Since the federal Government introduced the long-awaited new aged care legislation last month, there has been much speculation. For allied health providers and advocates, the ‘standout’ theme is the emphasis from Minister for Aged Care Anika Wells that the new aged care system will be ‘needs-based’.
Provision of allied health services to aged care consumers based on their individual needs has been a key theme of Allied Health Profession Australia (AHPA) policy work ever since the Royal Commission into Aged Care Quality and Safety identified ‘reablement’ -maintaining a person’s wellbeing and quality of life – as critical to older people’s physical and mental health and wellbeing.
The problem
The Commissioners identified that allied health care was significantly under provided in aged care, and this contributes to substandard care and neglect, particularly in residential aged care. The Royal Commission also identified allied health care as critical to reablement. Without their allied health needs being identified and met early, older people end up experiencing costly hospitalisations and having to move into residential aged care when with the right supports, they could have remained at home.
The Royal Commission therefore recommended that allied health care be embedded in the aged care system, with aged care consumers to be provided with allied health services on the basis of individual needs, ideally assessed and delivered by a multidisciplinary team, and generally paid for by aged care providers from Government funding.
Despite considerable aged care reforms since the Royal Commission’s Final Report three years ago, allied health service provision in aged care remains in a parlous state, particularly in residential aged care. The amount of allied health care provided to aged care residents is worse than ever, at just over 4 minutes of care per resident per day – around half the figure criticised by the Commissioners.
The Australian Institute of Health and Welfare’s 2023 Aged Care Provider Workforce Survey shows that between 2020 and 2023, the number of allied health professionals and assistants working in aged care homes decreased by 42 per cent. One specific example of under provision is the total national headcount of 64 psychologists, especially because it is unlikely that most of those psychologists are working fulltime in
aged care.
AHPA’s own survey last year of allied health professionals working in residential aged care found that just over half of respondents said their role had changed since introduction of the Australian National Aged Care Classification (AN-ACC) funding model. Almost one in five of those respondents had lost their role, and 48 per cent had their hours decreased. Others were leaving the sector or considering doing so due to concerns about declining service quality.
Aged care residents and their families have reported to AHPA their experiences of trying to obtain allied health services, including being told that the facility does not have these available and that they will have to find care themselves. At best, if they can afford to do so, consumers are then left out of pocket trying to access services via private health insurance, or they may receive a maximum of five Medicare subsidised treatments per year. The alternatives are that they simply pay for it entirely out of their own pocket, or go without.
In his recent Progress Report on Government implementation of Royal Commission
recommendations, the Inspector-General of Aged Care identified this crisis and called for the Commonwealth Government to implement the Royal Commission’s needs-based approach to aged care. At first glance then, Minister Wells’ public commitment is great news.
However, there is still no dedicated funding for allied health services in residential aged care, and no associated mandatory benchmark equivalent to nursing and personal care minutes. Instead, provider payment for allied health services in residential aged care is expected to be drawn from overall AN-ACC funding to providers for direct care.
A new limitation on allied health provision has now emerged via the combination of AN-ACC funding and the introduction of mandatory minutes for personal and nursing care. Care minutes have set benchmarks via which providers have begun to allocate portions of their AN-ACC funding. Without ring fencing for allied health care provision, there is no guarantee that AN-ACC funds will be spent on allied health – or indeed, on any direct form of care, despite Government intention. The latest report on the aged care sector from the UTS Ageing Research Collaborative concludes that aged care homes are tending to generate surpluses from direct care services to cross-subsidise losses from everyday living and accommodation.
The Inspector-General of Aged Care has noted these impacts and supports the Department initiating a review of the impact of the interrelationship of the AN-ACC and care minutes on the provision of allied health in residential care.
It's clear that allied health care is not currently being provided to aged care residents on a needs basis – but we need to take a step before that. There is no universally consistent needs assessment process for allied health. As the ANACC’s architects originally pointed out, ANACC is a funding tool which is not designed for allied health funding needs, and does not itself assess or prescribe the amount or types of allied health care to be provided.
Once the assessor has determined the ANACC funding classification level, it is then up to the staff of individual residential facilities to identify any perceived allied health needs.
Whether the resident ends up receiving allied health services depends on existing staff skills and breadth of knowledge of different types of allied health, and so may only occur in response to an adverse event, and may vary by provider facility and even among individual staff.
Government cannot claim to meet aged care residents’ allied health needs when these are not being reliably and consistently identified in the first place.
The solution
AHPA and its Aged Care Working Group have developed a sustainable model for allied health in residential care.
Under our model, allied health is an intrinsic component of the aged care system.
Older people in residential aged care settings typically present with a range of complex health and ageing-related needs, which require a comprehensive and collaborative care approach. Allied health professionals (AHPs) bring expertise and specialist knowledge with an emphasis on reablement and wellness approaches. With a focus on client centred care, AHPs promote functional abilities, independence and wellbeing of residents and facilitate enhanced care through staff training and systems support.
AHPs are vital members of the broader care team working with general practitioners, geriatricians, nurses and care workers to provide high quality care that directly meets regulatory and compliance requirements.
Our multidisciplinary model of care:
Embeds allied health into the aged care team - integrates allied health across the multidisciplinary care team with existing medical, nursing and care staff and supports clinicians to deliver to their full scope of practice.
Multidisciplinary needs assessment and care planning tool - supports the delivery of comprehensive multidisciplinary assessments, care plans and timely reviews to address changes in functioning, via the development and implementation of a standardised multidisciplinary needs assessment tool for health professionals.
Individual and service level input - supports delivery of services at both an individual resident level and system (facility) level, using the full scope of practice of the AHPs.
Access to a range of allied health services - allows each resident to access a range of different allied health professionals to meet their assessed needs, through a combination of approaches and funding mechanisms and via clinicians operating both in house and as external contractors.
Workforce development - recognises allied health as part of the aged care workforce in all workforce initiatives.
Our model provides the quality, accountability and transparency that are currently lacking from allied health provision in aged care. Nationally consistent needs assessment ensures fairness and that individual needs are met. Use of a needs assessment tool enhances accountability because whether identified needs are met is a measure of quality assurance. Transparency will be increased via a requirement that care funding is utilised for direct care service delivery only.
Lest this model appear too abstract, we have seen it work in practice via the recent ABC TV series Maggie Beer's Big Mission. Will Government rise to this challenge?
By Dr Chris Atmore, Senior Advisor Policy and Advocacy policy@ahpa.com.au
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