Call for ACFI overhaul to cover exercise therapy for pain management

The peak body for physiotherapists is calling on the Federal Government to fund contemporary pain management therapies in residential aged care, including exercise, and overhaul the funding instrument to support restorative care practices.

The peak body for physiotherapists is calling on the Federal Government to fund contemporary pain management therapies in residential aged care, including exercise, and overhaul the funding instrument to support restorative care practices.

The Australian Physiotherapy Association (APA) wants the government to amend the Aged Care Funding Instrument (ACFI) to enable residents to access clinically-prescribed and evidence-based therapies managed by allied health professionals including physiotherapist-led exercise.

The call has been backed by the umbrella group of 19 allied health professions, Allied Health Professions Australia (AHPA), which in a joint statement to government called for pain management to be brought in line with contemporary practice and consumer directed reform.

Rik Dawson
Rik Dawson

APA gerontology chair Rik Dawson said exercise was proven to manage pain and help improve independence and quality of life for aged care residents.

“Exercise is the most effective way to reduce musculoskeletal pain. There’s strong evidence and lots of it,” Mr Dawson told Australian Ageing Agenda.

While exercise was one of the key elements, there were other proven natural therapies that helped manage pain, such as joint mobilisation, occupational therapy, psychology and posture correction, Mr Dawson said.

Missed opportunity

Responding to the changes to ACFI announced in last month’s budget, AHPA executive officer Lin Oke said it was opportunity to bring pain management in line with contemporary practice and support consumer directed reform in conjunction with reducing expenditure and incentive for industry gaming in ACFI funding.

“Whilst the announced changes will reduce ACFI expenditure and reduce incentive for gaming in the sector, they will see client care move further away from contemporary practice, limiting existing services, and prohibiting evidence based services and consumer choice,” she said.

Consumers requiring pain management were limited to a choice of massage or transcutaneous electrical nerve stimulation (TENS), but a range of allied health services such as exercise were available to assist pain relief and aged care residents should have access to the full range, Ms Oke said.

“Limiting access to services through outdated and prescriptive description of funded treatment modalities is inconsistent with evidence-based practice and consumer-directed care,” she said.

Among the budget measures to redesign the scoring matrix for complex health care is a minimum weekly delivery requirement of at least four sessions and 120 minutes of treatment for complex pain management by allied health professionals.

“The 120 minutes is excessive,” said Mr Dawson. “It will interfere with other opportunities that older people may have using their times when their energy levels are compromised. It will limit the take up of these treatments and it will compromise people’s pain experience and perhaps lead to increased medication.”

ACFI needs to cover restorative care

Mr Dawson said ACFI continued to fund passive treatment to manage pain that caused resident dependence rather than evidence-based active treatments that promoted independence and function. The ACFI needed to be reformed to include restorative care therapies, he said.

“At the moment you can only apply treatment for pain management. There is nowhere in the ACFI funding for restorative, wellness or preventative healthcare measures,” Mr Dawson said.

“It’s time to say goodbye to ACFI and start thinking about what makes sense soon, not in 2020. It is a really good opportunity with the five-year review to bring funding in line with the accreditation guidelines,” Mr Dawson said.

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Tags: acfi, ahpa, Allied-Health-Professions-Australia, apa, australian-physiotherapy-association, exercise, pain-management, rik-dawson,

8 thoughts on “Call for ACFI overhaul to cover exercise therapy for pain management

  1. Absolutely agree. The ACFI has been a disaster for frail older people – instead of being assisted to maximise their abilities they have been encouraged to be more dependent with the result of increased care costs and less quality of life.
    For example: Until the subsidy is higher for facilitating residents to walk to meals and other activities than it is to push them in a wheelchair, there will always be a drift towards the quick, easy option for staff to use a wheelchair. It doesn’t take long for an elderly person to be unable to walk or at increased risk of falling if their mobility opportunities are diminished.
    Please have a Wellness approach as well as the Palliative approach in RACF rather than residents losing function steadily after admission.

  2. The excellent 2014 APA survey highlighted a range of negative outcomes associated with the ACFI model. It was ignored then and new calls to overhaul the model will most likely suffer the same fate.

    (It’s also interesting to note that even some of the culprits of over-servicing and CHC rorting that brought us to this juncture seem to endorse the need for change)

    As the sector’s main advisor to the government, the Aged Care Sector Committee is largely responsible for the mess we’re in as they continue to steer us over a cliff. Until these bodies consist of people with real-world experience and clinicians who understand the needs of the elderly (instead of provider CEO’s and career bureaucrats), the uninformed will continue to direct the course of aged care.

    Collecting board memberships and committee seats has become a full-time hobby for members of The Club. It’s time to start selecting on merit and actual achievements, not just the number of chairs you’ve sat on.

    Here’s the current list . Not very much direct experience at the coal face, is there?

    https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/aged-care-sector-committee

    Reform needs to begin at the top

  3. Great article, thank you. As a physiotherapist in aged care, I have found it frustrating that we are unable to provide more exercise based treatments which would clearly improve an individual’s function and therefore quality of life. Passive modalities can help, however we need to look towards best practice, which advocates a more active/exercise based approach.

  4. My two question are (1) if the evidence for exercise is strong and there is lots of it, why are the APA only jumping up and down about it now? Could it be linked to the aged care reforms that will decrease there strangle hold on aged care therapies? Exercise and Sports Science Australia (ESSA) have been asking the government for years to acknowledge exercise as a a feasible treatment across a plethora of physical and cognitive disabilities that drive poor health and increased aged care cost, but have achieved little traction to date. And (2) shouldn’t aged care exercise be led by professionals with university training in exercise prescription and delivery for complex aged care clients, not professionals with a therapy background? Clients in aged care will get the greatest benefits when their allied health professionals play a team game and everybody does what they are best at.

  5. Tim,

    The APA has been ‘jumping up and down’ about the provision of aged care services for quite some time. Benchmarking services in 2007, then looking at the effects of ACFI implementation in 2009 and subsequently conducting several large scale surveys since.

    Aged care needs clinicians with a comprehensive understanding of pathophysiology, rehabilitation and related therapy. Helping granny with her strength and balance isn’t rocket surgery and doesn’t necessarily require the expertise of someone who spent four years studying star-jumps. But I agree that we need an appropriate team approach.

    There are plenty of companies already using EPs and OTs in aged care. Thanks to a technical loophole in the definition of allied health provider, they’re in roles that weren’t originally intended for them. Flogging 4b treatments on 80 residents using just one EP/OT is one of the reasons for this latest ACFI adjustment.

    Dear AAA, perhaps disabling hyperlinks in the reader comments might reduce the number of thinly veiled business plugs.

  6. It’s wonderful for all residents in aged care to attend activities that assist their health and well-being. I run gardening programs in aged care settings, including dementia care, and see an improvement in participant’s physical and physiological well-being from participating in gardening activities.
    I think a holistic approach is needed to provide health improvements to residents, and there are many ways to deliver this, not just mainstream approaches.

  7. These days big companies hiring OT’s to do pain management program. My only question to all the big bosses who decide who should be implementing the program. if you or your mother or father have back, neck or knee pain will you take them to physio/Chiro or to occupational therapist?

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