Understanding occupational therapy practice in residential aged care facilities under the Aged Care Funding Instrument: A qualitative study.
Lora Calderone, Michelle Bissett, Matthew Molineux
PMID 35439846WHAT IT FOUND
Seven occupational therapists in Australian residential aged care described a funding system that rewarded documenting disability over independence.
They reported being pressured to record residents as needing more help than they did, and to document pain massage sessions that were not actually delivered.
Key findings
01Therapists described being encouraged to document residents as having higher care needs than observed to maximise facility funding, with one participant noting they were asked to revert a positive mobility assessment because it would have reduced funding.
02Participants reported being directed to document pain massage sessions as completed and of the required length even when sessions were shortened, not provided, or refused by the resident.
03Therapists described a lack of professional support and supervision, with pain massage techniques not taught in their education, leading to feelings of incompetence and fear of causing harm.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study included only seven participants, all employed by private companies contracted to provide services, which may not represent occupational therapists employed directly by facilities or in other models. The findings rely entirely on therapists' perspectives; no residents were interviewed to verify the reported practices or their impact. Participant validation of the analysis was not completed, as the researchers believed the team's deep understanding of the phenomenon would not be accurately validated by individual participants' limited views. The study explores experiences under the ACFI, which was set to be replaced by the AN-ACC in October 2022, so the specific funding pressures described may no longer apply in the same way.
Declared interests
The authors have no conflict of interest to declare.
The easy way to misread this
Do not generalise these findings to all aged care settings or assume the ACFI is the sole cause of poor outcomes. This is a small qualitative study of seven therapists' experiences, not a trial of a treatment or a measure of resident health. The reported practices describe a specific funding context that was undergoing change at the time of publication.