The new funding model for residential aged care, the Australian National Aged Care Classification (AN-ACC), has been the subject of much scrutiny as its activation in October 2022 draws closer.
The new model boasts some promising improvements on the outgoing Aged Care Funding Instrument (ACFI), including a $28.20 increase (per resident, per day) in the base rate of funding, and the mandating of new minimum care hours.
The 13-class payment system, which determines supplements above the base-rate according to a comprehensive assessment of residents’ physical and cognitive capacities, also provides additional funding for Indigenous elders and those living in rural care facilities.
But there are two enduring sticking points that have aged care advocates and workers concerned, namely:
- 1) that allied health services may not be adequately provided through a lack of mandating in the new system, and;
- 2) that the new model has not explicitly mentioned staff ratios, a longstanding demand of workers and their unions.
Aged Care News consulted with a range of stakeholders to seek clarity on these concerns.
Physiotherapists grimly eye the October change-over
Physiotherapists, who have been highlighting since late 2021 that the new model does not explicitly mandate care time for allied health care, have been particularly concerned.
In the words of a campaign kicked off by Queensland physiotherapist Alwyn Blayse and associates in September 2021, without explicit provision, many physiotherapists fear that cutting corners will be incentivised, which would trigger job losses, poorer resident outcomes and the overall “death of allied health” in aged care.
In March, Senator Richard Colbeck, Federal Minister for Aged Care and Senior Australians, rebuked these claims, saying that the AN-ACC will include monitoring of care time provided by all allied health professionals.
Furthermore, he noted that it will be in providers’ interests to enable access to these services, as they will be beholden to quality of care principles and a star rating system that rates residents’ health outcomes.
In a recent COTA Australia webinar, Colbeck doubled down on his assertion that the new model is ‘fairer’.
“It takes out some of the incentives that exist in the system that don’t facilitate re-enablement,” he said.
Physiotherapists have conceded that the outgoing ACFI funding model — which only provided financial incentive for the delivery of questionable treatments such as massage —is flawed, but they are looking for further clarity as to how it will be guaranteed that their proven, evidence-based therapies will be enabled under the new system.
Scott Willis, president of the Australian Physiotherapy Association, tells Aged Care News that whilst he was reassured by Colbeck in March that allied health would be protected, a lack of further clarity has caused unease.
“At our meeting, the minister reassured me that he understood the value of physiotherapy in aged care and that there would be increased funding into the aged care sector.
“My impression was that the physiotherapy profession would be properly recognised and represented in Government policies [but] along with our 30,000 members, I am awaiting further announcements from the Morrison Government on aged care funding, as well as their policies on physiotherapy and other allied health services in residential aged care.
“The Government has given us commitments and they should detail these immediately.”
Opposition and Greens express concern
According to Greens Senator Janet Rice, this retrospective policy is insufficient, especially given providers’ track records.
“It’s all ‘oh, yeah, we’ll do it and check up on them afterwards’,” she tells Aged Care News, in response to the point that monitoring allied health care hours will be included in the new model.
“But if you look at the accreditation of aged care services of how many of them fail on various measures… they get a wrap over the knuckles [for negligent service provision] but it’s always retrospectively, so you’re not guaranteed that those services are going to be there.
“Meanwhile, for all of that period of time, residents and older people are not getting the physiotherapy that they need, and we know the value of physiotherapy.
Supporting her 89-year-old mother to live at home, Rice says it’s hard enough to cobble together adequate services through the home care system.
“The very least if you’re in a residential aged care facility is that physio should be available very easily and readily for the residents who will benefit from it so much.”
With the federal election almost here, pressure has begun to amount on Clare O’Neil, Shadow Minister for Aged Care Services, to provide a solution of her own to advocates’ concerns.
In a recent Facebook live webinar run by COTA Australia, O’Neil expressed her sympathy, but said she was limited in her power as a member of the opposition.
“One of the difficulties from opposition is that we have to pick and choose what we focus on, as we don’t have the information and resources of government… but that’s certainly not because I don’t think allied health is crucial to the wellbeing of seniors and especially those in residential aged care,” she said.
“I’m contacted by providers of allied health, just feeling incredibly guilty what’s happened in allied health in aged care and their sense that it hasn’t been as much of a priority in the [Government’s] royal commission response, so I’m very keen to address it, but not from opposition.”
Blayse was disappointed with O’Neil’s response, citing the Greens Party’s proactiveness on the issue — which included receiving a Senate petition of almost 20,000 signatures from Blayse — as a sign she could be doing more.
“This pathetic response from Labor is hugely disappointing to older people, their families, allied health, nurses and carers who all know we need allied health certainty now, not when and if Labor get in.”
Creator of the model clarifies ratios and allied health concerns
Aged Care News spoke to one of the AN-ACC’s key architects, Professor Kathy Eagar, for further clarity on this contentious issue.
Eagar, as director of the Australian Health Services Research Institute (AHSRI) at the University of Wollongong, led a multi-disciplinary team of economic and health policy experts to build the new funding instrument from the ground up, in line with the findings of the Royal Commission into Aged Care Quality and Safety.
The new model, she tells Aged Care News, is sophisticated and by its very design encourages compliance with a number of advocates requests— but not in the explicit way they are used to seeing.
“We’re moving the aged care sector to a global payment, where it’s then up to the home to be accountable for achieving the best outcomes for the residents … but with standards.”
She says that reporting requirements, including gathering information on how many residents are able to walk, and how many falls are occurring, will form a series of checks and balances that will separate the new system from the rort-laden one of the past.
“Going forward, the difference is that homes will actually have to spend their care funding on care, and that hasn’t been what they’ve had to do, historically.
“In the past, some very unscrupulous providers have taken massive amounts of profits out … but they won’t be able to do that in the future, because they’ve actually got to meet standards.
In response to physiotherapists’ fears, Eagar says the new model, which encourages reablement, is good news for them and other allied health professionals.
“Of all the good people who can show what good value they are, it’s the physios. If they can get somebody walking, that’s worth heaps to the home.
“And there’s a whole lot of other health professionals who, if residents would have access to them, would allow residents to really do better — I’m thinking particularly about podiatrists and occupational therapists and speech pathologists who specialise in speech and swallowing, which a lot of older people have problems with.”
“There’s a whole lot of different allied health disciplines that can really, really make an important difference in people’s lives.”
Reablement is encouraged under the new AN-ACC, Eagar explains, because when a resident is assigned to a payment class, however high, their funding is never reduced, even when their health and abilities improve.
“Under the current [ACFI] model, residents are continually reassessed, so you get paid more, for example, if somebody can’t walk.
“If, on reassessment, the resident can walk, then the home loses money — now, that’s pretty perverse.”
Eagar adds that residential homes can request a reassessment if their residents’ needs increase, but not vice versa.
“The resident never has to be reassessed, so if you get somebody up and walking again, and you get them back to being independent, then you get the reward of being paid at that higher rate for ever in a day.
“[With the AN-ACC] if a person’s needs increase, the home can ask for an assessment, but if a person’s needs decrease, they don’t have to get them assessed.
“That is deliberately designed so that they do everything they can to make the resident more independent, without them being punished if that’s what they achieve.”
Will this equate to providers pocketing more money than is necessary?
“There won’t be many inefficiencies, because if somebody has lost their ability to walk, unless you keep the exercises up, they’ll lose it again,” Eagar replies.
Staff to patient ratios has been another key issue for workers, particular nurses, who are stretched thinly, working with ratios of 1:10 residents or more.
Eagar says that instead of one ratio, across the board, the new model will see ratios determined based on the unique care needs of each home’s resident cohort.
“People keep asking me where are the ratios, because what they are used to seeing is one nurse for every four beds, because that’s the way they’ve been historically described.
“These aren’t being described in the same way, but they achieve the same thing.
“[The major parties are] both saying 215 minutes or 200 minutes, depending on the side, and then you turn those into ratios, depending on how many beds you’ve got.”
“The reason that they’re expressing it this way, which is more complicated, is because there’s a different ratio for every AN-ACC class.”
Whilst she admits that no model is perfect, Eagar concludes that the model will cultivate a better care culture within care facilities.
“We want to empower residents and homes and make them accountable for actually making sure that their residents are doing OK.
“The homes have to accept responsibility for achieving the best outcomes for residents, and they have to be held accountable if they don’t achieve that.”