Introduction by Croakey: Last week’s Budget highlights “glaring gaps” in allied health funding, particularly in aged care, according Dr Chris Atmore, Policy and Advocacy Manager for Allied Health Professions Australia.
In this detailed overview, Atmore discusses the need for investment in the assessment and delivery of allied health services in aged care and priorities for the 2022 election.
Chris Atmore writes:
There were slim pickings for allied health in last year’s Budget, particularly in residential aged care.
This was despite the Aged Care Royal Commission finding that allied health services are underused and undervalued across the aged care system. Research led by Professor Kathy Eagar from University of Wollongong found that aged care residents receive an average of only eight minutes of allied health care a day.
This gross under-provision produces many of the morbidity, mortality and quality of life impacts highlighted by the Royal Commission, including those associated with dementia, mental health, malnutrition and falls.
The Royal Commission concluded that the aged care system should focus on wellness, prevention, reablement and rehabilitation, and extend beyond physical health to a multidimensional view of wellbeing.
Recommendation 38 supported this more holistic approach through requiring the provision of a level of allied health care appropriate to each person’s needs. Although the Federal Government supported Recommendation 38 ‘in-principle’, allied health was omitted from residential care costings.
One year on, inadequate funding and service delivery structures continue to limit access to allied health clinical assessments and services.
For allied health to become an intrinsic aspect of residential care, there must be some form of guaranteed allied health assessment and service delivery funding mechanism.
Allied health advocates therefore looked to this year’s Budget for indications that allied health would be taken seriously.
This year’s Budget
Associate Professor Lesley Russell, health policy analyst Charles Maskell-Knight and others have highlighted the health opportunities missed by this Budget.
Allied health items in general are particularly thin and skirt the issues of profound need (the standout exception being funding for interpreting services in private allied health).
As has been widely noted, the most glaring gap in aged care funding is any allowance for the increased personal care worker wage bill, which must eventually come if we are to have any hope of retaining and recruiting sufficient staff and improving quality of care.
But there is also a complete silence in the Budget about how a needs-appropriate level of allied services will be provided in residential aged care.
This omission is consistent with our engagement with the Department of Health in the past few months, when we have simply been referred to the Australian National Aged Care Classification tool (AN-ACC) as our funding ‘solution’.
The Australian National Aged Care Classification tool
The Federal Government had agreed with the Royal Commission that the current funding tool, the Aged Care Funding Instrument (ACFI), was not suitable for person-centred aged care, and that a new case-mix funding classification model, the AN-ACC, was required for allocating funded residential aged care places.
The ACFI requires a limited range of allied health services to be provided at no charge to particular categories of residents. Assuming provider compliance, this equates to the eight daily minutes.
An associated problem which has been inaccurately described as ‘over-servicing’, is that the limited range includes non-evidenced pain management services, and thus providers may use these items to comply rather than paying for allied health essentials.
AN-ACC health funding will continue to include allied health alongside nursing and personal care, but will remove the inappropriate restrictions. It will also encourage a reablement approach by removing the current ACFI requirement of reassessment and potential reassignment to a lower payment class if the capability of a resident improves.
However, while we welcome its replacement of the ACFI, the AN-ACC is not designed to provide for clinical care planning, nor for associated allied health funding needs.
Eagar, who is also the chief architect of the AN-ACC, has emphasised that the current version is only the first step in this process.
Report 6 of the Resource Utilisation and Classification Study underpinning the AN-ACC recommends that a best practice needs identification and care planning assessment tool be developed for use by residential aged care facilities.
Adequately building allied health into the AN-ACC would take several years. The Royal Commission also simply noted in passing that the AN-ACC ‘may’ achieve increased and appropriate allied health delivery.
AN-ACC funding will be an increase on the ACFI’s, with the 2021-22 Budget allocating an additional $3.9 billion for frontline residential aged care over four years. However, this year’s Budget does not directly allocate any further funds other than some provider assistance in transitioning to the AN-ACC.
As the Macquarie University Centre for the Health Economy has pointed out, to meet expected quality standards, aged care needs another $5 billion annually. Yet, the Government is now suggesting that its benchmark for allied health service provision is simply ‘not less than under ACFI’.
Best practice allied health care of older people who may have complex conditions is also to use multidisciplinary teams – various allied health professionals and others – to assess and deliver services. This is a familiar model in other areas of health, and was recommended by the Royal Commission.
However, the Budget allocates only $22.1 million for ‘trials’, and proposes cost sharing between the Commonwealth and the states and territories.
Accountability for service provision
Also missing from Government responses to Royal Commission recommendations was any clear accountability mechanism for the amount and quality of allied services provided in residential aged care.
Recommendation 122 requires residential aged care providers to report, on a quarterly basis, total direct care staffing hours provided each day at each facility, specifying the different employment categories including allied health care professionals engaged in direct care provision. The reports would be assessed against minimum staffing requirements, and trigger appropriate action in cases of non‐compliance.
Although Government accepted this recommendation, its response only referred to total care staffing minutes by registered nurses, enrolled nurses and personal care workers, which would then feed into a public star rating system.
One likely reason for the omission of allied health is that despite the recommendation of research led by Eagar that allied health staffing be benchmarked at 22 minutes per day, the Royal Commission did not propose a mandatory minimum for allied health.
Allied health advocates have since worked hard to persuade Government to include reporting – in minutes – of how much is spent on allied health.
However, this is unlikely to include data on specific allied health care by individual professions, and so far does not look like feeding in to the new star rating system.
And without assured funding for both assessment and delivery, what will be the point?
Calls for action this election
While Australian Labor Party policy appears to improve on current Government commitments to care time, aged care worker pay rises and reporting, it is not yet clear whether allied health needs will be specifically addressed.
To date, aged care does not appear to be a big ticket item for the Greens’ election campaign, although general party policies support the principles of needs-based allied health residential aged care.
Allied Health Professions Australia is focusing on residential aged care as one of our key asks this election and is surveying parties and candidates in key seats.
The National Aged Care Alliance has also released a Position Statement supporting allied health in residential aged care.
The Royal Commission called for a change in culture in the aged care sector, to view allied health services as valuable rather than a burden on funding. As things stand currently, person-centred aged care remains a burden.
See Croakey’s extensive coverage of the Federal Budget and health
