residents; and the volatility of the RCS, including its susceptibility to manipulation and the potential for residents with similar care needs to be classified into different categories.” An integrated residential care system with the full spread of resident dependencies included in the RCS funding model, also meant that the number of residents for whom higher levels of funding could be claimed increased significantly. The RCS Review Audit program was expanded to address this issue, as without controls to prevent the documentation of ever rising care needs, systematic increases in RCS claims had the potential to significantly increase government expenditure. Over time, RCS claims did rise significantly with the majority of aged care residents being classified as needing the highest levels of funding (RCS 1 and 2), outcomes which significantly impacted on the relativities in the original scale design and government expenditure, which increased beyond budget projections. Claims also became harder to audit effectively with a high proportion of Departmental review decisions being challenged. For example, during 2008-09, 12,548 reviews of RCS appraisals were completed. Of those reviews, 3,749 or 30 per cent resulted in reductions of funding, of which 350 or 9.3 per cent were appealed by providers. In approximately 43.7 per cent of appealed cases, the original by the home was reinstated (Commonwealth of Australia 2009). 2005-2008: Development of the ACFI In response to concerns about the perceived burden resulting from the administrative and documentation requirements of the RCS assessment tool and a financial growth at a higher level than expected by Government, four reviews were undertaken and culminated in a project (starting in 2005) to develop and implement the Aged Care Funding Instrument (ACFI). The ACFI and Assessed Care Needs Resulting from the learnings associated with the RCS operation it was deemed more appropriate to build future funding systems around assessed care need as: It would provide for a standardised basis for funding system determinations wherever a person was supported, including community care. Providers could build flexible care models to address the assessed care needs without having the care provided aspect dictated by a funding mechanism. It would allow more flexible ‘care provided’ responses by providers to resident desires and preferences (promotes consumer directed care). Care provided is a quality of care matter that is better covered separately by the Specified Care and Services requirements and the Quality Agency. It allowed for the introduction of an External Assessment model and funding determination if required at a future time .
residents; and the volatility of the RCS, including its susceptibility to manipulation and the potential for residents with similar care needs to be classified into different categories.” An integrated residential care system with the full spread of resident dependencies included in the RCS funding model, also meant that the number of residents for whom higher levels of funding could be claimed increased significantly. The RCS Review Audit program was expanded to address this issue, as without controls to prevent the documentation of ever rising care needs, systematic increases in RCS claims had the potential to significantly increase government expenditure. Over time, RCS claims did rise significantly with the majority of aged care residents being classified as needing the highest levels of funding (RCS 1 and 2), outcomes which significantly impacted on the relativities in the original scale design and government expenditure, which increased beyond budget projections. Claims also became harder to audit effectively with a high proportion of Departmental review decisions being challenged. For example, during 2008-09, 12,548 reviews of RCS appraisals were completed. Of those reviews, 3,749 or 30 per cent resulted in reductions of funding, of which 350 or 9.3 per cent were appealed by providers. In approximately 43.7 per cent of appealed cases, the original by the home was reinstated (Commonwealth of Australia 2009). 2005-2008: Development of the ACFI In response to concerns about the perceived burden resulting from the administrative and documentation requirements of the RCS assessment tool and a financial growth at a higher level than expected by Government, four reviews were undertaken and culminated in a project (starting in 2005) to develop and implement the Aged Care Funding Instrument (ACFI). The ACFI and Assessed Care Needs Resulting from the learnings associated with the RCS operation it was deemed more appropriate to build future funding systems around assessed care need as: It would provide for a standardised basis for funding system determinations wherever a person was supported, including community care. Providers could build flexible care models to address the assessed care needs without having the care provided aspect dictated by a funding mechanism. It would allow more flexible ‘care provided’ responses by providers to resident desires and preferences (promotes consumer directed care). Care provided is a quality of care matter that is better covered separately by the Specified Care and Services requirements and the Quality Agency. It allowed for the introduction of an External Assessment model and funding determination if required at a future time .
acfi_review_report_part_1_summary.docx