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Aged Care Funding Instrument (ACFI)201041005347

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Aged Care Funding Instrument (ACFI)201041005347 Powered By Docstoc
					Aged Care Funding
Instrument (ACFI)
     December 2004
1.1. ACFI BACKGROUND QUESTIONS – Not directly used for
funding purposes

1.1.1: ACFI Complex Care Indicator (CCI)

The following questions should be used in the national trial to assist with the identification of
people who may qualify for funding supplements and intermediate care support. The questions
are designed to identify shorter-term needs in complex health, nursing and behavioural areas. It is
not suggested at this stage that the questions be incorporated into the final ACFI.

The questions have been developed from the findings of the literature review that emphasised the
importance of this approach in many other aged care funding models. The questions outlined in
this section will require review before inclusion in the national trial.

There are three sets of questions in the CCI that should be used in conjunction with current ACFI
questions of diagnosis and technical nursing requirements to rate client needs for supplements.
The outcomes of this approach should be assessed in the national ACFI trial.

The CCI questions broadly cover:

1. Accommodation Settings: – accommodation setting at time of assessment and in past 30 days

2. Health/Nursing and Behavioural Summary Care Needs: - prognosis, predictability and
stability requirements

3. Goals Of Care: - covers the basic reasons why the person requires care and support (eg.
palliative care) and the expected goals of the care intervention.




                                                                                                    2
1. Identify settings before admission to residential care that could indicate
shorter term needs
•   accommodation setting when assessed
•   discharge setting(s) in past 30 days

Recommend the ACAP variable Accommodation setting - already collected by ACATs be
modified as follows as it does not identify rehabilitation settings*, geriatric assessment units* or
psychiatric settings*.

1 Private residence – owned/purchasing
2 Private residence – private rental
3 Private residence – public rental or community housing
4 Independent living unit within a retirement village
5 Boarding house/rooming house/private hotel
6 Short term crisis, emergency or transitional accommodation facility
7 Supported community accommodation
8 Residential aged care service- low level care
9 Residential aged care service- high level care
10 Hospital
11 Other institutional care
12 Public place/ temporary shelter
13 Other
14 Rehabilitation setting*
15 Geriatric assessment units*
16 Psychiatric setting*
99 Not stated/inadequately described




                                                                                                       3
2. To identify the ‘summary’ care needs for (i) health/medical/nursing care
and (ii) those with the behavioural and psychiatric symptoms of dementia
(BPSD)
2a. Identifying health and behavioural care needs
The assessor would rate the client on each of the three elements (complexity, predictability,
stability) described in Tables 2 (i) and (ii).

Table 2 (i): Medical/Health Care needs

 Complexity                Low                       Medium                                    High
                  Care needs can be met        Physical needs are         Physical needs are highly complex;
                  with minimal skilled         moderately complex;        mechanical/technical and/or therapeutic
                  health professional          mechanical/ technical      interventions are needed frequently, including
                  input.                       and/or therapeutic         frequent reassessment over a 24 hour period.
                                               assistance are needed
                                               regularly or
                                               intermittently. The
                                               interventions require
                                               regular reassessment.
Predictability                       Predictable                                           Unpredictable
                  Client responds to their health or disease              Client responds to their health or disease
                  processes/disorder predictably or any internal or       processes/disorder unpredictably or any
                  external triggers can be anticipated with some          internal or external triggers cannot be
                  certainty through established interventions and         anticipated with certainty, and there is a
                  regularly reviewed care plans.                          requirement for ongoing assessment, care
                                                                          planning, intervention and review.
  Stability                             Stable                                               Unstable
                  Health or disease process/disorder, including           A fluctuating disease process/disorder, or
                  physical needs, are in a steady state, and are likely   physical conditions, resulting in an alternating
                  to remain so if correct treatment/care regimes          health state and requiring frequent or regular
                  continue.                                               intervention or treatment.



Table 2 (ii): Dementia with Behaviour needs (BPSD)

  Complexity               Low                      Medium                                     High
                   Care needs can be met      Behaviour needs are         Behaviour needs are highly complex.
                   with minimal skilled       moderately complex;         Interventions are needed frequently, including
                   health professional        Interventions are           frequent reassessment over a 24 hour period.
                   input.                     needed regularly or
                                              intermittently. The
                                              interventions require
                                              regular reassessment.
 Predictability                      Predictable                                           Unpredictable
                   Client responds in a predictable way and can be        Client responds in a unpredictable way and
                   managed with some certainty through                    there is a requirement for ongoing assessment,
                   established interventions and regularly reviewed       care planning, intervention and review.
                   care plans.
   Stability                            Stable                                               Unstable
                   Condition is in a steady state and is likely to        A fluctuating condition requiring frequent or
                   remain so if appropriate interventions provided.       regular intervention or treatment.




                                                                                                                             4
3. Goals of Care
The Assessor would classify the client, taking into account the assessment outcomes and informant
reports on the following:-

1. Overall Prognosis: Description of client's overall prognosis for recovery from their
condition/illness.

Rating   Severity
0        Poor: little or no recovery is expected and/or further decline is imminent
1        Fair: partial recovery is expected
2        Good: full recovery is expected
3        Unknown

2. Rehabilitative Prognosis: Description of client's prognosis for functional status.

Rating   Severity
0        Guarded: minimal improvement in functional status is expected; decline is possible
1        Good: marked improvement in functional status is expected
2        Unknown

3: Summary of Care Focus

Rating   Goal of Care
         Complex clinical care needs (i.e. sub acute nursing, high nursing needs))
         Intensive rehabilitation (i.e. sub acute with good rehabilitative prognosis)
         Advanced skilled assistance for dementia with severe BPSD (i.e. very high behaviour needs)
         Palliative Care phase 4 - terminal phase*
         Palliative Care phase 3 - deteriorating*
         Palliative Care phase 2 - unstable, unplanned or emergency problem*
         Maintenance of current level of independence & functioning
         Slowing of deterioration in the level of independence & functioning
         Respite
         Other
*Australian Palliative Residential Aged Care Project (APRAC) has nominated five phases in
palliative care. These being:

•   Phase 1- stable and no new issues;
•   Phase 2- unstable, unplanned or emergency problem may develop;
•   Phase 3- deteriorating;
•   Phase 4- terminal, death is only a matter of days or weeks away;
•   Phase 5- bereavement, after death.




                                                                                                      5
2.1: Aged Care Funding Instrument (ACFI) - Funding
Questions
2.1.2: ACFI Part 2 - Funding Questions


1. Read the domain information

2. Complete the Assessment

3. Complete the Checklists and Flowcharts


For each question* the ACFI Instrument document contains:

    •   Domain descriptions
    •   Relevant definitions
    •   Recommended Assessment
    •   Checklists
    •   Flowcharts
    •   For ACFI 13 & 14 the relevant diagnosis, who diagnosed and date of diagnosis is recorded.


DEFINITIONS
Activities: these are tasks that underpin the ACFI question domains.

Recent assessments: assessments or clinical reports completed within the past 3 months that take account
of usual care needs, not occasional or exceptional needs.

Usual care needs: are those regularly required throughout the day, not occasional or exceptional needs.

Supervision: includes setting up and non physical assistance.

a) setting-up activities which assist the resident to initiate an activity or complete part of an
activity e.g. locking wheels on a wheelchair to enable a transfer, setting up articles, organise taps
(refer to table on the next page). In the domain of meals and drinks setting up is an activity in
itself.

b) non-physical assistance is defined as observing, verbal prompting, directing, or being ready to
provide assistance from a position of close proximity while an activity is happening e.g. this may
be required for safety purposes due to impaired navigation or frailty.

c) In the toileting domain the emptying of drainage or stoma bags or bedpans or flushing toilets is
to be recorded as supervision assistance.

Physical assistance: the activity cannot be completed without one-to-one individual physical
assistance from another person or persons to complete an activity.




                                                                                                           6
The following table provides an overview of the ACFI questions and the assessment information
that provides all the necessary evidence. Shaded questions have assessments included in this pack.

      Domain                                                          Evidence
 1    EATING & DRINKING
      Activities: Setting Up / Eating & Drinking                        Eating & Drinking Assessment
      Level of need= supervision or physical assistance
      Impairments = Physical, Cognitive, Behavioural, Sensory
 2    MOBILITY
      Activities: Transfers / Locomotion                                Physical Mobility Scale
      Level of need= assistance (setting up, non physical,
                        physical) or mechanical
 3    PERSONAL HYGIENE
      Activities: Dressing/ Washing/ Grooming                           Personal Hygiene Assessment
      Level of need= supervision (setting up & non physical)
                        or physical assistance
      Impairments = Physical, Cognitive, Behavioural, Sensory
 4    TOILETING
      Activities: Use of toilet/ Toilet hygiene                         Toileting Assessment
      Level of need= supervision (setting up & non physical)
                        or physical assistance
      Impairments = Physical, Cognitive, Behavioural, Sensory
 5    CONTINENCE (urinary & bowel)                                      Continence Logs or
      Level of need= frequency or continence management                 Continence Assessments
 6    COGNITIVE SKILLS                                                  MMSE or
      Level of need= None, Mild, Moderate, Severe                       Cognitive Assessment
 7    PROBLEM WANDERING: Absconding or interfering                      Behaviour Log or
      whilst wandering                                                  Behaviour Assessment
      Level of need= frequency
 8    CHALLENGING BEHAVIOUR: Physical or Verbal                         Behaviour Log or
      Level of need= frequency                                          Behaviour Assessment
 9    OTHER BEHAVIOUR: Socially Inappropriate                           Behaviour Log or
      Level of need= frequency                                          Behaviour Assessment
 9    OTHER BEHAVIOUR: Mood/depressive                                  Behaviour Log or
      Level of need= frequency or assessment                            Depression Assessment
 9    OTHER BEHAVIOUR: Imminent high risk                               Behaviour Log or
      Level of need= frequency or clinical report                       Behaviour Scale or
                                                                        Clinical Assessment
10    MEDICATION                                                        Medication Chart
      Level of need= supervision, physical assistance, daily
      administer controlled drug, daily administer injection
11    TECHNICAL & COMPLEX NURSING                                       Documented assessments by
      Level of need =                                                 Medical Practitioner, Registered
      frequency of daily procedures from list 1 or list 2 or list 3   Nurse, or other health professional
                                                                      appropriate to the particular
                                                                      procedure.
12    THERAPY: a minimum of 15 minutes per day, designed for            Documented assessments by
      physical therapy or physiotherapy                               Medical Practitioner, Registered
      Level of need = total weekly minutes                            Nurse, Physiotherapist,
13    MENTAL & BEHAVIOUR DIAGNOSIS                                      Documented diagnosis
14    MEDICAL DIAGNOSIS                                                 Documented diagnosis
* ADL questions 1, 3 & 4 may require information for physical or sensory impairments to provide a more
comprehensive assessment approach.


                                                                                                            7
This table provides a description of the assistance that could be provided for each ADL domain

   ADL                             Supervision                       Physical Assistance       Mechanical
  activity

                Setting Up                 Non Physical Assist       Requires physical
                                                                     assistance throughout
                                                                     the activity
                                           Eating & Drinking
setting up is   position person or food
an activity     or utensils, cut up
                food, give one dish at a
                time
eating &/or                                prompt to eat meal        put food into mouth,
drinking                                                             hold drink container
                                                 Mobility
transfers       locking wheels,            observe, verbal prompt,   assist movement           lifting
                apply rails                stand by                                            equipment
locomotion      hand resident the aid      observe, verbal prompt,   push wheelchair , help    mechanical
                                           stand by                  with use of aids etc      aids
                                                                                               - electronic
                                                                                               muscle
                                                                                               stimulation/
                                                                                               mobile units

                                            Personal Hygiene
dress/          set up or hand over        verbal prompt,            physical assistance
undress         clothes                    stand by                  throughout the activity
wash/ dry       set up articles within     verbal prompt,            physical assistance
                reach, organise            stand by                  throughout the activity
                taps, hand towel to
                resident
groom           set up articles            verbal prompt,            physical assistance
                                           stand by                  throughout the activity
                                                 Toileting
use of a        place seat down, high       verbal prompt,           physical assistance
toilet          seat on toilet , frame      stand by                 throughout the activity
                over toilet etc,                                     - positioning,
                hand resident the pan,                               adjusting clothes etc
                place ostomy articles in
                reach
                Supervision in this activity includes the emptying
                of drainage or stoma bags or bedpans or flushing
                                       toilets.
toilet          set up tap etc              verbal prompt,          physical assistance
hygiene                                     stand by                throughout the activity
                                                                    - wiping & cleaning of
                                                                    peri-anal area
* mechanical aids: to justify a claim staff must be present throughout the activity




                                                                                                              8
ACFI 1: Eating & Drinking
DOMAIN DESCRIPTION: This domain relates to the assessed usual care needs with regard to
eating and drinking. This domain excludes clinical aspects of tube feeding, which are covered in
the ACFI 10 - Technical and Complex Nursing Care.

There are two activities to eating & drinking:
1. Setting Up
2. Eating & Drinking

Usual care needs: are those regularly required throughout the day, not occasional or exceptional needs.

Supervision: includes setting up and non physical assistance.

Setting up: the act of setting up enables the person to manage independently - it includes
positioning of person who is unable to position their chair appropriately, positioning of utensils on
table or in hand, cutting up of food. It excludes the act of getting the person to the dining room.

Supervision: non-physical assistance as defined by verbal prompting or directing.

Physical assistance: the activity cannot be completed without one-to-one individual physical
assistance from another person or persons to complete an activity. Requires physical assistance
throughout the activity.

PROCESS
Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented.

The Recommended Assessment is the Eating & Drinking Needs Assessment.
1. Rate the level of assistance needed for each activity (tick one)
2. Indicate the types of impairment that impact on care needs for these activities- at least one
impairment must be selected when claiming assistance.

                                                                Assistance Rating       Impairments
Eating & Drinking Needs Assessment                              (tick one only)         (multiple selections
                                                                                        allowed)
Eating & Drinking Activities                                    0= Independent
                                                                1= Supervision
                                                                2=Physical Assistance


1. Setting up                                                              0               Physical
The steps involved in this activity include but are not                    1               Cognitive
limited to– positioning of person, position utensils, cut up               2               Behavioural
food, apply butter or condiments to bread, apply salt and
pepper or sugar.
                                                                                           Sensory

2. Eating and or drinking                                                  0               Physical
The steps involved in this activity include but are not
limited to– ability to hold cup, use cutlery (knife, fork,                 1               Cognitive
spoon etc), swallows food safely.                                          2               Behavioural
                                                                                           Sensory




                                                                                                               9
Step 2. Checklist: Complete the checklist items, then complete the flowchart to determine the
rating for ACFI 1 – Eating and Drinking.



R       Item      EATING & DRINKING CHECKLIST                                 Tick if YES

1.         1      Assistance in setting up?
1.         2      Supervision in eating and/or drinking?
1.         3      Physical assistance in eating and/or drinking?
1.         4      Attends to eating & drinking independently



HOW TO USE THE CHECKLISTS TO GET A RATING
Rating A = yes to item 4
Rating B = yes to item 1
Rating C = yes to item 2
Rating D = yes to item 3

Step 3. Flowchart: Use flowchart or checklists to indicate rating

ACFI Q1: EATING & DRINKING FLOW CHART
                                                                     RATING A
      Does the person attend to eating &
                                                           YES
           drinking independently



                     NO

                                                                     RATING B
 Does the person need assistance with
                                                           YES
           setting up only



                     NO

                                                                     RATING C
Does the person need supervision only
                                                           YES
     with eating &/ or drinking



                     NO

                                                                     RATING D
        Does the person need physical
                                                           YES
     assistance with eating &/or drinking




                                                                                                10
ACFI 2: Mobility
DOMAIN DESCRIPTION: This domain relates to the assessed usual needs with regard to
mobility.

It includes:
• assistance with moving to and from chairs, wheelchairs, beds or toilets
• assistance with walking, on a 1:1 basis
• assistance in the use of mobility aids, including wheelchairs, and walking frames; and
• advanced technological equipment for change of location

This domain excludes extensive manual handling for maintenance of skin integrity such as
frequent changing of the position of a chair-fast or bed-fast person, which is covered in ACFI 10 -
Technical and Complex Nursing Care.

There are two identified activities of mobility.
1. Transfers
2. Locomotion (previously called walking).

Usual care needs: are those regularly required throughout the day, not occasional or exceptional needs.

Assistance includes the provision of supervision or physical assistance with usual care needs, not
occasional or exceptional needs.

Supervision: includes setting up and non physical assistance

a) setting up activities which assist the resident to initiate an activity or complete part of an activity
 e.g. locking wheels on a wheelchair to enable a transfer, handing the person an aid, staff push the
wheelchair.

b) non-physical assistance is defined as observing, verbal prompting, directing, or being ready to
provide assistance from a position of close proximity while an activity is happening e.g. this may
be required for safety purposes due to impaired navigation or frailty.

Physical assistance: the activity cannot be completed without one-to-one individual physical
assistance from another person or persons to complete an activity. Requires physical assistance
throughout the activity.

Advanced technological equipment: does not include an electric wheelchair, includes such aids as
electronic muscle stimulation braces, electronic mobile units (EMU) etc. This does not include an
electronic wheelchair.

Locomotion: is the act of moving from place to place, it includes assisting the resident in
movement to enable a change of location.




                                                                                                          11
PROCESS

Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented.

The Recommended Assessment is a section of the Physical Mobility Scale.

Tick    score M7. Transfers
one
             0     Non-weight bearing, hoist required: specify
             1     Weight bearing, hoist required: specify
             2     Physical Assistance of two persons required: describe
             3     Physical Assistance of one person required: describe
             4     Stand-by assistance/prompting required
             5     Independent

Tick    score      M8. Locomotion
one
             0     Bed/chair bound
             1     Wheelchair mobile
             2     Ambulant with physical assistance of two persons: describe
             3     Ambulant with physical assistance of one person: describe
             4     Stand-by assistance/prompting required
             5     Ambulates independently


Step 2. Checklist : Complete all checklist items, then complete the flowchart to determine the
rating for ACFI 2: Mobility.



R      Item      PHYSICAL MOBILITY SCALE CHECKLIST                                       Tick if
                                                                                         YES
2.      1        Assistance in transfers? (refer to M7. Transfers score of 2, 3 or 4)
2.      2        Supervision in locomotion? (M8. Locomotion score of 1 or 4)
2.      3        Physical Assistance in locomotion? (M8. Locomotion score of 0,2 or 3)
2.      4        Lifting equipment for transfers (M7. Transfers score of 0 or 1)
2.      5.       Requires advanced technological equipment for change of location
                 (Should be described in question M8.Locomotion score 2 or 3)
2.      6.       Is independently mobile

HOW TO USE THE CHECKLISTS TO GET A RATING
Rating A = yes to item 6
Rating B = yes to (item 1or item2)
Rating C= yes to (item 1) & (item 2)
Rating D = yes to (item 1) & (item 3)
Rating D = yes to (item 4 or item 5)




                                                                                                   12
Step 3. Flowchart: Use flowchart or checklists to indicate rating.

ACFI Q2: MOBILITY FLOW CHART

                                                                     RATING A
       Is the person independently mobile
                                                        YES



                       NO

                                                                     RATING B
   Only requires assistance with transfers that
          does not include equipment                    YES



                       NO

                                                                     RATING B
     Requires supervision with mobility only
                                                        YES



                       NO

                                                                     RATING C
 Requires assistance with transfers (not including
                 equipment) AND                         YES
       Requires supervision with mobility


                       NO

                                                                     RATING D
 Requires assistance with transfers (not including
                 equipment) AND                         YES
   Requires physical assistance with mobility


                       NO

                                                                     RATING D
        Requires equipment for transfers
                                                        YES



                       NO

                                                                     RATING D
 Requires advanced technological equipment for
                                                        YES
              change of location




                                                                                13
ACFI 3: Personal Hygiene
DOMAIN DESCRIPTION: This domain relates to the person’s assessed usual needs with regard
to personal hygiene.

There are three defined activities of personal hygiene
1. Dressing & Undressing
2. Washing & Drying
3. Grooming


Usual care needs: are those regularly required throughout the day, not occasional or exceptional needs.

Supervision: includes setting up and non physical assistance.

Supervision: includes setting up and non physical assistance

a) setting up activities which assist the resident to initiate an activity or complete part of an activity
 e.g. setting up articles, organise taps, hand towel to resident.

b) non-physical assistance is defined as observing, verbal prompting, directing, or being ready to
provide assistance from a position of close proximity while an activity is happening e.g. this may
be required for safety purposes due to impaired navigation or frailty.

Physical assistance: the activity cannot be completed without one-to-one individual physical
assistance from another person or persons to complete an activity. Requires physical assistance
throughout the activity.


PROCESS

Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented.




                                                                                                          14
The Recommended Assessment is the Personal Hygiene Needs Assessment.

1. Rate the level of assistance needed for each activity (tick one)
2. Indicate the types of Impairment that impact on care needs for these activities- at least one
impairment must be selected when claiming assistance.

                                                               Assistance Rating       Impairments
Personal Hygiene Needs Assessment                              (tick one only)         (multiple selections
                                                                                       allowed)
                                                               0= Independent
Personal Hygiene Activities                                    1= Supervision
                                                               2=Physical Assistance


1. Dress and Undress
The steps involved in this activity include but are not                   0               Physical
limited to– Choosing appropriate garments, putting on or
taking off clothing (e.g. underwear, shirts, skirts, pants,
                                                                          1               Cognitive
cardigan, socks, stockings), undoing and doing up zips                    2               Behavioural
and buttons, putting on and taking off footwear.                                          Sensory
2. Wash & Dry                                                                             Physical
The steps involved in this activity include but are not                   0               Cognitive
limited to– set up toiletries and towel, turn on and adjust
taps, wash and dry reachable sections of body, wash and
                                                                          1               Behavioural
dry other areas, apply deodorant, moisturizing skin ,                     2               Sensory
dental care (remove & insert dentures, clean).
3. Grooming                                                                               Physical
The steps involved in this activity include but are not                   0               Cognitive
limited to– brush or comb hair, shaving, applying make-                   1               Behavioural
up, put on jewellery, daily monitoring of finger nails and
toe nails.
                                                                          2               Sensory

Step 2. Checklist: Complete all checklist items, then complete the flowchart to determine the
rating for ACFI 3 – Personal Hygiene.




R    Item      PERSONAL HYGIENE CHECKLIST                                                    Tick if YES

3       1      Supervision in dressing & undressing?
3.      2      Supervision in washing & drying?
3.      3      Supervision in grooming?
3.      4      Physical assistance in dressing & undressing?
3.      5      Physical assistance in washing & drying?
3.      6      Physical assistance in grooming?
3.      7      Attends to personal hygiene independently




                                                                                                              15
HOW TO USE THE CHECKLISTS TO GET A RATING
Rating A = yes to item 7
Rating B = yes to any number of items from (item 1, item 2, item 3)
Rating C= yes to (item 4 or item 5 or item 6)
Rating D = yes to more than one item from (item 4, item 5, item 6)

Step 3. Flowchart: Use flowchart or checklists to indicate rating.

ACFI Q3: PERSONAL HYGIENE FLOW CHART

   Does the person                                                         RATING A
  attend to personal
                             YES
       hygiene
    independently

         NO

                                          in any activity or activities    RATING B
Requires supervision                      - dressing & undressing
                             YES
        only                              - washing & drying
                                          - grooming


         NO


                                          in one activity                  RATING C
  Requires physical                       - dressing & undressing OR
                             YES
     assistance                           - washing & drying OR
                                          - grooming

                                                        OR

                                          in more than one activity from   RATING D
                                          - dressing & undressing
                                          - washing & drying
                                          - grooming




                                                                                      16
ACFI 4: Toileting
DOMAIN DESCRIPTION: This domain relates to the assessed needs with regard to toileting.

It refers to the degree of assistance required to use a toilet.
It includes toileting aspects associated with a person who has a catheter or a stoma bag, for
example emptying drainage bags, personal hygiene and adjusting of clothing.

It excludes location change in order to use the toilet which is covered in ACFI 2 - Mobility.
It excludes care of catheters and colostomies which are covered in ACFI 11 Technical and
Complex Nursing Procedures. It excludes toileting activities associated with suppositories and
enemas which are covered in ACFI 11 Technical & Complex Nursing Procedures.

There are two defined activities in toileting:-

1. Use of a toilet (including setting up, positioning and adjustment of clothing, emptying
   drainage bag associated with a catheter or stoma)
2. Toilet hygiene (personal hygiene related to toileting i.e. wiping peri-anal area)

Definition of a toilet: This includes any kind of appropriate toilet such as a commode, urinal,
bedpan or bluey used for a planned episode of evacuation of the bowel or bladder.

Definition of use of a toilet: ability to position self onto the toilet, the ability to appropriately
manage the toilet item.

Supervision:

a) setting up activities which assist the resident to initiate an activity or complete part of an activity
 e.g. preparing toilet, hand resident the bedpan, place ostomy articles in reach.

b) non-physical assistance is defined as observing, verbal prompting, directing, or being ready to
provide assistance from a position of close proximity while an activity is happening e.g. this may
be required for safety purposes due to impaired navigation or frailty.

c) Supervision in this activity includes the emptying of drainage or stoma bags or bedpans or
flushing toilets.

Physical assistance: the activity cannot be completed without one-to-one individual physical
assistance from another person or persons to complete an activity. Requires physical assistance
throughout the activity.


PROCESS

Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented.




                                                                                                        17
The Recommended Assessment is the Toileting Needs Assessment.

1. Rate the level of assistance needed for each activity (tick one)
2. Indicate the types of Impairment that impact on care needs for these activities- at least one
impairment must be selected when claiming assistance and there should be appropriate evidence
to support the impairment.

                                                            Assistance Rating       Impairments
Toileting Needs Assessment                                  (tick one)              (Can tick multiple)
                                                            0= Independent
                                                            1= Supervision
Toileting Activities                                        2=Physical Assistance

1. Use of toilet                                                       0              Physical
The steps involved in this activity include but are not                1              Cognitive
limited to– setting up the toilet, adjusting clothing,                 2              Behavioural
positioning on toilet item, emptying drainage bag.                                    Sensory
                                                                                      Physical
2. Toilet Hygiene                                                      0              Cognitive
The steps involved in this activity include but are not                1              Behavioural
limited to– wiping peri-anal area., washing hands.                     2              Sensory



Step 2. Checklist: Complete the checklist items, then complete the flowchart to determine the
rating for ACFI4 – Toileting.


R     Item         TOILETING NEEDS CHECKLIST                                          Tick if YES

4.      1          Cannot use any kind of toilet
4.      2          Supervision in use of toilet?
4.      3          Supervision in toilet hygiene?
4.      4          Physical assistance in use of toilet?
4.      5          Physical assistance in toilet hygiene?
4.      6          Attends to toileting independently

HOW TO USE THE CHECKLISTS TO GET A RATING

Rating A = yes to (item 1 or item 6)
Rating B = yes to (item 2 or item 3)
Rating C = yes to (item 2 & item 3)
Rating C = yes to (item 4 or item 5)
Rating D = yes to (item 4 & item 5)




                                                                                                          18
Step 3. Flowchart: Use flowchart or checklists to indicate rating.

ACFI Q4: TOILETING Flow Chart
 The person attends to                                               RATING A
toileting independently
                               YES
or cannot use any kind
         of toilet

         NO

                                             in one activity         RATING B
 Requires supervision                        - use of toilet OR
                               YES
        only                                 - toilet hygiene

                                                            OR
                                             in BOTH                 RATING C
                                             - use of toilet &
         NO
                                             - toilet hygiene



                                             in one activity         RATING C
   Requires physical                         - use of toilet OR
                               YES
      assistance                             - toilet hygiene

                                                            OR
                                             in BOTH                 RATING D
                                             - use of toilet &
                                             - toilet hygiene




                                                                                19
ACFI 5: Continence
DOMAIN DESCRIPTION

This domain relates to the assessed needs with regard to continence of urine and faeces. It is
designed to reflect the degree of incontinence present and the resulting complexity of the
continence management program needed to meet the person’s individually assessed continence
needs.

Continent is:
• continent of urine or self manages continence devices AND
• continent of faeces or self manages continence devices

Occasional Incontinence is:
• incontinent of urine less than or equal to once per day OR
• incontinent of faeces less than or equal to once per week

Frequent Incontinence is:
•  incontinent of urine 2-3 times per day OR
•  incontinent of faeces 2-3 times per week

Always Incontinent is:
• incontinent of urine more than 3 times per day OR
• incontinent of faeces more than 3 times per week

Continence Management Program is:
A continence management program means more than the use of pads only, or prompting only. In
addition it must include at least one of the following:
   • bladder retraining
   • habit training
   • scheduled toileting

Bowel Management Program is:
For the prevention of constipation, management of irritable bowel syndrome or diverticulitis and
must involve daily monitoring and recording of bowel activity and an assessed need for at least
one of the following:
    • stool softeners or other aperients
    • fibre supplements
    • suppositories or enemas
    • habit training


PROCESS
Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented.

The Recommended Assessments are a Continence Log OR Continence Assessment.




                                                                                                   20
                                                                CONTINENCE LOG

     Code        Description
      0          Dry
      1          Incontinent of urine or faeces
      2          Self manages

3 Day Urinary Log- check resident hourly for 3 consecutive days
Date MD- 2am 3am 4am 5am 6am 7am 8am 9am 10am                        11am    12   1pm   2pm   3pm    4pm    5pm   6pm   7pm   8pm   9pm   10pm   11pm   12pm
       1am




7 Day Bowel Log- check resident hourly for 3 consecutive days, then at least 3 hourly for the next 4 days
Date MD- 2am 3am 4am 5am 6am 7am 8am 9am 10am 11am 12 1pm 2pm 3pm 4pm                                       5pm   6pm   7pm   8pm   9pm   10pm   11pm   12pm
       1am




                                                                                                                                                          21
URINARY ASSESSMENT AND MANAGEMENT FORM
Only a section of the full assessment is reproduced. Reproduced with permission of Ballarat Health Services

Date of Assessment:

Person able to give an accurate history?                        Yes                                       No
If No, specify                                                  language barrier                          memory problems
                                                                other cognitive problem                   other:………………….
Other history obtained by:                                      family                                    Staff
                                                                medical record                            other:…………………
Current urinary continence/voiding status
(General description of voiding pattern/ continence problem )
Current frequency of voiding                                …………………….per day                           …………………………..per night
Has this changed from usual                                  No                                         Yes: specify:…………………….
Past history of urinary problems                             No                                         Yes: specify……………………..
Current urinary problems:
Continence                                                      Voiding                                   Other
How long has it been a problem ?                                week                                      month
                                                                < 1 year                                  > 1 year
Frequency of incontinence
                                                            …………………….per day                           …………………………..per week
Comments:




BOWEL ASSESSMENT AND MANAGEMENT PLAN
Date of Assessment:

Person able to give an accurate history?                        Yes                                                No
If No, specify                                                  language barrier                                   memory problems
                                                                other cognitive problem                            other
Other history obtained by:                                      family                                             staff
                                                                medical record                                     other
Current Bowel Pattern (frequency timing)
  regular                                                       irregular                                          more than 1/day
   daily                                                        less than daily ( ______ / week)

Usual time of day for bowel motions ................................................................................
Has this changed from usual                         No                                                               Yes

If yes, document the usual pattern....................................................................................
Any specific toileting routine for bowels              No                                                              Yes: specify…………..
Comments:


Continence status                                               No bowel incontinence - stop
Is aware of soiling or incontinence                             Yes                        No
Frequency of incontinence
                                             …………. per day OR           …………………. per week
Only a section of the full assessment is reproduced from the Ballarat Continence Assessment.




                                                                                                                                            22
Indicate which Assessments were completed:-


Tick     Code         Supporting Evidence

              01      3 day Urinary Log
              02      7 day Bowel Log
              03      Urinary Assessment
              04      Bowel Assessment


Step 2. Checklist: Complete the checklist items, then complete the flowchart to determine the
rating for ACFI 5 – Continence.




R      Item        CONTINENCE ASSESSMENT CHECKLIST                                      Tick if YES

5.       1         Continent of urine or self manages continence devices
5.       2         Incontinent of urine less than or equal to once per day
5.       3         Incontinent of urine 2 to 3 times per day
5.       4         Incontinent of urine more than 3 times per day
5.       5         Continent of faeces or self manages continence devices
5.       6         Incontinent of faeces less than or equal to once per week
5.       7         Incontinent of faeces 2 to 3 times per week
5.       8         Incontinent of faeces more than 3 times per week
5.       9         A continence assessment recommends regular prompting to manage
                   occasional urinary and/ or bowel incontinence
5.      10         A continence assessment recommends a continence management
                   program to manage frequent urinary and/ or bowel incontinence
5.      11         A continence assessment recommends a bowel management program
                   to manage constipation, irritable bowel syndrome, diverticulitis
5.      12         A continence assessment recommends a continence management
                   program to manage a person who is always incontinent of urine and/
                   or faeces



HOW TO USE THE CHECKLISTS TO GET A RATING
Rating A = continent yes to (item 1 & item 5)
Rating B = occasionally incontinent    yes to (item 2 or item 6 or item 9)
Rating C = frequently incontinent    yes to (item 3 or item 7 or item 10 or item 11)
Rating D = always incontinent     yes to (item 4 or item 8 or item 12)

Step 3. Flowchart: Use flowchart or checklists to indicate rating.




                                                                                                      23
ACFI Q5: CONTINENCE Flow Chart

    The person is                                                                 RATING A
continent of urine and
       faeces or
     self manages                                                           YES
  continence devices
         AND
does not have a bowel
management program

         NO


                                The person is                                     RATING B
     The person is                                      The person needs
                                incontinent of
 incontinent of urine                                  regular prompting
                          OR   faeces less than   OR                        YES
 less than or equal to                                     to manage
                               or equal to once
     once per day                                         incontinence
                                   per week


  incontinent more
     frequently


                                                         (i) A continence         RATING C
                                The person is
    The person is                                          management
                                incontinent of
incontinent of urine 2-   OR                      OR   program is needed    YES
                                 faeces 2 to 3
   3 times per day                                     to manage frequent
                               times per week
                                                           incontinence
                                                              OR
                                                          (ii) A bowel            RATING C
                                                          management
                                                       program is needed    YES
                                                           to manage
                                                          constipation


  incontinent more
     frequently

                                                          A continence            RATING D
    The person is                The person is            management
 incontinent of urine            incontinent of        program is needed
                          OR                      OR                        YES
more than 3 times per          faeces more than        to manage a person
         day                   3 times per week           who is always
                                                           incontinent




                                                                                             24
ACFI 6: Cognitive Skills for Living Activities
DOMAIN DESCRIPTION

This domain relates to the person’s assessed needs with regard to cognitive skills for living
activities. It reflects on the person’s ability to remember, understand, plan for, initiate and perform
general living activities and to react appropriately to information provided.

PROCESS
Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented.

The Recommended Assessment is the Mini Mental State Examination.

INSTRUCTIONS

This is not suitable for non English speaking or indigenous clients or residents – for these
persons complete the MSSE summary and the checklist (based on information other than the
MMSE)

FOR COMPLETING THE MMSE WITH PERSONS WITH SENSORY OR PHYSICAL IMPAIRMENTS-
the assessor will have to take into account informant information and observations to complete the
checklist

If the person has a hearing impairment:-
     • use a large font MMSE
     • do not ask Q4 (spell WORLD backwards)
     • do not ask Q 8 (repeat ‘no if’s ands or buts’)

If the person has a visual impairment but can read with large print:-
     • use a large font MMSE
     • do not ask Q6 (what is this…pencil)
     • do not ask Q7 (what is this…watch)

If the person has a severe visual impairment and cannot read with large print:-
     • do not ask Q6 (what is this…pencil)
     • do not ask Q7 (what is this…watch)
     • do not ask Q9 (read ‘Close your eyes’ & do the action)
     • do not ask Q11 (write a simple sentence)
     • do not ask Q12 (copy this drawing)

If the person cannot write due to physical impairment:-
     • do not ask Q11 (write a simple sentence)
     • do not ask Q12 (copy this drawing)

In question four you ask the person to Spell WORLD backwards.
Record the person’s response and check against the table below to assist in scoring.
Response                     How many correct/ wrong                         Points
D    L      R     O    W     5 correct                                       5
D    L      R     O          omission of 1 letter                            4
D    L      R                omission of 2 letters                           3
D    L      O     R    W     reversal of 2 letters                           3
D    L                       omission of 3 letters                           2
D    R      L     W    O     reversal of 4 letters                           1



                                                                                                     25
MMSE Summary Score

i) Tick the one appropriate response
ii) Complete the actual score for persons with codes 5 to 10

      Tick     Score       MMSE
01                         no response due to severe cognitive impairment or unconsciousness
02                         no response due to other e.g. mute, speech impairment
03                         refusal to participate
04                         non English speaking
05                         has hearing impairment, partially completed using large font aid (omit Questions 4,8)
06                         has visual impairment, partially completed using large font aid (omit Questions 6,7)
07                         has severe visual impairment, partially completed (omit Questions 6,7,9,11,12)
08                         has physical impairment, partially completed (omit Questions 11,12)
09                         none of the above, but did not attempt all questions
10                         attempted all questions



Step 2. Checklist: Complete the checklist items, then complete the flowchart to determine the
rating for ACFI 6 - Cognitive Skills for Living Activities.


For all residents please select the response that best describes the person’s cognitive skills based on the
evidence available to you (i.e. MMSE, documentation, ask an informant, observation)



R     Item     COGNITIVE SKILLS & IMPAIRMENT CHECKLIST                                   Tick if Yes

6.       1     NO IMPAIRMENT
               (MMSE score of 30-24 when attempting all questions)
               Independently makes decisions about living activities
               Demonstrates none or only minor difficulties in the following
               - memory loss, handling money, solving problems, cognitively
               capable of self care
6.       2     MILD IMPAIRMENT
               (MMSE score of 23-20 when attempting all questions)
               Needs cues or prompting to make decisions
               - short term memory loss, some difficulties with Instrumental
               Activities of Daily Living (IADL’s) e.g. banking, use of telephone,
               shopping, cooking, domestic cleaning
6.       3     MODERATE IMPAIRMENT
               (MMSE score of 19-10 when attempting all questions)
               Needs frequent repetition and reminding
               - disorientation to time and place is likely, cannot manage IADL’s,
               some difficulty with Activities of Daily Living (ADL’s) e.g. personal
               hygiene, toileting, eating and drinking
6        4     SEVERE IMPAIRMENT
               (MMSE score of 9-0 when attempting all questions)
               Unable to respond to prompts or make decisions
               - severe memory loss, only fragments of past events, oriented to
               person only, requires assistance with most or all ADL’s


                                                                                                              26
HOW TO USE THE CHECKLISTS TO GET A RATING

Rating A = yes to (item 1)
Rating B = yes to (item 2)
Rating C = yes to (item 3)
Rating D = yes to (item 4)

Step 3. Flowchart: Use flowchart or checklists to indicate rating.

ACFI Q6: COGNITIVE SKILLS Flow Chart
                                                                     RATING A
  makes decisions about living activities
             independently                           YES



                   NO

                                                                     RATING B
needs cues or prompting to make decisions
          about living activities                    YES



             is more impaired

                                                                     RATING C
needs frequent repetition and reminding to
  make decisions about living activities             YES



             is more impaired

                                                                     RATING D
  is unable to respond to any prompts for
       cognitive impairment reasons                  YES




                                                                                27
ACFI 7: Problem Wandering
DOMAIN DESCRIPTION

This domain relates to absconding or making strenuous attempts to abscond, or whilst wandering
interfering with other people or their belongings.

This may include a person who makes repeated attempts to leave the facility or someone who goes
uninvited into any areas within or outside the facility where his/her presence is unwelcome or
inappropriate - for example, kitchens, or other persons rooms.

PROCESS

Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented.

The Recommended Assessments are:-
(a) Behaviour Log OR (b) Behaviour Assessment to be determined

If there is a Problem Wandering behaviour complete ONE assessment.



Tick         Assessment type completed as evidence of behaviour- select ONE only

     0       None
     1       Recommended Behaviour Log
     2       Recommended Behaviour Assessment

Step 2. Checklist: Complete the checklist items, then complete the flowchart to determine the
rating for ACFI 7- Problem Wandering.




                                                                                  Tick if Yes
R        Item   PROBLEM WANDERING CHECKLIST

7.       1      Problem wandering does not occur
7.       2      Problem wandering occurred at least once in a week
7.       3      Problem wandering occurred daily
7.       4      Problem wandering occurred daily and with more than one episode
                in any one day of a week

HOW TO USE THE CHECKLISTS TO GET A RATING
Rating A = yes to item 1
Rating B = yes to item 2
Rating C = yes to item 3
Rating D = yes to item 4




                                                                                                28
Step 3. Flowchart: Use flowchart or checklists to indicate rating.

ACFI Q7: PROBLEM WANDERING Flow Chart

                                                                     RATING A
    The person displays problem
                                                  NO
            wandering



                YES

                                                                     RATING B
   The person displays problem
wandering at least once in a week but             YES
              not daily


                NO

                                                                     RATING C
    The person displays problem
                                                  YES
   wandering not more than daily



                NO

    The person displays problem                                      RATING D
 wandering daily and with more than
                                                  YES
  one episode in any day of a week




                                                                                29
ACFI 8: Challenging Behaviour
DOMAIN DESCRIPTION

a. This domain includes any physical conduct by the person that is threatening and has the
potential to physically harm another person, visitor or member of staff. It includes, but is not
limited to, hitting, pushing, kicking, biting, resistive to care.

b. It also includes abusive language and verbalised threats directed at another person, visitor or
member of staff. It also includes a person who indulges in behaviour that causes sufficient noise
to disturb other people. That noise may be either, or a combination of, vocal and non-vocal noises
such as rattling furniture or other objects.

PROCESS

Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented.

The Recommended Assessments are:
(a) Behaviour Log OR (b) Behaviour Assessment to be determined

If there is a Challenging Behaviour complete ONE assessment.


Tick          Assessment type completed as evidence of behaviour- select ONE only

     0        None
     1        Recommended Behaviour Log
     2        Recommended Behaviour Assessment



Step 2. Checklist: Complete the checklist items, then complete the flowchart to determine the
rating for ACFI 8- Challenging Behaviour.


R        Item    CHALLENGING BEHAVIOUR CHECKLIST                                  Tick if Yes

8.        1      Challenging behaviour does not occur
8.        2      Challenging behaviour occurred at leat once in a week
8.        3      Challenging behaviour occurred daily
8.        4      Challenging behaviour occurred daily and with more than one
                 episode in any one day of a week




                                                                                                   30
HOW TO USE THE CHECKLISTS TO GET A RATING

Rating A = yes to item 1
Rating B = yes to item 2
Rating C = yes to item 3
Rating D = yes to item 4


Step 3. Flowchart: Use flowchart or checklists to indicate rating.

ACFI Q8: CHALLENGING BEHAVIOUR Flow Chart
                                                                     RATING A
   The person displays challenging
                                                 NO
             behaviour



                 YES

                                                                     RATING B
   The person displays challenging
 behaviour at least once in a week but           YES
               not daily


                 NO

                                                                     RATING C
   The person displays challenging
                                                 YES
    behaviour not more than daily



                 NO

   The person displays challenging                                   RATING D
 behaviour daily and with more than
                                                 YES
 one episode in any day of the week




                                                                                31
ACFI 9: Other Behaviours
DOMAIN DESCRIPTION

This domain includes socially inappropriate behaviours which includes but is not limited to
anxiety, spitting, intentional falling, eating inappropriate substances and hoarding;
mood/depressive symptoms and high risk behaviour which has the potential to result in self
damage or damage to others such as unsafe smoking habits and behaviour which puts the person
at risk of falling.

It excludes behaviour which is covered in ACFI Question 8 (Challenging Behaviour).

This domain excludes where a person has a medical condition that might lead to injury, for
example, through fitting or loss of consciousness, or where a person has a risk of falls related to
poor mobility or balance, or frailty or a disease.

It excludes a range of behaviours which might in the longer term be considered as damaging or
health reducing such as smoking generally, or non-compliance with a specialised diet. For a high
risk behaviour to be included, there needs to be an imminent risk of harm.

PROCESS

Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented.

The Recommended Assessments are:-

(a) Behaviour Logs for Socially Inappropriate, Mood & High Risk behaviours
(b) Behaviour Assessment (to be determined) for Socially Inappropriate & High Risk behaviours
(c) Depression Assessments (to be determined) for Mood behaviours
(d) Clinical Assessments (to be determined) for High Risk behaviours

If there is a socially inappropriate behaviour complete ONE assessment .



          Assessment type completed as evidence of socially inappropriate
Tick
          behaviour- select ONE only

  0       None
  1       Recommended Behaviour Log
  2       Recommended Behaviour Assessment




                                                                                                      32
If there are mood or depressive symptoms behaviours complete ONE assessment .


Tick      Assessment type completed as evidence of mood behaviour- select ONE only

     0    None
     1    Recommended Behaviour Log
     2    Recommended Depression Scale

If there is high risk behaviours complete ONE assessment.


Tick      Assessment type completed as evidence of high risk behaviour- select ONE only

     0    None
     1    Recommended Behaviour Log
     2    Recommended Behaviour Assessment
     3    Clinical Assessment by a person skilled in mental health or clinical assessments



Step 2. Checklist: Complete the checklist items and complete the flowchart to determine the
rating for ACFI 9 Other Behaviours.




R        Item    OTHER BEHAVIOUR CHECKLIST                                             Tick if Yes

9.        1      Socially Inappropriate behaviours do not occur or are not attempted
9.        2      Mood/depressive symptoms do not occur or are not attempted
9.        3      High risk behaviours do not occur or are not attempted
9.        4      Behaviours occurred or attempted at least once in a week
9.        5      Behaviours occurred or attempted daily
9.        6      Behaviours occurred or attempted daily and with more than one
                 episode in any one day of a week



HOW TO USE THE CHECKLISTS TO GET A RATING
Rating A = yes to (item 1 & item 2 & item 3)
Rating B = yes to item 4
Rating C = yes to item 5
Rating D = yes to item 6



Step 3. Flowchart: Use flowchart or checklists to indicate rating.




                                                                                                     33
ACFI Q9: OTHER BEHAVIOURS Flow Chart

                                               RATING A
 The person displays other behaviour
                                         NO



                 YES

                                               RATING B
The person displays other behaviour at
                                         YES
  least once in a week but not daily



                 NO

                                               RATING C
 The person displays other behaviour
         not more than daily             YES



                 NO

                                               RATING D
The person displays other behaviour
daily and with more than one episode     YES
        in any day of a week




                                                          34
BEHAVIOUR LOG

The behaviour must impact on care needs and be attended to by a staff member. Record any events of the
behaviour when it happens (not just at the end of the shift) . Zero or blank spaces indicate that the behaviour
did not occur in that hour. A frequency of one or more indicates the number of separate events of that
behaviour that were attended to within the hour.

In the example below only on a section of the 24 hour chart has been shown.
Behaviour Type e.g. Problem Wandering                                                                                      70
Describe e.g. interfering in other people’s bedrooms while wandering


DATE        Monday            Tuesday           Wed               Thursday          Friday            Sat                  Sun
TIME
            05/04/2004        06/04/2004        07/04/2004        08/04/2004        09/04/2004        10/04/2004           11/04/2004
            date              date              date              date              date              date                 date

0700        1                                                     1                 0                 0
0800        0                                                     1                 0                 0
0900        1                 1                 2                                   0                 0                    1


Client ID                                                                                                               Office Code
Behaviour Type :
Description :


DATE             Monday            Tuesday             Wed            Thursday            Friday             Sat                  Sun

                ___ ___ ___       ___ ___ ___       ___ ___ ___       ___ ___ ___       ___ ___ ___       ___ ___ ___          ___ ___ ___
TIME               date              date              date              date              date              date                 date
MD-0100
0200
0300
0400
0500
0600
0700
0800
0900
1000
1100
1200
1300
1400
1500
1600
1700
1800
1900
2000
2100
2200
2300
2400




                                                                                                                                        35
ACFI 10: Medication
DOMAIN DESCRIPTION

This domain refers to the needs of the person in following a medication regimen ordered by a
health professional authorised to prescribe medicines under relevant poisons and other legislation.

It is assumed that administration of medication(s) will be carried out in accordance with
requirements in relevant State/Territory legislation.

This domain includes eye and ear drops, nebulisers, metered aerosols, turbuhalers, canisters and
inhalers, the application of transdermal medication patches, other topically applied medication(s)
and rectally or vaginally administered medication(s) ordered by an authorised health professional.

It includes intravenous drug administration through a cannula or hypodermic.

It excludes intravenous infusions, which are covered in ACFI 11 - Technical & Complex Nursing
Procedures. It excludes aperients, which are covered in ACFI 5 – Continence.

Authorised health professional means medical practitioner, dentist, nurse practitioner or other
health professional authorised to prescribe by relevant State/Territory legislation.

Medication(s) refers to:
  • any substance(s) listed in Schedule 2,3,4, 4D or 8 of the Standard for the Uniform Schedule
      of Drugs and Poisons (and its amendments) and/or
  • any therapeutic agent(s) ordered by an authorised health professional. Such agent(s)
      include:
          o eye drops and eye lubricating formulations
          o all vitamins excluding food supplements
          o therapeutic complementary medications, including homeopathic products and/or
  • any therapeutic agent(s) authorised for nurse initiated medication by a Medication
      Advisory Committee or its equivalent

It relates to medication(s) administered on a regular basis. Infrequent, less than weekly,
administration of oral analgesic medication(s) are not covered in this domain. It does not cover
infrequent injections such as influenza vaccination or multi-vitamin injections.

A Controlled Drug means a Schedule 8 drug. In some states this may be called a dangerous drug.
In some states or territories, this may include Schedule 4D drugs where there is a legal
requirement for the recording and storage of Schedule 4D drugs to be the same as for Schedule 8
drugs.

Supervise: to give the correct medication(s) to the care recipient in the correct manner, at the
appropriate times.


Assistance: provide physical assistance or extensive prompting so that the care recipient
completes the ingestion or takes the medications(s).

Administration: to prepare and give the medication(s).




                                                                                                   36
PROCESS

Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented.

Step 2. Checklist: Complete all checklist items, then complete the flowchart to determine the
rating for ACFI 10 - Medication.




R     Item     MEDICATION CHECKLIST                                            Tick if Yes

10.     1      Self manages medication?
10.     2      Needs supervision with medication?
10.     3      Needs assistance with medication?
10.     4      Needs daily administration of a controlled drug?
10.     5      Needs daily administration of a subcutaneous drug?
10.     6      Needs daily administration of an intramuscular drug?
10.     7      Needs daily administration of an intravenous drug?



HOW TO USE THE CHECKLISTS TO GET A RATING
Rating A = yes to item 1
Rating B = yes to item 2
Rating C = yes to item 3
Rating D = yes to (item 4) or (item 5) or (item 6) or (item 7)



Step 3. Flowchart: Use flowchart or checklists to indicate rating.




                                                                                                37
ACFI Q10: MEDICATION Flow Chart
                                                  RATING A
   Does the person self manage their
              medication                    YES



                  NO

                                                  RATING B
Does the person need supervision but not
                                            YES
       assistance with medication



                  NO

  Does the person need assistance with            RATING C
                 medication
                                            YES
 NOT INCLUDING ADMINISTRATION
          -of a controlled drug or
  -of a subcutaneous, intramuscular or
             intravenous drug

                  NO

                                                  RATING D
Does the person need daily administration
           of a controlled drug             YES



                  NO

                                                  RATING D
Does the person need daily administration
   of subcutaneous, intramuscular or        YES
            intravenous drug




                                                             38
ACFI 11: Technical and Complex Nursing Procedures
DOMAIN DESCRIPTION

This domain relates to the assessed need for technical and complex nursing procedures and
activities. The ratings in this domain relate to the technical complexity and frequency of the
procedures and to the requisite competencies of the persons that carry out the procedures in the
three lists. The pilot phase results indicated that the National Trial data should be used to adjust
the final ratings.

The activity should be provided by staff on at least a daily basis.

Identify the frequency any complex procedure needed and locate it in the relevant list and apply
the appropriate rating.
    • List 1- comprises the least complex daily clinical activities & procedures
    • List 2- comprises moderately complex daily clinical activities & procedures
    • List 3- comprises the most complex daily clinical activities & procedures

Frequency                                               List 1
 per day
            Maintenance of skin integrity, including changing position of a chair-fast or bed-fast person but
            does not include only the routine application of a moisturizer.
            Eye care other than eye drops which are covered in ACFI 10 - Medication
            Maintenance of oral hygiene including mouth care after nebulisers etc (excluding cleaning of
            teeth which is covered in ACFI 3 – Personal Hygiene)
            Blood pressure measurement
            Blood sugar measurement
            Simple foot care
            Care and fitting of prosthesis
            Anti-embolic stockings, hip protectors or sling/collar/cuffs
            Application and/or daily monitoring of condition of dry dressings for non infected condition
            Catheter care other than insertion or removal of catheter, including perineal/penile toilet and
            change of drainage bag
            Oxygen therapy where the supply of oxygen is continuous and has been prescribed by a
            medical practitioner, or where the person is capable of self-managing oxygen
                                                        List 2
            Application and/or daily monitoring of condition of wet wound dressings
            Special feeding for persons with dysphagia (difficulty with swallowing)
            Tube feeding and cleaning of tube following feeding
            Maintenance of an established pain management or palliative care program
            Maintenance of a stoma care program
                                                        List 3
            Suctioning airways
            Tracheostomy care
            Application and/or daily monitoring of condition of complex wound dressings – e.g. requires
            removal of exudate or aseptic wound management
            Oxygen therapy which needs ongoing supervision
            Dialysis treatment
            Insertion, care and maintenance of tubes including peg, intravenous and naso-gastric tubes
            Establishing and reviewing a catheter care program, including the insertion, removal and
            replacement of catheters
            Planning, implementation and supervision of a complex pain management or palliative care
            program including monitoring and managing any side effects’
            Planning, implementing and reviewing stoma care


                                                                                                          39
PROCESS (NOTE: this rating methodology will be changed after the national trial and
will use both frequency and complexity as a proxy for resource utilization)

Step 1. ACFI Assessment: Carried out within the last 3 months and the identified usual care
needs, not occasional or exceptional needs have been documented. Documented assessments to be
completed by a Medical Practitioner, Registered Nurse, or other health professional appropriate
to the particular procedure.

Step 2. Checklist: Complete the checklist items, then complete the flowchart to determine the
rating for ACFI 11 - Technical and Complex Nursing Procedures.

R        Item      TECHNICAL & COMPLEX CHECKLIST                                      Tick if Yes
11.         1      Requires a daily procedure from list 1
11.         2      Requires N (number & frequency tbd) daily procedures from list 1
11.         3      Requires a daily procedure from list 2
11.         4      Requires N (number & frequency tbd) daily procedures from list 2
11.         5      Requires a daily procedure or procedures from list 3
11.         6      Free of any procedures from list 1 to list 3


HOW TO USE THE CHECKLISTS TO GET A RATING
Rating A = yes to (item 6)
Rating B = yes to (item 1)
Rating C = yes to (item 2) or (item 3)
Rating D = yes to (item 4) or (item 5)

Step 3. Flowchart: Use flowchart or checklists to indicate rating.
ACFI Q11: TECHNICAL NURSING Flow Chart
                                                                               RATING A
      Is the person free of any procedures
                                                            YES
               from list 1 to list 3


                      NO


                                                                               RATING B
          Requires 1 procedure only
                                                            YES
                 from list 1


                      NO


                                                                               RATING C
Requires N procedure(s) from list 1 &/OR
                                                            YES
         a procedure from list 2


                      NO


                                                                               RATING D
Requires N procedure(s) from list 2 &/OR
                                                            YES
         a procedure from list 3




                                                                                                    40
ACFI 12: Therapy
Note: this question will not be applicable for external assessors.
DOMAIN DESCRIPTION

This domain relates to the assessed needs with regard to therapy.

The therapy interventions should be carried out for a minimum of 15 minutes over a 24 hour day
and be provided by staff on at least a weekly basis?

It relates only to therapy assessed and documented as a care need by a qualified therapist who
meets the requirements for full membership of the therapist’s national or state body OR be a
registered nurse for physical therapy.

Therapy is justified where there is an assessed need for therapy to improve, maintain or minimise
loss of, a person’s existing level of function.

Therapies which are covered in this domain are limited to:
      • physiotherapy;
      • physical therapy developed by registered nurses, for example:
          o passive movements for unconscious or severely disabled persons, and
          o chest percussion


PROCESS

Step 1. Assessment: Carried out within the last 3 months and the identified usual care needs,
not occasional or exceptional needs have been documented. Documented assessments to be
completed by Medical Practitioner, Registered Nurse or Physiotherapist.


Step 2. Checklist: Complete the checklist items, then complete the flowchart to determine the
rating for ACFI 12 Therapy.




R     Item   THERAPY CHECKLIST                                                    Weekly
                                                                                  minutes
12.    1     Requires Physical therapy?
12.    2     Requires Physiotherapy?
12.    3     Total weekly therapy minutes




                                                                                                 41
HOW TO USE THE CHECKLISTS TO GET A RATING

Rating A = 0 total weekly minutes
Rating B = between 15 to 30 minutes total weekly minutes
Rating C = between 31 and 119 total weekly minutes
Rating D = 120 minutes or more total weekly minutes


Step 3. Flowchart: Use flowchart or checklists to indicate rating.




R- RCS Q12: THERAPY Flow Chart
                                                                     RATING A
 Does the person need therapy on a
  one-to-one basis or on a regular,               NO
           ongoing basis


                YES

                                                                     RATING B
        Requires therapy for
     15 to 30 minutes per week                   YES



                NO

                                                                     RATING C
         Requires therapy for
     31 to 119 minutes per week                  YES



                NO

                                                                     RATING D
       Requires therapy for
   120 minutes or more per week                  YES




                                                                                42
ACFI 13: Mental & Behaviour Diagnosis

DOMAIN DESCRIPTION

This question relates to a documented diagnosis. The diagnosis should be relevant to the current
care needs of the person and selected from the list of mental and behavioural disorders as
indicated.

Mental and Behavioural disorders (500 to 580)

□      Dementia Alzheimer’s disease
       e.g. early onset, late onset, atypical or mixed type, unspecified
□      Vascular dementia
       e.g. multi-infarct, subcortical, mixed, other
□      Dementia in other diseases
       e.g. pick’s disease, Creutzfeldt-Jakob, Huntington’s, Parkinson’s, HIV
□      Other dementias
       e.g. alcoholic dementia, unspecified
□      Delirium
       e.g. superimposed on dementia, not superimposed on dementia, unspecified
□      Psychoses, mood disorders
       e.g. schizophrenia, depressive/mood affective disorder, paranoid states
□      Neurotic, stress related, somatoform disorders
       e.g. phobic and anxiety disorders, nervous tension/stress, obsessive-compulsive disorder,
       other
□      Intellectual & developmental disorders
       e.g. intellectual disability (e.g. mental retardation – re JP query), intellectual disorder,
       autism, Rhett’s syndrome , Asperger’s syndrome etc
□      Other mental & behaviour disorders
       e.g. due to alcohol or psychoactive substances (includes alcoholism, Korsakov’s
       psychosis), adult personality & behavioural disorders


PROCESS

Does the person have any of the following mental & behaviour disorder(s) that have a current
impact on their need for support, assistance with activities of daily living and social participation?

Step 1. Appropriate documentation of a diagnosis has been sighted.

Step 2. Checklist: Complete the checklist items. If the person has no disorder of relevance, place
a tick in the first option (no diagnosis) and STOP.




                                                                                                     43
If known, indicate the profession of the person who provided the documented diagnosis.


PROFESSION OF WHO DIAGNOSED                                       CODE
General Practitioner                                               1
Geriatrician                                                       2
Psychiatrist                                                       3
Neurologist                                                        4
Psycho-geriatrician                                                5
Psychologist                                                       6
Nurse Practitioner                                                 7
ACAT validate the diagnoses                                        8
Unknown                                                            9




              MENTAL & BEHAVIOURAL                      Tick if       Who       Date of diagnosis
                   DISORDERS                            YES        diagnosed     (month & year)
                                                                   (code from
                                                                     above)
 0     No diagnosed disorder of interest
500    Dementia Alzheimer’s disease
510    Vascular dementia
520    Dementia in other diseases
530    Other dementias
540    Delirium
550    Psychoses, mood disorders
560    Neurotic, stress related, somatoform disorders
570    Intellectual & developmental disorders
580    Other mental & behaviour disorders




                                                                                                    44
ACFI 14: Medical Diagnosis

DOMAIN DESCRIPTION

This question relates to a diagnosed and documented disease or disorder excluding the mental and
behavioural disorders recorded in ACFI 13. The health condition should be relevant to the current
care needs of the person.

The full list of codes is available in ACAP data dictionary (Appendix H of the ACAP MDS v2.0),
and a selection of the most commonly reported health conditions is provided at the end of the
Health Checklist. These items are based on the ICD-10-AM classification and are comparable to the
ABS 4 digit code.

PROCESS

Does the person have any of the following health disease(s) disorder(s) that have an impact on
their need for assistance with activities of daily living and social participation?

Step1. Appropriate documentation of a diagnosis has been sighted or the ACAT service has
provided the diagnosis.

Step 2. Checklist: Complete the checklist items. If the person has no disorder of relevance, tick the
first line and STOP.

       Tick the types of health conditions that have been diagnosed.
       Select the health condition code from the attached list or write the details.




                                                                                                   45
HEALTH CHECKLIST


14   Health Condition                     Tick     Provide written details or Code
     relevant to the current              if     (use ACAP Health Condition codes)
     care needs of the person             YES
 0   No diagnosed disease or disorder
 1   No formal diagnosis available
 2   Not stated or inadequately
     described
 3   Certain infections and parasitic
     diseases

 4   Neoplasms (tumours / cancers)



 5   Diseases of blood, blood forming
     organs, immune mechanism

 6   Endocrine, nutritional &
     metabolic disorders

 7   Diseases of the nervous system



 8   Diseases of the eye & adnexa



 9   Diseases of the ear & mastoid
     process

10   Diseases of the circulatory system



11   Diseases of the respiratory system



12   Diseases of the digestive system



13   Diseases of the skin &
     subcutaneous tissue

14   Diseases of the musculoskeletal
     system & connective tissue

15   Diseases of the genitourinary
     system




                                                                                     46
Example of ACAP Medical Condition Codes
Code      Examples
0000      No health condition diagnosed
9998      No formal diagnosis available
9999      Not stated/ inadequately described
0100      Certain infectious and parasitic diseases
          e.g. TB, Polio, HIV/AIDS, , meningococcal infection, viral meningitis, scarlet fever
0104      Diarrhoea & Gastroenteritis of presumed infectious origin
0200      Neoplasms (tumours / cancers)
0205      skin cancer
0206      breast cancer
0207      prostate cancer
0209      non-Hodgkin’s lymphoma
0210      leukaemia
0298      other neoplasms e.g benign tumours or tumours of unknown or uncertain behaviour
0300      Diseases of blood, blood forming organs, immune mechanism
          e.g. haemophilia, immunodeficiency disorder (not AIDS)
0301      anaemia
0400      Endocrine, nutritional & metabolic disorders
0401      disorders of the thyroid gland
0402      diabetes mellitus type 1
0403      diabetes mellitus type 2
0404      diabetes mellitus - other specified/unspecified
0405      malnutrition
0498      other endocrine, nutritional & metabolic disorders e.g. malnutrition, obesity
0600      Diseases of the Nervous System
0602      Huntington’s disease
0604      Parkinson’s Disease
0607      Multiple Sclerosis
0608      epilepsy
0698      other diseases of the Nervous System e.g. non viral meningitis & encephalitis, T.I.A.’s, brain
          diseases/disorders, muscular dystrophy, cerebral palsy, paralysis
0700      Diseases of the eye & adnexa
0701      cataracts
0702      glaucoma
0703      blindness
0704      poor vision
0798      other diseases of the eye & adnexa
0800      Diseases of the ear & mastoid process
0801      Meniere’s disease (includes vertigo)
0802      deafness/hearing loss
0898      other diseases of ear & mastoid process e.g. tinnitus
          Diseases of the circulatory system (0900 to 0920)
0900      Heart disease
          e.g. angina, myocardial infarction, ischaemic heart disease, congestive heart failure
0910      Cerebrovascular disease
          e.g. subarachnoid/intracranial haemorrhage, cerebral infarction
0915      Stroke (CVA) – cerebrovascular accident unspecified
0920      other diseases of the circulatory system
          e.g. hyper/hypotension, aortic/arterial aneurism, atherosclerosis
0921      hypertension
0922      hypotension
0999      other diseases of the circulatory system
1000      Diseases of the respiratory system
1001      Acute upper respiratory infections (common cold, acute sinusitis, acute tonsillitis, upper
          respiratory infections)


                                                                                                           47
1002   influenza & pneumonia
1003   acute lower respiratory infections (bronchitis)
1004   other diseases of the upper respiratory tract (includes- respiratory allergies excluding allergic
       asthma, chronic rhinitis & sinusitis, diseases of chronic tonsils & adenoids)
1005   chronic lower respiratory diseases including emphysema, COAD, asthma
1098   other diseases of the respiratory system
1100   Diseases of the digestive system
1101    diseases of the intestine, ulcers, hernias, enteritis, colitis, diverticulitis, irritable bowel syndrome
1103   diseases of the liver
1198   other diseases of the digestive system e.g. diseases of the peritoneum, gallbladder, pancreatitis etc
1200   Diseases of the skin & subcutaneous tissue e.g. skin allergies
1201   skin & subcutaneous tissue infections (impetigo, boil, cellulitis)
1202   skin allergies – dermatitis & eczema
1298   other diseases of the skin & subcutaneous tissue e.g. bedsore
1300   Diseases of the musculoskeletal system & connective tissue
1301   rheumatoid arthritis
1302   other arthritis and related disorders (gout, arthrosis, osteoarthritis)
1304   back problems
1306   osteoporosis
1398   other diseases of the musculoskeletal system & connective tissue e.g. rheumatism, osteomyelitis,
       soft tissue & muscle disorders
1400   Diseases of the genitourinary system
1401   kidney and urinary system- renal failure, cystitis
1402   urinary tract infection
1403   incontinence – urinary (stress, overflow etc- do not include unspecified)
1498   other diseases of the genitourinary system e.g. prostate, menopausal disorders
1500   Congenital malformations, deformations, chromosomal abnormalities
1598   other e.g. spina bifida, Down’s syndrome, congenital brain damage
1600   Injury, poisoning or consequences of external causes
1601   injuries to head
1602   injuries to upper limbs
1603   injuries to lower limbs
1604   amputation of finger/thumb/hand/arm/shoulder
1605   amputation of toe/ankle/foot/leg
1611   fracture of the femur
1613   poisoning by drugs, medicaments & biological substances
1698   other e.g. complications of surgical/medical care
1700   Symptoms and signs (without diagnosis, unspecified)
1703   breathing difficulties/shortness of breath
1704   pain
1707   incontinence - bowel
1708   unspecified urinary incontinence- (check against 1403)
1714   abnormalities of gait & mobility
1715   falls (frequent with unknown aetiology)
1716   disorientation (confusion)
1717   amnesia (memory disturbance, lack or loss)
1719   restlessness & agitation
1720   unhappiness
1722   hostility
1723   physical violence
1727   malaise & fatigue
1798   other




                                                                                                             48

				
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Description: Aged Care Funding Instrument (ACFI)201041005347