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Stakeholders at loggerheads regarding AN-ACC and future allied health provision in aged care

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The health department, researchers and allied health practitioners are at odds in the debate surrounding the perceived effectiveness of the new funding tool for services in residential aged care.

In the wake of the “Death of Aged Care” campaign launch, the Federal Government has largely rebuffed the campaigns concerns that the new Australian National Aged Care Classification (AN-ACC) will result in a reduction in allied health provision in residential aged care.

In a statement to Aged Care News, a spokesperson from the health department says that the claims made by the campaign are ‘incorrect’:

“The introduction of the AN-ACC is not changing providers’ responsibility and obligation to provide a range of specified care and services to all residents, when they need them.

“The schedule of specified care and services contained in the Quality of Care Principles 2014 specifies that if allied health services are required as part of a therapy program, the aged care home is responsible for covering the costs for eligible residents who meet the criteria under the Act.”

The introduction of the AN-ACC is not changing providers’ responsibility and obligation to provide a range of specified care and services to all residents, when they need them.

Spokesperson, Australian Department of Health

In response, Alwyn Blayse, leader of the Death of Aged Care campaign and practicing physiotherapist, tells Aged Care News that the Government is overlooking the compliance issues experienced by professionals on the ground.

“Their response shows exactly what we are fearing – that they will just say they expect nursing homes to provide, and then spend money on compliance without specifics on how to make sure certain allied health levels are maintained,” Blayse says.

He adds that in practice, robust therapy programmes are already very rare, so therapists are not confident in leaving care-planning decisions in the hands of residential providers alone.

“Regardless of how they are saying they will strengthen compliance to make sure nursing homes do the right thing and spend money on allied health, the key question is still: ‘how can government be confident nursing home residents will even get the same amount of allied health they are getting now?’”

Research called for more, not less, care time

Whilst Blayse and colleagues’ bear minimum call is for a maintenance of current standards of care, the intention of policy developers involved in the Royal Commission into Aged Care Quality and Safety was originally more ambitious.

The Resource Utilisation and Classification Study (RUCS) Reports were released in February 2019 as part of the Royal Commission into Aged Care Quality and Safety.

Carried out by the Australian Health Services Research Institute (AHSRI) at the University of Wollongong, the set of six report spelt out the rationale for the development of the AN-ACC.

Regardless of how they are saying they will strengthen compliance to make sure nursing homes do the right thing … the key question is still: ‘how can government be confident nursing home residents will even get the same amount of allied health they are getting now?’

Alwyn Blayse, physiotherapist and leader of the Death of Aged Care campaign

A key part of the research involved benchmarking the standards of allied health care in Australia against comparable health systems across the globe.

This research declared the British Columbian (Canada) system’s 22 minutes of care to be the gold standard and noted that only 2 per cent of Australian RACF residents currently receive such care.  

Anita Westera, co-author of the paper and AHSRI Research Fellow, points to this finding, as she tells Aged Care News that augmenting care was the intention of researchers.

“It has always been our position that allied health should be embedded within the AN-ACC… and be able to be publicly reported against within the new 5-star rating system that the Royal Commission has recommended,” she says.

“It’s actually in this latter piece of work that we were able to identify just how poorly Australia rates compared with international benchmarks, in regards to allied health staff time in residential aged care.”

“Despite this, the Royal Commission and the Government have been at odds in regards to supporting the need for increased funding and accountability of allied health in residential aged care.”

Blayse says that a mandate of 22 minutes is vitally needed for Australian therapists to provide adequate care to older Australians.

“Anything other than that will be catastrophic for residents, with more load on nurses, falls, side effects, deaths as well as job losses for allied health,” he says.

‘Perverse incentives’ vs evidence based care

In a further statement to Aged Care News, a spokesperson for the health department noted that the new model is intended to guard against the overuse of services with minimal evidence base.

“The new funding model enables appropriate treatment, including allied health, to deliver the care that is best aligned to residents’ needs and goals in accordance with the resident’s care plan.

“This removes the risk of perverse incentives to deliver treatments that are not clinically appropriate in order to maximise funding, such as providing massages for residents with paper-thin skin.”

Westera echoes this claim, noting that the ACFI incentivised extensive use of ‘massage therapy’ under ‘pain management’ funding.

“And that’s despite the fact that there is no evidence of massage helping manage pain,” she says.

However, Blayse states that physiotherapists are aware of the limitations of this therapy; he, in fact, laments that the funding model itself denied provision of the full range of physiotherapy interventions.

“I did four weeks of my four year course on massage therapy, so I found that really weird… there’s a great evidence base on exercise and mental health and pressure…

“But I was specifically told not to do exercise,” he says.

He says that the Government’s claims are an insult to the integrity of allied health professionals across Australia.

“No allied health professional I’ve ever worked with, or have heard of, would massage a resident with paper-thin skin, regardless of “incentives”,” he says.

“The department of health were the ones who instituted the ACFI with the perverse incentives in the first place, but to tar us all with a statement about doing massages on paper thin skin, is an insult to the care and love we have for our older residents we see every day.”

To find out more about the ‘Death of Aged Care Campaign’, follow this link.

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