Funding models for residential aged care can seem complex. This page has information about funding to enable residential aged care facilities to provide palliative care for residents and families. The Australian government allocates subsidised funds to residential aged care facilities through the Aged Care Funding Instrument (ACFI). Residents with the most complex and highest care needs receive the highest care subsidy. Department of Health and Ageing suggests the use of standardised tools to assess the need for care as well as ACFI checklists. However, ACFI is a funding tool and not a comprehensive assessment or care-planning tool.
There are three streams of funding in the funding model. These domains are:
- activities of daily living,
- behaviour, and
- complex health care.
Each domain has three funded levels: low, medium and high. Palliative care is included under the domain Complex Health Care stating that a resident requires a: 'Palliative care program involving end of life care where ongoing care will involve very intensive clinical nursing and/ or complex pain management in the residential care setting'.
In order to meet these criteria, a directive is required by a CNC / CNS in pain or palliative care or a medical practitioner and pain assessment.
The CareSearch pages, Recognising Residents' Needs, contain information about a palliative approach in aged care. These pages also provide helpful resources to help residential aged care facilities determine whether a resident meets the ACFI criteria requiring a palliative care program. Of particular note is that care in the last days and / or hours of life is only a very small part of palliative care provision.
Department of Health and Ageing website upholds the WHO definition of palliative care emphasising that 'The need for palliative care does not depend on any specific medical diagnosis, but on the person's needs. Some of the common medical conditions of people requiring palliative care include: cancer, HIV/AIDS, motor neurone disease, muscular dystrophy, multiple sclerosis and end-stage dementia'.
The myagedcare website has been developed by the Department of Health to provide information on Commonwealth funded services available for carers' caring at home and also describes the process for applying for the various levels of residential aged care.
Medicare Benefits Scheme
The Medicare Benefits Scheme also provides for residents when the goal of care is palliative. GPs can access remuneration from medicare items including:
- case conferences
- residential medication management review
- comprehensive medical assessment
- contribution to care plans, and
- consultations including after-hours consultations.
Further information about medicare items can be found on the Medicare Benefits Schedule website.
The MBS telehealth items can also be accessed for the benefit of residents of aged care facilities. For eligible residential aged care services, MBS items provide for video consultation with a specialist or consultant physician attending to the patient. The MBS Online website contains further information about eligibility.
Medicare also provides for other specific palliative needs. For example, residents with a specified medical need, oxygen is a primary supplement paid to aged care services. This benefit includes residents receiving respite care and is not dependent on how the resident is classified.
A medical practitioner is required to certify that a resident requires oxygen on a continual basis and an application form (available from the Department of Human Services website) needs to be submitted to Medicare. There is information available on the Clinical Evidence pages of CareSearch relating to the symptom management of breathlessness and the use of oxygen.