Aged care residents are missing out on exercise as a vital, evidence-based treatment for pain management under the Aged Care Funding Instrument (ACFI).

Australia’s peak physiotherapy body says residents are limited to choosing from a physiotherapist using massage or Transcutaneous Electrical Nerve Stimulation (TENS) regardless of their condition, despite evidence showing the overwhelming benefits of using exercise to manage pain.

Australian Physiotherapy Association Gerontology Chair Rik Dawson said while the ACFI has put a positive focus on pain management, the tool has failed to support the use of exercise and other evidence-based allied health treatment modalities, such at Cognitive Behaviour Therapy (CBT), for pain relief since it was introduced in 2008.

Mr Dawson said the ACFI reforms, outlined in this month’s 2016-17 federal budget, were a missed opportunity by government to expand pain management to incorporate evidence-based practice.

“There’s strong evidence that exercise reduces the pain for an older person with arthritis compared with weak evidence for massage and TENS,” he said.

The APA has reiterated its pre-budget calls for the government to change its funding to enable aged care residents to access physiotherapy-managed exercise, which works to control pain while improving residents’ independence and their quality of life.

“Opening up pain management to current evidence-based practice will allow residents to have the best health outcomes regarding pain management,” Mr Dawson said.

“It also gives residents choice because at the moment they are not allowed to choose exercise and a lot of them want it.”

The federal budget revealed $1.2 billion in cuts over four years through changes to the ACFI.

The government said the redesigned matrix is a response to “the higher than expected increase in residential aged care funding”.

Indexation of funding in the Complex Health Care (CHC) domain of the ACFI will be halved in 2016-17 alongside changes to certain scores in the matrix, with the new redesigned CHC scoring matrix taking effect from January 1, 2017.

Under the changes to scores, complex pain management (ACFI item 12.4b) by allied heath professionals at least four times a week will receive a reduced score from six to four points. A timing requirement will also be added, requiring 120 minutes of treatment delivery over a week.

The APA has labelled the 120 minute requirement as “excessive”. It says residents will achieve clinical improvement in their pain management with 20 minute sessions, four times a week with allied health professionals.

Mr Dawson, a Sydney-based aged care physiotherapist in private practice, said the changes will act as a financial disincentive for aged care providers to access allied health professionals for treatment delivery.


“There’s a real disappointment among physiotherapists and also some fears for their future when it comes to jobs in residential aged care because there’s not enough profit to make it viable for facilities to choose a physiotherapist,” he said.

“They will probably prefer to just manage residents’ pain through medication and simple treatments.

“There will be a negative impact on residents’ pain and residents are now in danger of losing touch with physiotherapists all together.”

The comments come as University of Sydney researchers, including APA member Jennifer Hewitt, investigate the health outcomes and economic value that exercise has in preventing falls.

The study, due to be published later this year, is already showing promising results.

Residents of aged care facilities comprise about four per cent of the older population yet the cost of their falls is more than 20 per cent of the total cost of falls to the health system.