In a recent INsite article, Max Robins, deputy chair of the New Zealand Aged Care Association (NZACA) and chief executive of CHT Healthcare Trust outlined the rationale behind the pay equity funding formula used to fund the residential aged care sector.
In this, Robins says it is difficult to see what alternative model could have been used. This is in response to questions over whether the funding could have been based on actual rather than averaged data. The home and community support services sector have based their model on actuals data.
“Unlike homecare, there is not a one to one relationship between resident numbers and staffing level, and occupancy and service mix change constantly,” states Robins in his article.
Linking the formula to these fluctuating occupancy levels has caused many providers concern.
In commenting on Robins’ article, aged care provider Louis Fick says it fails to address the effect of occupancy levels on the fee rate, which is “the most significant deficiency of the funding model”.
“Adjusting the funding model to the average or median occupancy level would have eliminated most of the issues as occupancy has the single biggest impact,” states Fick.
“Not many facilities would have a continuous 100 per cent occupancy, but staff to full occupancy as staffing levels are not that flexible.
“This would have been as simple adjustment not affected by staffing or education levels. Subsequent approval of qualifications, after the funding was put in place, is also not addressed.”
Fick questions whether Robins is supporting the Ministry of Health rather than the providers, or protecting the negotiations team.
However, Robins disputes this.
“I run a group with 16 facilities and have no desire to shoot myself in the foot by supporting the MOH at the expense of providers,” he told INsite. “My role was to represent providers in the best way I could using the information supplied by providers as the basis for calculating the impact of the settlement and putting forward the case on behalf of providers.”
Robins says ultimately the two factors that influence the cost impact are the number of hours of care per resident per day (HPRPD) and the wage differential.
“Occupancy has not been ignored as the hours per resident per day calculation includes the occupancy effect.
“When we surveyed providers we asked how many care hours they provided and how many residents they had on the survey day.
“This enabled us to calculate the hours per resident per day for each provider.”
Robins gives the following example to illustrate:
Provider One operates a 40-bed rest-home at 100% occupancy (i.e. 40 residents) while Provider Two operates a 40-bed rest-home at 75% (i.e. 30 residents). Both facilities run exactly the same roster.
|AM||4 x 7.5 Hours||30|
|AM||2 x 5 hours||10|
|PM||2 x 7.5 hours||15|
|PM||1 x 5 hours||5|
|Night||2 x 8 hours||16|
|Total care hours per day||76|
Hours per resident per day – 40 residents = 1.90
Hours per resident per day – 30 residents = 2.53
Average impact 10.63
By averaging the hour per resident per day we were also averaging the occupancy impact, explains Robins.
He acknowledges that smaller rest homes are likely to feel more acutely the effects of fluctuating occupancy levels.
“However, for small facilities, there is practically no room to adjust staffing hours and therefore any change in occupancy has a significant impact on the gap between revenue and cost,” says Robins.