The government’s plans to fund allied health through the new residential aged care funding model is welcome, but there is not enough allocated in this Federal Budget to do it, an expert has told Australian Ageing Agenda.
The budget handed down by Treasurer Josh Frydenberg this week includes an additional $18 billion for aged care to 2024-25 – with $8 billion of that for residential aged care – in response to the Royal Commission into Aged Care Quality and Safety’s recommendations.
In a separate report responding to each of the royal commission’s recommendations, the government has accepted or accepted in principle 126 of the 148 recommendations.
One of those the government “accepts-in-principle” is recommendation for providers to be funded through a blended funding model to engage allied health professionals to ensure residential aged care included a level of allied health care appropriate to each person’s needs.
In its response, the government said it was acting to improve allied health and palliative care services through the design of the Australian National Aged Care Classification, the new funding model developed by the University of Wollongong’s Australian Health Services Research Institute (AHSRI) now undergoing trials through shadow assessments.
This week’s budget commits $189 million to implement the AN-ACC as the new funding model from October 2022 but it includes no specific funding for allied health services in residential aged care.
AHSRI director Professor Kathy Eagar welcomed the inclusion of allied health in the AN-ACC but noted a lack of investment.
“It is a better structural solution to include allied health than to be treated as fees and services through Medicare. The structure is right, but the money isn’t,” Professor Eagar told AAA.
She said the $27.9 million allocation over four years for allied health in aged care in the government’s COVID-19 package was insufficient.
“That’s only $7 million a year across 2,700 homes, which is very short sighted and just not enough,” Professor Eagar said.
She said allied health was the “real loser” in the budget because the royal commission had made “naive” recommendations about allied health.
“We recommended 22 minutes of allied health per day be built into the funding model. And that be the mandated minimum and it be publicly reported up from the current average, which is eight minutes per resident per day,” she said.
“They’ve not included that in the mandated staff time… and once the [Aged Care Funding Instrument] goes, which creates incentives around pain, it’s quite likely that there will even be a reduction in allied health. This is a really serious deficiency in the package that’s just been announced,” she said.
Professor Eagar said they would undertake a costing study that adequately built allied health into the model, but said it would take several years.
“In the meantime, the government has built in a small package of money for allied health as an extension of the COVID items in the [Medicare Benefits Schedule], but they are demonstrably inadequate,” she said.
“Allied health will still miss out”
Gerontological physiotherapist and Australian Physiotherapy Association vice president Rik Dawson said there were positive aspects to the AN-ACC but it won’t provide for adequate allied health care.
“It doesn’t go far enough in its structure to prioritise allied health and restorative care,” Mr Dawson told AAA.
“We believe AN-ACC just replaces how residents are classified for the amount of funding that they need. There are no structural reforms currently in place or have been proposed in the budget that direct the facility to how they should spend that money; what services they should have,” Mr Dawson said.
“Currently, there’s a real lack of restorative reablement and rehabilitation services for residents and our concern is that they’ve swapped one system for another and allied health will still miss out.”
The APA consider there should be a third layer of funding in the AN-ACC allocated to allied health, he said.
Mr Dawson said he would have liked the government to extend and expand the COVID-19 temporary MBS for allied health in aged care, which currently allow an extra five treatments to residents until mid-2022.
“We would like that to be ongoing and potentially expanded up to 20 [treatments] to match the mental health MBS item. Because we believe that multidisciplinary care that involves allied health will prevent functional decline and promote independence, which ultimately increases the sustainability of the healthcare system,” Mr Dawson said.
APA is also calling for specific funding for a rehabilitation mobility and fall prevention program in residential aged care, he said.
“It’s disappointing that emerging evidence is showing the value of allied health especially physiotherapy in regards to falls prevention and it’s disappointing that this was ignored.”
Oral health neglected
Elsewhere in its response and budget, the government has sidelined better oral health for aged care residents saying the commission’s recommendation to establish a Senior Dental Benefits Scheme is subject to further consideration by 2023.
The royal commission recommended the dental benefits scheme to fund dental services for aged care residents and eligible seniors living at home.
“The delivery of adult public dental services is currently a state and territory responsibility for which the Australian Government provides additional financial support through a National Partnership Agreement,” the government said in its response to the royal commission’s recommendations.
Australian Dental Association NSW president Dr Kathleen Matthews said older Australians would continue to endure unnecessary pain and an increased risk of life-threatening conditions due to a lack of funding for much-needed oral health in this year’s budget.
“Poor oral health for older Australians costs an estimated $750m a year, but is also responsible for excruciating pain and contributing to other life-threatening conditions including heart disease and Type 2 Diabetes, malnutrition and the risk of pneumonia,” Dr Matthews said in a statement.
“Sadly the budget has failed to address the oral health needs faced by older Australians so ADA NSW will continue to work with key stakeholders on advocating for best models of dental care for our older Australians.”