Aug 01, 2019

Remember the Physical Therapy Subsidy?


The aged care community and its consumers are desperately searching for positive change. A significant determinant of the current stagnated system is the current funding tool. That fact has been recognised and is in the process of redevelopment. But have we been too quick to completely discard a valuable idea due to its close association with the Aged Care Funding Instrument (ACFI)?

The “Physical Therapy Subsidy” was a great idea and there’s some very good reasons to consider its inclusion in the revised funding model. In fact, the basis of the proposed Australian National Aged Care Classification System (AN-ACC) would support its inclusion.

For those of you who aren’t familiar, the R-ACFI proposed that a physical therapy subsidy be included as part of an adapted version of the current funding tool. The subsidy would be available to all residents and would involve a wide range of therapeutic inputs from a variety of health professionals. Therapy programs could be delivered on a one-on-one or group basis, depending on the resident’s physical therapy needs and individual choice. This is consistent with the new care standards. Importantly, these programs would also need to include structured goal setting, be based on current evidence and show effectiveness. The R-ACFI even detailed a cost analysis and proposed funding rates.

We know that exercise has the potential to significantly improve a range of health factors which negatively impact on the lives of older people. Physical activity has been proven to lower falls rates, prevent a range of chronic diseases, improve physical capacity and functional status, drive increases in psychological wellbeing including the treatment and prevention of anxiety and depression, as well as assist in achieving better social outcomes. So how does this relate to the proposed new funding tool?

The AN-ACC system is driven by the assessment of a consumer’s capacity. That is, it does not focus on the person’s diagnosis. It operates by capturing the functional consequences of health conditions rather than the conditions themselves.

In the branching model of the AN-ACC, if a consumer is not classified as requiring palliative care then they are immediately classified based on mobility. What the team from the University of Wollongong has determined is that a resident’s level of mobility is one of the most significant determinants of a consumer’s capacity, and as such the funding level required to ensure an appropriate level of care.

The AN-ACC also recognises the significant impact of other contributing factors including cognition, frailty, pressure injury risk, behaviour, mental health status, obesity and falls.

So, if we want to reduce the financial burden of care why aren’t we directly funding physical therapy? Exercise has been proven to positively influence almost all of the determinants of a consumer’s physical capacity. If the government wants to reduce the cost of funding aged care whilst promoting their healthy ageing message, physical therapy is the obvious choice.

With the AN-ACC, we are at risk of creating another system which does not support residents needs. If physical therapy is not directly funded, we will likely see the end of the multi-disciplinary services which consumers currently have access to. It is also likely that although it won’t directly promote disability as with the ACFI, it will inadvertently achieve disability through the organisational reassignment of budgetary funds. In other words, organisations will cut their allied health hours.

Through the development of a new funding tool for residential aged care, we have the opportunity to create a system which will truly promote preventative and restorative care. The physical therapy subsidy is the obvious choice to achieve this outcome.

Click here, and go to Chapter 7 for a detailed overview of the proposed Physical Therapy Subsidy as part of the R-ACFI.

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