Dear Minister Colbeck

Dear Minister Colbeck,

“Government targets aged care ‘over-servicing’ by physiotherapists”

?This was the title of an article published by the Sydney Morning Herald on 19th March 2022. It’s worth noting that date, as it should ensure that allied health services continue to be funded in residential aged care. We now have the aged care peak industry bodies and the Australian Physiotherapy Association up in arms. I must say, it’s about time.

Of course, my initial reaction to your letter was one of shock and anger as well. But it didn’t take me too long to realise that having the Minister for Senior Australians and Aged Care Services opinion of physiotherapists on the public record, is exactly what we needed.

As someone who’s followed the Royal Commission and the development of the AN-ACC closely, it was difficult to understand why allied health was seemingly omitted. Well, it isn’t anymore. It’s the position of the federal government that older people don’t need physiotherapy. It feels good to have that out in the open, and here’s why:

Because it’s ridiculous.

As someone who’s spent the last 10 years as a physiotherapist “over servicing” residents in aged care homes across Australia, I can assure you that if there’s one thing they do need, it’s allied health services. What you, as the Minister for Aged Care, have failed to realise, is the problem is not the fault of the clinicians but unsurprisingly, at the feet of your federal government and those before you.

The Royal Commission concluded that the ACFI wasn’t fit for purpose and probably never was. This wouldn’t have been a difficult conclusion to make. For more than a decade, both liberal and labour governments are guilty of not creating change. Physiotherapists and their Occupational Therapy colleagues have been reluctant to work within a system which funds passive treatments such as those in the ACFI. It’s seen quality allied health professionals leave in their droves. The reason some of us have tolerated this system, is because we’ve used it as a way of getting ourselves through the door to deliver effective, evidence-based treatments. Why? Because we care, and we know older people benefit from what we do. Essentially, we’ve had our hands tied, but we’ve continued to assist older adults to live healthier and happier lives.

We’ve also persevered in the hope that one day, a better tool will become available that allows us to treat people as individuals. A tool that allows us to be effective practitioners, to clinically reason and to be evidence-based. A tool that no longer incentives disability and limits our scope of practice. One which funds the type of care which your government outlined in the new aged care quality standards, implemented on 1st July 2019.

Here is a quote from the aged care quality and safety commission website; “The Quality Standards clearly define what good aged care should look like.. Good care is not about 'ticking boxes'.” Within the care standards are obligations to support residents to “take risks to enable to for them to live the best life they can”. It requires aged care providers to “identify and address the consumer’s current needs, goals and preferences” as part of an “ongoing partnership with the consumer”. The standards outline that “each consumer gets safe and effective personal and clinical care that is best practice, tailored to their needs, and optimises their health and well-being.” These are the fundamentals of physiotherapy and more broadly, are instilled in the ethos of any multi-disciplinary team. We don’t want to tick boxes, we want to provide the best care possible to older adults.

There’s one more thing which should be highlighted from your new standards. That is, that the consumer was placed at the heart of all decisions. I implore you to spend some time talking to residents living in aged care homes. Ask them what they think of the physiotherapist and other allied health clinicians who work in their homes. Ask them if they would want their hours reduced. For years, aged care has talked about a shift from disability to wellness and reablement. A change which would ensure better lives and better outcomes for residents. Now is not the time to take away the funding for those professions best placed to achieve this goal.

Minister Colbeck – we haven’t been over-servicing aged care, we’ve been working within the framework created by the federal government. In your letter you stated you will ‘remove incentives to deliver treatments “that are not necessarily the most clinically appropriate”’. Great! This is exactly what we want.

I believe you’re on the right track, you’re just going about it in the wrong way. You don’t need to cut allied health funding; you just need to remove the limitations which you’ve put on our practice. If you do this, you’ll have residents who move better, are in less pain, experience less falls, breathe easier, are less impacted by chronic disease, are stronger, fitter, healthier, more confident and happier. In turn, you’ll place less stress on carers, improve the confidence of family members, and ultimately create a better aged care for all.

Professor Kathy Eagar, the director of the University of Wollongong’s Australian Health Services Research Institute, who you employed to create the AN-ACC has publicly said that providers should be forced to provide 22 minutes a day of allied health, up from the current average of eight minutes. The AN-ACC is the system being introduced in October which you are referencing as a vehicle to remove physiotherapy funding. This doesn’t make sense.

The Royal Commission also made clear recommendations that to improve the aged care system, the federal government needs to increase access to physiotherapy and other allied health services in aged care.

It seems the people and institutions which your government has entrusted and paid to provide advice, do not think aged care residents are being over serviced. As such, no one will blame you for rethinking your position on physiotherapy. In fact, this decision would be widely celebrated and would create a long-lasting benefit to senior Australians, the people you represent. Alternatively, if you don’t action the recommendations of Professor Eager and the Royal Commission, you may find yourself guilty of spending money to fund care which is “not necessarily the most clinically appropriate” – once again.