Those of us that work in aged care appreciate and share the frustration and hurdles we have to deal with when it comes to the new funding tool ACFI (aged care funding instrument).
When we first changed from RCS to ACFI many of us were sceptical and saw that we were going to lose a lot of much needed dollars to look after our resident, but were happy that the documentation required was going to be sliced and thus give us more time for direct resident care. We were all told to give it a chance and told that in the long run we would see that the system change was for the better not worse.
Now that ACFI has been up and running for 2 years we still are having issues with trying to reflect the true needs of the resident and the amount of time it takes to care for them and thus getting the correct amount of funding.
Let me give you 2 examples that I have come across where because of the assessment and the fact that they do not correctly capture the needs of the resident I am not being adequately funded for either resident.
I have a resident, he has dementia, he is diagnosed with dementia, he is soooo confused, but for some reason his short term memory is excellent, he has a history of absconding and falls +++.
When I conducted the PASS (the cognitive skills assessment) on him, the final total score indicated he did not have any cognitive deficit (much to my surprise) so we could not claim anything. There is no section in the behaviour management section for absconding residents (which requires many hours of supervision) and because he is quite mobile despite his unsteady gait the funding is low. Our nurses spend a lot of their day providing supervision, assisting and helping him and yet he is classified as low care. The assessments do not capture the correct picture of him.
Another resident I have is classified as high care for some things as we need to provide full assistance for all of his personal hygiene but he is very mentally alert and he is very fussy about everything. To give him a shower takes 45 minutes because he likes things in particular order and done a certain way.
There is no assessment in ACFI to capture this. He takes a lot of staff time wanting to talk about issues in the home and discuss things that are going on during the day. He comes to the nurse’s station and talks to staff taking up a lot of their time and once again there is no assessment to capture this. We cannot put it down as intrusive behaviour as it isn’t. He is coming to us to talk for a reason this does not classify as a behaviour.
So what are Aged Care nurses to do?
This story is common across the board and we cannot get it through to the government that they are not funding us adequately and that their assessments are not true indicators of how things are. I do not believe that it is because staff is not efficient enough, or working smart enough. The government needs to understand that we are dealing with people and more to the point elderly people that are not always acutely ill and just lying in a bed. It does not take 10 minutes to attend to them, and then we move on to the next one.
The assessments need to reflect the real issues that nurses battle and that effect their time management. I don’t understand why they don’t get nursing home staff to help develop their assessments and not people that once upon a time used to work in Aged Care.
What do you think about the ACFI tool? What are your stories and frustrations surrounding government funding?
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I think that your field of Nursing must be one of the hardest – you may not have to front up to an Emergency Room or ICU or even Critical care but your work is just as trying. The only difference is your field is at the end of the road and most people tend to forget no matter how old you are – you still deserve the best of care. Thank you and congratulations keep up the good work and hopefully one day things might improve after all is not Gough Witlam going into a nursing home? a high profiled politician may force the powers that be to improve your system
We have a computer program at work, called TRAX. It uses elements of the ACFI, in order to comprehensively document all Resident care ( the only things written on paper are medication signatures, and VMO’s notes. )
However, this system has many errors and omissions.
In some cases, the nurse entering the data has to select the closest item to what has occurred. Eg. Resident awake at night. drop down boxes available = Insomnia; Restless ( awake ); Restless ( asleep ); sleeping.
There is no option to record that the Resident is awake BECAUSE they are in pain, and required Nursing time for assessment & medication administration. Another option missing, relates to FALLS at night. The Resident can be awake after climbing over the bedrails, and sustaining a fall injury. This takes up a longer period of Nursing time, yet there is no official drop down box to record a fall – AS THE DIRECT CAUSE OF BEING AWAKE AT NIGHT. ( there is an electronic Incident Form – but our Facility Manager says he doesn’t want us to use it – because it will attract attention…… oooops! wasn’t supposed to say that !! )
Anyway, main point is, that I agree, there are a number of aspects of Resident Care, that are not accurately reflected on the current ACFI documentation. ( and with certain facilities using computerised documentation systems, there is even more potential for less accurate records )
regards,
In reposnse to your queries re ACFI and the two scenarios listed. I am a RN who has devloped a simple user friendly way of capturing the info for a ACFI that guides care staff on what to look for. It has been effectitive becasue of this simplicity. It is called the Orana Care System and it not too complicated for care staff to master. Call me on this email and I can give you more info. My website is being redesigned at present. II am putting out an ACI Matters newlsteer where I will highlight things. No obligaiton to receive this newslteer.
Re the resident with dementia if they are not doing well under the PAS there are grounbds where you can assess them on a clinical basis- and by what you describe of hime you would score him say a B or C. you have to indicate in the appraaisl guide the reason why a PAS couldnt be done. Oftem this is a way around it.
i am interested Robyn in your newsletter and information on ACFI. I am interested in the tools you use to capture information about residents.
can you supply any
R
Cheryl
Hi Robyn
I am interested in your newsletter and info on acfi
cheers Keryn