Our #DeathofAlliedHealth campaign must have hit a nerve with government, as we've finally had some official responses back to us directly. See our media page at https://www.deathofagedcare.com.au/mediagovtstatements for some of them. Essentially government are saying that our DOAH campaign is incorrect in regards to our concerns that allied health won't be provided after October 2022. And they even included some pointed and odd references to allied health like us working in a perverse system just for funding, doing things like massaging older people's paper like skin (see here)!
The official responses other than the paper like skin part are pretty boring though. We've summarised it in a more interesting way below.
"All those Death of Allied Health people and those who've written to us are wrong. They're just not smart enough to understand why this new complex system is so brilliant. Even though the authors of that brilliant system say allied health minimum ratios should be included we won't do that. And anyway, what would allied health know? They just massage older people with frail skin for money. They're in a perverse system we ignored until a Royal Commission meant we had to change it. But we'll still keep the perverse old system's standards that don't say how much allied health is needed. But allied health will somehow happen. We just won't say how we'll make sure that will happen or how much allied health that will be. But trust us. Not the paper skin massagers."
See pic - Why allied health all went into looking after older people apparently. For funding and to massage paper like skin. #paperskinmassagers
"Nothing to see here!" is the basic response from Richard Colbeck and Greg Hunt and the Morrison government and any MPS who get asked the question who cut and paste the same responses when people raise the concern about allied health for their mums and dads with them. Allied health being dead after October 2022? It’s all in our heads apparently.
The government's official position is that in the new funding model somehow our mum's and dads who paid taxes all their life will still get all the free allied health they will ever need. However if for some reason, this allied health doesn't happen (but it will!) it will all be nursing home's fault!
You see, the government states that nursing homes are still required to provide allied health as part of the Aged Care Quality Standards 2014 which continue to be in place in the new AN-ACC funding model that starts in October 2022. And the government as of October 2021 is asking homes to provide financial reports on how much care including allied health they are providing now. They will then monitor and publish those figures once the new funding model starts. Essentially it will be "name and shame" nursing homes. They've put more money into compliance you see (but not care).
The government response though does not exactly leave anyone confident we will even have anywhere near the same amount of allied health (8 minutes a resident per a day) that's provided now, let alone the 22 minutes recommended by the author of the new funding model and the Royal Commission.
Why aren't we confident? Because government won't say how much allied health SHOULD be provided. Just that they'll monitor it. That's a bit like saying that they are like policeman with a speed gun on a highway watching speeding cars go by. The policeman won't set a speed limit; they'll just record the speed of cars going by and let everyone know. And if everyone is speeding and everyone knows there is no consequence of speeding, then how can you stop the speeding and the accidents that will occur? You can't.
Similarly, how can you expect to have allied health if you won't even say exactly how much should be provided? You can't. And if no-one provides allied health there's no point in naming and shaming providers.
It’s pretty easy to benchmark (and fund) the amount of allied health older people should be getting. The research that led to the AN-ACC even compared allied health provision in Australia to other countries and found that the 22 minutes a resident per a day that was needed was only met by 2% of providers currently (who remember are supposed to be following the Aged Care quality standards right now as well). Stewart Brown's 2020 deep dive into allied health also measured allied health hours and broke down into hours for physios, OTs, lifestyle, podiatry, speech pathology and dietetics. So it’s not like the numbers aren't out there already.
The author of the new funding model Professor Eagar’s agreed that “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.
The government's position then is that water isn't wet. That somehow nursing homes will magically provide allied health without separate funding, dedicated ratios and minimums, because they are required to provide allied health in care plans under the current Quality Standards. Even though these Quality Standards are there right now and aren't working to provide enough allied health.
And why then does the government feel confident that nursing homes can be trusted to provide allied health as part of care plans without a minimum ratio, but then say ratios are needed for nursing (also part of care plans and Quality Standards)?
Don't let the government answers and spin fool you. Physios and allied health all openly discussing and expecting job loss know. See this article from the Australian Physiotherapy Association
What would they know though right? They only represent 6000 odd physios working in aged care right now and who have been asking government for answers.
Nursing homes setting budgets already know and so do their industry advisors who are advising them to remove allied health and fund lifestyle programs instead. The authors of the new funding model know. And the government know too. That allied health will NOT be funded by nursing homes other than the bare minimum. Government will then just turn around and blame nursing homes when the inevitable loss of allied health happens. But they then won't actually require nursing homes to do anything about this and it will be too late. Allied health will just be gone.
And this is because the Quality Standards the government cites don't specify a minimum amount of allied health nursing home’s need to provide. What DO the Quality Standards say about allied health?
In the quality of care principles 2014 which was reiterated as law in November 2019, the government stated in regards to allied health/therapy a facility needs to provide
Individual therapy programs designed by health professionals that are aimed at maintaining or restoring a care recipient’s ability to perform daily tasks for himself or herself, or assisting care recipients to obtain access to such programs.
Assistance in obtaining health practitioner services
Arrangements for aural, community health, dental, medical, psychiatric and other health practitioners to visit care recipients, whether the arrangements are made by care recipients, relatives or other persons representing the interests of care recipients, or are made direct with a health practitioner.
Assistance in obtaining access to specialised therapy services
Making arrangements for speech therapists, podiatrists, occupational or physiotherapy practitioners to visit care recipients, whether the arrangements are made by care recipients, relatives or other persons representing the interests of care recipients.
(using the authority made under section 96‑1 of the Aged Care Act 1997)
Under this legislation, approved providers of residential aged care services are required to provide therapy services, such as recreational, speech therapy, podiatry, occupational therapy, and physiotherapy services, to certain residents (as defined by the resident's funding classification) at no additional cost.
The services to be provided are:
Maintenance therapy delivered by health professionals, or care staff as directed by health professionals, designed to maintain residents' levels of independence in activities of daily living; and
More intensive therapy delivered by health professionals, or care staff as directed by health professionals, on a temporary basis that is designed to allow residents to reach a level of independence at which maintenance therapy will meet their needs.
These Aged Care Quality standards are all very vague which is why they don't work now, and won't in the future either. They do not specify time frames i.e. how often a physio should visit for example. The nursing home decides if someone needs the care, not the resident or their family. And note this line "OR care staff as directed by health professionals". So this means a lifestyle officer for example could run an exercise group, take someone for a walk etc and say they were following direction from a visiting allied health every six weeks who doesn't actually see the clients just signs off on the care plans. This is what groups advising nursing homes like Mirus Australia have been saying -move away from 4Bs and allied health and plan your workforce more around "wellbeing"
The trouble is not every client wants or can go to wellbeing programs like yoga and tai chi run by cheaper to employ and find lifestyle officers. We love lifestyle and work with them every day, but this doesn't replace qualified university trained allied health who have specific therapies like falls prevention only they can provide. Wellbeing groups are also not the individualised rehab that the Quality Standards and the ANACC model are supposed to provide.
Keep in mind these Quality Standard principles have been there since 2014, and the end result was no reablement and rehabilitation, just massage for some residents receiving pain management. If you wanted rehab you'd have to pay for it or hope you had a nice allied health provider who added it on to some massage treatments.
The Royal Commission into Ageing didn't think that these Quality standards did enough to ensure allied health or reablement. They found that allied health provision of 8 minutes a resident per a day on average was manifestly inadequate. In other words the Royal Commission found that the Quality Standards the government still has faith in apparently, actually had no effect on ensuring residents had access to enough allied health or reablement.
These Quality standards were there in the OLD funding system (ACFI) so how could they still work in the new one (AN-ACC?), when the new funding model doesn't even have an incentive to provide allied health (massage and more funding) like the old one did?
The Government through responses to our campaign are saying it’s because there IS an incentive for homes to provide re-ablement, because if a resident improves they won't have to be reassessed and potentially lose funding. This however relies on the idea that residents will improve in areas like level of assistance required. A lot of clients of course have conditions which worsen over time like Parkinson’s disease, Arthritis, dementia etc. Allied health won't fix these conditions or often lead to improvement in areas the ANACC assesses like level of mobility. The ANACC doesn't even assess pain! Search it for pain and have a look yourself. You won't find it. So where's the incentive to improve pain?
What allied health can do though is manage pain, reduce preventable falls, hospital admissions and improve quality of life. None of that would show up in ANACC reassessments. So none of these things allied health do will provide tangible financial benefit to a home having to justify every dollar they spend.
And nursing homes DO have to watch every dollar. Over half of nursing homes are losing money around $2 million a home on average.
Stewart Brown just released a report showing this is still happening even more than last year "the survey shows 58 per cent of aged care homes operated a loss last financial year, up from 55 per cent the previous year, and almost one third of aged care homes made a cash loss (32 per cent), up from 28 per cent." Source
And this is when unions are calling for immediate 25% pay rises for workers now, and the new funding system will mandate at least 200 minutes of nursing care per a day. Providers have already expressed concerns how they'll pay for those 200 minutes when they are losing money already. If nursing homes are losing money now, they will have to spend any new funding on these extra care minutes which are required. They won't spend on allied health that is not required.
To be clear we are NOT blaming nursing homes here even though government intends to. Nursing homes are being left to hang out to dry by the government. Government are doing this in a way they can have plausible deniability because they are saying nursing homes need to provide allied health, but they aren't actually giving the nursing homes the separate funding they need to provide this allied health.
So when families complain about mum and dad not having physio, or having to pay for it themselves, government will just blame nursing homes. Bad nursing homes!
And that's not fair. There are of course substandard homes and care, as the Royal Commission found. However there are also a lot of very good nursing homes out there. Nursing homes and residents and their families all want allied health if they can get it. We all know that allied health reduces falls, helps pain and leads. Nursing homes can't afford to provide allied health though. The government is just passing the buck and blaming a home that doesn't have the money to spend on allied health because they have to start with nursing care first.
If we do nothing, allied health in nursing homes will die. But it’s not too late. There is an election coming. If you think your mum and dad should have allied health like physio, without having to pay for it, don't be fooled by government spin. Write to your local member and opposition/minor party through our take action page. Demand separate funding for allied health with a minimum of 22 minutes per a resident per a day. Ask to meet with them so they can't hide behind government cut and pasted statements from Minister Colbeck and Hunt's offices. Remind them that you and your community vote and care about older people.
Older people need more allied health not less. And the allied health treating them can do a lot more than massage paper like skin. Fund them and then let allied health, the resident and the nursing home give older people the care they need and deserve.