A resource allocation instrument, The Aged Care Funding Instrument (ACFI) focuses on the main areas that discriminate care needs among residents. From there, ACFI assesses core care needs and allocates funding based on the assessments.
Sound understanding of both comprehensive clinical assessment and ACFI knowledge helps facilities receive the funding they are entitled to and thus deliver the right level of care to their residents.
To help facilities better understand ACFI, we’ve compiled a glossary of key words used by ACFI.
The Aged Care Assessment Program is an important part of Australia’s aged and community care system. It aims to assess the needs of frail older people and facilitate access to care services appropriate to their needs. The ACAP data dictionary supports the collection and reporting of the Aged Care Assessment Program Minimum Data Set, by providing definitions for all the data elements in that collection.
The ACCR is the Aged Care Client Record or earlier equivalent, completed by an Aged Care Assessment Team/ Service. A copy of the ACCR content that the service received should be filed in the ACFI Appraisal Pack.
ACFI Appraisal Pack
The ACFI Appraisal Pack is the completed record of the resident’s ACFI appraisal or reappraisal including all the evidence specified for inclusion.
Activities are the action steps to meet a care need. In each of the ACFI questions 1 to 4, the activities that are to be taken into account in completing the checklist which are informed by an assessment. Only these specified activities are to be taken into account in the appraisal.
In ACFI questions 5 to 10, the appraiser will need to complete the assessment summary to indicate which evidence source(s) are included to support the rating.
Checklists form the minimum data set (MDS). They are single-focussed items about the care needs within each question.
A clinical report is not mandatory for any ACFI question. For ACFI 6 (Cognition) and ACFI 10 (Depression), existing clinical reports, if available, may be included in the ACFI Appraisal Pack to support the rating.
A clinical report for these purposes is a report that has been completed by consultants in the following disciplines: general or specialist medical practitioner, physician, geriatrician or psychogeriatrician, registered psychologist, nurse practitioner or clinical nurse (mental health)1. The details about the clinical report must be completed in the relevant ACFI assessment summary.
There are three ACFI domains:
- Activities of Daily Living (consisting of the ACFI questions–Nutrition, Mobility, Personal Hygiene, Toileting and Continence)
- Cognition and Behaviour (consisting of the ACFI questions–Cognitive Skills, Wandering, Verbal Behaviour, Physical Behaviour and Depression)
- Complex Health Care (consisting of the ACFI questions–Medication and Complex Health Care Procedures).
Notes provide further information about a domain to assist an assessor. Only the specified activities for each care need are to be taken into account in completing the checklist.
A nurse practitioner is a registered nurse working at a clinically advanced level of practice who meets the legislative requirements to prescribe (within limits), order certain diagnostics and to refer patients. As with nurses, regulation of nurse practitioners is the responsibility of the relevant state/ territory authority.
A person licensed to practice nursing under an Australian state or territory nurses act or health professional act (referred to as a Registered Nurse Division 1 in Victoria).
Scheduled toileting for the purposes of question 5 (Continence) is: staff accompanying a resident to the toilet (or commode) or providing a urinal or bedpan or other materials for planned voiding/ evacuation according to a daily schedule designed to reduce incontinence.
In questions ACFI 11 and 12, and the diagnosis sections, the appraiser will need to complete the source materials to indicate which evidence source(s) support the rating. Only source documents which continue to reflect the status of the resident at the time of appraisal can be used. Copies of the source materials must be stored as part of the ACFI Appraisal Pack. In the case of diagnoses covering depression, psychotic and neurotic disorders (refer mental and behavioural diagnosis codes 540, 550A, 550B, 560) the diagnosis, provisional diagnosis or re-confirmation of the diagnosis must have been completed within the last twelve months.
Usual care needs
The ACFI questions refer to usual care needs. This is the ongoing care need at the time of the appraisal, not any expected occasional needs and not any occasional or unusual needs that are present at the time of the appraisal. For ACFI questions 1 to 4, these are the day to day care needs that are predictable and required for the specific activities.