ACFI Funding - where does the money go?

Wednesday, 18 April 2012 18:05 | Print page:

Recently, the Minister for Ageing was reported in the media (15 April 2012) to comment about a multi-billion-dollar cost blowout in the aged care system.

The Minister was referring to a report to the effect that there were unusual claiming patterns by aged care Providers which result in increased subsidy payments but which are not having any effect on spending on extra staffing.

Under the Aged Care Act 1997, aged care providers may re-classify residents according to their care needs under an assessment system called the Aged Care Funding Instrument (ACFI). Residents may be reassessed from time to time and if their needs classification requires it, application may be made for a higher funding subsidy from the Commonwealth Department of Health & Ageing. The ACFI assessment is usually carried out by qualified people on behalf of the aged care Provider.

The objective of the ACFI system is to cover the extra staffing costs which are involved in caring for persons with higher needs. However, when an application is successful and a higher subsidy is granted, the funds go directly to the aged care provider who appears to disburse or spend funds according to the discretion of management.

In other words, all extra funding arising from re-classification is received by the provider as part of total gross income derived through subsidy.

The Aged Care Act 1997 includes among the responsibilities of approved providers, the requirement to maintain an adequate number of appropriately skilled staff to ensure that the care needs of care recipients are met (Part 4.1 – Quality of care, 54-1 Responsibilities of approved providers, (1) (b) ).

Accordingly it is reasonable to assume that if a person's needs are assessed at a higher level because of increased disability through illness or other cause, there will be a corresponding increase in attention from appropriately skilled staff. Anecdotally however, this appears not to be the case.

Although it is not possible to be definitive about it, it seems to be rare that there is any correlation between a higher classification under the ACFI scheme and any increase in skilled staff attending to the person whose classification has changed. If that be the true position, the result seems to defy the logic of the process and its intended outcome, namely to provide a direct benefit to the person whose disabilities have been adversely assessed and re-classified upwards.

How can the resident get extra benefits from reclassification?

Recently I was talking to a client who happened to mention that he experienced a reclassification of his disabilities but that although the provider had apparently been granted extra subsidy, there had been no discernible change in the level of care he had received and certainly no increase in the number or type of care staff who attended him.

When I eventually was able to look at his residential care contract with the Provider which he signed when he entered into the residential care home, I found an interesting provision which I strongly suspect is contained in many such contracts.

It went like this:

"the provider will provide to you the care and services required by the Aged Care Act according to your needs, as assessed from time to time…"

So, in this case there was a contractual obligation on the part of the Provider to provide care according to the needs of the resident with "as assessed from time to time".

It is my guess that such a provision is relatively common and residents should therefore make sure that if they find such a provision and if they are reassessed to a higher level of need with a consequent increase in Commonwealth subsidy going to the provider, they should ask how that extra subsidy will be spent in order to accommodate their increased need.

Considering that extra daily subsidies can exceed $100 as a result of reclassification with under the ACFI system, it may be that significant and very helpful assistance can be sought by the resident and should be offered by Provider as a logical outcome and obligation under the residential care contract itself.

Author: Copyright 2009 Rodney Lewis. Solicitor, practising in Elder Law (Mona Vale, NSW)
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What concerns me though is that a provider may get extra funding for a high care resident to provide care, however at the same time make residents or families pay for services such as speech pathology thru Medicare (EPC - enhanced primary care, now known as CDM). Providers try to keep the money in their pockets by making residents think that the only way to have some services is by the Medicare EPC, allied health services. It clearing states under high care specified care and services that some allied health services should be provided at no cost to resident Excludes intensive, long-term rehabilitation services required following, for example, serious illness or injury, surgery or trauma. I think the aged care department should look into this. Has anyone else experienced or heard of these unlawful practices?

There is no transparency in the care provided - funded by public money to elderly residents in need of care. If the funding was connected to the ratio of staff to residents, perhaps some of the extra funding might possibly be spent on more staff. At present some of the bad nursing homes can have the minimum level of staffing even for very high care residents leaving them distressed and unable to get the help they need just to make their life a little more bearable. It makes me physically ill to think of all those poor people calling out for help, ringing buzzers, crying and giving up because they just can't get help. The whole system needs an overhaul. People have been complaining for years that there are not enough staff to the number of residents yet nothing is done about it. I wonder what it will take for the Government to stop handing out meaningless accreditation, platitudes to the public and worthless promises of fixing the system. Nothing seems to change for those who cannot speak up for themselves who are locked in these homes with no one about for hours and hours at a time.

The recent changes to ACFI funding have been implemented by the Department of Health and Ageing (DoHA) due to approved providers, both for profit and not for profit, making exagerated claims for the level of care required by individual residents. While DoHA are aware of this, the choose not to address the fraudulent claim issues with providers. In many instances staff are asked or coerced to falsify documents on the pretense that there is insuffcient money received from DoHA for staffing and care services. I believe the ANFs request for transparency of income and profit margins by approved providers needs to be considered and made available to the public as often the facilties providing poor care are maximising their profits. Not for profit groups are also involved in this practice and they are building their empires at the expense of the residents while exploiting their staff. There has also been a practice where consultants are employed to increase the income for approved providers. These consultants have a vested interest in increasing the ACFI claims by falsifying claims and they take a per centage of the additional money claimed. Sometimes funding is increased by millions of dollars with the commission to consultants of 10% would therefore be hundreds of thousands of dollars. One has to ask the question, 'is this appropriate and ethical use of the funded aged care dollar? In many cases there is no evidence that additional funding is fed back into staffing levels or resources for care of the residents.

I understand, that aged care system will not work if it stays in private business. The government must take care in own hands and responsibility and must provide this care. The solution to put money in home care is not wise and will work only in some cases.

It is so disheartening to see that still funding for the aged is misused and stolen from its intended recipients. why is it that there is non humanity in the care of our aged?

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