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:

• How is it flexible? How could it be modified i.e. what plans are there? 
• Important to keep ACFI $ 44 standards complimentary so then documentation can be reduced
• What progress is being made about e-validation? 
• Why couldn’t the RCS been reduced? 
  • Kept nutrition/ mobility/ hygiene, toilet/ continence; but got rid of communicator = time
  • Kept behaviours but decrease types of behaviours as behaviours do take the most time.
  • Kept meds complex
• If ACFI was designed to reduce documentation and  time with residents when is accreditation documentation requirements going to reduce to  time and residents?
• Can the accreditation and the ACFI become more streamlined together?
• Why did the department push for IT increase usage and also for electronic submission but nit insist that CNO’s be trained to use electronic systems. Printing out info for the sake of validation is counter productive when we are being asked to do Data Entry for Medicare with online claiming, this is also insulting!
• Why was Cornell chosen as the tool of choice for depression?
• Why view / visualise resident of validation assessment may be 6 – 8 months old? Changes could have occurred ACFI valid for length of stay.
• Yes, more streamlined.
• The need or documentation every day of the assessments which is usually the same as the 1st particularly in ADCS.
• Why is there such a disparity between Aged Care and Acute Care funding documentation and record keeping in as such that in Aged Care we have to prove what we do? i.e. tick sheets to say we toileted someone, administered a heat pack etc. we are all professionals with the ability to assess and evaluate care needs.
• Perhaps not exactly right place for this connect however after experience in acute care sector with ACHA, I find aged care a punitive and infantilized system. Some panel members exhibit power. To treat the industry with an expectation of professionalism and support them in an optimistic manner to achieve this would progress Aged Care and it social reputation immeasurably in a short time. It is time the industry matures. 
• Did you even consider  44 outcomes to  documentation?
• Yes - linking assessments to ACFI was much easier
• Documentation needed
• Diagnosis based better than providing care provided
• Ratio’s for staff – same overheads and costs yet if resident improves, because of good ongoing care; you get less money after the 6 months review. Not fair.
• Can we reduce assessment burden for accreditation. We feel unsure of how intense they need to be. i.e. Does it really matter if they have stress incontinence, difficulty functional etc once in aged care?
• Record keeping for Q12 (What? Why? ) 
• Why is dispensing time not accounted for in ACFI? In medication why is there no claim for oral drug of addiction administration?
• Why can’t we have all the behaviours? = the ACFI client assessment
• Documentation has not changed

2. Comments you would like to make (eg: positives, negatives, issues)

• High care knowledge – How does knowing how many H / M / L residents assist anything?
• Letting facilities know names in advance
• ACFI is simple so long as the various prompts and requirements are adhered to
• We need to constantly guard against – more information will lead to positive validators. just provide what is asked for but only give what is asked for. Nothing extra.
•  No, not as far as assessments and length of assessment did decrease the need annual R/V as compulsory
• In according if I am asked to provide a profit and loss of balance sheet for ? documents, regardless of the system I am using it is a document that can be provided – yet for ACFI and accreditation there are no listing of reports that are required – it is relative to each facility and perhaps it would be better to state specific reports or documents that particularly accreditation need and let the facility work ad the program / process they need to supply it. (re Pal B/S standard)
• Not repeating 12 monthly so in progress notes documentation
• Eventually ACFI should reduce documentation and streamline record keeping. It has for funding but not for RCS. In fact it’s added to the load.
• Hardest thing has been separated ACFI from accreditation needs.
• Advantages: care plans new reflect real needs to residents, not RCS-focused. Thank you!
• Barriers:
  • Difficulty integrating assessment for care planning & ACFI requirements, as a result need 2 lots of forms 
  • No clear trigger for need for re-appraisal
• It does not matter what the industry says the government will implement what they think. There is never enough money allocated to aged care as soon as there is an increase in funding, there are other equipments put in place that cost the industry.
• ACCR needs to support and correlate to ACFI
• ACFI has reduced documentation
• More standardised model of a funding tool, less paperwork to complete to obtain funding.
• I don’t think ACFI reduced documentation. With the ACFI pack that needed to be stored separately – is an extra load documentation. For us it’s just drinking up as we need to do / review/ reassess residents annually.
• Negative so much reliant on medical diagnoses, when LMO spreads little time with them and can feel threatened by RN tool or observations.
• Value of documentation – crucial tool in communication across skills and between different team members and important in reflection on and evaluation of care, i.e. just time with the residents it is realistic.
• The ACFI.gov@vic email ACFI question line turn around time is too long. Some questions are never answered! Please advice of the timeframes. Suggest a phone number to ACFI validation.
• Office is available to seek advice when a DHA validator gives questionable decisions at a site audit.
• Its hasn’t changed the amount of documentation that is required across the board.
• Hasn’t made any difference. There will always be plenty of paper work / computer based notes with nursing. That will never change as we need to cover answers legally!
• Difficult to implement adequate education to all staff – time constraints – lack of funding for education. Staff ratio’s unable to implement in work time. Some amount of documentation required to validate funding and accreditation.
• Has recorded documentation, in respect of ACFI. Overall there is no reduction in pack work for the industry due to accreditation, legal, professional a social reasons )more complex than ever!)
• Behaviour charts/ continence records are difficult to read-charts read review. Care staff consistently enter incorrect codes onto charts despite education.
• There is an education and funding documentation but because of all other related assessments and paperwork it doesn’t seem to have made a great difference.
• Has streamlined what is needed to be provided. Very specific in what required.  Only ACFI pack as evidence. Did not reduce paper work. Still needed for accreditation.
• ACFI has increased documentation- new admission from hospital – another ACFI in 6 months. Feasible for one resident to have had 3 or 4 ACFI’s in 1 year i.e. admission 1- admission from hospital 2- hospitalisation over 30 days. 3- increase 2 domains and 4 time wasting and fee wasting!!!
• Our documentation has not decreased as quite often we have to resubmit ACFI especially when residents are low interim.
• After many years of encouraging staff to spend the extra time to maintain a resident’s independence, how did we end up with ACFI that is a dependence model – where we are rewarded in money for more dependant residents – for dependence with ADL’s, demonstrated behaviours (not the interventions put in place and present them)  is ACFI not a step backward in good actions for residents?
• Validation packs ACFI – more easily managed validators need to have an objective reliable approach – a standardized and reliable process - need a quality assurance process to ensure compliance.
• ACFI caused for RN’s to seriously review their need / purposes in Aged Care Facilities as in their already busy say, they now have added documents to complete. Especially PAS and depression scales.
• Because people are staying at home longer – residents are arriving at facilities as old and sick people. Initial assessment then again 6 months later than they die and often within 18 months and then you start again.
• ACFI should be done once only. If the person gets better than when they arrive, facilities should keep the funding as it really costs to get people well and maintain health.
• Not overall, as you need to keep ACFI documentation separate. This means doubling up if you want to use those assessments in care planning.
• Reduced documentation for funding; no change for care planning and progress notes documentation still some over documenting in “historical” / “habitual” end of shift reporting. Definitely streamlined and logical “neat and organized”.
• If the care plan states BD heat packs, the C/P is reviewed and evaluated surely this is adequate validation that the care is happening – why does ticking a sheet validate?
• It’s about behaviours
• Medical model reliance on the doctors.

3. Working strategies your group would like to share

• Facilities having input into quality processes on ACFI assessors
• Facilities need to have input into ACFI validation processes.
• Use care planning assessment to get information to fill in ACFI check list. Train staff to record accurately on assessments. 
• Make part of care plan review process.
• Working strategies reduced documentation
• Stick to the “rules” accurate and timely documentation
• Funding to homes to employ OT’s / psychologists to complete the PAS & Cornell
• Funding to home to employ a RN to do PAS & Cornell, as homes now with  funding are struggling to employ staff esp. RN’s @ Grade 5
• ? pay staff ?
• Opportunities: eliminate tick sheets. Barriers: lack of trust from government 
• We thought you could have a more generic assessment pack that was suitable for ACFI and accreditation. How do we prove care in a move condensed way for accreditation?
• Packs are good – stored security separately
• Validation rules clear: 1- list of residents ACFI packs required given 24 hours has ahead of visit. 2- Why is it a secret until the validators arrive