RUCS Overview and Reports
The department engaged the University of Wollongong to undertake a Resource Utilisation and Classification Study (RUCS). The purpose of this study was to determine the characteristics of residents that drive residential care costs, and use this information to inform the government’s consideration of future reform options.
The RUCS was completed in December 2018. The Australian Health Services Research Institute (AHSRI) at the University of Wollongong have produced a suite of seven reports on the key elements of the RUCS. Report Six synthesises the findings of the study and consolidates the recommendations.
Report One: The Australian National Aged Care Classification (AN‐ACC)
Report One covers the design and conduct of the study undertaken to develop the Australian National Aged Care Classification (AN‐ACC). It covers the design and use of the AN‐ACC assessment tool and the resource utilisation study undertaken to develop AN‐ACC Version 1, including the preparation and analysis of the data collection. It discusses the results, the classification development process and key outcomes including the statistical analysis and clinical validation.
Report Two: The AN‐ACC assessment model
Report Two presents detailed findings relating to the external assessment tool and assessment process. This includes the development of the assessment tool using expert clinical panels and a summary of feedback from assessors regarding the use of the tool and the suitability of individual instruments. The skills and competencies required for the assessment workforce and other implications for implementation of the external assessment model are considered as well as triggers and protocols for reassessment.
Report Three: Structural and individual costs of residential aged care services in Australia
Report Three presents the analysis and findings of Study Two which identified the proportions of total care costs that are fixed (including shared care) and variable (relating to individualised resident care). The analysis focuses on the differences in fixed costs between different types of facilities, characterised by ownership, size, remoteness and service specialisation. It includes an analysis of the drivers of fixed care costs.
Report Four: Modelling the impact of the AN‐ACC in Australia
Report Four presents an analysis of modelling the introduction of the AN‐ACC across Australia. This is based on the findings of Study Three. The sampling and assessment data collection process and the casemix of residents in aged care across Australia are described. The focus of this report is on modelling the introduction of the AN‐ACC to replace the ACFI.
Report Five: AN‐ACC: A funding model for the residential aged care sector
Report Five presents the design of a new funding model based on the AN‐ACC. It includes a consideration of other payment issues such as existing payment supplements, a discussion of incentives in funding model design and key issues in implementing the new model.
Report Six: AN‐ACC: A national classification and funding model for residential aged care: synthesis and consolidated recommendations
Report Six syntheses and consolidates the findings presented in other reports and provides a consolidated set of recommendations.
Report Seven: AN‐ACC Technical appendices
Report Seven contains detailed data for reference purposes.
Presentation of preliminary results (November 2018)
On the 19th of November 2018 the Department held a stakeholder forum. Professor Kathy Eagar presented the Version 1 of the Australian National Aged Care Classification (AN-ACC). Professor Eagar’s presentation can be viewed below.
Background to the Resource Utilisation and Classification Study (RUCS)
The Study consisted of four (originally three) separate but linked sub-Studies.
- Study One comprised 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 were assessed using a tool specifically developed for this study and administered by independent external assessors. The tool was developed based on the advice of four panels of experts from the health and aged care fields and was aimed at capturing the resident care requirements that are likely drivers of care staff time and resource use.
- Data were also collected about the services that these residents receive, the amount of time and the type of care staff involved. These data were used to create a ‘casemix’ classification that captured the different care needs groups of residents within Australian residential aged care facilities. Study One also captured 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 informed the design of a funding model that includes fixed (shared care) and variable (individualised care) components. Study One also examined whether there is an initial adjustment period for each new resident that involves a higher level of individualised care inputs and costs.
- Study Two involved the collection of financial information (expenses only) from a nationally representative sample of homes across Australia. The focus of this study was to identify the characteristics of residential care homes that result in different in levels of fixed cost. The analysis targeted factors such as facility size, geographic location, target populations (e.g. indigenous and CALD groups) and any seasonal impacts. This analysis informed the design of the proposed fixed and variable payment model.
- Study Three used the results of Studies One and Two to develop and test a new funding model. The classification system developed in Study One was 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 was used to develop and test of the impact of moving to the new model.
- Study Four was a supplementary study that was added to measure how the care needs of residents changed over a period of about six months. This involved 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 were 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
Overview of RUCS activities
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 were 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 was 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 were received from the participating facilities across Australia and was principally been used to determine the fixed cost component of the funding model. This analysis included identifying any facility characteristics that drive care costs.
The resident assessments were undertaken throughout October and November 2018 in the participating facilities. The results of the assessments from this representative sample across Australia were 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 measured how the care needs of the residents have changed over the period between the Study One and the Study Three assessments. This work was 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.