ACFI Development and ToolKit Projects

Development of the Aged Care Funding Instrument

Client Australian Government – Commonwealth Department of Health and Ageing (DoHA, now DSS)
Project Requirement DoHA and the Aged Care Industry wanted a new system developed to provide for:
(i) a more accurate way of assessing residents for government subsidy payments – higher care residents were believed to be underfunded
(ii) a reduction in the documentation requirements to justify claims
(iii) a system that would provide clear evidence requirements and a reduction in the disagreements between government auditors and providers; and
(iv) an approach that allowed for easy IT integration with the Department IT and providers systems
The new system was to be cost neutral and equitably distribute $8 billion in Commonwealth funding per year.
Why did they choose AACS? AACS was chosen by DoHA as an acknowledged expert in the field of resident clinical and general care need, assessment systems & tools, complex data analysis and financial modelling.
Skills Demonstrated AACS conceptualised, designed and then developed the Aged Care Funding System and Assessment Tool (ACFI) for the Commonwealth Department of Health and Ageing. AACS demonstrated an ability to turn an innovative concept into a practical and robust assessment and funding system. This involved:

1. ACFI Tool Development and Measurement Model

  • Selecting and adapting the assessments
  • Creating a measurement model based on ordinal based assessment summary items (e.g. A, B, C, D)
  • Creating new items within new or modified questions
  • Developing the depression and cognition sections
  • Modifying the health assessment area etc
  • Determining how the assessment tool approach could be used to allocate funding
  • Designing a set of items that could be subject to audit
  • Based on best practice assessment principles to fit the requirements of all stakeholders [the target population, the users (both aged care providers and auditors) and government bodies]
  • Created an innovative approach to the determination of funding for aged care residents – based on assessed care need in contrast to care provided

2. Developing the Funding Model which included:

  • A recalibration of the total funding from the RCS to ACFI
  • Examining the budget impact of grand-parenting with actuarial models
  • Scoring, weighting and setting of all cut-points and relative resource distribution between the categories
  • Ability to create an assessment system and financial models that resulted in the equitable distribution of $8 billion in funding for residents of aged care facilities
  • Developing models to assess the impact on individual homes including the identification for homes at risk
  • Special visit to conduct in-depth reviews of some ‘homes at risk’ to determine if the ACFI or their assessment approach was an issue
  • Conducting ACFI reviews in more special services homes (e.g. facilities focusing on the homeless) and proposing how these homes could receive appropriate funding under the ACFI model

3. Researching the Approach – Designing and Running the National Trial

  • Development of a robust research and evaluation design for the National ACFI Trial
  • Managed, ran and analysed the national trial data – this included aged care home assessors, external nurse assessors and agencies and aged care assessment team assessors completing ACFI’s
  • Further testing in a limited trial of the changes made after the National Trial Development of all the ACFI training material including a DVD demonstrating how to complete the assessments
  • Analysis of qualitative and quantitative data
  • Statistical analysis, modelling and reporting

4. Liaising with Industry

  • Participation in presentations, conferences and extensive discussion groups with industry during the development of the ACFI
  • Ability to liaise, consult and obtain co-operation from all aspects of the Aged Care Industry (Residential Care Facilities, Industry and peak bodies, ACATs, Australian and State Government departments, Commonwealth Nursing Officers, Community Care Sector)

5. Developing the Audit Model based on the ACFI

  • Development of the audit model methodology
  • Conducted a trial and tested how it would work in practice, then modified the approach
  • AACS also conducted all training with the DoHA assessors around Australia
  • Created, tested and then documented the audit system that DoHA now uses to check on facility compliance with funding claim requirements.

Evidence-Based Clinical Assessment Toolkit for ACFI (2014 – in progress)

Client Barwon Health
Project Requirement The development of an evidence-based clinical assessment toolkit (EBCAT) and associated process guidelines for public sector residential aged care services (PSRACS). The Toolkit comprises six Workbooks and Quick Guides covering (i) Activities of Daily Living (ii) Continence (iii) Cognition (iv) Behaviour (v) Medication and (vi) Complex Health.

The ACFI evidence-based clinical assessment toolkit (EBCAT) project is to include:

  • a review of known resources (ie. screening / assessment / guidelines and references to be reviewed by domain, topic, target population and usability)
  • development of a toolkit to assist PSRACS staff in the selection and use of a set of valid evidence based and reliable assessment tools
  • practical resources such as case studies, associated clinical risk guidelines and administrative checklists for ACFI appraisals.
Why did they choose AACS? Barwon Health has engaged Applied Aged Care Solutions to undertake the development of the ACFI EBCAT project due to their extensive experience in designing assessment models and best practice tools for residential aged care. Additional content matter expertise for the project is to be provided in collaboration with the:

  • Australian Centre for Evidence Based Care, La Trobe University
  • School of Psychiatry, Monash University
Skills Demonstrated The ACFI EBCAT project will provide further opportunities to improve effectiveness and sustainability of PSRACS with:

  • strengthened screening and assessment of residents to enhance quality of care processes and outcomes
  • address the assessment requirements and approaches to be eligible for the new dementia and severe behaviours supplement
  • support objective and appropriate resident assessment and recording for appropriate ACFI claiming purposes


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