Older Australians deserve the best care they can get.

Written by Simon Kerrigan, Summer 2020, Fusion Magazine.

Allied health services in residential aged care have long been underfunded and undelivered. While the Aged Care Royal Commission has clearly highlighted the need to promote better access to allied health services for residents, the Federal Government continues to push forward with the Australian National Aged Care Classification scheme, which will not directly support these types of services. 

A multidisciplinary approach has long been the cornerstone for care in our public health system. We know that if different health professionals work as a team, the best possible outcomes will be achieved for the person. However, the age services industry continues to struggle to find where it fits into the healthcare sector, meaning the importance of allied health services is continuously overlooked. 

As a physiotherapist working in the sector for nearly eight years, I’ve struggled with the misconceptions which aged care workers and even residents have about my profession and my role within homes. We know that this has primarily been driven by ACFI, with ‘complex pain management’ claims dominating the scope of physiotherapy. As clinicians progressively exit the sector, we’ve seen the growth of the ‘hybrid physio’ or ‘pain management professional’. These are usually clinicians with a background in Occupational Therapy, Osteopathy or Chiropractic care. 

I know my frustrations are shared by these professionals, many of whom report that they actually have limited opportunity to draw on their own individual skill sets.  

We now have a unique opportunity to create the age services industry of the future. So how do we address the lack of access to allied health services? I think we can do this by focusing in two areas. 

The first thing that needs to change is the funding model. We’ve known for many years about the perverse incentives of ACFI and the opposing forces of ACFI versus the Quality Standards. While the AN-ACC will resolve some of the current issues, what it lacks is direct funding for allied health services. Complex Pain Management claims under the ACFI, while extremely frustrating and certainly not evidence-based interventions, at least gave some allied health professions a ‘foot in the door’. 

With no clear indication of increased funding levels, we can only presume that providers will cease to employ these professions on a full-time basis. More advocacy is needed in this space to ensure older adults are not deprived of these important services. The physical therapy subsidy outlined in the ACFI-R would be a great place to start.

Secondly, the debate has long raged about mandated staffing levels versus an appropriate skill mix model. I think this is something that we need to get right. We need to look beyond just care staff and registered nurses and consider all allied health professionals as necessary members of every aged care home. Of course, funding is going to play a key role in ensuring that this is prioritised. 

The new Quality Standards have provided a good framework for how we should move forward. The standards are saturated with words like independence, best-practice, tailored care, goals and partnerships—and this is a good thing.  

We need to actively place residents at the heart of all of our decisions. Quality Standard One states that ‘each consumer is supported to exercise choice and independence, including to make decisions about their own care and the way care and services are delivered’. I understand that this is unique to each individual, but I don’t think we’ve done enough to truly define what types of services are important to our current consumer population.

Quality Standards Three and Four attempt to ensure that ‘organisations deliver safe and effective personal care, clinical care and services and supports for their daily living, in accordance with the consumer’s needs, goals and preferences to optimise their independence, health, well-being, and quality of life’, as well as ‘services and supports which promote each consumer’s emotional, spiritual and psychological well-being’. In order to have choice and achieve these outcomes, allied health services need to be readily available and promoted.  

All residents in aged care homes want to achieve the highest level of function and the best quality of life possible. If there’s one thing that working in aged care has taught me, it’s that getting old is not easy. 

Aged care residents deserve to live out the end of their lives with the most effective supports available. The reality is that whether that’s achieved through improved communication, reduced pain levels, having emotional supports, improved ability to eat normal foods, ability to mobilise more easily, have better means to engage in activities or even have healthier feet, allied health professionals are a crucial part of the picture. 

Right now is a time of opportunity. Let’s look back on this period and be proud of what we achieved.