Call for an increased focus on wellness in ACFI

HammondCare Chief Executive Dr Stephen Judd, has backed moves to change aspects of the Aged Care Funding Instrument, announced in the 2016 Budget, agreeing it needs to be simplified and calling for an increased focus on wellness.

The Federal Budget on May 3 included aged care savings of $1.2 billion through changes to ACFI and a 50 per cent reduction in the indexation of ACFI's  Complex Health Care (CHC) component, addressing an anticipated $3.8 billion overrun in spending.

CHC, as the name suggests, is intended to provide additional subsidy to age care providers for the extended care of a resident with more complex health needs and this is assessed by two 'questions' - medication as a stand-alone item for scoring, and 18 complex health care procedures that earn points. Depending on the result from these sections, the provider can make a claim of Low, Medium or High in CHC.

Too complex, encourages dependency

"Look, I am probably going out on a limb here, but Minister Ley is right in saying that 'the current Aged Care Funding Instrument model is too complex,'" Dr Judd said.

"Doesn't it seems abnormal that 51 per cent of all residents receive a High claim? That’s because there are perverse incentives within the Instrument. A provider is being rewarded for promoting dependency and  invasive procedures and by not encouraging wellness.

"For example, a resident may be given a suppository or enema regardless of whether they want it or not, and points are earned towards increased subsidy. In the medication area, it encourages up to 11 minutes a day of assistance in daily medications or administration of an intravenous, intramuscular or subcutaneous injection. The more medication provided, the more funding received. The Instrument is silent on how well the disease or condition is being managed!

"Another example is that in the CHC area, if you take the blood pressure of someone daily, you are 3 out of 10 points towards getting the highest subsidy score for that section! If you also give everyone elasticised, arthritic bandages you get another 30 per cent. And we wonder why providers are maxing out!

Peverse incentives

Dr Judd said that with the perverse incentives in the current subsidy regime, it was of little surprise that projections showed that subsidies will be $1 billion per annum over budget.

"The end result is there for all to see in the Annual Reports of the listed aged care providers:

  • Estia said it lifted its subsidy by 11 per cent to $173 in FY15;
  • Japara said it lifted it by 5.3 per cent to $175.10 during the same year; and
  • Regis recorded a $179 average.

"Together, these providers on average had subsidies of almost $20 per-person, per-day (pppd) above the industry average which was $156 pppd."

In regard to external assessments, Dr Judd said, "I do not agree with the idea of independent assessors because that too is flawed. Independent assessors are not reviewing a person’s care needs for more than, say, one to two hours. These sorts of assessments take weeks.

"Rather, it would be better to manage by exception. The question should go to providers who have such high ACFI scores: justify why the residents in your services have higher dependency and why should the Government subsidise the promotion of dependency and, indeed, invasiveness?"

What should a revised instrument look like?

Dr Judd said that a domain within ACFI that looked at chronic disease management was needed, rather than having medication administration as a stand-alone score.

"Within this domain, items should align with the national list of chronic diseases that are on the health priority list - diabetes, arthritis, cardiovascular disease, dementia. Then the domain should capture what is done to manage the chronic disease including a wellness component.

"I think this will be more accurate given that a clear diagnosis of chronic condition will need to be present and have an overall management plan rather than just a diagnosis and procedure. In short, look at the whole person.

"And, as an aside, the management of psychotropic medications could then be captured with a higher level of accountability from providers. Pain and wound management should be where providers are excelling but, because of the pure focus on inputs, that’s not the case."

Other aged care budget measures
  • Provision of $102.3 million over four years from 2016‑17 to target the aged care viability supplement more effectively to areas of greatest need by replacing the current outdated remoteness classification system with the more up to date Modified Monash Model. This will bring the viability supplement into line with other health programs.
  • The Government will provide $136.6 million over four years from 2016‑17 to support the operation of the My Aged Care contact centre and to help it meet growing demand.
  • $10.1 million in 2016‑17 to continue unannounced compliance site visits by the Australian Aged Care Quality Agency to aged care providers until June 30, 2017.
Further into the fine print
  • 400 short term restorative care (STRC) places - initially announced in the 2015 budget - are now to be part of a competitive Aged Care Approvals Round to be announced in late 2016 with the number of places projected to grow to 1250 by 2019-20.
  • Establishment of the Commonwealth Continuity of Support (COS) Program with the aim of supporting 1,875 people in the coming year.
  • The Government reaffirmed its commitment to a nationally streamlined approach to dementia services through changes previously announced to Dementia Behaviour Management Advisory Services (DBMAS) and the establishment of Severe Behaviour Response Teams (SBRT) with projected service episodes in the coming year of nearly 8,000 across both services.
  • The Dementia and Aged Care Services Fund supports activities that target sick and frail older people, including those experiencing dementia or who have diverse social and cultural needs. The Government plans to offer an open funding round for grants during 2016.

In summary, budget savings or 'efficiencies' in the aged care space total $1.2 billion with new or reinvested money totaling $249 million. Overall aged care funding through the Department of Health will be $17.8 billion which is a 7.7 per cent increase on 2015–16.