be provided for all care recipients who need them’ section related to both maintenance and intensive therapy that we can highlight in our advocacy for ongoing physiotherapy access for residents.
 

Advocacy

The APA continues to advocate for the role of physiotherapists working in aged care and this is something in which we can all be involved. 

Collectively, we need to demonstrate—to key stakeholders in residential aged care as well as to the general public—the important contribution that physiotherapists make to the quality of life of older adults through:

• providing evidence-based rehabilitation and reablement
• improving residents’ quality of life and social engagement
• becoming involved with facility risk and audit programs
• performing manual handling prescription and training
• communicating with other health professionals to improve multidisciplinary care.

Thank you to everyone who provided feedback.

Don’t hesitate to reach out to your state branch of the APA Gerontology national group if you have further feedback or questions.

The authors would like to acknowledge the contribution of Angelique Ferguson APAM and Michael Peachey APAM to this article.

For references for this article, please click here. 

Caitlin McDonald APAM is an experienced physiotherapist working in community aged care in Western Australia and is the WA Gerontology group Chair and national Vice Chair. Caitlin is a strong advocate for physiotherapy care to improve health outcomes for

APA Gerontological Physiotherapist Joanna- lee Tan APAM is the APA Gerontology group national chairperson and APA representative on the National aged Care Alliance. Jo has worked across Australia in many clinical settings and currently works in residentia