Recommendations made to the royal commission on allied health go a long way to supporting physiotherapy in aged care and improving the quality of life of residents, an allied health peak body has told  Australian Ageing Agenda.

At last week’s two-day and final hearing Counsel Assisting the Royal Commission into Aged Care Quality and Safety presented 124 recommendations to overhaul the aged care system including to improve residents’ access to multi-disciplinary and restorative allied health care services.

Counsel Assisting found that aged care residents have insufficient access to allied health professionals and that practitioners are not funded to deliver the most appropriate or evidence based interventions.

“Multidisciplinary allied health care is not being systematically provided to people as part of aged care,” Counsel Assisting said in their submission.

“A particular complaint about the operation of the Aged Care Funding Instrument was that it is reactive and does not incentivise or support preventative care.”

The current policy also means that residents may be charged for allied health services if they are not assessed as requiring it under ACFI, Counsel Assisting highlighted.

“It is perverse that people are charged for services that may avoid or delay deterioration in their health, but services are provided for free once they have deteriorated,” they said.

“A number of physiotherapists told us of their frustration at not being able to provide the allied health care they knew their client needed because they were required, by the approved provider, to provide a limited range of non-evidence based pain management services to ensure retention of funding under the Aged Care Funding Instrument,” Counsel Assisting said.

Counsel Assisting have called for far better integration of allied health provision in residential aged care. Their recommendations include that the Australian Government:

  • require residential care providers to engage a team f allied health practitioners that includes physiotherapists, occupational therapists, exercise physiologists, podiatrists, pharmacists, speech pathologists, oral health practitioners and mental health practitioners
  • provide funding to providers to engage allied health professionals through a blended funding model with a capped base payment per resident to cover about half of the costs of establishing ongoing engagement and an activity-based payment to cover each item of direct
  • ensure strict monitoring of the level of allied health services actually delivered.
Rik Dawson

Australian Physiotherapy Association director Rik Dawson the recommendations support holistic and multidisciplinary care options.

“We’re broadly supportive of Counsel Assisting’s recommendations. They are wide reaching and go a long way to supporting allied health’s increased involvement in aged care,” Mr Dawson told AAA.

“We support the recommendations because a multidisciplinary approach is the best way to maximise older people’s outcomes within aged care.

“And physiotherapy is essential and critical for managing a frail older person with declining mobility and independence,” said Mr Dawson, a gerontology physiotherapist.

He said many of the proposals were in line with what the APA has called for.

“The recommendations recognise allied health’s critical role in delivering care appropriate to each person’s individual needs,” he said.

The APA also supports the recommendation to review undergraduate curricula including for allied health courses, Mr Dawson said.

“Ensuring that undergraduate physiotherapy courses give emerging professionals and physiotherapists the skills to work with an increasingly aged population is essential,” he said.

The recommendation to ensure allied health representation in aged care health assessments and management through Medicare is also positive, Mr Dawson said.

Elsewhere Mr Dawson said the recommendations were not clear enough on aged care funding.

“It’s leaving it up to the royal commissioners and the department to fill in and be a little bit more didactic about how allied health can be funded,” he said.

Senior Counsel Assisting Peter Gray QC delivers final submissions on October 22, 2020.

Senior Counsel Assisting Peter Gray told commissioners that in line with the work underway by the department, a case mix-based funding approach was appropriate for residential aged care.

“There is significant work being done on the Australian National Aged Care Classification model and the trialling of that model and that should continue,” he said.

Mr Gray said it should be considered seriously as the appropriate model to bring case-mix based funding to residential aged care adding that it may need to be varied or refined, or even overhauled at a later time. 

“We think there needs to be some more work done against the AN-ACC and making sure the systems match the Counsel’s recommendations,” Mr Dawson said.

Mr Dawson said Counsel Assisting’s recommendations make physiotherapy a priority in aged care.

“It certainly is a great start to maintain the dialogue around aged care reform, in particular around physiotherapy’s much needed increased role within aged care,” he said.

The APA is intending to submit a response to Counsel Assisting’s final submissions.

Submissions are due by 12 November. Find out more about submitting here.

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4 Comments

  1. As vital as physiotherapists (and other allied health professionals) are to the approach and conversation, please don’t leave out diversional therapists/leisure & lifestyle staff out of the equation.
    We are the ones providing &/or organising quality of life care through cognitive, physical, social, spiritual, creative, mental and sensory interventions to meet the residents needs. For every media piece on some amazing activity held at a facility there is a lifestyle team/professional behind the scenes organising those sort of interventions (besides the fact there is usually some manager taking credit for the work). This includes all the uses of technology which have been employed to help keep residents connected with their loved ones during lockdowns.
    The ACFI instrument needs to be overhauled to include funding these beneficial interventions provided by Leisure & Lifestyle/Diversional Therapy staff, and not just touching on the behavioural areas involved.

  2. Unfortunately, Counsel Assisting’s recommendations do not go far enough in terms of embedding/entangling allied health within residential aged care. Our review of aged care staffing levels for the Royal Commission recommended the British Columbia benchmark for allied health of 22 minutes per resident per day; the current Australian average is 8 minutes per day. We recommended a 175% increase in allied health staffing AND this be captured in a public reporting system such as the CMS 5 star rating system so the public can gauge the quality of care provided by a care home. Instead of integrating allied health within residential care, Senior Counsel’s recommendations effectively separate it out from routine care services. Access will be at the discretion of the provider and/or resident and their family, so those who can’t advocate for themselves may miss out on allied health services from which they may benefit. A dangerous proposition, given the high level of cognitive impairment in res care.

  3. In my opinion Leisure and Lifestyle should be part of an Allied Health Team approach. A well-orchestrated professional approach to body and mind health is paramount to wellness in aged care, physical and mental health. The reason for transitioning to a residential facility is multifactorial – and a necessary component of a healthy lifestyle falls within the realm of an allied health construct.

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