According to the Australian Physiotherapy Association (APA), there is light at the end of the tunnel for members who have been concerned about aged care providers reducing their provision of of allied health in residential aged care – a feared consequence of the new funding instrument, the AN-ACC (Australian National Aged Care Classification).
Scott Willis, CEO of APA, met with Senator Richard Colbeck, minister for aged care services, last Friday afternoon.
“He reassured us of his understanding of the value of physiotherapy, particularly in the aged care sector,” Willis notes.
“Minister Colbeck also maintained that more money will be injected into the system and that physios will be well represented.”
How these promises will be translated into practice to the AN-ACC may become clearer in the coming days, when Colbeck is scheduled to release a public statement on the matter.
The meeting between Willis and Colbeck was the result of a furore over an article published in the Sydney Morning Herald, which signalled that the lack of mandated allied health minutes – despite researchers from the University of Wollongong explicitly suggesting so as they designed the model – was due to the Government’s intention to limit physiotherapists allegedly ‘over-servicing’ older patients for financial gain.
As a spokesperson from the federal health department told Aged Care News in October last year, the AN-ACC as it stands “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”.
The implications caused widespread offence amongst the Australian physiotherapy community, as Willis clarifies that the current system of “perverse incentives” is “the terrible situation that the Government’s put them in”.
“I think it’s quite disrespectful of anyone coming out and attacking a professional standing that was regulated by the Government themselves,” he says.
The outgoing system, the Aged Care Funding Instrument (ACFI), has severely limited physiotherapists’ scope of practice since its implementation in 2014.
Physiotherapy, under this funding scheme, is only allowed for the purpose of ‘pain management’ under items 12.4(a) and 12.4(b), which warrants treatments involving massage or use of technical equipment, such as a TENS (Transcutaneous Electrical Nerve Stimulation) machine.
Physiotherapists, backed by the APA, have been lamenting for years that the funding model does not incentivise the best, evidence-based use of physiotherapists’ time and skillset.
“There’s clear evidence that massage and electrotherapy still provides some significant improvements within aged care itself … but what we’re really advocating for is that we need to be able to do that full scope of practice, and not just massage and electrotherapy,” Willis says.
Willis adds that when older adults are provided with holistic care, utilising the full spectrum of physiotherapy techniques, fall risk is reduced, incontinence may be resolved or improved, and older person’s overall quality of life improves.
But the ACFI, by design, limited physiotherapists to passive treatments – with physiotherapists at risk of regulatory action if they are caught incorporating restorative techniques into their treatment of elders.
“I always say, it’s like if you go to a GP with an infection, and they say, ‘OK, I’m going to give you some Panadol but I can’t give you any antibiotics because, you know, we don’t get funded for it’,” Willis says.
Echoing this sentiment is Simon Kerrigan, a Sydney physiotherapist who, in an open letter to Minister Colbeck published on his LinkedIn page last week, expressed his dismay at the lack of accountability from Government regarding its role in perverting the system.
“… the problem is not the fault of the clinicians, but, unsurprisingly, at the feet of your Federal Government and those before you,” Kerrigan writes.
However, Kerrigan says that the incoming AN-ACC is a welcome reform in principle, as physiotherapists agree that there should be no incentives directing practitioners towards therapies that are “not necessarily the most clinically appropriate” – as Colbeck put it, in a letter seen by Aged Care News.
“Great! This is exactly what we want,” Kerrigan says.
“I believe you’re on the right track; you’re just going about it in the wrong way.
“You don’t need to cut allied health funding; you just need to remove the limitations which you’ve put on our practice.
“If you do this, you’ll have residents who move better, are in less pain, experience less falls, breathe easier, are less impacted by chronic disease, are stronger, fitter, healthier, more confident and happier.”
Colbeck did state in his letter that his department saw the AN-ACC as the enabler of restorative care.
“Consistent with the Royal Commission’s recommendation 121, under AN-ACC, if the capability of a resident improves, there is no requirement for reassessment and potential reassignment to a lower payment class. This provides an inbuilt incentive for aged care providers to invest in restorative care,” the letter reads.
The real root of the discord between the Morrison Government and allied health providers, therefore, is to be found in the level of trust the respective parties have in providers to spend allocated funds appropriately.
What the Government is yet to address are advocates’ suspicions that aged care providers, when given the freedom to decide how AN-ACC funding will be used in practice, will preference cheaper, non-clinical alternatives over treatments such as physiotherapy.
A September 2021 report from Stewart Brown showed that while the average, internally-employed ‘lifestyle officer’ earns $31 per hour, an internally-employed physiotherapist costs, on average, $41 per hour but can cost up to $74 per hour if employed as an external contractor.
Providers taking the opportunity to save money by cutting physiotherapy, Willis notes, will mean a significant drop in quality of care.
“The problem with that, is that sometimes you can get some services delivered by professions that, one, aren’t regulated or, two, that haven’t really got the skill set that is up to the scratch of physiotherapists,” Willis notes.
He tells Aged Care News that in order to prevent aged care providers cutting corners, the meaning of an allied health practitioner should be clearly defined.
“Because if it’s not defined as a university educated person… [ACFI funding] is not going to go on physios, OT’s or speechies [speech pathologists] or whatever else is needed.
“We further request that the allied health professional’s treatments be an individualised session rather than a group session, and not be provided by other therapists such as lifestyle coordinators, music therapists, and therapy assistants.”
Blayse is travelling to Canberra today to lodge a Senate petition with Greens Senator Janet Rice, which implores the Government to amend the AN-ACC so that it explicitly protects allied health provision in residential aged care facilities.
The petition has garnered 20,000 signatures from concerned physiotherapists, aged care advocates and members of the public.
And although the final transition to AN-ACC is still months away, there are already signs that physiotherapists’ worst fears regarding the AN-ACC are coming to pass.
“I’ve had many, many texts and emails and messages from members and a couple of members only texted me this morning to say that their hours have been halved already, in preparation,” Willis says.
“It’s sent a huge shock through our whole industry,” Blayse says.
Following is a statement provided to Aged Care News from Minister for Senior Australians and Aged Care Services, Richard Colbeck’s office:
“The Australian National Aged Care Classification (AN-ACC) funding model will be a game-changer for the aged care sector ensuring the care of older Australians is maintained and workforce support is prioritised.
The new model will incorporate existing residential aged care funding plus the $7.7 billion in additional funding for residential care announced in the 2021-22 Budget, resulting in a significant increase in funding for residential aged care.
Existing Aged Care Funding Instrument (ACFI) funding, which includes allied health care, will be rolled into the AN‑ACC funding allocation from 1 October 2022, with providers still funded for and required to provide allied health services to residents in accordance with their obligations under the Aged Care Act.
The September 2021 StewartBrown survey identified that allied health services costs were four per cent of the total care costs for providers.
This would mean that approximately $700 million per annum is available to providers under AN-ACC to spend on allied health services.
Unlike the ACFI, there is no requirement under the AN‑ACC care funding model for a resident to be reassessed and potentially reassigned to a lower payment class if the capability of a resident improves.
This means providers can invest in restorative care services, including through the use of allied health, if it is in the best interest of the resident.
Providers were required to report on the care time delivered by allied health professionals at the facility level from the 2020-21 financial year, as well as quarterly from July 2022.
This will give visibility over the use of allied health services, such as physiotherapy, during the transition to AN-ACC and inform future policy decisions.
Ultimately, the reforms will increase access and makes sure it meets the needs of the resident.
Providers will be required to offer care in keeping with the resident’s assessed needs and the quality of that care will be reflected in the publicly reported star rated system.
This will include consumer experience outcomes, any regulatory activity undertaken by the Aged Care Quality and Safety Commission, the care minutes being provided to senior Australians and service reporting against quality indicators.”