Just a few months ago I blogged about the government planning to ‘tighten up’ the ACFI. However, the announced cuts to funding go far beyond what I and the rest of the industry expected. In fact a survey of over 500 facilities across Australia revealed that the changes will have a much greater impact than the government predicted. With a projected drop in funding of around 11% on average, the modifications to ACFI could affect the viability of many care homes. The reductions could also mean that high-needs residents are excluded from residential facilities, which could significantly impair the care provided to the frail and elderly. Many vulnerable people may suffer increased pain and distress. As care providers, we need to respond to the cuts so that we ensure the ongoing health, wellbeing and dignity of elderly Australians.
What are the changes?
The changes are being introduced in two phases, further details are available here-but in summary:
Part A was effective from July 1st this year and means that all complex health care cases will have an increase in funding of only half those in the ADL Domain and Behaviour Domain. There will also be changes to the CHC scoring matrix for medication.
Part B, which is effective from January 2017, will have a far more significant and wide-ranging impact. The CHC scoring matrix has been redesigned, with decreases to scores for many Complex Health Care procedures including daily blood pressure, TENS, physio massage and the fitting of compression garments. There will also be further changes to the scoring matrix for medication.
Although these cuts only refer to new or reappraised residents, individual changes in health or function as well as hospital stays will mean that many residents will require reassessment. Experts and many of us working in the sector believe that there could be full implementation within three years.
At the moment as many as 44.59% of residents have a high CHC score, most of these are receiving important treatments to alleviate pain, with others requiring skin care for pressure sores, management of swelling, lymphoedema and DVT.
Currently we, as physios, along with other allied health staff undertake complex pain treatments, which make a real difference to the comfort and contentment of our patients. An analysis shows that on average therapists spend 1.2 hours each week per resident on pain treatments. The change in treatment times from “At least four times a week” to “At least four hours per week and at least 2-hours of duration per week” means that the cost of delivering the best physiotherapy led pain treatments will increase between 7% and 94%. This simply isn’t feasible with the decreased funds available.
By January, the changes mean that a significant number of residents will shift down from high to medium complex health care classification. This will have dramatic effects on the funds the residential facilities receive, with each home estimated to a reduction of around $6,655 a year per resident, which translates into an 11% decrease. That is a huge change and it will be the homes with the highest number of high care and complex care needs residents that will be hit the most.
What does this mean?
The proposed funding cuts would have a devastating impact on aged care providers, particularly those caring for vulnerable people with complex care needs. It’s not surprising then that there has been a chorus of protest across the industry.
Providers, allied health professionals and patient groups have been united in their concern. Facilities have said that admission strategies would have to be reviewed, and many admitted that they may be reluctant to admit ‘expensive’ residents with complex needs. Most felt that staff cuts would be inevitable, with nearly three quarters saying they would reduce allied health resources and more than half of those surveyed saying that nursing numbers could be slashed.
Care should continue according to an individual’s specific needs – but some programs would have to be cut. This could particularly affect the management of pain and mobility and the prevention of falls. As someone who has seen real benefit in the wellbeing and function of those I have treated, this is frightening and could lead to increased accidents, injury and disease with more residents having to be displaced into hospital.
Rural and remote facilities could be worst affected, despite the promise of additional viability supplements. The increased viability supplement will be balanced out by the decrease in ACFI funding so that a greater number of rural and remote providers may record unsustainable losses and need to close.
What can we do?
So how can we make the most of a difficult situation and ensure that the elderly receive the care they need to help them lead a pain free, comfortable and dignified life?
The Government has said that it will consult with the sector on potential further reform to strengthen the way care funding is determined, so it’s vital that those of us who care passionately about the standard of aged care make our voices heard.
For now, it’s especially important for facilities to ensure they get the funding to which they are entitled, so that they make the most of the money available. However, the funding cuts reflect the financial challenges of an aging population, with increasing needs. Some change is inevitable and we need to respond to the change and innovate so that the quality of life of the people we care for is improved not impaired.
There have been significant advances in home care provision and with the deregulation of supply from February next year it is a good time to think about a real continuum of services from home into residential care and back to home, according to needs. If people are able to access great physiotherapy and reablement services in their own homes, we can help them improve function, stay safe and maintain independence for longer.
The Living Longer, Living Better legislation allows individuals to make a greater financial contribution towards their own care. By integrating this with government funding of home and residential care we can allow each individual to get the right funding according to their individual care and financial needs. This could allow individuals much greater choice and control. This increased autonomy often brings with it improved self-esteem and wellbeing.
This is a time of change but also opportunity, by making our voices heard and working to adapt and innovate we can continue to provide the very best service for the frail, the elderly and those in need.