Facilities that are using a combination of registered nurses, physiotherapists, and occupational therapists are the ones who are getting better resident outcomes whilst optimizing their ACFI income. By using this approach, core interventions that are common to each profession still get completed, but the overlapping scopes of practice allow a multi-disciplinary approach to resident care.

Many Registered ‘Treatment’ Nurses are now receiving specific training in carrying out complex pain management interventions, and can carry these out in accordance with prescribed directives; as per the ACFI User Guide either a registered nurse or an allied health professional may provide complex pain management and practice for a Directive-4a.

Physiotherapists specialise in the assessment and provision of modalities for the management of pain, stiffness, immobility, loss of function, etc. In order to ensure that these assessed needs are appropriately identified, many organisations are maintaining the assessment and prescription of directives as the role of the physiotherapist, and referring some of these interventions to the Treatment Nurses. The ACFI User Guide states that it is permissible for the service to be provided by a different health professional than the one who gave the directive, provided they are included in the list of health professionals who can undertake the service and are operating within their scope of practice.

Using this approach aged care facilities dramatically benefit, both clinically and financially, by having a combination of interventions in terms of complexity and/or frequency. This often involves a mix of Directive-3’s, Directive-4a’s, and Directive-4b’s. To achieve the 6-points from a Directive-4b, this must be performed by an Allied Health Professional. By utilizing a Treatment Nurse to complete the Directive-4a’s, then this potentially allows the Physiotherapist or Occupational Therapist to provide more Directive-4b’s, allowing sites to improve both from a financial and resident outcomes perspective.

Reference: ACFI User Guide
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acfi-1007-userguide.htm