A range of questions and feedback from the ACFI Symposium attendee participation forms are listed below, along with responses from the Department of Health and Ageing (DoHA). Responses and issued raised will also be considered in the forming of submissions to the current ACFI Review.
Question:
Why can’t cognitive impairment be accepted as a ‘diagnosis’? It still impacts on care needs and behaviours.
Answer:
Cognitive impairment is not a diagnosis, more a symptom - the result of an underlying condition. Behaviour Assessments are the key to ascertaining the underlying behaviours driven by such symptoms as cognitive impairment and short term memory loss. Once the behaviours have been established, appropriate interventions are put in place, and regularly evaluated to ensure the correct care needs are undertaken. A diagnosis for dementia is required to qualify for the highest level of the Behaviour Supplement.
Question:
Why can’t CVA be used as a diagnosis for mental and behavioural diagnosis checklist? It is a massive cerebral assault and causes brain damage and often causes cognitive impairment, and yet cannot be used in this context with ACFI.
Answer:
The diagnosis of CVA does not necessarily result in cognitive impairment.
Question:
Can the diagnoses/conditions accepted within the ‘mental diagnoses’ section be widened? “Short term memory loss”, “cognitive impairment” and “confusion” all impact on care. Getting a doctor to change a diagnosis for a funding claim should not be part of the facility’s requirements. (Doctors have also reported that they do not feel it appropriate that funding should dictate their current practice.)
Answer:
‘Cognitive impairment’, ‘short term memory loss’ and ‘confusion’ are not diagnoses, more symptoms - the result of an underlying condition. Behaviour Assessments are the key to ascertaining the underlying behaviours driven by such symptoms as cognitive impairment and short term memory loss. Once the behaviours have been established, appropriate interventions are put in place, and regularly evaluated to ensure the correct care needs are undertaken. A diagnosis for dementia is required to qualify for the highest level of the Behaviour Supplement.
The ACFI does not determine what is planned or provided. Rather it measures assessed care needs.
Question:
Why is it that a RN Div1 can write a diagnosis of ‘incontinence’ on an ACAS assessment but is unable to write and have it accepted on an ACFI appraisal?
Answer:
The initial diagnosis would have to have been made by a medical practitioner. The RN Div 1 may then have transcribed the diagnosis to the ACAS assessment.
Question:
Why is there such a reliance on diagnoses- and as a result, documentation from GPs (including writing directives)? This is focusing care onto a ‘medical model’.
Answer:
Because underlying medical conditions and the input of medical practitioners are considered to provide a good indicator of relative care needs. The conditions of most relevance are those that currently impact the care of the resident. The ACFI is not a comprehensive health assessment nor is it a tool that prescribes planning or provision of care or other specific interventions. The ACFI is designed to provide a simpler model identifying the care needs and to reduce the level of paperwork. In addition, collecting information about medical conditions is useful to gain an understanding of conditions that are most impacting care needs, and to support planning and research. This information enables a database to be set up and which will in turn determine future funding and planning.
Question:
What is the actual commencement of the timing for the medication administration process?
Answer:
Refer to ACFI FAQs, page 23 which indicates: The ACFI rating measures time taken to assist with ingestion or administration of daily medications ordered by an authorised health professional. Therefore, the commencement of the timing would indicate the moment the medications were offered to the resident.
Question:
What is the ‘intent’ behind the medication claim? It doesn’t seem to include the timing related to ‘best practice’ guidelines for medication administration.
Answer:
The ‘intent’ behind the medication claim is that the time taken to administer the prescribed medication is the best indicator of care needs associated with administrating medications. It should not affect best practice which is an integral part of resident care.
Question:
Why isn’t there any specific claim for Schedule 8 medications? Good practice means that there is more resources in ensuring that this is administered safely, including the checking before administration.
Answer:
The ACFI rating measures time taken to assist with ingestion or administration of daily medications ordered by an authorised health professional. Whether the medication is S8 or another listed substance is not relevant so long as it is included in the Medication definition. The ACFI User Guide p 34 defines medication as follows:
- Any substance(s) listed in Schedule 2, 3, 4, 4D, 8 or 9 of the Standard for the Uniform Scheduling of Drugs and Poisons (and its amendments) and/ or
- Medication(s) ordered by an authorised health professional or authorised for nurse
initiated medication by a Medication Advisory Committee or its equivalent. This excludes food supplements, with or without vitamins, and emollients (e.g. sorbolene
cream, aqueous cream, etc). Authorised health professional means a medical practitioner, dentist, nurse practitioner or other health professional authorised to prescribe by the relevant state/territory legislation.
Feedback from the National Trial indicates that the time taken to assist a person with their medication was more indicative of their resource need rather than just the type of medication taken.
As a result, the domain of medication was changed to the time needed to assist a resident (based on the resident’s impairments etc) with their medications over a 24 hour period.
If there are concerns that other elements of medication administration that provide a better indicator of measure is required, these can be raised as part of the ACFI Review which is currently underway, with the Terms of Reference announced by the Minister on 6 November 2009. A public call for submissions was announced on 5 December 2009.
Question:
“Complex pain management and practice undertaken by an allied health professional or registered nurse” – If this is the requirement to gain points for this question why is acceptable for the GP to write the directive although they are not required to give the treatment? Following the same line of thinking, why can’t a RN Div1 give the directive and yet delegate part of the treatment to a suitably trained staff member?
Answer:
Referring to ACFI User Guide – ACFI 12.4a – Requirements - requires a directive from a registered nurse OR medical practitioner OR allied health professional. A registered nurse directive refers to a nursing directive by a nurse practitioner or registered nurse that describes the complex health care procedure to be performed and the associated management and/or treatment plan. A medical practitioner directive refers to a medical directive by a general or specialist medical practitioner or a consultant physician that describes the complex health care procedure to be performed and the associated management and/ or treatment plan. If pain management is not undertaken by an allied health professional or registered nurse, this could be claimed if it meets the requirements of ACFI 12.3 – Pain Management. These requirements are there to measure relative care needs, not dictate what is provided – there is nothing in ACFI to prevent approved delegation of services.
Question:
Why does therapeutic massage conducted by a physiotherapist gain 6 points and one conducted by a RN Div1 only gain 3 points?
Answer:
Therapeutic massage conducted by a RN Div 1 – the procedure has a requirement of frequency of at least weekly AND involving at least 20 minutes of staff time in total. Therapeutic massage conducted by a physiotherapist (allied health professional) – the procedure has a requirement of frequency at least 4 times per week. This definition reflects the difference in services.
Question:
Pain management - what is covered under ‘technical equipment’? TENS is included, but what else? Can we get a list so that we know what is claimable?- would decrease a ‘grey’ area for both Providers and CNOs.
Answer:
A claim can be made in either 4a or 4b for complex pain management and practice if it involves therapeutic massage and/or pain management involving technical equipment
specifically designed for pain management - see page 37 of the ACFI User Guide. ‘Technical equipment designed specifically for pain management’ refers to electro-therapeutic equipment such as TENS, interferential therapy, ultrasonic therapy, laser therapy, wax baths etc. This has been confirmed by the Australian Physiotherapy Association. The Department of Health and Ageing does not maintain a list of included equipment as this may change without notice.
Question:
Can hydrotherapy be claimed for pain management?
Answer:
This could be claimed under Item 3 - Pain Management as long as it meets the specified requirements. With respect to items 4a and 4b, it depends on the therapist’s status as an ‘allied health professional’ to direct and provide such services. Hydrotherapy does not involve ‘technical equipment designed specifically for pain management’. (‘Technical equipment designed specifically for pain management’ refers to electro-therapeutic equipment such as TENS, interferential therapy, ultrasonic therapy, laser therapy, wax baths etc. This has been confirmed by the Australian Physiotherapy Association.) Again, the other requirements of these items must be met i.e. a directive and an assessment.
Question:
If the main intent behind the pain management claim is to provide for a facility to manage a resident’s pain to the best possible level, why isn’t a RN Div 2 included in the ability to claim? They have the skills to respond to this.
Answer:
Refer to page 4 of the ACFI User Guide (Terminology) – Registered Nurse – A person licensed to practice nursing under an Australian state or territory nurses act or health professional act.
Referred to as a Registered Nurse Division 1 in Victoria. The ACFI User Guide explains the requirements for a directive for items in ACFI 12 – “Only the stated procedures or health care needs that have been identified in a directive (that may include an assessment) by a registered nurse including nurse practitioner, or other appropriate medical or health professional, are taken into account.” Design issues relating to how the ACFI recognises the roles of nurses and other health professionals will be considered in the ACFI Review which is currently underway.
Question:
What determines whether a wound is classified as ‘chronic’ or not?
Answer:
Refer to page 25 of the ACFI User Guide. While there is no exact ruling when a wound becomes chronic, a chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do. The vast majority of chronic wounds can be classified into three categories: venous ulcers, diabetic ulcers, and pressure ulcers.Some procedures can only be claimed where there is a ‘directive’ or an ‘assessment’, or a ‘diagnosis’.
Question:
Why can’t a facility claim for wound care? The fact that only ‘chronic’ wounds are claimable implies that residents with wounds are a ‘normal’/ standard part of care. However in reality not all residents have wounds, nor is it acceptable to expect that.
Answer:
Refer to page 25 of the ACFI FAQs regarding “chronic wounds”. Given that it is quite common for residents to have wounds from time to time it is only when the wounds are chronic, i.e. an ongoing issue, that they provide a good indicator for ongoing need. ACFI 12 relates to the assessed need for ongoing complex health care procedures. This is the ongoing care need at the time of appraisal, not any expected occasional needs and not any occasional or unusual needs that are present at the time of the appraisal.
Question:
Why can’t we claim for skin care/ moisturising/ skin checks, when these are required to prevent the problems developing which can develop into the claimable wounds? (Isn’t this a better option for the resident?)
Answer:
It is best practice and a part of standard care to meet these needs for all residents: the items that are included or excluded under ACFI should have no bearing on provision of these services to residents who need them. The Accreditation Standards, Schedule 2, Part 2 – Health and personal care – Principle – Residents’ physical and mental health will be promoted and achieved at the optimum level in partnership between each resident (or his or her representative) and the health care team. – Item 2.11 – Skin care – Residents’ skin integrity is consistent with their general health. Complex Health Care relates to the assessed need for complex nursing procedures and activities. The ratings in this domain relate to the technical complexity and frequency of the procedures. This domain was finalised using the analysis and feedback of the National Trial data and input from an expert panel. Items that were selected by most participants in the national trial and did not identify the complex needs were assimilated into other ACFI domains where possible.
Question:
BSL/ Blood pressure - why can’t we claim for weekly? The frequency is dictated by the GP, and weekly or daily, it doesn’t change the skills, training and competency testing required by the facility to manage this. This all costs.
Answer:
While taking blood pressure is a normal part of care requiring skills, training and competency of the part of staff, it is considered that daily need for testing provides an indication of higher care needs and is therefore relevant to assessing the relative care needs of residents under ACFI.
Question:
Why can’t a stoma ‘break down’ be claimed under wound care? This requires much more care than the usual stoma care management.
Answer:
Refer to ACFI User Guide – ACFI 12.15 which indicates: Management of ongoing stoma care. The requirements are 1. Diagnosis or ACCR AND 2. Directive from registered nurse or medical practitioner. There is no defined frequency of treatment required for a claim to be validated. ACFI 12 relates to the assessed need for ongoing complex health procedures and activities.
This is the ongoing care need at the time of appraisal, not any expected occasional needs and not any occasional or unusual needs that are present at the time of the appraisal.
Question:
Can the rating claimable for day to day stoma care be reviewed? It requires more time than the 1 point implies.
Answer:
This area of complex health care has generated some queries and could be considered in the ACFI Review.
Question:
Why is there such a limited list of claimable areas under complex health care?
Answer:
This domain was finalized using the analysis and feedback of the National Trial data and input from an expert panel. Items that were selected by most participants in the national trial and did not identify the complex needs were assimilated into other ACFI domains where possible. Design issues such as the structure and comprehensiveness of the complex health care domain can be looked at during the ACFI Review that is currently underway.
Question:
How can we demonstrate directives for Complex Health Care?
Answer:
ACFI 12 does not specify the format in which the directives are captured. However, the details of the procedure, and the name and profession of the person directing the procedure, must be clearly identified. Directives could include e.g. description of procedure, frequency of procedure, items required for the procedure, who is responsible for the procedure, review /evaluation dates etc.
Question:
When will we see the additions of other items e.g. other time consuming interventions within complex health care claims?
Answer:
As indicated above, design issues such as the comprehensiveness of the complex health care domain can be looked at during the Review that is currently underway.
Question:
Feedback seems to be that there are a limited range of claims being made under the complex health care area. When will this be reviewed & will we get to hear of the results?
Answer:
As indicated above, design issues such as the comprehensiveness of complex health care domain can be looked at during the Review that is currently underway.
Question:
If one of the ideas behind ACFI was to reduce documentation, why are we needing to complete treatment charts (and produce them) to validate claims? Why isn’t the directive enough? (The other areas of ACFI are based on ‘need’ rather than ‘treatment’ so why is this different).
Answer:
ACFI 12 relates to the assessed need for ongoing complex health care procedures and activities. The ratings in this question relate to the technical complexity and frequency of the procedures. The ACFI questions refer to usual care needs.
This is the ongoing care need at the time of appraisal, not any expected occasional needs and not any occasional or unusual needs that are present at the time of the appraisal.
With reference to ACFI 12 – Complex health care procedures – directives and records are required for:
- 12.1 – Blood pressure measurement
- 12.2 – Blood glucose measurement.
- 12.3 – Pain management
- 12.4a and 12.4b –Complex pain management
- 12.7 – Administration of suppositories
- 12.10 – Management of chronic wounds
- 12.18 – Technical equipment (CPAP)
A key objective of the ACFI was that residents and staff would benefit from less staff time being spent on assessing residents for funding, completing unnecessary paperwork, thus resulting in more staff time available for providing care. At the same time, each of these procedures require some paper trail to enable staff to undertake the required treatment and validate that the procedure has been undertaken. The directive generally goes hand-in-hand with the treatment charts etc. This documentation also forms part of the Accreditation process, under the Aged Care Principles, Quality of Care Principles 1997. The ACFI is not a comprehensive health assessment nor is it a tool that prescribes planning or provision of care or other specific interventions – and there is no need to include any documentation into the ACFI Appraisal Pack other than what is specified in the ACFI User Guide.
Question:
If we need to complete treatment charts/ records, what is the time frame of the charting that needs to happen to validate the claim- do we only have to be able to provide them for the time around the actual claim e.g. as per RCS? Can you clarify this please?
Answer:
Records required for ACFI appraisal include:
- 3 day urinary record
- 7 day bowel record
- 7 day behaviour records
Records -on request – (i.e. treatment charts) could include:
- Wound dressings – chronic wounds
- Eye drop instillation
- Daily blood pressure measurements
- Daily blood glucose measurements
- Pain management
- Administration of suppositories /enemas
- Technical equipment for continuous monitoring of vital signs including CPAP machine
Question:
Complex skin integrity- If a resident refuses to ambulate and requires 2 staff to assist ambulation, is there a claim for complex skin integrity? Does this fit the category of ‘cannot self ambulate’?
Answer:
A Physiotherapist would be required to conduct a mobility and dexterity assessment to determine the extent of self ambulation for a claim in ACFI 2 – Mobility.
Once assessed, a Skin Integrity assessment may be undertaken to determine the need for a claim in ACFI 12.5 if the resident is deemed incapable of self ambulating.
Refer to page 25 of the ACFI Frequently Asked Questions.
Question:
What is the definition of ‘cannot self ambulate’ in ACFI 12 item 5?
Answer:
A resident cannot self ambulate if they require extensive assistance with transfers and locomotion.
Question:
Why is Complex health care base on treatment when the rest of the ACFI is supposed to be based on ‘needs’?
Answer:
The Complex Health Care Domain is not based on treatment. Complex Health Care is a supplementary domain and is paid in recognition of care staff that are required to provide complex health care. ACFI 12 relates to the assessed need for ongoing complex health care procedures and activities. The ratings in this question relate to the technical complexity and frequency of the procedures.
Question:
ACFI 9- what is ‘socially inappropriate behaviour’? Can you use behaviours not covered in the descriptions in P2?
Answer:
Refer to page 30 in ACFI User Guide to peruse the description of socially inappropriate behaviour. No, behaviours not covered in the description in P2 cannot be used. Only those behaviours listed may be used. ‘Socially inappropriate behaviour’ is any behaviour that impacts on other residents.
Question:
Are you allowed to transcribe behaviours from a facility behaviour reporting form onto the ACFI form? On page 5 of the ACFI User Guide, it states ‘ensuring that the behaviour record has been initialled by the staff member who has observed the behaviour occurrence’ BUT FAQ states on page 18 says ‘yes’. There have also been reports of different interpretations from different CNOs, with variation between the states as well.
Answer:
Refer to page 18 of the ACFI Frequently Asked Questions. Yes, in some cases. If they contain sufficient detail the information can be transcribed into the ACFI Assessment Pack from the provider’s existing records so long as the recording was undertaken in the past six (6) months, they continue to reflect the care needs of the resident and they provide all the necessary information to complete the specific ACFI record. If the existing records do not contain sufficient detail, the ACFI records must be completed independently.
Facilities often have a ‘Signature Log’ of all staff, which enables easy identification of documents signed or initialled. During the Behaviour Recording over the 7 days, staff should have noted and initialled when the behaviours occurred.
Question:
Why are ‘well managed’ behaviours not claimable e.g. psychiatric residents cared for in a psych-specific facility are discriminated against because these facilities are better are treating these behaviours through appropriate medication and care planning, so that the triggers for the behaviours are not present.
Answer:
Refer to page 18 of ACFI Frequently Asked Questions. Residents with behaviour problems may have interventions in place that are effective in managing behavioural issues.
However the frequency of the issues can still be recorded in an ACFI behaviour assessment even if the outcome for the person and staff is better managed because of the developed interventions.
Note: if a behaviour record has been completed for the resident in the last six months, you may transpose that information across to the ACFI behaviour records as long as it:
- Reflects the residents current behaviour status at the time of the appraisal
- Contains all the information that is required in the ACFI behaviour records; and
- Records behaviour episodes listed on page 44 of the ACFI User Guide.
Question:
Why can’t behaviour prevention be claimed? It often requires a large amount of work.
Answer:
The ACFI behaviour areas are targeted to those individuals who have persistent and regular care needs in the behavioural areas over and above what is able to be managed via basic care approaches. It is accepted that residents receive basic care support that reduces the expression and perhaps impact of many lower level behaviours. The more persistent and difficult to manage behaviours will have an ongoing expression that will be detected by the 7 day behaviour logs. Most of the more difficult behaviours are due to a person's cognitive impairment (e.g. dementia) and the inability to correctly interpret and respond to their environment. This will result in an ongoing behavioural expression but it is the impact (to other residents, staff etc) that can over time be sometimes better managed by the facility. The ACFI measures the ongoing core persistent and regular behavioural problems and provides additional funding for facilities attempting to better support and manage residents in this category.
Question:
Why is depression, identified and treated, not claimable?
Answer:
Depression is claimable. ACFI 10 – Depression relates to the symptomology of depression, which is why it is important to conduct the Cornell and document interventions.
The Cornell Scale for Depression scoring must be 9 or above to make a claim, even though there is a diagnosis of depression. A diagnosis of depression alone will not validate a claim.
The diagnosis of depression also must be current (no older than 12 months).
Question:
Is the Cornell tool that most appropriate tool for diagnosis of dementia?
Answer:
For the purposes of ACFI the Cornell Scale for Depression is considered to provide the best available tool to identify changes for diagnosis of depression for people with dementia.
Question:
Why does it take so long for an ACAS reassessment if a new resident with a low care assessment is coming up as high care under ACFI?
Answer:
The average time from when a person’s referral to be assessed in a residential setting is accepted by the Aged Care Assessment Team (ACAT) and when the ACAT has the first face to face contact with a person, for Australia as a whole, is 16 days.
Question:
Why do we need to wait 12 months to reassess a resident if they fit the interim low category?
Answer:
Under ACFI the full ACFI high care subsidy may be paid for a resident with an ACAT approval limited to low care when one of the following events occurs:
- The resident ages in place i.e. a high care ACFI reappraisal is conducted. The circumstances of the reappraisal might include:
- Expiry of an existing ACFI classification (e.g. following a period of extended hospital leave, or six months after entering care directly from hospital);
- When there is a major change in care needs;
- A voluntary reappraisal 12 months or more after a previous appraisal; or
- A voluntary reappraisal following a transfer within 28 days.
- An ACAT assessment is provided which is not limited to low care; or
- A Departmental Review Officer confirms the resident requires an ACFI high level of care during a classification review.
It is acknowledged that there an anomaly in the new arrangements has resulted in some residents being appraised as High Care who would have previously been appraised as Low Care – and therefore increased the number of residents classified at the Interim low level. In the May 2009 Budget, the Government announced action to address this anomaly by modifying the definition of High Care. From 1 January 2010 there will be a definition change to High Care. While it is expected that the new definition will go a long way to addressing industry concerns, there may be scope to consider further improvements to the interface between ACAT and ACFI processes. This is a matter that has been specifically identified for further examination as part of the ACFI Review, as reflected in the Terms of Reference announced by the Minister for Ageing on 6 November 2009.
Question:
‘Needing to re-direct a resident to the toilet’- does this constitute a claim in ACFI Question 4 for ‘setting up for the toilet’?
Answer:
No. This is not claimable in any of the 12 ACFI questions.
Question:
Is refusal to take part in lifestyle activities ‘refusal of care’?
Answer:
No. It is the resident’s choice whether they attend lifestyle activities. It is not classed as ‘refusal of care’.
Question:
If a resident comes in with a low care assessment, but their initial ACFI appraisal is high, do we have to wait a full year before we re-do their ACFI and they become ‘high care’?
Answer:
No. Under ACFI the full ACFI high care subsidy may be paid for a resident with an ACAT approval limited to low care when one of the following events occurs:
- The resident ages in place i.e. a high care ACFI reappraisal is conducted. The circumstances of the reappraisal might include:
- Expiry of an existing ACFI classification (e.g. following a period of extended hospital leave, or six months after entering care directly from hospital)
- When there is a major change in care needs
- A voluntary reappraisal 12 months or more after a previous appraisal; or
- A voluntary reappraisal following a transfer within 28 days.
- An ACAT assessment is provided which is not limited to low care; or
- A Departmental Review Officer confirms the resident requires an ACFI high level of care during a classification review.
Question:
With regard to the above question, if an ACFI appraisal is sent a year later, can their second assessment be the same as the first one, or if not, how different does it have to be?
Answer:
It can be the same. A voluntary reappraisal of residents’ care needs may be completed in the following circumstances:
- At any time 12 months or more after the existing classification took effect;
- When the resident has a ‘major change’ in care needs;
- At any time where the resident is classified at the lowest applicable classification level
- (ie, no or minimal assessed care needs in all three ACFI care domains or is classified as RCS8); and
- Within 2 months after a resident transfers from an aged care service.
If a resident transfers to another facility the accepting facility will continue to be paid at the ‘Interim Low’ until the new facility reappraises the resident.
Question:
How can a resident be assessed as requiring residential aged care (no longer suitable to receive community care), and not receive any funding when they enter residential care, and yet for the same care needs would be receiving subsided community care?
Answer:
A major part of government policy over recent years has been to respond to consumer demand and concerns raised by the sector, and this is reflected by the increased funding for community care and for those residents with very high care needs. As part of this increased focus on community care and higher care needs in residential settings, there has some shift away from residential care as the preferred option for caring people with lower care needs and less funding has become available for some residents with very low care needs. While a key objective for the ACFI has been to redirect funding to residents with higher care needs, there will be scope within the ACFI review to consider the impact the ACFI has had on access to appropriate care, especially for residents with special needs, and whether the ACFI fails to recognise the relative costs of meeting the care needs of certain classes of residents.
Question:
If the ACAS assesses whether a resident requires residential care or not, why can’t their assessment also correlate with a baseline claim for care funding?
Answer:
Aged Care Assessment Team (ACAT) assessments are focused on the needs of individuals and their decisions are made independently of funding considerations for aged care homes. The main objective of the ACAT is to assess the overall care needs of an individual, using a multi-disciplinary approach. Under this Program, ACATs assess the medical, physical, psychological and social care needs of older people and provide information and assistance for people to access a range of care options. A recommendation is made by the ACAT following the assessment process. This recommendation is based on the professional judgment of the team together with the preferences and wishes of the clients and the families or carers.
Question:
Can you clarify the 6 month reappraisal rule? We had two residents admitted from one hospital, so we submitted re-appraisals after 6 months. One reappraisal was accepted and one was rejected – the difference was that one came from acute care section of the hospital and one came from the rehab section. It is very confusing. Can you clarify please?
Answer:
The Aged Care Act 1997, 27-2 defines an in-patient hospital episode in relation to a care recipient, means a 'continuous period during which the care recipient:
- (a) Is an in-patient of a hospital; and
- (b) Is provided with medical or related care or services.
Accordingly, a care recipient in transition care is not generally entering the aged care service directly from an in-patient episode in hospital, irrespective of whether or not the transition care place is located within a hospital environment. The reappraisal from the rehab section may be transition care is not classed as an ‘in hospital event’ and does not require a six month re-appraisal.
A voluntary reappraisal of residents’ care needs may be completed in the following circumstances:
- At any time 12 months or more after the existing classification took effect;
- When the resident has a ‘major change’ in care needs;
- At any time where the resident is classified at the lowest applicable classification level (ie, no or minimal assessed care needs in all three ACFI care domains or is classified as RCS8); and
- Within 2 months after a resident transfers from an aged care service.
Question:
Why is lifestyle/activities not regarded as a ‘care need’ and so not claimable?
Answer:
The ACFI distributes care subsidies to residential aged care providers based on an assessment of care needs. The research conducted along with the development of the ACFI showed that it is not necessary to measure every indicator to accurately set a level of subsidy. The change in the method of allocating funding has not changed any of the obligations of providers to meet resident lifestyle and other needs of their residents.Aged Care Principles - Schedule 1 – Specified care and services for residential care services 1.11 – Resident social activities – relates to programs to encourage residents to take part in social activities that promote and protect their dignity, and to take part in community life outside the residential care service. It is a basic right of all care recipients in aged care facilities to have these services provided for all residents who need them.
Question:
Concern raised regarding definition of primary diagnosis- CMA of a resident said ‘incontinence’ CNO wasn’t happy that this was on ACFI appraisal as they said that this wasn’t the primary diagnosis. This seems an arbitrary judgement when it is stated on the CMA which is a summary of the resident’s major conditions. Why?
Answer:
This has been referred to the Accountability section of the Department and this section will answer this question.
Question:
When a resident becomes very unwell, their care needs go up. However, their funding can decrease e.g. if they become unwell and become ‘bedridden’ their behaviours decrease although their physical care needs increase? Is this being addressed?
Answer:
The ACFI does take into account these issues, by measuring and matching funding to care needs in each of the three domains, including Complex Health Care and Behaviour. Furthermore, the arrangements provide for residents needs to re-appraised and classified over time as care needs change.
Question:
Does the PAS have to be completed using the specific ACFI form of this tool?
Answer:
Yes, this is the instrument used.
Question:
When a resident is re-appraised, do all the assessments have to be re-done, or just the ones in which there is a new claim?
Answer:
Yes. A complete application for classification must be submitted.
Question:
For a grandparented resident on low care category 5, with high care ACFI- are they low care or high care for specified care & services?
Answer:
The resident would be classed as low care.
Question:
We have a new resident. They have come up as ‘low care’ under ACFI even though their ACAS is high. Do we have to supply all the required high care specified care and services, even though we have assessed them as low care and they are only getting funded as low care?
Answer:
No. Low Care Specified Care and Services only apply in such cases.
Question:
How do we manage the admission of a resident with a low care ACAS and yet knowing the ACFI appraisal puts them into the high care range? Do we underscore the initial ACFI so that we can put in a major change one month later to compensate for this ‘unintended consequence’? (If they come up as high care under ACFI, we still need to have in place the changed staffing to manage their medication.)
Answer:
It is the responsibility of the approved provider under the Act to ensure that they correctly appraise the resident. As indicated above, it us acknowledged that an anomaly in the new arrangements has led to an increase on the proportion of residents in this situation (ACAT Low, ACFI High). In the May 2009 Budget, the Government announced action to address this anomaly in the new arrangements by modifying the definition of High Care. From I January 2010 there will be a definition change to High Care. While it is expected that the new definition will go a long way to addressing industry concerns on these issues, there may be scope to consider further improvements in the interface between ACAT and ACFI processes. This is a matter that has been specifically identified for further examination as part of the ACFI Review, as reflected in the Terms of Reference announced by the Minister for Ageing on 6 November 2009.
Question:
As it has been recognised that there is a difference between ACAS assessments and ACFI assessments, why can’t we just use the one tool e.g. be able to rely on the ACAS assessment.
Answer:
Issues relating to the relationship of the ACFI to ACAT assessments, including options to improve alignment, will be considered in the review of the ACFI.
Question:
The 2009 Residential Aged Care Manual states that if a resident is on leave (includes hospital), then transfers to another provider within 28days, then this is a ‘transfer’. However Medicare will reject the claim and state that it is an ‘admission from hospital’. Why?
Answer:
The general rule is that if a resident transfers within 28 days the ACFI classification transfers with the resident. If the resident is on extended hospital leave ie is more than 30 days in hospital and transfers to another facility when discharged from hospital this is an admission from hospital. However, there may be other specific issues involved and further information on the individual cases involved may be necessary to establish why certain claims have been rejected. If you need further clarification, please send queries to acfi@health.gov.au
Question:
Can you reappraise a resident after 12 months to get them off interim low care, even if their appraisal score is the same?
Answer:
Yes. A resident whose initial approval for permanent residential aged care is limited to low care will continue to be able to ‘age in place’ to a high care classification without the need for an ACAT reassessment. The introduction of the ACFI does not change this basic policy. Under the ACFI an ‘aging in place’ event defines when the full ACFI high care subsidy may be paid if the resident’s ACAT approval is limited to low care.
A resident may ‘age in place’ in one of the following three ways:
- A reappraisal is conducted that results in a HIGH CARE classification (e.g. on expiry of an existing classification, or a voluntary reappraisal following a transfer, or following a major change in care needs);
- An ACAT approval for care is provided which is not limited to low care; or
- A Departmental Review Officer confirms the resident’s ACFI classification during a classification review.
Question:
Why is there a $15 rule to change from RCS to ACFI payment?
Answer:
This rule was designed to ensure that there was no funding reduction for existing residents. Once an ACFI appraisal has been completed for an existing resident, the rate of subsidy will be either the new ACFI rate or the person's existing RCS rate. If the ACFI appraisal results in an increase in the daily subsidy of $15 or more, the ACFI based subsidy is payable. If the ACFI appraisal results in a rate that does not increase the daily subsidy by $15 or more, the RCS rate of subsidy continues to be paid. This 'RCS saved rate' for existing residents will continue to until either the person's care needs increase to the extent that an ACFI rate becomes payable or the resident departs care.
Question:
When the questions are answered by DoHA, will the FAQs be updated to reflect these questions? Will the ACFI appraisal pack be updated?
Answer:
Yes the FAQs will be updated to reflect the questions. The Department is currently working on updating the FAQs and will eventually place them on the web. Due to the extensive number of queries this may take some time, and result in further ongoing with updating.
Yes, the ACFI Appraisal Pack will in turn be updated.
Question:
Can the FAQs on the DoHA website, be dated to ensure that we know when it has been added to?
Answer:
Yes. The new FAQs will be dated.
Question:
When will the FAQs be updated on the website? They are still dated October 2008, and yet there must have been many new questions posed to DoHA since then.
Answer:
The Department is currently working on updating the FAQs and will place them on the web in due course. Due to the extensive number of queries this may take some time.
Question:
When will we be given statistics on ACFI? eg. Claims results/diagnoses summaries etc.
Answer:
Statistics are already up on the web site at: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acfi-30june.htm. It is expected that further information will be provided in a background paper that will soon be released to inform public submissions to the ACFI Review.
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