The biggest mistakes facilities make with ACFI funding

Efficient application of the Aged Care Funding Instrument (ACFI) requires more than just a fundamental understanding of the definitions, assessments, and business rules (click here to download as PDF)

 

There are several red flags that indicate that an organisation may be under-claiming, at risk of downgrades at validation, or why it takes more than one week to complete a reappraisal. Although some mistakes are quite obvious, others are more subtle but have just as significant implications.

 

Some of these mistakes include:

Routinely initiating the reappraisal process based on a schedule. Reviewing the gap between a resident’s care needs and their ACFI rate is good practice. It should, however, be noted that elements of the documentation required from an ACFI perspective do not contribute to the care planning process. In addition, they are not useful for the monitoring and comparison of a resident’s care needs. So when this comparison takes the form of routinely initiating all of the documentation that would be required for an ACFI reappraisal (e.g. annually), the end result is often an ACFI Appraisal Pack that can’t be submitted. This means that staff have been spending valuable time for no gain, financially or clinically, when a screening assessment could have produced the same results. This is especially the case when a resident has a high-claim in all three domains (i.e. HHH). In this case there is absolutely no reason to review their ACFI unless a mandatory reappraisal is due.

Completing all assessments and charts. Once a resident is identified for an appraisal, the results of individual ACFI questions contribute to the final rating. In many cases, however, they do not. This creates a situation where time is being spent completing documentation that does not contribute financially, from a care planning process, and does not have the inter- or intra-tester reliability to be of use for clinical comparison. Prior to commencement of the appraisal process a skilled ACFI clinician should be able to identify what documentation is required and, just as importantly, what isn’t.

Completing the Cornell Scale for Depression (CSD) at the wrong stage of the process. The CSD is a tool that provides an opportunity for the capture of qualitative information that can assist in substantiating many other areas of an ACFI claim. As a result, it also creates a risk that the recorded comments can also conflict with other areas of the claim. The completion of this assessment should be positioned along the process such that enough information about the resident’s care needs are known. This will then enable the assessor to complete all comments in a carefully considered and precise manner.

Putting charts out for care staff to identify behaviour and pain issues.  Charting is useful for establishing a clinical picture when a resident’s cognition does not allow them to reliably report their own signs or symptoms over a period of time. The average care worker does not, however, receive sufficient training to identify all of the 64 ACFI specific behaviours nor all of the relevant elements of a pain assessment. This creates issues associated with inadequate data capture, or recording behaviours that are not congruent with ACFI definitions. Good practice involves a collaborative assessment being completed before charts are initiated, so primary caregivers can be guided as to what to look for.

There are 64 ACFI specific behaviours. This leads to:
  • Underfunding – staff not identifying them
  • Risk – documenting non-ACFI behaviours

Having multiple people contribute to a claim. Sustainable claiming relies upon congruency between all assessed needs and the care being provided. Having a multi-disciplinary team provide input into the direction of an appraisal is invaluable, but when multiple people document about the same area of care, this creates significant risk of incongruent claiming and downgrade at validation. All assessments that are inter-related should be completed by the same individual, and the resultant care plan be completed by the same person. At the very least, the process should be sequential, so that one clinician’s assessments build upon another.

Not initiating charts in the initial stage of the process. There are elements of the ACFI process that require charting to be completed for seven consecutive days. If these are initiated late in the process, even if completed correctly, it is this step that can single-handedly delay the completion of the ACFI Appraisal Pack. Considering that funding is calculated daily and any increases are based upon the day of receipt of reappraisals, this gap in the process can cost facilities over five-figures per annum.

Acknowledging that every organisation is different, a standardised approach that minimises variability is a practice that should not only be adopted, but also documented. It is only then that organisations can ensure that they’re claiming the correct amount of funding for their current residents’ care needs, validation downgrade risk is minimised, and appraisals can be completed quickly and efficiently.