DOI: 10.1111/ajag.12036
Brief Report Does the Aged Care Funding Instrument provide increased funding in residential care? Comparisons with the Residential Classification Scale Geoffrey ZP Chan, Collin KL Chin, Douglas J McKitrick and Roger W Warne School of Medicine and Pharmacology, University of Western Australia; and Department of Geriatrics, Royal Perth Hospital, Perth, Australia
Aim: To determine whether the Aged Care Funding Instrument (ACFI) provides more funding than the Residential Classification Scale (RCS) for residents in the Hellenic Residential Care Facility. Methods: All residents within the care facility were assessed over a six 6-month period using ACFI, RCS and Clifton Assessment Procedures for the Elderly (CAPE) scores. Differences in funding levels were calculated using ACFI and RCS instruments against a standardised CAPE score. Results: CAPE dependency RCS funding per resident per day varied from $32.20 for grade A to $116.20 for grade E4 residents. CAPE ACFI funding varied from $20.20 for grade A to $127.50 for grade E4. There was no significant difference in mean overall funding between the two scales (ACFI $92.50 vs RCS $90.35, P = 0.76). Conclusions: The ACFI does provide a small but not significant increase in funding to residents in residential care. It redirects funding to higher dependency residents. Key words: assisted living facility, finance, funding, geriatrics, nursing home.
Introduction The Aged Care Funding Instrument (ACFI) was introduced in March 2008 as a resource allocation instrument for residential care [1,2]. The ACFI is a system to allocate funding in line with nursing home resident behaviours and replaces the Residential Classification Scale (RCS), which had determined funding on the frequency of required interventions and corresponding care levels [3,4]. The reason for change was that the RCS required a burdensome level of documentation with the main emphasis of the tool on documenting planned interventions for care. The ACFI is designed to be more effective in that it assesses the residential need for care, as opposed to care already provided [1,3]. The management of the Hellenic Community felt that Correspondence to: Dr Geoffrey Chan, Royal Perth Hospital. Email [email protected] Australasian Journal on Ageing, Vol 33 No 2 June 2014, 121–123 © 2013 The Authors Australasian Journal on Ageing © 2013 ACOTA
bs_bs_banner
despite the new instrument measure, there was little increase in funding of residents in the care facility. In this brief report, we present the results of an audit of ACFI versus RCS funding in the Hellenic Community Care Facility.
Methods Resident population The population in the study comprised 72 residents at the Hellenic Community Aged Care Facility. RCS and ACFI scores were collected for each resident over a 6-month period. Instrument and measures Funding levels were calculated using ACFI and RCS instruments. The population in residential care comprises a significant number of dependent older people with dementia, often with behavioural disturbance. For this reason, resident dependency was measured using the Clifton Assessment Procedures for the Elderly (CAPE), an established psychogeriatric rating scale in the assessment of mental and physical functioning [5–7]. Cognitive function was assessed using the CAPE Information Orientation Subscale (IOS). Behavioural dependency was documented by the CAPE Behavioural Rating Scale (BRS). Both scales have high inter-rater and test–retest reliability [7,8]. The CAPE objectively stratifies residents into various dependency levels from Cognitive Assessment (CAS) Grade A (independent) to E4 (incontinent/ non-ambulant/confused) based on physical disability, apathy, communication difficulties and social disturbance criteria. Differences in funding level were then examined by contrasting ACFI and RCS for residents against a standardised CAPE score. Data collection Resident characteristics were documented by nursing staff and fourth year medical students. CAPE IOS were obtained by medical students and CAPE BRS from observations by residents’ caregivers. Residents who died after an RCS score had been obtained but before an ACFI was conducted were excluded from the study. Statistical analyses All data are expressed in terms of means, which were calculated using the Statistical Package for the Social Sciences. Differences between patients and corresponding funding 121
C h a n
G Z P ,
C h i n
Figure 1: Boxplot of the Resident Classification Scale and Aged Care Funding Instrument provided funding per resident per day. Units are expressed in dollars.
C K L ,
M c K i t r i c k
D J
e t
Table 1: Mean daily funding for residents according to CAPE Behaviour Rating Scale subgroups. A comparison of Resident Classification Scale and Aged Care Funding Instrument funding is provided Dependency levels
200
159.08 Mean daily funding per person
150 130.54
132.75
118.37
43.91 27.94 6.81
0 RCS scheme
ACFI scheme
were tested using t-tests for continuous, normally distributed variables and c2 tests for categorical variables. For these comparisons, a P-value of
Brief Report Does the Aged Care Funding Instrument provide increased funding in residential care? Comparisons with the Residential Classification Scale Geoffrey ZP Chan, Collin KL Chin, Douglas J McKitrick and Roger W Warne School of Medicine and Pharmacology, University of Western Australia; and Department of Geriatrics, Royal Perth Hospital, Perth, Australia
Aim: To determine whether the Aged Care Funding Instrument (ACFI) provides more funding than the Residential Classification Scale (RCS) for residents in the Hellenic Residential Care Facility. Methods: All residents within the care facility were assessed over a six 6-month period using ACFI, RCS and Clifton Assessment Procedures for the Elderly (CAPE) scores. Differences in funding levels were calculated using ACFI and RCS instruments against a standardised CAPE score. Results: CAPE dependency RCS funding per resident per day varied from $32.20 for grade A to $116.20 for grade E4 residents. CAPE ACFI funding varied from $20.20 for grade A to $127.50 for grade E4. There was no significant difference in mean overall funding between the two scales (ACFI $92.50 vs RCS $90.35, P = 0.76). Conclusions: The ACFI does provide a small but not significant increase in funding to residents in residential care. It redirects funding to higher dependency residents. Key words: assisted living facility, finance, funding, geriatrics, nursing home.
Introduction The Aged Care Funding Instrument (ACFI) was introduced in March 2008 as a resource allocation instrument for residential care [1,2]. The ACFI is a system to allocate funding in line with nursing home resident behaviours and replaces the Residential Classification Scale (RCS), which had determined funding on the frequency of required interventions and corresponding care levels [3,4]. The reason for change was that the RCS required a burdensome level of documentation with the main emphasis of the tool on documenting planned interventions for care. The ACFI is designed to be more effective in that it assesses the residential need for care, as opposed to care already provided [1,3]. The management of the Hellenic Community felt that Correspondence to: Dr Geoffrey Chan, Royal Perth Hospital. Email [email protected] Australasian Journal on Ageing, Vol 33 No 2 June 2014, 121–123 © 2013 The Authors Australasian Journal on Ageing © 2013 ACOTA
bs_bs_banner
despite the new instrument measure, there was little increase in funding of residents in the care facility. In this brief report, we present the results of an audit of ACFI versus RCS funding in the Hellenic Community Care Facility.
Methods Resident population The population in the study comprised 72 residents at the Hellenic Community Aged Care Facility. RCS and ACFI scores were collected for each resident over a 6-month period. Instrument and measures Funding levels were calculated using ACFI and RCS instruments. The population in residential care comprises a significant number of dependent older people with dementia, often with behavioural disturbance. For this reason, resident dependency was measured using the Clifton Assessment Procedures for the Elderly (CAPE), an established psychogeriatric rating scale in the assessment of mental and physical functioning [5–7]. Cognitive function was assessed using the CAPE Information Orientation Subscale (IOS). Behavioural dependency was documented by the CAPE Behavioural Rating Scale (BRS). Both scales have high inter-rater and test–retest reliability [7,8]. The CAPE objectively stratifies residents into various dependency levels from Cognitive Assessment (CAS) Grade A (independent) to E4 (incontinent/ non-ambulant/confused) based on physical disability, apathy, communication difficulties and social disturbance criteria. Differences in funding level were then examined by contrasting ACFI and RCS for residents against a standardised CAPE score. Data collection Resident characteristics were documented by nursing staff and fourth year medical students. CAPE IOS were obtained by medical students and CAPE BRS from observations by residents’ caregivers. Residents who died after an RCS score had been obtained but before an ACFI was conducted were excluded from the study. Statistical analyses All data are expressed in terms of means, which were calculated using the Statistical Package for the Social Sciences. Differences between patients and corresponding funding 121
C h a n
G Z P ,
C h i n
Figure 1: Boxplot of the Resident Classification Scale and Aged Care Funding Instrument provided funding per resident per day. Units are expressed in dollars.
C K L ,
M c K i t r i c k
D J
e t
Table 1: Mean daily funding for residents according to CAPE Behaviour Rating Scale subgroups. A comparison of Resident Classification Scale and Aged Care Funding Instrument funding is provided Dependency levels
200
159.08 Mean daily funding per person
150 130.54
132.75
118.37
43.91 27.94 6.81
0 RCS scheme
ACFI scheme
were tested using t-tests for continuous, normally distributed variables and c2 tests for categorical variables. For these comparisons, a P-value of
