industry & reform
No guarantee
Why increased nurse hours aren ’ t enough to fix aged care .
By Claire Hewat
Allied Health Professions Australia strongly supports increasing the hours of registered nurses in aged care , just as we support all the recommendations of the Royal Commission .
Unfortunately , cherry picking recommendations does people in aged care a disservice .
A single nurse is not going to be able to undertake rehabilitation of residents , improve mobility , address malnutrition and poor food services , assess swallowing risks and communication issues , provide counselling and psychological support and all the other interventions that are the skill set of allied health professionals .
The Royal Commissioners were very clear that there was insufficient access to allied health services , and that to effectively address reablement and quality of life for residents , adequate access to the breadth of allied health services was required .
The response of the government was to accept Recommendation 38 for allied health in residential aged care ‘ in principle ’, which commits them to nothing . The Opposition has largely ignored allied health in aged care .
Instead of any clear plan there appears to be a passive approach in the hope that the new AN-ACC funding model will somehow solve the problem , but it was never designed to address poor access to allied health services , a point reinforced by Professor Kathy Eagar , its lead designer .
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This is also well understood by all the key players in the sector , who are calling for dedicated funding for needs-based allied health services . The National Aged Care Alliance ( NACA ), made up of 52 organisations from all facets of the aged care sector , has released a position paper in support of this .
Currently the inadequate ACFI model mandates that around 4 % of its budget be spent on a limited range of allied health services . The AN-ACC funding model , which will be implemented in October , mandates nothing . Allied health care minutes will be required to be reported , but there is apparently no benchmark . The spend is unlikely to be more than 4 % of the budget under AN-ACC although it is a slightly larger pool of funds . There is no plan to increase access to allied health services as part of core funding .
The assumption is that aged care facilities will undertake full clinical assessments , though by whom remains unclear . Allied health will then be engaged according to a resident ’ s needs .
The ( frankly naive ) assumption is that engagement of allied health will ultimately reduce care costs and therefore the facility will gain a ‘ return on investment ’. Maybe , in some cases , but this cannot be guaranteed .
The recent $ 10 / day basic care funding increase for residential aged care facilities provides a stark reminder of why a passive approach is unlikely to be successful . The evidence is clear that there has been no improvement and that the extra funding has been consumed to address general underfunding .
The federal Budget ’ s $ 22m investment in a ‘ pilot ’ to explore multidisciplinary in-reach services from hospitals , while welcome , misses the point . This approach is likely to be useful after an acute episode such as a fall or development of a pressure sore , but there would simply not be the capacity to address the ongoing needs of the majority of residents requiring access to a range of allied health services .
Neither of these funding options ( AN- ACC or Hospital in-reach ) ensures a systems approach that meets the needs of residents , such as providing training to personal care staff to support ongoing therapies for individual residents , or ensuring appropriate food and fluids are provided .
Older Australians have overwhelmingly indicated a desire to stay at home and age in place as long as they possibly can . Ultimately , strong investment in wellness and reablement in the person ’ s own home will also reduce the overall costs in the aged care system .
However , there is grave concern that the design of the ‘ Care at Home ’ program is being rushed , and that the value and breadth of allied health is still poorly understood by policy makers . The risk then is that allied health may not be effectively incorporated into the program in a way that serves the best interests of older people at home .
To address all the identified issues in aged care a comprehensive approach is needed , not just headline-grabbing announcements that make people think something effective is being done . The sad fact is that there are not enough nurses to provide 24 hour coverage in every nursing home in the foreseeable future , and meanwhile , other valuable opportunities are falling by the wayside . ■
Claire Hewat is CEO of Allied Health Professions Australia .