Home' Australian Ageing Agenda : AAA Jul-Aug 2017 Contents Richelle Street
Need for funding system that promotes activity
RESIDENTIAL AGED care is delivered to older people
in Australia by ser vice providers who are approved under
the Aged Care Act 1997. The department plays a vital role
in developing policies, managing programs and providing
regulator y ser vices to improve the quality of residential
aged care in Australia.
The Aged Care Funding Instrument is the classification
instrument used to pay subsidies to residential aged care
ser vices. The ACFI under went major reforms on Januar y
2017 that consequently impacted the level of care and
ser vices provided by specific allied health disciplines and
allied health as a whole.
There are several factors that would improve the provision
of allied health services in residential aged care, which include:
• Increasing the pain management treatment modalities to
extend beyond the current massage and electrotherapy
modalities provided. Time spent on other treatments
unfortunately cannot be claimed. These limited
treatments do not place any emphasis on preventative
health measures and further prevents the funded allied
health disciplines from providing rehabilitation exercises
to enhance mobility that would assist those in residential
care to reach a level of independence and quality of life at
which maintenance therapy would meet their needs.
• Increasing the number of disciplines funded under
the ACFI model. Currently, the only allied health
professionals who can deliver care and health directives
are physiotherapists, occupational therapists, podiatrists,
chiropractors and osteopaths. The
addition of other allied health
disciplines (i.e. exercise physiology) to
ACFI funding would effectively provide
great value and expertise in health
promotion and preventative programs
to ultimately assist residents to reach a higher level of
independence and mobility.
• Allowing residents to access community-based wellness
and preventative exercise programs and not be entirely
restricted to ACFI only funded modalities.
Overall, ACFI continues to recognise passive treatment
to manage pain causing resident dependence, rather than
evidence-based, active treatments such as exercise that
promote independence and function.
The population of those aged 75 years and older is
set to double in the next 20 years, so it’s more important
than ever that we have a funding system focused on
preventing injur y and promoting an active lifestyle for
Increasing ACFI funding to include preventative
education programs and a broader scope of treatments
together with funding more allied health disciplines as a
whole, would assist in addressing the current obstacles for
allied health in residential care and improve
Richelle Street is an exercise physiologist working
in aged care.
Need to lobby for change
ALLIED HEALTH professionals can and do contribute
greatly to the wellbeing of older adults by providing
counselling, rehabilitation and ser vices to improve physical
and mental wellbeing which benefits independent living.
Their ser vices in residential aged care facilities, where
older adults often face multiple health challenges, could be
seen as even more critical for this vulnerable population.
However, just as the medical issues of older people
living in residential aged care often overshadow functional
and psychological issues, the inter ventions for residents are
frequently limited to medical ones, particularly pharmacological.
Older people living in residential aged care who have
depression, anxiety, functional limitations (such as problems
moving or speaking), sensor y deficits and/or dementia can all
benefit from ser vices provided by allied health professionals.
In particular, psychological inter ventions are lacking in
residential aged care, while rates of depression, anxiety and
dementia are particularly high among residents.
Furthermore, psychological inter ventions can produce
increases in wellbeing and decreases in distress or behavioural
issues. They can also help family members and professional
aged care staff cope better with the stress of dementia.
Less than 1 per cent of older people living in aged care
receive any kind of psychosocial treatment, despite the high
prevalence of mental health disorders in this group.
What’s more, decades of research from
Australia as well as globally points to
high levels of effectiveness for a variety of
psychological assessments – to recognize
distress, for example – and interventions,
such as those to treat distress and
However, access to allied health ser vices within
residential aged care settings remains fragmented for older
people, and confusing or frustrating for providers.
How can this change?
Funding models for psychosocial care, including
psychological care, need to change.
Both healthcare professionals and the wider community
can lobby providers and legislators to change this situation.
For example, older people living in residential care should
be eligible to receive Medicare rebates for psychological
ser vices, just as seniors living in the community can.
Older people in residential aged care settings need to
be able to access the best standards of care to ensure their
quality of life remains high, and this includes access to allied
health care ser vices.
Nancy Pachana is a Professor in the School of
Psychology at The University of Queensland and
co-director of the UQ Ageing Mind Initiative.
20 | JULY – AUGUST 2017
We asked four industry figures:
What’s needed to improve the provision of
allied health services in residential aged care?
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