ACFI is primarily a funding tool but proper usage by carers can improve care delivery. It provides a mental checklist for carers to tick off with each resident. The added benefit being that such attention to detail can also increase your revenue. Great webinar by Tiffany Wiles RN from Key 2 Care.

1. ACFI Through Education

2. How did I get
to this point?
A bit of History
Began nursing in 1986 (firstTertiary qualified group in
NSW) with Gerontological studies completed 1992.
Rural and Remote primary care.
Various middle / senior management roles
• Clinical care coordination.
• Facility/ Service Management – multiple
organisations, stand alone, non-profit as well as
large providers.
• Area clinical development across FNQ to theTorres
Strait – Indigenous care.
Funding consultancy in partnership.
2013 Started key2care to address the inequity between
funding entitlements and funding actuals and to build
capacity and independent sustainable growth enabling
excellence in care and quality of life for our elders.
Tiffany Wiles
RNGerontology

3. Presentation
Outline
webinar
ACFI Disruptors
Example of our achievements and offerings
Our approach - goals and guarantees and a new way of
thinking.
The importance of Diagnosis
Normal Ageing
The impact of Ageing and disease
Aspects of assessment
Accreditation -Impacts on standard 2.
How Key2care can help…
 some take home suggestions.

4. ACFI
Disruptors
Care
Mismatches
Intention
Care Delivery
• Funding activities seen as non-essential
• The little red hen mentality- It’s not my job!
• Staff don’t know the residents at all well
• Too many other tasks that are seen as
priority – care before paperwork
• Differing priorities
Lack of focus
• No shared skill or knowledge
• ACFI training doesn’t teach the
tools for success
• Accountability issues – registration
at risk!
• ACFI seen as Work flow disruption
• Lack of staff engagement
Documentation Complexity
• Onerous burden of documentation
• Lack of clarity around non-mandatory
assessments & the use of mandatory tools
• Lack of congruence with too many
contributors to the claiming process
• Multiple recording of data
Who is thinking
ACFI???

5. The
Financial
Rewards
Our
Achievements 19 beds
Ave daily increase $121.88
Total site increase $845,270
40 beds
Ave daily increase $127.27
Total site increase $1.858 million
20 beds
Ave daily increase $129.67
Total site increase $946,591
NB: All increases validated
With zero loss in funding

6. Our
Approach
Goals and a New
Way ofThinking.
Key2care’s Overarching Principle…
…is to achieve the highest possible quality of life for
Australians living within our aged care community.
A new way of thinking…
…consistent engagement of care staff connecting
them to why they do what they do rather than just
following instructions.
…some new ideas for assessment – the gaps.
…a team model? Sure… How novel!

7. Diagnosis
Why is this
important?
It’s a requirement!
Be an artist – paint a picture!
How to colour in to create impact.
Care Pathways and ACFI Intersections.

8. The Impact
ofAgeing
The slippery
slope
Getting old is no walk in the park!
Skin – reduced elasticity, lines and wrinkles; less oil production
leading to dryness; this and becomes more fragile.
Hair –Thins and loses pigment (becomes grey).
Height reduction – By age 80 it is possible to have lost 5cm in height
related to changes in posture, compression of joints, spine and spinal
discs.
Hearing – loss speeds up after 55 with higher frequencies harder to
hear with the nuances of speech (tone) less clear. 48% of men and
37% of women >75 experience hearing difficulties.
Vision – Presbyopia (lens inflexibility) develops in the 40’s. Night
vision and visual sharpness decline. Difficulty locating objects.
Sleep – Less nocturnal sleep, more nocturnal awakenings.
Bones – Gradual loss of mineral content with bones becoming
less dense and strong. Higher risk of osteoporosis. Increasing
probability of arthritis.

9. The Impact
ofAgeing
The slippery
slope continues
Metabolism – generally lower energy requirements; hormone
changes result in shifting body fat and loss of muscle mass…which
slows metabolism. Increased probability of diabetes.
Brain and nervous system – from 30 the brain’s size, neural
network and blood flow decreases (there is some adaptation so
don’t despair); Less recall with newly learned information lost more
quickly (STML).Greater need for repetition to learn new
information.Word finding and spatial ability declines with age.
Slower response times.
Heart and circulation – Becomes less efficient; heart muscle
enlarges; reduction in energy and endurance. Increased probability
of hypertension.
Lungs – become less efficient and so supplies the body with less
oxygen.
Kidneys – reduce in size and function.Takes longer to clear waste
and medicines from the blood as quickly and less able to manage
homeostasis in dehydration.

10. Clinical
Assessment
The Key
Aspects?
Sensory
Physical
Neurological
Mental / Psychological
Emotional
Chemical
Cultural

11. Accreditation
Effects on
Standard2 -
Health &
PersonalCare
The Principle:
Residents’ physical and mental health will be promoted and achieved at the
optimum level in partnership between each resident (or his or her representative)
and the health care team.
2.1 Continuous improvement:
2.3 Education & staff development
2.4 Clinical care
2.5 Specialised nursing care needs (ACFI 12)
2.6 Other health and related services (ACFI 12)
2.7 Medication management (ACFI 11)
2.8 Pain management (ACFI 12, relates to ACFI 1,ACFI 2, ACFI 3, ACFI 4, ACFI 5 )
2.9 Palliative care (ACFI 12 specifically but additionally D1 and D2)
2.10 Nutrition and hydration (ACFI 1, relates to ACFI 2 ACFI 12)
2.11 Skin care (ACFI 12, relates to ACFI 2, ACFI 4, ACFI 5)
2.12 Continence management (ACFI 5)
2.13 Behavioural management (ACFI 7 - 9)
2.14 Mobility, dexterity & rehabilitation (ACFI 2, ACFI 3, ACFI 4,
relates to ACFI 5, ACFI 10, ACFI 12)
2.15 Oral and Dental care (ACFI 3, related to ACFI 1)
2.16 Sensory loss (AllACFI Domains)
2.17 Sleep (AllACFI domains)

12. The
Human
Rewards
WhyWE Do
WhatWe Do
ACFI
Outcomes for
Residents
Fewer falls
Better skin care
Mood elevation
Improved pain
management
Better Nutrition
Compliance
Increased Funding
Health
Increased financial and
Service sustainability.
Ability to attract and
maintain quality staff.
More resources per
resident.Documentation
Improved standard of
documentation.
Clear and concise care
planning.
Defined ACFI process
with clear allocation of
responsibility
Workforce Satisfaction
Staff understand why they
do what they do.
They are able to focus on
caring for their residents.
Increase in job satisfaction,
engagement and a sense of
contribution to the bigger
picture.

13. Our
Solutions
What weOffer
Our goal is to ensure that every resident is fully funded given
their unique and specific care needs….no exceptions!
We charge nothing until your increased income is realised
plus we do not charge expenses as additional but absorb them to
increase affordability.
We come to your site and reassess EVERY resident and train
your staff in ACFI… care staff, RN’s,AHP’s even your GP’s on
ACFI and the specific requirements.Your residents learn
about it too.
We charge 20% of increases for 12 months from the date of the
ACFI claim. 20% is half, yes HALF, the percentage charged by
other companies. PLUS we guarantee to refund our fee if there
is any loss at validation…but so far we have had no loss.
We take on only 3 age care groups per year related to the time
commitment for each, perhaps only one for larger groups.Your
success is our success…and that takes time.

14. Some
Takeaways
Suggestions
 The language used by staff is very impotent and is an area validators use to
claw back funds. Nurses tend to use non-specific terms like ‘occasionally’.
Remove it, and others like it, from your vocabulary now.
 Be specific and confident in descriptive terms. If you lack confidence the
validators will ‘sense your fear’. NO Fear!
 Case conference all ACFI claims. Interview staff from all shifts. Behaviours
don’t only happen on the pm shift. Get a broad picture covering all shifts.
This will give credence to any single observation. Behaviours, especially,
happen in clusters…and often at peak care intervention times.
 Identify your care and funding targets based on your case conference
data…then cement the anecdotal information into clinical assessments.
 Carers are an integral team component. Use their skills…they are the eyes
and ears of the facility.
 Cross check all information for congruence across allACFI questions. Any
errors will give raise doubt in the mind of your validator. Firm confident
evidence will raise no questions.
 Remember that residents respond to questions with answers they think you
want to hear or because they are concerned that you will ‘do’ something to
them. Use or create relationships of trust for the best outcomes.
 Always, always, always use the area for comments in assessments.

15. More
Takeaways
Clinical
 TheWorld Health Organisation defines a chronic wound is one that
has failed to progress through the phases of healing in an orderly and
timely fashion.
 Continence is like death or pregnancy…
…Either you are or your aren’t!!
It’s not possible to be a little bit dead or slightly pregnant.
 Incontinence is defined as any involuntary loss of urine.
Volume is of no consequence.
It’s euphemistically called LBL or light bladder leakage onTV
advertisements.
 Its only the lucky ones who don’t experience pain.The elderly wear
pain like a cloak.They put it on like they put their clothes on and
habituate to its presence even though it really does hurt.
 The Cornell Scale for Depression IS NOT a happiness scale…why do so
many comments paint a rainbows and unicorns type of picture?The
presence of depression does not reflect the quality of care.

16. Questions ?
PH: 0418669206
getfunds@key2care.com.au