Through personal experiences of having a family member in aged care, I have been aware for some time that aged care providers may be overlooking or ignoring their obligations in regards to providing allied health services and care to residents or recipients under the Quality Care Principles 2014 - Schedule 1 - Care and services for residential care services - Part 3 - 3.11 (a) and (b).
Therapy services such as, recreational, speech therapy, podiatry, occupational, and physiotherapy services must be provided at no cost for all care recipients whose classification level includes any of the following care recipient ACFI classifications:
- high ADL (Activities of Daily Living) domain category
- high CHC (Complex Health Care) domain category
- high behaviour domain category
- a medium domain category in at least 2 domains
(This excludes intensive, long‑term rehabilitation services required following, for example, serious illness or injury, surgery or trauma).
Classification Level Update 2023: This page was composed in 2019 and based according to section Part 2 Division 1 - 7(6) of the prior version of the Quality of Care Principles of 2014 which ended 14 March 2019. The new version of the Quality of Care Principles 2014 (version 1 July 2023) does not specify the classifications or include the level details above but obligations in regards to providing allied health services and care to residents or recipients still applies. From 1 October 2022, ACFI funding for allied health care was rolled into AN-ACC and providers are still funded for and required to provide allied health care services to residents. Refer to the 'How allied health care is supported under AN-ACC' Factsheet. A resident’s AN-ACC class (13 AN-ACC classes for permanent residents) is used to help the Government work out how much funding the aged care home will receive to provide for the residents’ daily care needs. You (or your authorised representative) can view your AN ACC class in the My Aged Care Online Account, through your MyGov Account.
From 1 October 2022, approved providers could not charge care recipients additional fees for care and services outlined in Part 3 of Schedule 1 of the Principles based on their classification level. Rather, under AN-ACC, the price and the NWAUs for each classification level are calculated based on the cost of providing all specified care and services to all residents. Approved providers cannot charge additional service fees:
- for specified care and services outlined in Schedule 1 of the Principles
- for services already covered by the payment of an extra service fee or accommodation payment
- for services required to be delivered under their responsibilities as a provider.
Providers may charge a fee for genuine additional care and services if they can demonstrate that they are not otherwise required to be provided or are substantially better than the standard that must be provided under Schedule 1 of the Principles. Providers must not charge more for additional services than an amount agreed beforehand with the resident and must give the care recipient an itemised account of the additional services. Refer to the Australian National Aged Care Classification (AN-ACC) Funding Guide for further details.
Double dipping of government funds?
I am concerned that there is some form of 'double dipping' of government funds to provide the allied health services to residential aged care residents. In addition, it appears misleading information may be provided in some instances in accessing these services.
For example, some aged care providers may be misinforming residents by indicating that the only access to these services is through the CDM - Individual Allied Health Services Under Medicare (patient information). However, the Department of Health has stated the legislated responsibilities under the Aged Care Act of allied health services:
"... Medicare-rebateable allied health services should not replace services that are expected to be provided to residents by the facility, as a requirement under the Aged Care Act 1997 (the Act). Under this legislation, approved providers of residential aged care services are required to provide therapy services, such as recreational, speech therapy, podiatry, occupational therapy, and physiotherapy services, to certain residents (as defined by the resident's funding classification) at no additional cost..."
It goes on further to state:
"... If residents are entitled to receive the allied health services noted above at no additional cost to themselves through the RACF, those residents should not routinely be referred for allied health services under Medicare ..."
This concerns doctors too, as they have a duty of care to residents including responsible legal and ethical practices. It is essential doctors are aware that Medicare-rebatable allied health services should not replace services that are expected to be provided to residents by the facility, as a requirement under the Aged Care Act 1997.
If the resident is informed and wishes to use the Medicare service and eligible to do so, then the resident is responsible for any out of pocket charges. The fact that I have come across this issue personally in residential aged care and also discussions with other community members, led me to examine this issue further.
"After checking my father's Medicare records, I found that he was placed on the CDM Allied health (EPC) to access podiatry services. Apparently a podiatrist was attending to cut his toe nails. I was very surprised as I was aware that this service should already be in place without needing to use the Medicare allied health items. I wondered then, what happens if all the total amount of allied health services per year is used, would they neglect cutting his nails and are they just relying on the Medicare service to fund this type of care? What about those residents without family members - how often is this occuring?"
Source: Quote by family member
Some allied health professionals have even raised the issue with various government agencies and probably Ministers, that some allied health providers are lodging Chronic Disease Management (CDM) allied health payment requests via the Medicare system for services that should be provided by federal government. In essence, double dipping of government funds seems to be occurring under this arrangement.
Feedback provided to the department stressed the importance of involving consumers or community members in their committees, which would help to highlight aged care issues or gaps in the system. Sadly this has not occurred.
I believe in this instance, allied health providers can be ideal witnesses for the Aged Care Royal Commission or be approached to provide more information.
What questions should be asked by Government in regards to Allied Health Services?
Q: Are the Medicare Chronic Disease Management (CDM) allied health items commonly used for RACF recipients?
Perhaps access to Medicare statistical information and numbers of the Allied health Medicare items 10950-10970 used in residential aged care facilities (RACFs) through CDM each calendar year may help to uncover more.
Q: If a recipient classified as high Activities of Daily Living (ADL) needs to be assessed by an Allied Health professional such as a Speech Pathologist or Occupational Therapist, how is this service provided to them?
This is an important question to ask Residential Aged Care providers, Doctors and Allied Health professionals. Update for noting: The new version of the Quality of Care Principles 2014 does not specifiy the classifications but obligations in regards to providing allied health services and care to residents or recipients still applies. From 1 October 2022, ACFI funding for allied health care was rolled into AN-ACC and providers are still funded for and required to provide allied health care services to residents. Refer to the 'How allied health care is supported under AN-ACC' Factsheet mentioned above.
Q: If residential aged care recipients who are eligible for some of the Allied Health services under Schedule 1, Part 3 - item 3.11 are they been informed about this prior to selecting the option to access the Medicare CDM Allied Health items?
It is not uncommon for residents, family members or representatives lacking knowledge or not fully aware of care and services set under the Quality of Care Principles 2014. It is quite possible that Doctors also may be lacking knowledge in regards to Schedule 1 and therefore do not provide the necessary information to their patients.
Q: Why are some networks advocating for more funding towards Allied Health services in Residential Aged Care when RACF's could be pocketing funds since accessed through Allied Health MBS items?
If more funds are provided toward RACF's they need to be monitored rigorously to ensure that funds is spent towards Allied Health Services for residents. As mentioned there are already concerns that funds now not spent where needed and directing recipients to Medicare CDM for access instead.
Aged care recipients have a right to appropriate care and to be informed, whilst ensuring that rorting of taxpayer funds do not occur.
Concerned community member: I have been following the Aged Care Royal Commission hearings and observed a specific concern regarding allied health in Residential Aged care which seems to have remained unnoticed. I am hoping that the Commissioners or assisting Counsel will investigate further and ask witnesses or involved parties the right questions to reveal what is occurring.
Update April 2021: Refer to attachment: Royal Commission into Aged Care Quality and Safety Submission - Allied Health in Residential Aged Care (by a community member).
Attachment: Royal Commission into Aged Care Quality and Safety - Submission re Allied Health in Residential Aged Care, 16 July 2020