A range of questions and feedback from the ACFI Symposium attendee participation forms are listed below. Responses are being taken into consideration in the preparation of a submission to the current ACFI Review.

1. Questions for the Panel:

• Resident profiles – should we provide them to group? (ie. Unfunded residents)
• Interim low – why? 
• Why can’t we dispose with the High care – Low care differentiation?
• It’s an artificial construct, politically not wanted and services AC industry + clients no useful purposes at all. Need do anomaly of 2 car jump family if =  in BEH
• Have low care residents who funding doesn’t meet care needs?  
• Bring ONE VALIDATION – remove personal bias or interpretation of validators.
• Is consideration being given to ACATS just approving the needs for care and the ACFI determines level of care?
• Why do we have the interim Low default?
• If the ACFI rate is High care and the resident needs can be met in a low care setting, why isn’t it paid? There are many residents that are better suites to hang in a low care facility rather than a high care.
• (ACFI anomaly group) ‘walking’ with dementia – resident’s with extreme behaviours take significant staff resources to meet care needs – they are often funded at a much lesser amount than residents with complex care needs.
• Will the department by family definition small rural areas?
• Staff/ resident ratio & EBA – it’s all law
• Drop interim L/C cop
• These profiles not reflected well
• L/C – dementia (not safe alone)
• L/C – psyche (behaviours not always evident but need to be monitored)
• L/C – where assessed by ACAT but why? If not going to get care through ACFI – i.e. Don’t give approval or give some money.
• How do you support dementia residents who are otherwise physically well – the behaviour supplement does not represent the significant time needs of staff spent caring for such residents?
• Business rule 2  domains increate before increase in funding so many 95 different levels surly any increase should be funded
• Social care (isolation, risk and emotionally ready) no funding based on emotional / spiritual and social care which can take up more time than anything else.
• ACFI – is not holistic – very task oriented whereas care is more multidimensional. 

2. What is working well?

• We find that keeping all the information together and readily available for validation has saved the hassle of having to search for information
• Documentation
• Basic assessments (behaviour, continence, medication)
• Medicare on line claiming is fast and efficient but often need to submit them more than once due to computer glitches.
• ACFI has led to meaningful, realistic care planning
• Care staff-less documentation order
• Love the focus on diagnosis – helps tighten our care plans
• Nice not to have the compulsory annual review
• Easy to check accuracy of ACFI packs
• Tools mostly ok, good to identify depressions previously not identified.
• Easier to assess and submit ACFI also less interruptive and inconsistency. Don’t have to reappraise annually.
• Behaviour charting
• Clear requirements for evidence
• Removal of need for annual reappraisal
• Specified evidence that needs to be kept is kept to a minimum.
• Accreditation and ACFI as very separate entities with same end point

1. About money – prove care – complaint = funding = $
2. About quality care and services – result for residents = complaint

3. Suggestions for Inclusion in the ACFI Review:

• Collaboration with AWMA re wound care, definition of complex wound, and wound products classified as “basic” dressings. (As per specified care and services)
• Would it be possible to set up sub-committee to collate, analysis and submit results; of resident profiles of residents who are funded or not at all due to psyche conditions and / on social needs.
• Important questions were brought up today that were not answered.
• Complex health
• That for a large group of residents who score nil/ nil/ nil the reasons that they needed to come into residential care disappear the minute they walk through the door but are not considered or even mentioned again under ACFI. Eg. The ability to chef/ cook/ manage finances/ be healthy safe and happy yet don’t need feeding or talking etc.
• R/V ACFI assessment forms (defined set, with set criteria for all ACF to follow)
• Initially told not to use any other forms other than what’s in the assessment pack.
• R/V of classifications for residents who do have care needs, BUT no ID. In ACFI: no funding.
• Put care focus back on to the staff who actual provide care to resident
• Clarity of validators understanding & having ALL validators on the same page.
• What is going to happen for those residents whose profile makes them unattractive for RACF? They need to go somewhere and many do not manage with community based services.
• How do you demonstrate questions for ACFI 12?
• Why is there the $ 15 rule + (30for major change)
• Why can’t you get ACFI funding if it is higher than the RCS?
• CACP is close to RCS categories 6 and provides a limited number of hours of care- shopping, cleaning, meal provision, personal care etc. yet a resident can enter a residential and receive less than this for 24/7 care.
• Q 12 = introduce a pre-approval process / application for other un-specified complex issues which are time consuming / care intensive and not covered by the exclusive list. Eg. Caring for renal AV shunt (resident attending dialogues OH site) 
• Documentation transfer from other facilities so when looking at ‘e’ validation – would this be used to transfer required documents for ACFI?
• Please get rid of record keeping for CHC 3, 4a, 4b – if there is a diagnosis and a directive, it is infantilizing and instantly to be treated like children.
• E-Validation on ACFI
• Should be able to increase funding not need  to achieve two CAT jump
• Funding in resident’s unit needs that include profound defence, speech inability and fill ADL needs.
• Clarification for the CHC directive for 4B claims. Why does the treatment require an AHP to carry out the procedures? An assistant of PCW could do that under the direction of the person who wrote the direct?
• ACAS and ACFI anomaly resulting in the interim low default of $44.98 pre day. At present initial submissions to be LLL and then major change in 2 months results in correct claim but another ACFI to be submitted in 6 months as a result 3 claims instead of one
• Pain record – under RCS only require a 7 day record, why does ACFI require ongoing records? This has created more work / documentation.
• Various groups included in Aged Care need tot talk to each other. We still have a fragmented approach and this was demonstrated to some extent today. (ACFI/ accreditation/ stats/ commonwealth DOHA)
• Good Luck
• Remove High/ Low care areas from ACFI and rely on ACAS to complete this – they are accurate! There is not a need for it to be in ACFI as High/ Low care classification is based on right resident in right care setting – not funding.
• RN DIV 2 should be able to provide therapeutic massage (4a)
• ACCR is not matching ACFI. Interim Low in fair to facilities.
• Review the need for a D claim in ACFI 1 to reach H in AOL’s
• Increased funding for behaviours
• Increase the numbers of behaviours that can be claimed
• More money for CHC needs
• Preparation of medications (where it is a care need eg. Crushing) should be counted
• Cognitive impairment added as a mental behavioural diagnosis – affects behaviours but may not be dementia
• Staff find CSD very difficult and time consuming
• Not properly capturing L/C psyche even though they may behave like dementia in terms of behaviour and time spent.
• Match ACCR to ACFI or get some completion between for high and low medication times not relevant – include crushing etc instead of time spent administering.
• Electronic validation
• Removal of record requirement for heat packs
• Alternative tool for depression assessment
• The ACFI is proposed to direct finding to the needs of the resident. It is however, a medical model that directs funding to physical needs only – nothing towards social needs / emotional needs – that are equally as important.
• ACFI pack validations to be conducted off site. If validators are checking the contents of the pack there is NO need, unless there is incongruence, for validators to be on site.
• IL situation Low Care ACCR and High Care ACFI. When this situation arises, why isn’t the ACFI pack validated and if determined ACFI truly reflects the care provisions of care being provided appropriate ACFI funding paid. Happy to discuss further (Alison 03 9724 1555 Somercare)
• Statistics / results – progress / outcome and update
• ACCR (quick)  / ACFI (long)  incongruent
• Tools need to be the same questions (eg. 3 domains + ax = Cornell could be reduced to GDS for quicker when doing ACCR)
• Transfers from other facilities – difficult to get ACFI assessment validation pack from sending faculty