Today Painaustralia participated in the Australian Institute of Health and Welfare’s consultation around the National Aged Care Quality Indicator Program for residential aged care services (QI Program). From 1 July 2019, reporting of quality indicators for all Australian Government-subsidised residential aged care providers will be mandatory.
This week has also seen the announcements of the Darwin and Cairns rounds of hearings under the Royal Commission into Aged Care Quality and Safety, with a welcome focus on pain management.
With a third of people over the age of 65 living with chronic pain, a figure that rises to up to 80% for residents of aged care, pain is a significant factor as we age. As noted in our submission to the Royal Commission into aged care, the data suggests a high proportion of people with chronic pain also have cognitive or communicative impairment and inability to report pain.
The evidence we have heard at the Hearings so far has underpinned and underlined this distressing neglect that the most vulnerable people in our communities’ face. An important theme that has emerged from the evidence is the funding model that drives the level and quality of care.
Residential aged care in Australia is predominantly funded by the Commonwealth Government through tax revenue with some finance coming from other levels of government and user co-contributions. Funding for each individual resident’s care needs is determined by the Aged Care Funding Instrument with residents receiving a subsidy paid directly to the residential aged care provider.
A recent evaluation of the tool notes it is ‘no longer fit for purpose’.[i] The ACFI subsidy level is not related to the factors that determine the need for care. This is a fundamental flaw in the ACFI as it inevitably leads to negative consequences where providers are rewarded for admitting higher subsidy residents who will be relatively less expensive to care for.
We do also note that the consultation paper does not attribute enough weighting to the incidence of chronic pain management within residential aged care. In outlining the factors found to drive individual care, the paper outlines end of life needs, frailty, functional decline, cognition, behaviour and technical nursing needs, but it does not acknowledge that chronic pain is an issue common across all the other identified risks, and in fact often a significant marker for high care needs.
This is a concern we have noted about the new Aged Care Quality Standards as well. For instance the new aged care quality standards do not acknowledge or consider the high risk and prevalence of chronic pain, despite nearly 80% of residents in residential aged care reporting chronic pain and despite the clear need for providers to have specialist capacity to manage pain appropriately given that poor management of pain can lead to significant adverse outcomes for residents.
We need to make the link between pain management and quality care clear and distinct. Historically, pain management has often suffered on account of arbitrary definitions of quality care.
Funding freezes to the ACFI in 2016, resulted in the reduction of subsidy for the complex health care supplement which particularly impacted high-needs residents with complicated pain-management regimes. This subsequently led to the removal of essential pain management services such as necessary physiotherapy and palliative care and diminished the capacity of the sector to provide appropriate levels of pain management in aged care.
We must recognise that pain is an often underdiagnosed and underfunded area across aged care, an issue that has compounded problems across the sector.
Better pain management is inextricably linked to better quality care. It’s time that it is included in all policy and funding models across aged care.
Carol Bennett, CEO
[i] Department of Health 2017. Webinar on an alternative funding model for residential aged care. Watch online at: http://livestream.education.gov.au/health/17may2017/