Advocacy & aged care: an update for podiatrists (part 3)

What is needed when it comes to the allied health service provision of quality aged care in the context of multidisciplinary care, and the regulation of allied health quality and safety? 

Multidisciplinary care 

Many older peoples’ needs, especially if complex, are best assessed and addressed via multidisciplinary teams which include various allied health professionals working alongside nurses, GPs and specialists. 

As an example of a multidisciplinary aged care model, AHPA originally proposed the Encompassing Multidisciplinary Block-funded Reablement in Aged Care Evaluation (EMBRACE) project. The EMBRACE project would include identification of pathways to the full range of allied service delivery, student placements, and outcome evaluation.  

AHPA’s longer term vision is for multidisciplinary outreach care to be available for aged care residents, tailored to location so that appropriate services are available wherever older people live. AHPA has since become aware that work has begun on a joint Commonwealth–States / Territories project, ‘Multidisciplinary Outreach Service trials in Residential Aged Care Facilities’. The trials, with a concurrent evaluation, are intended to reduce emergency department attendances and potentially preventable hospitalisations. 

AHPA had an initial meeting with the Department of Health and Aged Care in December 2022 concerning the models and is now seeking further engagement. 

Outcomes needed in this area

• Allied health services are an integral aspect of the trial models.  
• AHPA and individual discipline peaks are part of collaborative design, implementation and evaluation of the trials.  

Regulation of allied health quality and safety

As outlined in previous instalments in this series, despite the previous Government’s acceptance of Royal Commission Recommendation 36, and in-principle acceptance of Recommendation 38, there is still no accountable standard for allied health service provision.  

Equally concerning, explains AHPA, is what seems to be a trend for aged care providers to substitute ‘cheaper’ workers from outside allied health, such as lifestyle coordinators, to provide services that considerations of quality and safety require to be delivered by an allied health professional.  

Similarly, AHPA notes that allied health assistants (AHAs) are sometimes used to carry out essential allied health tasks. Although valuable contributors to the workforce, AHAs are less qualified than allied health professionals. AHAs therefore either require supervision, or are simply not suited to the task, which exposes residents to unacceptable risks. Compromising allied health quality and safety in these ways exacerbates Australia’s already considerable health sector burden, via outcomes such as increased hospitalisations and surgeries.  

Currently the Aged Care Quality and Safety Commission (ACQSC) is the only statutory entity tasked with identifying any insufficient or inappropriate aged care provision. But the ACQSC’s yardstick is mainly the Aged Care Quality Standards, and even if recently proposed reforms to them are implemented, they will not ensure consistency with the Royal Commission’s allied health recommendations. 

Possible future development of an allied health-related Quality Indicator will also not provide the accountability urgently needed. In addition, AHPA notes that the ACQSC has not yet addressed systemic allied health issues, despite provision of needs-based allied health clearly being a quality and safety issue. 

AHPA therefore welcomes the federal Government’s proposal to establish an office of Inspector-General of Aged Care. Together with a stronger ACQSC to ensure sufficient allied health provision, the Inspector-General should play a key oversight role in ensuring systemic transparency and accountability of the aged care system, including for allied health.  

AHPA asserts it is particularly important that the Inspector-General review Commonwealth implementation of responses to the Royal Commission’s recommendations. This is because this process has been especially lacking for most of the allied health-related recommendations. The Review should include examining how Commonwealth measures and actions taken correspond to the recommendations, and an analysis of their effectiveness (Royal Commission Recommendation 148). 

Outcomes needed in this area  

• Systemic monitoring of allied health service provision via strengthening the Aged Care Quality and Safety Commission, including through its own motion powers similar to those of the NDIS Quality and Safeguarding Commission.  
• Quarterly Financial Reporting requirements for allied health service provision by residential aged care facilities include reporting against a recommended best practice minimum ratio of allied health professionals to allied health assistants.  
• The Commonwealth works with States and Territories to develop a National Allied Health Assistant Delegation and Supervision Framework that applies across the care and support, and public and private sectors.
• A strong, independent, and well-resourced Inspector-General of Aged Care, with a focus on increasing the accountability of all aspects of Australia’s aged care system, legislatively embedded in a consultative structure that requires input from the aged care sector on systemic concerns. One possible mechanism is a stakeholder consultative committee similar to those currently operating for the NDIS Quality and Safeguards Commission. 
• An independent unit within the Office of Inspector-General for monitoring implementation and responses to allied health-related Royal Commission recommendations, including those concerning the workforce, funding, and the role of allied health in reablement. The unit is mandated to report on implementation of Royal Commission recommendations at least every six months. 

Next month 

In the final installation in this four-part series, STRIDE will share AHPA’s insights into three areas when it comes to allied health care service provision in aged care. These areas are the role of allied health data, workforce planning and support, and digital integration.