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What has the media, health experts and the Royal Commission and government said on the need for physio and allied health for older people?

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They are often considered a luxury, but access to allied health services for older Australians can mean the difference between ageing well at home, being institutionalised or worse.

Key points:​

  • The royal commission into aged care said allied health had not been prioritised

  • It said allied health could help older Australians live at home for longer and improve the health of those in aged care

Allied health services, which include specialist therapies like physiotherapy, podiatry, psychology and occupational therapy, were found to be severely lacking in aged care by the recent royal commission into the system.

It made recommendations to change that and put the focus on preventing illness where possible to keep people in their homes for longer. Source

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The Royal Commissioner Lynelle Briggs called this an ineffective allied health response

 

Ineffective primary, allied care response

Ms Briggs said the government also “failed” to embrace the commissioners’ recommendation for a voluntary primary care model where general practices apply to become accredited for aged care and receive an annual payment for all enrolled residents.

“[It] would have provided a more comprehensive healthcare service to other people. I don’t believe that the continuation of the GP fee for service arrangements will work to increase the provision of fair and equitable health care services to this group,” Ms Briggs said.

“Similarly, I hope that you will not give up on the provision of effective allied health services in residential care. Older people deserve the opportunity to retain and maintain their health for as long as possible rather than be written off.” SOURCE

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The author of the NEW funding model Professor Kathy Eagars also thought the allied health response was inadequate.

 

She said the $27.9 million allocation over four years for allied health in aged care in the government’s COVID-19 package was insufficient.

 

“That’s only $7 million a year across 2,700 homes, which is very short sighted and just not enough,” Professor Eagar said. She said allied health was the “real loser” in the budget because the royal commission had made “naive” recommendations about allied health.

“We recommended 22 minutes of allied health per day be built into the funding model. And that be the mandated minimum and it be publicly reported up from the current average, which is eight minutes per resident per day,” she said. “They’ve not included that in the mandated staff time… and once the [Aged Care Funding Instrument] goes, which creates incentives around pain, it’s quite likely that there will even be a reduction in allied health. This is a really serious deficiency in the package that’s just been announced,” she said. (SOURCE)

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The lack of funding  for was announced right after the government agreed with the Royal Commission that MORE allied health was needed!

Source
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We asked the Department of Health how they would make sure allied health would be provided by homes. They wouldn't answer this question
directly in June 2021.
We watched all the webinars and asked the question again about allied health and how it would be made sure it would happen. This video isn't exactly clear how they will make sure allied health its provided either other than answering about physiotherapy and its "a complex answer".  Listen yourself and see if you feel confident!
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We wrote to MPs, professional associations and checked government sites and couldn't get a straight answer HOW government would ensure as per the royal commission recommendations that residents would get more allied health (or even the same amount they get now). So we launched our campaign to call for dedicated mandated funding of allied health including physio. Source

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We kept asking how governm

Our campaign called for minimum allied health minutes to be mandated in the new funding model. Source

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The Australian Physio Association called for minimum mandated minutes as well, however they asked for out of existing nursing minutes per a day which we do not support (as nursing minutes are inadequate also) Source

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The reason mandated minutes are needed was even stated by the author of the NEW funding model Professor Kathy Eagars.

“In the long run, if you’re going to have staff ratios and public reporting, and if you don’t include allied health, then they’re left out. It’s as simple as that,” she said. Note we do not agree with her criticism of the Royal Commissioners. We feel they were very clear more allied health was needed. The government even accepted this. Source

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Richard Colbeck wrote back to our specific questions about how the government would ensure residents had allied health. His answer? That somehow there would be an "inbuilt financial incentive" for homes to provide re-ablement. But no mention of how this would be enforced other than "monitoring whats spent" and "informing future policy decisions". Care planning would be left up to homes.

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Many people contacted local members though our website. They often got responses like this one which were near identical to the Colbeck response. Every time we heard that homes would decide how allied health would be provided. And government would monitor that but wouldn't enforce any minimum. If they thought the incentive for reablement would work, then why not commit that it should improve from now? And why mandate nursing minutes unless government felt homes wouldn't provide without minimum minutes?

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The message each time from some government figures that allied health WOULD still be provided, but not HOW they would ensure this. In our industry physios and other allied health are openly talking about job losses. Nursing homes aren't committing to allied health after October 2022. Allied health Providers are changing workers to casual or contractors. Doesn't sound like the governments assurances are actually reassuring allied health! Source

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Our campaign must have been hitting a nerve because we went from form responses from MPS to being directly refuted as "incorrect" by Department of Health (still not actually saying how they would make sure allied health was provided at all other than again nursing homes being required to provide with no minimum). They also included a strange statement that physios were part of a "perverse system" providing massages for residents with paper like skin! What?   Source

Many groups lodged concerns about allied health not being funded and included in government funding model including OT Australia, Services for Rural and Remote Allied Health and AAC Allied Aged Care/Death of Allied Health in submissions, as well as ACSA, LASA and Palliative Care Australia during evidence at a public hearing 9th November 2021. Senators followed up with questions on this to Department of Health (see video to left) where key concerns weren't answered)

Senate submission lodged by AAC - Allied Aged Care here  (number 14)

 
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The Senate Committee reported to Senate 16th November here  and noted many of these concerns about allied health from Labour and Greens senators. Governments response in this report about how allied health would occur was not exactly convincing see below -note references to "if required" and "meant to provide" - didn't the Royal Commission say that 8 minutes a day per a resident was inadequate and 22 minutes per a day of allied health was needed REGARDLESS of whether this is assessed as "required"?. And the quality standards mentioned are the same ones in the new model that we have now . As we covered in our submission, were referred to by the royal commission as inadequate to provide allied health.

 

2.9 A representative of the Department of Health (the department) advised the committee on how allied health, social or leisure activities are covered:

In the act at the moment there are the quality of care principles. There's a schedule—schedule 1, the schedule of specified services. That outlines the type of care that should be provided to residents by a facility. AN-ACC is a funding model; AN-ACC is not a comprehensive assessment of someone's care needs. A facility would undertake that assessment and develop a care management plan. Then the quality of care principles that I just pointed to outline the type of care that a facility would be required to provide. Allied health, social or leisure activities are all covered under that schedule. If someone is assessed as requiring those, then a facility is meant to provide them.10

10 Mr Mark Richardson, Assistant Secretary, Residential Care Funding Reform Branch, Home and Residential Division, Department of Health, Committee Hansard [Proof], 9 November 2021, p. 32.  

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Aged Care news November 22 covered this committee hearing that not having allied health is life and death.

Also cited - Anita Westera, an Australian Health Services Research Institute fellow whose work underpinned the AN-ACC, told Aged Care News in October that there is indeed a disparity between their research and the current policy outcome.

“It has always been our position that allied health should be embedded within the AN-ACC… and be able to be publicly reported against within the new 5-star rating system that the royal commission has recommended,” she said.

“Despite this, the royal commission and the Government have been at odds in regards to supporting the need for increased funding and accountability of allied health in residential aged care.”