Aged care is going through a massive industry wide overhaul in Australia. There have been many horror stories of mismanaged aged care facilities in the news over the past few years which prompted the establishment of the Royal Commission into Aged Care Quality and Safety, with the final set of hearings about to start in Melbourne. The recommendations of the Royal Commission will impact the lives of not just the elderly using these services, but their families, staff and greater society. Aged care is a $20 billion+ industry in Australia, employing over 224,000 staff across more than 1,800 businesses, who care for over 270,000 elderly and disabled Australians across the country – a number which is sharply growing. 

Many of these hearings have focused on the elderly themselves and rightly so, but the final week of hearings will be on the issues faced by the aged care workforce. The goal of these is twofold; to find ways to enhance the aged care workforce’s capacity and capability to provide high quality care and support to care recipients, and to make the aged care sector a more attractive and rewarding place to work. Both goals will likely focus on the restrictive nature of the government’s Aged Care Funding Instrument (ACFI) which can limit the ability to provide meaningful and progressive therapy. In work funded by the ACFI, allied health professionals are restricted primarily to “pain management” therapy – which is as limiting as its title suggests.  

Not all aspects of a role must be a joyful experience (there are not many recruiters who enjoy writing an ad on Friday at 4pm for example) but this isn’t an annoying administration task we are talking about. The ACFI is funding the therapy itself, the thing that these people have trained in and dedicated their lives to doing. Becoming a therapist is a vocation for most people, especially when it comes to dedicating your life to therapy in an ageing population. When there is an industry wide issue with the way that government funding enables you to do your job you know there is a serious problem. This is not the case for all government funded work. The National Disability Insurance Scheme (NDIS) – whilst it had issues in its rollout, in terms of wait times, is similar in that it is a funding instrument, but it allows therapists to conduct therapy plans tailored to the participants. It is the rigidity of the ACFI that is the main issue.   

I spoke about this with one of my clients Scott Lynch, who is the chair of the APA Gerontology Committee for NSW and is also the managing director of Community Therapy – a community and aged-care service provider operating in the greater Newcastle, Hunter and Central Coast region that is trying to change the conversation around aged-care. Given his unique perspective as both an employer of aged-care professionals and as an expert aged-care therapist himself, I thought he would be the perfect person to discuss this with. 

Why do you think therapists​ are less likely to enter a career in aged care currently in Australia?  There are many reasons that new graduate Physiotherapists and Occupational Therapists may not consider Aged Care as a career pathway. One of the primary reasons is that many new graduates do not have dedicated aged care clinical placements during their degree, and they do not get the chance to see how clinically challenging and professionally rewarding Aged Care can be. Another reason is that the current residential aged care funding model, the ACFI, is a barrier for therapists to deliver their full scope of evidence-based interventions. At Community Therapy, and many other allied health organisations do similar, we support our graduates to continue their professional development through mentoring by senior clinicians, by attending in-services, external training and by working in other areas of our business such as community healthcare. 

What changes do you think are needed in government funding structures to make aged-care a better industry for therapists to work in? It is well documented by organisations, individuals and even the Department of Health that the current residential aged care funding tool, the ACFI, is no longer fit for use. The Resource Utilisation and Classification Study (RUCS) was commissioned by the Department of Health in August 2017 and is still continuing with the aim of developing and implementing a new funding tool. As of August 2019, we are entering the trial phase of the recommended new funding tool, the Australian National Aged Care Classification (AN-ACC). Following the completion of the trial in mid 2020, we would expect further liaison with the industry prior to a defined timeline and guidance and education for implementation to be released.

What do you do at your company to combat the current limitations created by the ACFI model? At Community Therapy we work with our approved providers to ensure our interventions satisfy the current ACFI model and work collaboratively at a site level to ensure care standards are being met. As the ACFI does not fund active based interventions we work with care staff, lifestyle staff, volunteers and family to facilitate group projects and individual exercise programs. As an organisation, we funded innovative projects earlier this year to allow our new graduates to do more than pain management in residential care and we had great outcomes completing, upper limb rehabilitation, hydrotherapy classes, dementia specific activities and falls prevention programs. 

You are chair of the NSW Gerontology Committee at the APA? Apart from what you have already discussed, what else is the APA lobbying the government to change in aged-care care? ​I am privileged to be serving as Chair of the APA NSW Gerontology Committee and a member of the National Committee. I have been so impressed with the amazing support and resources that the APA are providing to ensure that the best interests of Physiotherapy members and most importantly consumers are heard by the Department of Health. It is not my role to speak for the APA however you can read articles and position statements such as the following on the APA's website

What future do you want to see for the aged-care industry in Australia? Can the Royal Commission deliver it? Speaking purely from an Allied Health perspective, we all want consumers to have equitable access to evidence based interventions for their health conditions. At present, the ACFI, does not provide any funding items to support this. The concern at present with the AN-ACC is that in its current form it does not provide specific funding for access to Allied Health professionals at all. It is very clear in healthcare funding that you need to either provide standalone funding for interventions or mandate the provision of such interventions in a quality framework if that standalone funding is not provided. If the AN-ACC does not provide standalone funding for Allied Health Professionals, then it will be up to the Aged Care Quality and Safety Commission to hold approved aged care providers accountable when consumers are not facilitated to access evidence based Allied Health interventions for their conditions.

**The views expressed above are those of Scott Lynch and Community Therapy and are not representative of the APA or any committee or organisation that he is associated with.