The Aged Care Funding Instrument (ACFI) assesses the relative care needs of residents and is the mechanism for allocating the government subsidy to aged care providers for delivering care to residents. The ACFI replaced the former Resident Classification Scale (RCS) on 20 March 2008. The instrument consists of 12 care need questions, some of which have specified assessment tools.
Under the Aged Care Act 1997, aged care providers may re-classify residents according to their care needs under an assessment system called the Aged Care Funding Instrument (ACFI). Residents may be reassessed from time to time and if their needs classification requires it, application may be made for a higher funding subsidy from the government.
ACFI assessments are usually carried out by qualified people who are employed by the provider and may be in-house staff, or specialist consultants hired for the purposes of helping the provider with their ACFI requirements.
The objective of the ACFI system is to cover the extra staffing costs which are involved in caring for persons with higher needs. However, when an application is successful and a higher subsidy is granted, the funds go directly to the aged care provider who appears to disburse or spend funds according to the discretion of management.
In other words, all extra funding arising from re-classification is received by the provider as part of total gross income derived through subsidy.
The Aged Care Act 1997 includes among the responsibilities of approved providers, the requirement to maintain an adequate number of appropriately skilled staff to ensure that the care needs of care recipients are met (Part 4.1 – Quality of care, 54-1 Responsibilities of approved providers, (1) (b) ).
Accordingly, it is reasonable to assume that if a person's needs are assessed at a higher level because of increased disability through illness or other cause, there will be a corresponding increase in attention from appropriately skilled staff. Anecdotally however, this appears not to be the case.
Study examines the utility of ACFI
A recent study examined the utility of the ACFI and the conclusions drawn, were that the utility of the ACFI in care planning appears not to be effective partly due to the lack of accessibility and credibility of the ACFI information and more notably the culture of poor care planning practice.
Little has been done to explore ways to maximise the utility of the ACFI in enhancing staff skills and knowledge in care of residents, and improving care quality.
The study commented on the validity of ACFI data - it found that the potential utility of the ACFI in care planning was found to be hindered by two main factors, the credibility and accessibility of the ACFI data and the culture of RACFs where direct care staff were often removed from using care plans and the ACFI results in their care. The ACFI assessment scores were not available to most care staff in four out of the five RACFs and when they were available it was found that most staff did not read them.
Source: Examining the utility of the Aged Care Funding Instrument (ACFI) as a vehicle for improving staff skills and knowledge in care planning and management of behavioural and psychological symptoms of dementia (BPSD) (UNSW)
What others are saying about ACFI
Aged Care Crisis have long been concerned about the Aged Care Funding (ACFI). Media reports quoted departmental whistleblowers of federal government funding being used to service the profits of aged care providers rather than the care of their residents.
Other groups (as well as Aged Care Crisis) have recently voiced their concerns regarding the delivery of allied health services to aged care recipients (A new call for allied health in aged care - Australian Ageing Agenda, 12 Feb 2015)
RODNEY LEWIS, LAWYER, AGED CARE CRISIS: When extra funding becomes available as a result of reclassification, there is normally and generally no change in staffing and no change in care services to the person concerned.
SALLY SARA: Mr Lewis represents an 84-year-old man who was reclassified as high care even though his family believes he was mentally and physically sound. It delivered extra funding to the aged care facility, but there was no extra care.
RODNEY LEWIS: There was not an extra pill in his pill box. There was not an extra chip on his plate. It made no difference to him.
RODNEY LEWIS: It's actually a fraud on the Commonwealth. I mean, if you inflate claims and you receive money as a result of those so-called inflated claims and if you make a false claims on the Commonwealth for money, you may very quickly get a knock on the door from the Australian Federal Police.
Aged care providers and supporting industry hacks where quick to extinguish the fallout and subsequently criticise the ABC's coverage of ACFI rorting, whilst Government were swift in laying the blame of the ill-fated funding supplement to 'bad design':
Unfortunately, the Supplement – due to the previous government’s design – exceeded its budget by ten-fold, costing around $110 million in its first year (2013-14), well over the budgeted $11.7 million. If claiming patterns had continued, the $16 a day Supplement would have cost $780 million over the four years from 2014-15 rather than $52 million, and over $1.5 billion over ten years.
Source: Senator the Hon Mitch Fifield - media release (16 Dec 2014)
Others have publicly voiced their concerns around the funding model of ACFI:
The APA believes that the current funding model allows the opportunity for unethical behaviour; including private consultants who instruct Aged Care providers on ways to maximise funding, with no evidence of improved outcomes for residents.
“We are very concerned that the current funding models encourage passive modalities to manage pain that are not supported by the evidence literature. Under this model, physiotherapists are denied autonomy, and are being forced by the funding instrument to treat in a way which is not in the best interests of the patient.”
Source: Australian Physiotherapy Association (media release, 2 Aug 2012)
Following a 2014 ACFI Survey to APA members, they had more to say about the funding arrangements:
Problems with the ACFI 12 4a and 4b: This survey highlighted a lack of support for (items) 4a and 4b of the ACFI. In practice, 4a and 4b create incentives to treat residents not based on clinical need but to receive related funding. One respondent called the ACFI 12 4a and 4b a ‘racket that needs to be cleaned up.’
The ACFI creates financial incentives to treat residents, which encourage rorts and over-servicing. It also channels funding to passive treatments to manage pain rather than evidence-based, active treatments and causes resident dependence, rather than developing independence and function and the quality of residents’ life.
Respondents noted that the ACFI is prescriptive, inflexible and allows only limited interventions that are passive and not supported by evidence-based practice. This does not make best use of physiotherapist skills; it removes professional judgement to assess and review as clinically appropriate, and to manage pain and effect reablement.
ACFI - unintended consequences
Wintringham are a not-for-profit welfare organisation that provide aged care service to frail elderly homeless people. This is some of what they said about ACFI:
The introduction of the ACFI has had the unintended consequence of transferring income from elderly homeless service providers to the wealthier mainstream providers.
There is also the ethical issue of Wintringham agreeing to take some of the most difficult clients in the aged care sector and then being expected to provide for those clients with far less money available that the rest of the industry which studiously avoids such clients.
This is simply intolerable: mainstream aged care providers deliberately choose not to provide services to the homeless largely because of the complexity of the issues presented, yet as a result of ACFI now receive higher subsidy rates than do homeless providers.