How risky is your ACFI advice when maximising funding?

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There are many external ACFI consultants claiming to maximise funding for residential aged care providers. While there is an undeniable need for correct claiming, relying on the ability to increase ACFI funding can directly lead to an increase in questionable claiming of these subsidies.

The current health minister announced that 1 in 8 of 20,000 ACFI claims last year were incorrect or false. In response, auditing will increase, and tough new fines of$10,800 per offence will be introduced for a false claim. See here:http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-ley152.htm

This has resulted in a game of ‘cat and mouse’ where aged care providers employ experts to help them find more creative ways of claiming through ACFI. The government then concludes that spending is too high and has introduced new rules to limit this type of claiming. ACFI consultants have good intentions, however with increasing pressure in government funding, ACFI rules will keep changing to maintain control of the health budget. Seehttp://www.australianageingagenda.com.au/2016/06/24/why-acfi-isnt-the-only-game-in-town/

A previous article by MedeHealth demonstrated how medicines will be reclassified from the time spent with the care recipient to a classification of complexity (i.e. none, medium and high). The conclusion is that the number of care recipients classified as high care for medicines will drop tenfold from January 1st 2017. View the article here.

The net effect of these activities is a reduction in the options and services offered to aged care recipients. They receive care based on what is determined by the provider due to an over reliance on government funding.

Consumer Directed Care (CDC) and home care packages will be a game changer since care recipients will have a choice of where their government allocated funds will be spent. The inevitable extension into residential aged care will further give care recipients choice about how funding should be spent, including the ability to “top up” the amount spent with their own money if they choose an activity that is not within their funded budget. The aged care industry needs to focus on what care recipients and their families will consider as a good service, then provide options that they are prepared to pay for.

MedeHealth has a series of peer reviewed Consumer Directed Care modules which have been developed in partnership with industry experts, aimed at assisting staff through the transition of these major changes currently happening in aged care. It is well documented that interpersonal relationships with care staff is a key area and is important and beneficial for everyone, but is especially so for older adults. See:http://www.agedcare.org.au/publications/social-isolation-and-loneliness

So, while ACFI is an important area of funding, the reliance on it as a funding model must now be put into perspective. More effort should be placed into providing staff with the necessary tools to establish Consumer Directed Care resulting in a wider funding model, and the ability for care recipients to choose and pay for extra services.