Has RUCS spelt the end of Physiotherapy in Aged Care?

In late 2017, I sat with optimism as Professor Kathy Eagar from the University of Wollongong presented her findings on the Aged Care Funding Instrument and proposed alternate models. As a physiotherapist, I’ve been frustrated with the ACFI since commencing my first aged care role in 2013. One thing that Professor Eagar remonstrated, was that the new funding tool must not have perverse incentives. The most important of these, was that it should not promote disability. However, as I sat listening the presentation it suddenly dawned on me that ACFI provides one single benefit to me as a physiotherapist, it encourages aged care providers to employ me in order to drive funding. Immediately, I was less optimistic.

Complex pain management is a somewhat humorous definition for massage therapy and other passive treatment. Jokes aside, it at least creates the capacity to increase the on-site hours of a more diverse range of allied health professionals. I’ve always believed that 4b’s get me through the door, but once I’m there I can offer a whole lot more.

In March 2019, Professor Eagar was back to present our industry with the Australian National Aged Care Classification – Version 1.0. The new tool seems much more fit for purpose and will undoubtedly be better than ACFI. Creating an external assessment process and essentially “blinding” homes as to the classification of their new residents may be met with some adversity, but it will certainly decrease the high time burden which ACFI brings. The ability to define staffing requirements by AN-ACC class and develop best practice models of care for each class, would also seem like a huge advantage. The only real problem I see from a physiotherapy perspective, is that there’s now no provision in the tool for us to financially justify our position. Which leads me to think, has RUCS spelt the end of physiotherapy in aged care? As a profession, we’ve probably only got ourselves to blame. Here’s why:

Most people working in aged care have never seen an effective physiotherapy program. Since somebody realised that 6 points in complex healthcare was pretty valuable, physiotherapists have been actively assisting providers to game the system. Large external providers have created a cookie cutter approach to services, where everyone receives the same program and the only real discernible difference is cost. As such, most people’s knowledge of what we can provide to residents is massage, TENS machines and heat packs.

In actual fact, Physiotherapist’s are expertly placed to create a raft of significant benefits to residents. If we weren’t spending 8 hours a day doing massages, we could be delivering evidence-based exercise programs proven to reduce falls rates in residential aged care by 55% (Hewitt et al., 2018). We could be assisting to promote better cardiac health, controlling the symptoms of Parkinson’s Disease, reducing hospitalisations due to respiratory illness, improving bone mineral density, increasing rates of mobility and reducing the burden of care on staff. We could even be effectively treating chronic pain. Keep in mind, all of these have significant cost-benefits, regardless of funding.

What we’re now facing is the real possibility that the only time a resident will see a Physiotherapist or Occupational Therapist is when they’re “classified” under the AN-ACC; or when they’re having their care plan developed. My prediction is that many providers will have allied health professionals develop treatment plans and have care staff or therapy assistance deliver the treatments. For the record, it's not the same. Unless of course the resident has the capacity to pay for the service themselves. At a time when we’re supposed to be moving towards a focus on the individual and a consumer directed approach, that’s actually quite hard to fathom.

Which takes me back to late 2017, whilst I sat listening to Professor Eagar. Upon realising that Physiotherapist’s may be forced out of residential aged care through a new funding tool I stood up and asked, “If I no longer have 4b’s to get me through the door, will there be a provision in the new system for services such as physiotherapy?”. At that time, Professor Eagar replied that this had definitely been considered and that her team’s recommendation would be to have a separate subsidy for such services. Well I’ve seen the new tool, and I’ve read the 30 recommendations, and I can’t see that recommendation anywhere.

Let’s hope that if the “appropriate skill mix of staff” model comes to fruition, that ALL allied health professionals are recognised for their value in residential aged care. I know the excellent outcomes that myself and my colleagues have achieved for residents, and I would hate to see these services disappear. Our value is much greater than our ability to classify needs.