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Government trialling potential ACFI replacement in 2021

The Federal Government has announced a trial of an alternative funding model in the aged care sector, which could potentially replace the current Aged Care Funding Instrument (ACFI).

In November 2019, the AN-ACC model had its first trial, however, COVID-19 caused the trial to cease in April 2020. [Source: iStock]

This Australian National Aged Care Classification (AN-ACC) model will involve a shadow assessment process, which means the ACFI will still continue to operate over the trial period. The shadow assessment is running in the first half of 2021.

In November 2019, the AN-ACC model had its first trial, however, COVID-19 caused the trial to cease in April 2020.

The Government has said that this trial is to make sure they are able to respond flexibly to any recommendations in the Final Report from the Royal Commission into Aged Care Quality and Safety.

While it is not set in stone that this alternative funding model will replace the ACFI system, the Government believes the AN-ACC is a proactive approach to ensuring reform options are available.

A request for tender for one or more assessment management organisations has been issued, along with a request for tender to get a provider to deliver AN-ACC shadow assessor training.

Development of the AN-ACC has been in the process for a while, as the aged care sector has long called for a better system than ACFI.

Even the Royal Commission into Aged Care Quality and Safety has heard evidence of how the ACFI is inadequate to provide appropriate funding for residents in aged care facilities.

Problems with ACFI

The biggest problems providers have with ACFI is the incredible amount of documentation that is involved and the poor amount of funding providers receive through it.

Tanvi Dalal, General Manager (GM) of Funding at Signature Care, in Victoria and Queensland, explains that ACFI is not ideal for the aged care workforce due to their mixed skill base, the diversity of the workforce, and the available time to do these assessments.

She says the ACFI documentation is only available in the English language and requires specific ACFI assessment wording, that can be difficult for the diverse workforce and as a result of this funding might suffer.

Ms Dalal adds that ACFI also conflicts with the sector's change to the new quality aged care standards.

"The current ACFI model is not aligned with the quality standards. While the standards focus on consumer dignity, choice and support for independent living, ACFI is based on the assessed care needs which could be very different from [consumer] choice," explains Ms Dalal.

"The funding has also not increased over the last [few] years at the same rate as acuity of residents now coming into aged care has, and therefore ACFI funding is just not enough to meet the care needs of the consumers. 

"The validations in particular are an extremely stressful experience for residential aged care facilities (RACF). Often in the validations, the interpretation of the ACFI tool differs from validators to that of the facility staff because of the ambiguity of the ACFI tool, thus resulting in downgrades which hugely impacts aged care providers financially."

Commissioners from the Aged Care Royal Commission heard multiple witnesses explain their issues with the ACFI system. With some saying that it encourages aged care facilities to over-report issues of residents so they can receive extra funding for the facility.

One witness even said it was frustrating that the ACFI model didn't allow for person centred care.

It was also pointed out to the Commissioners that aged care facilities receive the funding in lump sums and this money may not be spent how it was intended.

AN-ACC: How does it work?

Unlike the ACFI model, AN-ACC doesn't require the organisation to undertake the assessment and submit it to Medicare; external assessors will be meeting with residents and doing this instead. 

Previously, providers had to lodge an ACFI request for a resident within two months of them receiving care. Now, every resident will already have an initial classification before they move into aged care.

The AN-ACC model will also be using a 13 classification system for assessing residents, based on their mobility, cognitive ability and functional ability. 

This is different compared to the ACFI's funding tool which assesses activities of daily living, behaviours, and complex health care, then residents are scored as nil, low, medium or high.

One big problem providers have with the ACFI model is the constant need for documentation. This new model eliminates a lot of the documentation required from staff, which should simplify the system for providers and their workforce.

Ms Dalal explains, "This means [staff] can focus on care delivery which is more important. With the new system, the aged care providers will have to inform the department when they think the care recipient’s care needs, and therefore the funding, has changed.

"The Department will then send their assessor to do the assessment to determine the funding change, if any. We do not know how long it might take from the time the Department is informed to them sending an assessor.

"AN-ACC does not include a class for independently mobile residents with low cognitive ability, which is a high percentage of residents and very time consuming in terms of care needs. Also, in the new model, as in the current model, the assessment will only be as accurate as the knowledge or training of the assessor which means it will be prone to bias."

A national study looking into the needs, costs and classification of residential aged care, Resource Utilisation and Classification Study (RUCS), suggested having a penalty for providers if they requested reappraisals too frequently.

Ms Dalal believes this may deter providers from seeking reclassification for their residents which would further impact the viability and funding for aged care businesses.

A positive potential model for the future

Ms Dalal says Signature Care is looking forward to the practical application of the new AN-ACC system.

She says it is too soon to tell whether the AN-ACC will work, as the Health Department may not have received enough data from their last pilot since it was cut short in 2020.

Ms Dalal is adamant that the Government spend in the sector needs to increase so the sector can provide high quality care. 

"Any funding model will only be able to meet the needs of the sector if the overall funding amount is increased," says Ms Dalal.


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