The registered nurse and care minutes across all Australian National Aged Care Classification classes should be revised to ensure there is no advantage or disadvantage for providers to take on residents based on their class, writes Mark Sheldon-Stemm.
As the new Australian National Aged Care Classification funding commences in residential aged care and the funding is tied to minutes per day per residential aged care, providers are looking at what mix of residents they should have to optimise their funding and returns.
I have seen considerable misinformation written lately about the best mixture of classes of residents, with some stating that you should not take any high-care residents because it is more profitable to take the lower classes.
Having developed a cost-of-care model over the past seven years and collected information from hundreds of residents across Australia on their direct care needs – and the minutes required – this real data does not match that allocated to the different classes in AN-ACC.
Our model has been operating for several years and it shows AN-ACC’s minutes for registered nurses and care is too high in the lower classes and insufficient in the higher classes. The care minutes are also skewed in the wrong direction.
For example, someone who is a class 2 has been allocated 32 minutes of registered nurse time per day. This is for someone who is mobile, has high cognition and no compounding factors. Whereas someone who is a class 13 has been allocated 53 minutes of registered nurse time per day to cover a non-mobile, low-functioning resident with a high risk of pressure sores and compounding factors.
However, in the case of a class 2 resident, we have found that 15 minutes of a registered nurse’s time per day is the right amount of measure and with a class 13 resident, the time averages out at 72 minutes of registered nurses time per day.
As a consequence of the current AN-ACC settings, providers who have residents at the lower end will be financially disadvantaged because they will be required to have higher registered nurses’ minutes, with less funding. The table below shows how minutes for both registered nurses and care is allocated for each class.
|AN-ACC class||Class 2||Class 3||Class 4||Class 5||Class 6||Class 7||Class 8||Class 9||Class 10||Class 11||Class 12||Class 13&1|
|Cost per minutes||$0.90||$0.89||$0.89||$0.90||$0.89||$0.89||$0.89||$0.89||$0.89||$0.88||$0.88||$0.88|
|Return per minutes||$1.09||$1.10||$1.09||$1.10||$1.10||$1.12||$1.12||$1.12||$1.13||$1.13||$1.13||$1.14|
|Registered nurse minutes/day*||32||34||30||39||35||37||38||44||52||41||42||53|
Source: Mark Sheldon-Stemm (calculations) and Department of Health and Aged Care (*)
The cost per minute of delivering care has been evenly spread across all classes. However, the return per minutes is an advantage to the higher classes. This means the high-level residents provide the greater return while the lower-level ones offer a financial disadvantage by comparison.
To address this, the minutes need to be revised across all classes for both registered nurse and care requirements. There is a more even distribution that reflects the real care needs and also ensures there is no advantage or disadvantage for an aged care provider to take in a lower or a higher-class resident. Below is a suggested change to the minutes per resident per day.
|Classes||Class 2||Class 3||Class 4||Class 5||Class 6||Class 7||Class 8||Class 9||Class 10||Class 11||Class 12||Class 13 – 1|
|Registered nurse minutes/day||15||21||25||33||35||37||38||48||58||47||48||72|
Source: Mark Sheldon-Stemm
By adjusting the minutes to the above levels, the cost and returns would be allocated to the different classes as per the table below.
|AN-ACC Class||Class 2||Class 3||Class 4||Class 5||Class 6||Class 7||Class 8||Class 9||Class 10||Class 11||Class 12||Class 13 – 1|
|Cost per Minutes||$0.86||$0.87||$0.88||$0.89||$0.89||$0.89||$0.88||$0.90||$0.89||$0.88||$0.88||$0.90|
|Return per Minutes||$1.09||$1.09||$1.09||$1.09||$1.09||$1.09||$1.09||$1.09||$1.09||$1.09||$1.09||$1.09|
Source: Mark Sheldon-Stemm
This is fairer and more even distribution of minutes, costs and returns. It also reflects what really happens in residential aged care.
Mark Sheldon-Stemm is principal of Research Analytics, and chief executive officer of ValleyView Residence