Physiotherapy is an essential component of high-value, quality and safe care in residential aged care facilities. Those of us fortunate enough to be able to work across our complete breadth of practice, or if not at least more broadly than the current residential aged care funding model supports, will see the positive difference and meaningful experiences that quality physiotherapy contributes every day.

These contributions are to the individual resident being at the centre of care— supporting their needs, strengths and preferences in areas such as mobility, movement and function, pain and continence; to staff—such as problem- solving the best way to assist someone to move in bed and stay safe; and organisational—such as with a systems- centred approach in areas of quality and safety.

The current Aged Care Funding Instrument (ACFI) is narrow in perspective and doesn’t support the diversity and complete scope of physiotherapy practice. The only physiotherapy service for which residential aged care facilities can claim funding is for passive pain management (such as TENS and massage). There is no funding for evidence-based and evidence-informed practice, including tailored assessment, planning and goal setting and therapy to support these. There is no funding for preventative healthcare, reablement or wellness.

The APA (and others) has agitated for change to the ACFI over many years. Recently, government commissioned two reviews to help inform funding reform/models: the Review-ACFI, publicly released in October 2017 (not the focus of this article); and the report by the Australian Health Services Research Institute (AHSRI) at the University of Wollongong (led by Professor Kathy Eager), released in April 2017.

The AHSRI identified major issues with the ACFI, namely, the additive design is the sum of individual item scores and ignores interactions—it doesn’t focus on what drives care costs, it doesn’t discriminate enough between residents, there are inequitable outcomes (geographic and socioeconomic), and it creates perverse incentives for income maximisation.

When the funding model was deemed no longer fit for purpose, the government invested $2 million to undertake a Resource Utilisation Classification Study (RUCS).

The RUCS aimed to identify a new funding model that better distinguishes the care needs of residents from lower to higher needs and identify fixed costs associated with the care of all residents.

The RUCS study was scheduled for completion in December 2018. It will produce a series of seven reports, with a variety of proposed implementation pathways (next steps, trials, legislative changes and more). These reports will invite public and industry feedback and is a further opportunity for the APA to provide comment.

What does this mean for physiotherapists, other colleagues and those living in residential aged care facilities? Apart from the opportunity to engage in minimum assessment guidelines, there are numerous factors to consider. Will the cessation of a prescriptive funding model mean greater practice scope ability? In the AHSRI model, without direct funding for physiotherapy and allied health, will workforce numbers reduce? Will a new funding model allow physiotherapists to practice to their full scope, including reablement? Will true consumer choice be enabled?

The government has made it clear that they have not yet selected the AHSRI or any other funding model, with the current ACFI expected to continue to 2021. Meanwhile, they will continue to explore options and engage with the sector. Significantly, now is the time to unite and work together.

Aged care funding reform is a nationwide opportunity for collaboration and innovation, and physiotherapists continue to have a significant role to play.

MORE INFORMATION

Australian National Aged Care Classification: A recording of Professor Kathy Eager’s presentation of the draft new classification system will be on the Department of Health’s website (not yet available at the time of writing).

Click here for a summary report of the Review-ACFI

Click here for the full report  

Click here for the Australian Health Services Research Institute report

Click here for the Royal Commission into Aged Care Quality and Safety

To find out more or to share ideas, email advocacy@australian.physio.

Vanessa Jessup, APAM, represented the APA at the Resource Utilisation Classification Study and Residential Aged Care Funding Reform Stakeholder Forum in Canberra on 19 November, where Professor Kathy Eager presented the draft of the new Australian National Aged Care Classification system.