The residential aged care sector’s funding model is negatively impacting allied health provision, according to the profession’s national peak.
While the Australian National Aged Care Classification funding model is supposed to cover sufficient spending on allied health, Dr Chris Atmore – manager, policy and advocacy at Allied Health Professionals Australia – told Australian Ageing Agenda: “We know that many providers either have little funds left after providing mandated nursing and personal care, or some may use any surplus to subsidise other non-allied health costs.”
More than three years ago, the Royal Commission into Aged Care Quality and Safety found that, despite being an important pillar of older people’s health and wellbeing, allied health was significantly underprovided and underfunded – particularly in residential aged care.
“And it’s only got worse,” said Dr Atmore.
Dr Atmore’s remarks follow the release this week of a Mirus Australia report, which showed aged care residents received a more than 50 per cent decrease in allied health care minutes per day during October than the month before.
In total, residents received 4.11 minutes of allied health care compared to September (8.97). “The Mirus result is not an outlier,” Dr Atmore said. “The most recent Quarterly Financial Snapshot figure is 4.55 minutes per day,”
Meanwhile, a recent AHPA workforce survey found that more than half of allied health workers’ roles had changed since the introduction of AN-ACC (56 per cent). Of those, 18 per cent had lost their role completely, 19 per cent had been redeployed, 48 per cent had their hours decreased, and 25 per cent had increased referrals.
“My hours have reduced by half and referrals have gone up from 40 per month to 50 per month.”Survey respondent
The survey was undertaken in September-October 2023 and the findings – based on feedback from 218 respondents – were analysed this month. Similar to a 2022 survey, the 2023 survey sought information about the experiences of the allied health workforce in residential aged care since the AN-ACC model commenced on 1 October 2022.
“Overall findings were similar,” said Dr Atworth, “although there are more striking comments about the deterioration of allied health quantity and quality this time around.”
For 61 per cent of respondents services had decreased, for 72 per cent the number of individual treatment sessions had decreased, and for 48 per cent available services had deteriorated.
“Residents are no longer receiving any mobility training, post-hospital rehabilitation, functional training and pain-management interventions. Our group exercises classes are scrapped. Most residents and their family members cannot afford private physiotherapy interventions.”Survey respondent
AHPA’s survey also found that half of allied health professionals experienced changes to their clinical team structure, with 90 per cent of those respondents seeing the number of AHPs decrease and about one-third (34 per cent) experiencing a fall in the number of allied health assistants.
“AHA role no longer exists, existing AHA switched over to a [personal care worker].”Survey respondent
In addition, AHPA’s survey found that about a third of respondents (32 per cent) were aware of cheaper AHAs being inadequately supervised or being assigned duties that should have been undertaken by AHPs.
More than 30 per cent of respondents also knew of instances where personnel from outside allied health were inappropriately assigned allied health clinical roles or duties.
“Lifestyle coordinators and AHAs are delivering clinically inappropriate exercise programs.”Survey respondent
“The essential problem is that there is no mechanism to ensure that older people’s assessed allied health needs are actually met,” said Dr Atmore. “Unlike nursing and personal care, there are no mandatory direct care minutes for provision of allied health and – despite amendments to the Aged Care Quality Standards – no clear enforced standards to ensure that people get both the right amount and the appropriate types of professional allied health services that they are assessed to need.”
Dr Atmore told AAA that allied health minutes might not need to be mandated if the federal government could ensure that all aged care residents are being appropriately clinically assessed for allied health needs, with subsequent delivery of services. “But there is no systematic monitoring of whether and how such assessment is done,” she said.
Dr Atmore added it was unlikely there would be any dramatic change to allied health service provision in aged care until the government committed to a model – as recommended by the royal commission – that ensureed the delivery of allied health services according to clinically assessed need.
“This model first requires government to work with the allied health sector to develop a best-practice needs assessment and care planning tool, as recommended in the Resource Utilisation and Classification Study informing development of the AN-ACC,” said Dr Atmore.
“Only when this tool is used consistently across aged care can we generate the comprehensive allied health data, including by AN-ACC class, that we need to inform realistic allied health costing and pricing, including of the funding necessary to supply sustainable models of best-practice multidisciplinary team care.”
Without change, AHPs will exit the sector, warned Dr Atmore. Indeed, 38 per cent of survey respondents said they did not intend to keep working in residential aged care while 82 per cent of respondents said they were concerned about the future of allied health in the sector. “This was overwhelmingly due to their concerns about the safety and quality of care for residents,” said Dr Atmore.
“I have come to appreciate providing treatment to aged care and wish to continue doing so but not in an aged care facility. It has now mainly become business focused, not resident focused. Staff are burnt out and residents are often neglected.”Survey respondent
Dr Atmore told AAA the peak – which represents more than 150,000 members – was calling on the government to “urgently work with the allied health sector and relevant workforce and training entities to develop a national allied health workforce strategy, supported by a national minimum dataset, and cognisant of the cross-sector character of many allied health professionals’ work.”
As these strategies will take time, AHPA suggests an interim, funded benchmark of 15 allied health minutes per resident per day.