The aged care sector in Australia is witnessing a significant decline in the provision of allied health services, despite their critical importance. Chris Atmore, Policy & Advocacy Senior Advisor for Allied Health Professions Australia (AHPA), shares insights into the challenges and complexities surrounding this issue.
AHPA, the national peak body for allied health, represents around 200,000 professionals through its 40 member organisations. These professionals include physiotherapists, occupational therapists, speech pathologists, dietitians, and social workers, all of whom play crucial roles in maintaining and improving the health and quality of life for aged care residents.
However, the availability and provision of these services are in a steady decline. According to Chris Atmore, the average aged care resident received about eight minutes of allied health care per day before the Royal Commission’s report in 2021. Today, that figure has halved to just over four minutes per day.
Why the Decline?
The primary reason for this decline is the lack of any mandatory targets for allied health services, unlike care minutes for nursing and personal care. Atmore explains, “The AN-ACC model funds allied health services, but without specific targets, providers have little incentive to allocate funds to these services.” She adds that many providers are using AN-ACC funding intended for direct care to subsidise other costs, such as accommodation and daily living expenses.
A related issue concerns a decline in quality and safety in allied health service provision. AHPA’s 2023 survey of the allied health workforce in residential aged care found that providers are sometimes using allied health assistants to carry out tasks that should be undertaken by allied health professionals, “Assistants are a valuable part of the workforce, but it can be inappropriate and dangerous to substitute them as a supposedly ‘cheaper’ option, especially if they are not supervised by a professional.”
Implications
The reduction in allied health services and associated quality risks have dire implications. Allied health professionals are essential for reablement, helping older people maintain their function and quality of life. The decline in services means that many residents are not receiving the preventive and rehabilitative care they need. Atmore states, “Allied health is about reablement—helping older people to maintain their function and quality of life. This is why the Royal Commission recommended that aged care consumers should be provided with allied health services on the basis of individual needs.”
However, there is still no universally consistent needs assessment process for allied health. As Atmore states, “How do we know we are meeting people’s allied health needs if we do not know what those needs are?”
Lack of a nationally consistent process leads to disparities in care. Some residents may receive adequate support but many others do not. Yet there is not even individual data on this, because currently, the Department of Health and Aged Care only publishes median care minutes for limited types of allied health across all residential aged care facilities, with several disciplines, such as occupational therapy, being deemed too small to even register as separate minutes,
The Consequences of Inaction
If the current trend continues, the quality of life for aged care residents will further deteriorate. Atmore notes, “Many allied health professionals are losing their jobs, leaving the sector or considering leaving due to concerns about declining service quality.” This exodus exacerbates the problem, leaving fewer professionals to provide essential services.
Furthermore, some providers are reportedly “gaming the system” to lower the incidence of falls, which are a quality indicator for aged care facilities. Atmore says this practice undermines residents’ quality of life, as they are left inactive in their rooms to avoid falls rather than being supported to move safely.
Moving Forward
Chris Atmore emphasises that allied health is a crucial component of high-quality aged care. To address the decline in services, there must be a concerted effort to implement the Royal Commission’s relevant recommendations, develop a comprehensive allied health needs assessment framework, and make meeting those needs mandatory.
The aged care sector must also prioritise data collection, transparency and accountability to identify best practices and require all providers to meet high standards of allied health care, via ringfenced government funding.
Atmore says that it is also essential for the aged care sector to be part of a national allied health workforce strategy. “Without this, we can’t ensure that sufficient numbers and types of allied health professionals are available to meet the needs of aged care residents.”
Only through these measures can we ensure that aged care residents receive the support they need to live full and dignified lives.
