New role for ACATs in proposed funding overhaul

The revised residential care funding tool contains fewer and simplified questions, introduces a new therapy program for pain management and suggests external assessment options, the government-commissioned report released this week shows.

Minister for Aged Care Ken Wyatt released the final report of the Aged Care Funding Instrument (ACFI) review undertaken by Applied Aged Care Solutions on Thursday.

Led by Dr Richard Rosewarne, the comprehensive review focused on ways to improve the current tool, including adapting it for external assessments of funding needs and updating it to bring it into line with current care practices (read our background story here).

The result is Revised-ACFI (R-ACFI), which contains eight modified questions compared to the current 12, with changes including a new rating scale in the activities of daily living domain.

The scale clarifies physical assistance into four levels with the highest attracting more funding than available now and all residents receiving at least the minimum.

It also includes a simplified nutrition section that focuses on evidence-based assessed nutritional risk including mandating the use of the currently suggested Mini Nutritional Assessment tool.

Stricter requirements in the form of a medical diagnosis or completed assessment have been proposed for continence claims while grooming has been removed as it was deemed a redundant item.

Physical therapy

As flagged by Dr Rosewarne in an interview with AAA last week, the report proposes changes in pain management to enable broad-based physical therapy care for all residents provided by a range of allied health professionals.

Under the revised tool, pain management items and the associated funding of $15 per day have been moved from the complex health domain into a newly designed therapy program featuring an evidence-based general wellness, restorative approach for all residents that allows their participation in both one-on-one and group activities with a maximum of five residents.

Complex health

Other major changes in the complex health domain are the addition of the depression item, which has been moved along with its funding from the behaviour domain, the relocation of medication management into the complex healthcare procedure’s list, and a trigger for a 6-month mandatory re-appraisal following a claim for palliative care.

Overall, the number of questions in this domain has been reduced while some have been weighted differently along with a new requirement that claims be supported by documented evidence that residents receive ongoing three-monthly comprehensive health assessments.

Behaviour

Elsewhere in the behaviour section, the report recommends three levels ranging from nil to moderate then high, combining the three questions covering wandering, verbal and physical behaviour into one and the inclusion of a new item to clarify whether staff intervention is required.

The domain also requires a referral and review by a behavioural specialist to attract the highest level of funding.

Funding assessment

The project researched options for improving the current audit system and introducing external assessment options.

It has proposed three options including a modified version of the current system or provider self-assessment and two external assessment options carried out by Aged Care Assessment Teams or Specialist Assessment Agency assessors.

The external options “are almost certain to bring about a lasting change to the pattern of unpredictable growth in residential care subsidies,” according to the report.

The ACAT option is likely to bring the most benefit overall but it would also be the most disruptive change to implement, it said.

The R-ACFI meets the review’s goals with reduced subjectivity in needs assessment and best practice assessments linked to claims that will be less open to gaming while allowing for more transparency for the audit program, the report said.

Minister Wyatt said this latest report added to the residential aged care funding model options in University of Wollongong’s report released in April that would inform the continuing aged care reforms.

No decisions have been made yet on the funding reforms, which aimed to put residential care funding on a more consistent, sustainable and equitable footing, he said.

The next step is the Resource Utilisation and Classification Study, now underway at the University of Wollongong’s Australian Health Services Research Institute, he added.

Follow AAA next week for analysis and stakeholder feedback on the proposed changes.

Access the report here.

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