Aged Care Funding Instrument (ACFI)
User Guide
1
Contents
Introduction
The ACFI as a calculator of the residential aged care subsidy
Definitions and acronyms
The ACFI process
Documentation Requirements
Diagnosis questions
Mental and Behavioural Diagnosis
Medical Diagnosis
Activities of Daily Living (ADL) Domain
ACFI 1 Nutrition
ACFI 2 Mobility
ACFI 3 Personal Hygiene
ACFI 4 Toileting
ACFI 5 Continence
Behaviour Domain
ACFI 6 Cognitive Skills
ACFI 7 Wandering
ACFI 8 Verbal Behaviour
ACFI 9 Physical Behaviour
ACFI 10 Depression
Complex Health Care Domain
ACFI 11 Medication
ACFI 12 Complex Health Care
Appendix 1: ACAP code list for health condition–long
Appendix 2–Description of behavioural symptoms
Appendix 3–Interaction of the Aged Care Funding Instrument and the funding model
ISBN: 978-1-76007-306-0
Publications approval number 11738
Publication Date: 8 December 2016
Copyright
© 2016 Commonwealth of Australia as represented by the Department of Health
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Apart from rights as permitted by the Copyright Act 1968 (Cth) or allowed by this copyright notice, all other rights are reserved, including (but not limited to) all commercial rights.Requests and inquiries concerning reproduction and other rights to use are to be sent to the Communication Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or via e-mail to .
1
Introduction
The Aged Care Funding Instrument (ACFI) is a resource allocation instrument. It focuses on the main areas that discriminate core care needs among care recipients. The ACFI assesses core care needs as a basis for allocating funding.
The ACFI focuses on care needs related to day to day, high frequency need for care. These aspects are appropriate for measuring the average cost of care in longer stay environments.
While based on the differential resource requirements of individual persons, the ACFI is primarily intended to deliver funding to the financial entity providing the care environment. This entity for most practical purposes is the residential aged care service. When completed on all care recipients in the service the ACFI provides sufficient precision to determine the overall relative care needs profile and the subsequent funding.
The ACFI consists of 12 questions about assessed care needs, and two diagnostic sections.
While the ACFI questions provide basic information that is related to fundamental care need areas, it is not a comprehensive assessment package. Comprehensive assessment considers a broader range of care needs than is required in the ACFI.
Comprehensive assessment is used for the purposes of ensuring care recipients receive quality and safe care that appropriately meets their care needs.Approved providers responsibilities in this regard are set out in the Aged Care Act 1997.In particular the User Rights Principles 1997 and the Quality of Care Principles 2014.
This ACFI User Guide applies to ACFI appraisals or reappraisals with a date of effect on or after 1 January 2017.
Earlier appraisals relate to previous versions of the ACFI User Guide, see table below.
Publication Date / Applicable to ACFI Appraisal dates29 February 2008 / 20 March 2008 to 31 December 2009
15 December 2009 / 1 January 2010 to 31 January 2013
7 January 2013 / 1 February 2013 to 30 June 2013
1 May 2013 / 1 July 2013 to 31 December 2016
The ACFI as a calculator of the residential aged care subsidy
Three domains of residential care are subsidised by the ACFI:
•Activities of Daily Living Domain (ACFI Questions 1-5; Nutrition, Mobility, Personal Hygiene, Toileting and Continence) Ratings calculated from completing checklists in this domain determines the level of the subsidy.
•Behaviour Domain (ACFI Questions 6-10; Cognitive Skills, Wandering, Verbal Behaviour, Physical Behaviour and Depression). Ratings calculated from completing checklists in this domain determines the level of the subsidy.
•Complex Health Care Domain (ACFI Questions 11-12; Medication and Complex Health Care Procedures) Ratings calculated from completing checklists in this domain determines the level of the subsidy.
The amount payable in respect of a particular care recipient depends on the ratings (A, B, C or D where relevant) determined for each of the ACFI questions (1–12) as well as the supporting documentation provided in the Answer Appraisal Pack against each of the ratings. Diagnoses are also required to be contained in the ACFI Answer Appraisal Pack and are used to support the claim for subsidy.
Appendix 3 sets out the relationship between the ACFI questions and the three domains, and provides the question scores and category thresholds.
Definitions and acronyms
ACAP
The ACAP (Aged Care Assessment Program) is an important part of Australia’s aged care system.The Commonwealth engages each state and territory government to manage the day-to-day operations of the ACAP and Aged Care Assessment Teams (ACATs or in Victoria referred to as the Aged Care Assessment Services).The focus of the ACAT’s is to comprehensively assess the care needs of frail older people to determine eligibility for care types under the Aged Care Act 1997.
ACCR
The ACCR (Aged Care Client Record) prior to the introduction of the NSAF was completed by an Aged Care Assessment Team or Service. A copy of the ACCR content can be filed in the ACFI Answer Appraisal Pack if relevant and provides evidence to substantiate an ACFI claim made in the pack.
Activities
Activities are the actions required to meet a care recipients care needs. Activities must be informed by an assessment and only the specified activities in a nominated ACFI question can be taken into account in the ACFI appraisal.Also refer page 19, Activities of Daily Living Domain, for further information.
Answer Appraisal Pack
This refers to an ACFI Answer Appraisal Pack and is the completed record of the care recipient’s ACFI appraisal or reappraisal. The pack must include all relevant documentation required to substantiate the claim for ACFI subsidy.
The documentation must be in the form specified in this guide and relates to the time of the appraisal/reappraisal.Refer page 13 ‘Table1: ACFI at a glance’ for evidence requirements.
Under section 7 of the Records Principles 2014, it is the responsibility of approved providers to ensure their Answer Appraisal Pack is up to date, complete, and available when ACFI reviews are undertaken by the Department of Health to validate the ACFI classification.
Assessment
Assessments are required to evidence the completed checklists for ACFI.The Assessment Pack prescribes some tools to be used in completing an ACFI.For questions that do not have a prescribed assessment tool the appraiser can use a validated evidence based tool of their choice. A list of suggested tools have been provided at
An Assessment provided as evidence for an ACFI checklist would be completed by a person who is appropriately qualified to undertake the assessment.It must be evidence based and identify the Usual Care Needs and dependencies of the care recipient at the time of the appraisal.
To be included as evidence in the Answer Appraisal Pack an assessment must be completed no greater than six months prior to the appraisal submission date and must be consistent with the dependencies of the care recipient at the time of the ACFI appraisal.
Details from the ACFI assessments must be completed in the relevant ACFI assessment summary.
Assessment Summary
Assessment Summaries are required to be completed for some ACFI questions.They indicate which assessment or evidence source was used to support a claim.The Assessment Summaries will then be included in the Answer Appraisal Pack.
Checklists
Checklists form the minimum data set (MDS) underpinning the ACFI appraisal. They are single-focussed items about the care needs within each question. Checklists are required to be completed for each ACFI question in the ACFI Answer Appraisal Pack.
Clinical Reports
A Clinical Report is not mandatory for any ACFI question. For ACFI 6 (Cognition) and ACFI 10 (Depression), existing clinical reports, if available, may be included in the ACFI Answer Appraisal Pack to support the rating.
The Clinical Report must be completed by a registered health professional in the following disciplines: medical practitioner, medical specialist (Pain medicine), medical specialist (Palliative medicine), medical specialist (Physician - Geriatric medicine), psychologist, registered nurse or nurse practitioner. The details about the clinical report must be completed in the relevant ACFI assessment summary.
Clinical Nurse Consultant (CNC) / Clinical Nurse Specialist (CNS)
For ACFI 12 item 14 a CNC (Clinical Nurse Consultant) / CNS (Clinical Nurse Specialist) is a registered nurse who has at least five years full time equivalent post registration experience and approved post-registration nursing qualifications in the specialty fields of pain and/ or palliative care.
Contemporaneous
The term Contemporaneous in the context of this guide refers to information completed no greater than six months prior to the appraisal submission date, and is consistent with the dependencies of the care recipient at the time of the ACFI appraisal.
End of Life
ACFI 12 item 14 enables a claim for a Palliative care program involving end of life care.For this claim the reference for the definition of End of Life is in the Palliative Approach Toolkit for Residential Aged Care Facilities March 2016, Fact Sheet 10
Medication(s)
Medication(s) refers to any substance(s) listed in Schedule 2, 3, 4, 4D, 8 or 9 of the Standard for the Uniform Scheduling of Drugs and Poisons (and its amendments) and/or Medication(s) ordered by an authorised health professional or authorised for nurse initiated Medication by a Medication Advisory Committee or its equivalent. For ACFI 11 this excludes food supplements, with or without vitamins, and emollients (e.g. sorbolene cream, aqueous cream, etc).
NSAF (National Screening and Assessment Form)
The National Screening and Assessment Form (NSAF) has been progressively replacing the ACCR since 1 February 2016.The NSAF is used to screen and assess the aged care needs of care recipients.
Throughout this document the term NSAF refers to the Comprehensive Assessment component of the National Screening and Assessment Form.For ACFI the NSAF can be accessed through the My Aged Care service provider portal and stored either electronically or in print form.
The Answer Appraisal Pack may include copies of the parts of the NSAF that are relevant as supporting evidence for the appraisal.On the day of the ACFI review, approved providers can provide this evidence:
•In hard copy, as part of the completed Answer Appraisal Pack
•Via email to the department’s relevant email address
•Via the My Aged Care service provider portal.
Nurse Practitioner
A Nurse Practitioner is a registered nurse working at a clinically advanced level of practice who meets the legislative requirements to prescribe (within limits), order certain diagnostics and to refer patients. Regulation of nurse practitioners is the responsibility of the Nursing and Midwifery Board of Australia.
Source Materials
In the diagnosis sections (refer page 15 to 18 of this Guide) and for ACFI questions 11 and 12, the appraiser will need to complete the Source Materials to indicate which evidence source(s) support the rating. Only source documents which continue to reflect the status of the care recipient at the time of appraisal can be used.
Under section 7 of the Records Principles 2014, approved providers must retain an ACFI Answer Appraisal Pack to support each ACFI claim.Copies of the source materials must therefore be stored as part of the Answer Appraisal Pack. For source materials evidencing ‘ongoing’ needs in ACFI 12 i.e ‘record of treatment’, the Answer Appraisal Pack must include copies of these records for a reasonable period post the appraisal date.
In the case of diagnoses covering depression, psychotic and neurotic disorders (refer mental and behavioural diagnosis codes 540, 550A, 550B, 560) the diagnosis, provisional diagnosis or re-confirmation of the diagnosis must be dated within the twelve month period, from the ACFI submission date.
Technical Equipment (Pain Management)
Technical Equipment designed specifically for pain management' refers to electro-therapeutic equipment such as TENS, interferential therapy, ultrasonic therapy, laser therapy, acupuncture, dry needlingand wax baths, the Department of Healthdoes not maintain an exhaustive list of equipment that can be included as this is subject to change over time.
Therapeutic Massage
Therapeutic massage involves skin to skin contact (or through / over clothes or towel) between the therapist and the care recipient.
Usual care needs
The ACFI questions refer to Usual Care Needs. These are what has been assessed as the ongoing care needs of the care recipient at the time of the appraisal. This does not include any expected occasional needs or any occasional or unusual needs that are present at the time of the appraisal. These needs are evidenced in relevant assessment documentation.
The ACFI process
For each question:
Step 1: Assessment
Assess the care recipient for the usual care required. Assessments must be provided for each question as detailed in Table 1, page 13, of this guide. The assessment supports the checklist.
Step 2: Checklist
Use the information provided in this guide to determine how to correctly complete the checklists in the Answer Appraisal Pack against each ACFI question.The direct relationship between the assessments and checklist requirements is detailed in Table 1.
Step 3: Rating A to D
Use the completed checklists to determine the rating to use in claiming subsidy for that question, and subsequently for that domain.
Step 4: Submissions
Submit claims for subsidy to the Department of Human Services (DHS), based on the ratings and supporting documentation you have determined in your ACFI Answer Appraisal Pack.
Queries related to the process of submitting ACFI claims to DHS can be emailed to;
•
Step 5: Record keeping
Approved providers must keep records relating to ACFI appraisals for the service for three years after 30 June in the year when permanent care ends for the care recipient.Answer Appraisal Packs must include all relevant information needed by the department to verify a provider’s ACFI claim.The types of records that must be kept are specified in paragraphs 7(a) – (c) of the Records Principles 2014.They include:
•care recipient assessments;
•appraisal and reappraisal records in the form of Answer AppraisalPacks e.g. assessment tools from the Assessment Pack and sources of evidence kept in accordance with this guide; and
•copies of classification for care recipient applications that were not sent to DHS in electronic form.
The care recipient’s pack is to be available on request when a review is undertaken by the department.
The person/s authorised by the approved provider to complete the Answer Appraisal Pack and submit the ACFI Application for Classification must certify as part of the application that it is true and correct.This includes ensuring the ACFI Appraiser Identification Details Boxes are completed.
ACFI Appraiser Identification Details Box
Name of appraiserProfession
Signature
Date
The ACFI Appraiser Identification Boxes are found on the assessments in the Assessment Pack.When these Assessments are completed and used as evidence for ACFI questions 5 to 10 the ACFI Appraiser Identification Details Boxes are to be completed by the person taking responsibility for the appraisal of that question.
Where the ACFI appraiser has chosen to use a previously completed assessment, in completing the ACFI Appraiser Identification Box, the ACFI appraiser is signifying that:
•he/she is responsible for the accurate transcription of the information into the records for allACFI questions;
•he/she is responsible for including the previouslycompleted Psychogeriatric Assessment Scales– Cognitive Impairment Scale (PAS – CIS) and/or Cornell Scale for Depression (CSD) in the ACFI Answer Appraisal Pack; and
•that the information in the records and assessments continues to provide an accurate reflection of the status of the care recipient.
Documentation Requirements
The documentation specified in this section comprises the requirements for a completed Answer Appraisal Pack to substantiate a claim.
The completed ACFI Answer Appraisal Pack must be presented upon request and must include:
•completed ACFI assessments;
•Assessment Summaries;
•completed Checklists;
•any clinical reports which provide supporting evidence for ACFI 6 and 10;
•diagnoses, assessments, directives and records of treatment, as required for ACFI 12;
•ACFI appraisal evidence and Source Materials used for the completion of all questions and the diagnosis sections; and
•a copy of the Application for Classification.
Diagnosis questions
Mental and Behavioural Diagnosis
•a completed Mental and Behavioural Disorders Checklist;
•a completed Source Materials Checklist; and
•copies of the source materials; e.g. NSAF, ACCR, GP comprehensive medical assessment, or other medical practitioner assessments or notes.
The filed Source Materials must identify the name and profession of the health professional who has made the diagnosis and the date on which it was made.
Medical Diagnosis
•a completed Medical Diagnosis Checklist;
•a completed Source MaterialsChecklist; and
•copies of the source materials; e.g. NSAF, ACCR, GP comprehensive medical assessment, or other medical practitioner assessments or notes.
The filed Source Materials must identify the name and profession of the health professional who has made the diagnosis and the date on which it was made.
Activities of Daily Living (ADL) domain
ACFI 1 to 4 Nutrition, Mobility, Personal Hygiene and Toileting
•a completed contemporaneous assessment for each of Nutrition, Mobility, Personal Hygiene and Toileting (A list of suggested tools can be found at