Jun 21, 2019

Has RUCS spelt the end of Physiotherapy in Aged Care?

By Simon Kerrigan, Managing Director | Physiotherapist at Guide Healthcare.

In late 2017, I sat with optimism as Professor Kathy Eagar from the University of Wollongong presented her findings on the Aged Care Funding Instrument and proposed alternate models.

As a physiotherapist, I’ve been frustrated with the ACFI since commencing my first aged care role in 2013. One thing that Professor Eagar remonstrated, was that the new funding tool must not have perverse incentives.

The most important of these, was that it should not promote disability. However, as I sat listening the presentation it suddenly dawned on me that ACFI provides one single benefit to me as a physiotherapist, it encourages aged care providers to employ me in order to drive funding. Immediately, I was less optimistic.

Complex pain management is a somewhat humorous definition for massage therapy and other passive treatment.

Jokes aside, it at least creates the capacity to increase the on-site hours of a more diverse range of allied health professionals. I’ve always believed that 4b’s get me through the door, but once I’m there I can offer a whole lot more.

In March 2019, Professor Eagar was back to present our industry with the Australian National Aged Care Classification – Version 1.0. The new tool seems much more fit for purpose and will undoubtedly be better than ACFI.

Creating an external assessment process and essentially “blinding” homes as to the classification of their new residents may be met with some adversity, but it will certainly decrease the high time burden which ACFI brings.

The ability to define staffing requirements by AN-ACC class and develop best practice models of care for each class, would also seem like a huge advantage. The only real problem I see from a physiotherapy perspective, is that there’s now no provision in the tool for us to financially justify our position.

Which leads me to think, has RUCS spelt the end of physiotherapy in aged care? As a profession, we’ve probably only got ourselves to blame. Here’s why:

Most people working in aged care have never seen an effective physiotherapy program.

Since somebody realised that 6 points in complex healthcare was pretty valuable, physiotherapists have been actively assisting providers to game the system.

Large external providers have created a cookie cutter approach to services, where everyone receives the same program and the only real discernible difference is cost.

As such, most people’s knowledge of what we can provide to residents is massage, TENS machines and heat packs.

In actual fact, Physiotherapist’s are expertly placed to create a raft of significant benefits to residents. If we weren’t spending 8 hours a day doing massages, we could be delivering evidence-based exercise programs proven to reduce falls rates in residential aged care by 55% (Hewitt et al., 2018).

We could be assisting to promote better cardiac health, controlling the symptoms of Parkinson’s Disease, reducing hospitalisations due to respiratory illness, improving bone mineral density, increasing rates of mobility and reducing the burden of care on staff.

We could even be effectively treating chronic pain. Keep in mind, all of these have significant cost-benefits, regardless of funding.

What we’re now facing is the real possibility that the only time a resident will see a Physiotherapist or Occupational Therapist is when they’re “classified” under the AN-ACC; or when they’re having their care plan developed.

My prediction is that many providers will have allied health professionals develop treatment plans and have care staff or therapy assistance deliver the treatments.

For the record, it’s not the same.

Unless of course the resident has the capacity to pay for the service themselves. At a time when we’re supposed to be moving towards a focus on the individual and a consumer directed approach, that’s actually quite hard to fathom.

Which takes me back to late 2017, whilst I sat listening to Professor Eagar.

Upon realising that Physiotherapist’s may be forced out of residential aged care through a new funding tool I stood up and asked, “If I no longer have 4b’s to get me through the door, will there be a provision in the new system for services such as physiotherapy?”.

At that time, Professor Eagar replied that this had definitely been considered and that her team’s recommendation would be to have a separate subsidy for such services.

Well I’ve seen the new tool, and I’ve read the 30 recommendations, and I can’t see that recommendation anywhere.

Let’s hope that if the “appropriate skill mix of staff” model comes to fruition, that ALL allied health professionals are recognised for their value in residential aged care.

I know the excellent outcomes that myself and my colleagues have achieved for residents, and I would hate to see these services disappear. Our value is much greater than our ability to classify needs.

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  1. As an Occupational Therapist, those 4b’s get us in the door too. I spend my days providing the massage service, but also promoting meaningful occupation, and educating staff on the benefits that Allied Health can provide. I have seen the benefit of OT and Physio for residents. A shame that we are only there for funding and I hope going forward we can still provide appropriate services including equipment, prevention of occupational deprivation, meaningful activities for residents with dementia, exercise programs, and promote good manual handling techiques.

  2. Absolutely agree for dietitians also!! If people were fed adequately and got to engage in meaningful physical and socially interactive activity, between us physios, dietitians, OTs could save so much money for providers in the consequences of falls, pressure injury and many more malnutrition-related costs, as well as improve QOL. But rarely do providers engage dietitians to do more than provide and assessment and a dietary prescription (which is often useless if food service systems cant be assessed to ensure food makes it into the mouths that need it) and I can’t see many funding incentives in the new tool either that will improve that.
    I felt as you did at the outset Simon, but sadly it seems they didn’t speak to practitioners who actually work in aged care (dare I say ‘again’…..) sigh, Ngaire

    1. In the last 3 yrs or so the facility I work for not only have AINs giving out MEDs (and only get paid a measly amount for the time the company thinks it will take) but they expect the AINs to give everyone a 5 minute massage during hygiene cares. This was unheard of when I first started as only a trained Physio was allowed to massage the resident’s very fragile body. If they have a sorry shoulder for example we need to fill out the appropriate form of Therapeutic Massage (on average 5 mins) and get to 20 mins a week. I am sure the staff mostly fill it in even when they haven’t performed such tasks as they are so so busy as it is. This is a money saver like no other at the expense of AINs that earn under $23.00 an hour. The AINs are also expected to cut nails! Unheard of again years ago due to the danger of cutting skin. Especially Diabetics. Cleaners were hired and often after you change a faecies filled pad you go to wash your hands and there is no soap in the dispenser! After complaints by frustrated AINs we were told to virtually give the now 4hr a day hired cleaners a break as they are so busy!! Doing what? All they do now is vaccum the main entrance and hallways and once a week dust and clean each resident’s rooms. As far as that is concerned the AINs do a ROD for each resident’s room and we clean the rooms anyway! All this extra work compared to public hospitals nurses work loads leaves me fuming! It is more demanding and most blame is focused on AINs when something goes wrong.

  3. I have made several enquires with the people involved and the outcome is, there will be no seperate funding for allied health in aged care with the new funding tool. It is sad, and disappointing. Allied health is most needed in aged care.

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