The Aged Care Funding Instrument (ACFI) Explained

The Aged Care Funding Instrument (ACFI) is managed by the Australian Government’s Department of Health.

ACFI is used to assess the degree of care each aged care resident needs and to allocate funding accordingly. ACFI pays subsidies to the residential aged care facility that is providing the care (National Care Solutions 2019).

While questions regarding care needs relate to individual residents, the sum of results provides a broader picture of the amount of funding deemed necessary for the facility (National Care Solutions 2019).

ACFI focuses on care needs that relate to day-to-day and high-frequency need for care. These are deemed necessary considerations to make in order to estimate the average cost of care in longer stay environments, i.e. residential aged care (Australian Government Department of Health 2016).

The Aged Care Funding Instrument is best understood as a resource allocation instrument. It focuses on the main areas that distinguish core care needs among care recipients. (Australian Government Department of Health 2016).

These core needs fall into three domains:

• Activities of Daily Living
• Behaviour
• Complex Health Care

ACFI criteria takes into account factors such as a resident’s continence; mobility; cognitive ability; and other daily care factors, ultimately categorising a resident as being ‘low-care’ or ‘high-care’ (National Care Solutions 2019).

ACFI assessments are carried out by trained assessors employed by the aged care provider (National Care Solutions 2019).

Within the Aged Care Funding Instrument User Guide there are:

• 12 questions relating to assessed care needs:
• • Each with four ratings (A, B, C or D {rising in severity}) where relevant; and
  • Two diagnostic sections.

The 12 questions – in combination with other considerations such as health diagnoses and assessments – produce the resident’s ‘ACFI rating’ (National Care Solutions 2019).

ACFI’s Three Domains

• Activities of Daily Living
• • Nutrition:
  • • A person’s assessed day-to-day care needs with regard to eating.
    • This also applies to people receiving enteral feeding.
    • The checklist must be completed with regard to the care need: readiness to eat and eating.
    • Assessed in terms of assistance level required.
  • Mobility:
  • • A person’s assessed day-to-day care needs with regard to mobility.
    • The checklist must be completed with regard to transfers and locomotion.
    • Assessed in terms of assistance level required.
  • Personal hygiene:
  • • A person’s assessed day-to-day care needs with regard to personal hygiene.
    • The checklist must be completed with regard to dressing and undressing; washing and drying; and grooming.
    • Assessed in terms of assistance level required.
  • Toileting:
  • • A person’s assessed day-to-day care needs with regard to toileting:
    • • Including toilet, commode, urinal or bedpan and drainage bags for residents who have stomas and catheters.
    • The checklist must be completed with regard to a person’s use of toilet and toilet completion.
    • Assessed in terms of assistance level required.
  • Continence:
  • • A person’s assessed day-to-day care needs with regard to continence of urine and faeces.
    • The checklist must be completed with regard to urinary continence and faecal continence.
    • Assessed in terms of measurement (frequency).

(Australian Government Department of Health 2016)

• Behaviour
• • Cognitive skills:
  • • A person’s assessed cognitive skills.
    • Assessed in terms of measurement (none to severe).
  • Wandering:
  • • A person’s assessed tendency to attempt to leave a facility or enter areas within or outside the service where their presence is considered inappropriate.
    • Assessed in terms of measurement (frequency).
  • Verbal behaviour:
  • • A person’s assessed verbal behaviours including verbal refusal of care, verbal disruption, paranoid ideation (that disturbs others), and verbal sexually inappropriate advances.
    • Assessed in terms of measurement (frequency).
  • Physical behaviour:
  • • A person’s assessed physical conduct in terms of whether it is threatening and/or could potentially cause harm; socially inappropriate; or if they are constantly physically agitated.
    • Assessed in terms of measurement (frequency).
  • Depression:
  • • A person’s assessed symptoms associated with depression and dysthymia (chronic mood disturbance).
    • Assessed in terms of measurement (none to severe).

(Australian Government Department of Health 2016)

• Complex Health Care
• • Medication:
  • • A person’s assessed needs in relation to medication (specifically, medication administered on a regular basis).
    • Assessed in terms of measurement (complexity and frequency).
  • Complex health care:
  • • A person’s assessed care needs in relation to ongoing complex healthcare procedures and activities (this excludes temporary nursing interventions).
    • Assessed in terms of measurement (complexity and frequency).

(Australian Government Department of Health 2016)

The ACFI Process

ACFI should be carried out in this progression:

1. Assessment
2. Checklist
3. Rating A to D
4. Submissions
5. Record keeping

Further Information

Under ACFI, residents may be reassessed as needed and if their needs classification require it, an application can be made for a higher funding subsidy from the government (Aged Care Crisis 2015).

Note: While the ACFI questions provide basic information that is related to fundamental care need areas, it is not intended to be a comprehensive assessment package. A holistic assessment must take into account a broader range of care needs than is necessarily required in a funding instrument (Australian Government Department of Health 2016).

Understanding changes that took place on 1 January 2017 with regard to ACFI

Additional Resources

• The Aged Care Funding Instrument User Guide:  https://agedcare.health.gov.au/sites/default/files/documents/02_2018/final_acfi_user_guide_2017.pdf

References

• Aged Care Crisis 2015, Aged Care Funding Instrument (ACFI), Aged Care Crisis, viewed 25 September 2019, https://www.agedcarecrisis.com/resources/acfi
• Aged Care Guide n.d., Aged Care Funding Instrument (ACFI), Aged Care Guide, viewed 26 September 2019, https://www.agedcareguide.com.au/terms/aged-care-funding-instrument-acfi
• Australian Government Department of Health 2016, The Aged Care Funding Instrument User Guide, Australian Government Department of Health, viewed 26 September 2019, https://agedcare.health.gov.au/sites/default/files/documents/02_2018/final_acfi_user_guide_2017.pdf
• Australian Government Department of Human Services 2017, Coffee Break - Aged Care Funding Instrument (ACFI), online video, Australian Government Department of Services, viewed 26 September 2019 https://www.youtube.com/watch?v=F6IzAGfOK24
• National Care Solutions, ACFI What Does It Stand For?, National Care Solutions, viewed 4 October 2019,https://www.nationalcaresolutions.com.au/acfi/

(Answers: d, b, d)