The Commonwealth Minister for Aged Care announced in August 2017 that the Australian Health Services Research Institute at the University of Wollongong had been engaged to undertake a Resource Utilisation and Classification Study (RUCS) in residential aged care. The purpose of this study is to determine the drivers of cost in residential aged care and to develop a resident classification system and funding approach that reflects these drivers. This will inform the Government’s decisions around future funding reforms.
The Study consists of four (originally three) separate but linked sub-Studies.
- Study One comprises a detailed collection and analysis of service utilisation and assessment data for residents and financial data from 30 homes across three regions of Australia, the Hunter region in NSW, metropolitan Melbourne and North Queensland. All residents in these residential care homes will be assessed using a tool specifically developed for this study and administered by independent external assessors. The tool has been developed based on the advice of four panels of experts from the health and aged care fields and is aimed at capturing the resident care requirements that are likely drivers of care staff time and resource use.
- Data will also be collected about the services that these residents receive, the amount of time and the type of care staff involved. These data will be used to create a ‘casemix’ classification that will capture the different care needs groups of residents within Australian residential aged care facilities. Study One will also capture information about the proportion of time and costs involved in providing care across all residents generally (shared care). These more general care activities include facility level supervision, or supervision of dining and lounge rooms, delivering meals and medications etc. This additional analysis will inform the design of a funding model that includes fixed (shared care) and variable (individualised care) components. Study One will also examine whether there is an initial adjustment period for each new resident that involves a higher level of individualised care inputs and costs.
- Study Two involves the collection of financial information (expenses only) from a nationally representative sample of homes across Australia. The focus of this study is to identify the characteristics of residential care homes that result in different in levels of fixed cost. The analysis will target factors such as facility size, geographic location, target populations (e.g. indigenous and CALD groups) and any seasonal impacts. This analysis will inform the design of the proposed fixed and variable payment model.
- Study Three uses the results of Studies One and Two to develop and test a new funding model. The classification system developed in Study One will be applied to a national sample of aged care facilities, based again on external assessments, to identify a national residential aged care casemix profile. The fixed and variable cost information that resulted from Studies One and Two will be used to develop and test of the impact of moving to the new model.
- Study Four is a supplementary study that was added to measure how the care needs of residents changed over a period of about six months. This involves the reassessment of half the Study One residents plus the capture of any critical events, such as hospitalisations, falls, and reablement/restorative care programs. The results of Study Four will be used to inform the development of reassessment protocols associated with the outcomes of the RUCS.
More information is available at: https://ahsri.uow.edu.au/aged-care-funding-project
The data collection for Study One was completed in the first half of 2018 at the 30 participating facilities. The care time reported by staff in the resource utilisation data collection showed that just over half the care time provided was individual time - supporting the proposed funding model that includes both a fixed payment and a variable payment rate for residents.
The resident assessment, resource utilisation and finance data have been used to develop and then test the branching classification. An expert clinical panel was consulted to provide feedback and endorsement of the draft version, and Version 1 of the classification has now been finalised and delivered to the Commonwealth.
Another outcome of Study One was the confirmation that the assessment tool developed for the study was suitable for use by external assessors and that the external assessment process was acceptable to residents.
Download the following resources:
- Study One Guide: Service utilisation data collection guide
- Study One Guide: Frequently asked questions
The Study Two data has been received from the participating facilities across Australia and has principally been used to determine the fixed cost component of the funding model. This analysis includes identifying any facility characteristics that drive care costs.
The resident assessments have been progressing throughout October and November in the participating facilities. The results of the assessments from this representative sample across Australia will be used to test the impact of the new funding model nationally.
The reassessment of half of the residents that were assessed in Study One has been completed. Analysis of the results will measure how the care needs of the residents have changed over the period between the Study One and the Study Three assessments. This work will be used to inform the development of reassessment protocols.
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For further information view additional material provided by the Department of Health and other sources.