Benetas Broughton Hall Measure & Improve ACFI

Broughton Hall is an 80 bed high care facility located in the Melbourne Suburb of Camberwell. It is operated by Benetas Victoria.

Benetas Broughton Hall first commenced benchmarking in 2008 as part of a focus on quality and continuous improvement. This energy has continued to grow and the staff are always looking for opportunities to improve practice and client experience. A large part of the improvement achieved over the past three years relates to better assessment of the needs of the residents.

As with many other facilities the management at Broughton Hall first saw the ACFI system as a continuation of the old RCS system but with a different name and in essence claiming was done around "what was being done for the residents". At that time Broughton Hall averaged just $85 per day in ACFI income.

After just two data collection periods the QPS Principal Consultant was invited to make a presentation to all Benetas Residential Managers about the organisation's data outcomes. Whilst numerous topics were covered the main thrust of the discussion revolved around the question "are our facilities really so low in care needs or are the residents being under assessed?" Reference was also made to a recent QPS Newsletter article where the author wrote that ACFI is about what you should be doing for your residents not just what you have been historically doing for them. This certainly made people think about ACFI differently and the managers left the room determined to see what could be achieved. One of them was Frank McInerny from Broughton Hall. "With support from Benetas' Support Office we took a fresh look at our ACFI assessment system and soon realised that we had not made the paradigm shift from RCS to ACFI" says Frank and added "if you look at the three graphs below you can certainly see a big difference between then and now."

Average income has risen by nearly $50 per day. Behaviour and Complex Needs scores have jumped from well below the industry line to well above the industry line.

According to Frank, the real story is not about the increased ACFI scores but more importantly how a better understanding of ACFI has assisted the staff at Broughton Hall to focus more on individual assessed needs and the provision of services.

Prior to the improved assessment of resident needs, the facility was providing 16 hours physiotherapy per week. Now that the needs of residents are better understood, physiotherapy hours have increased to 28 hours per week for the same number of residents. Residents are also benefiting from enhanced manual handling training for all staff, improved falls risk assessment, better equipment assessment and significant progress with the implementation of the facility's No Lift Policy. This is helping to maintain control over incidents such as skin tears.

The Broughton Hall skin tear rate is being maintained at a relatively low level in the high care data base.

Clinical review of residents has been more structured and each review is completed by the multidisciplinary team, including the physiotherapist. With the focus being on the care needs, there has been a "snowball" impact on our ACFI income without doing anything more than meeting the needs of people in our care.

In addition, Broughton Hall has changed the way they think about resident needs. For example, an assumption is made that all of resident experience pain to some degree and the question now is, to what level? Initiatives such as more structured pain medications reviews by doctors and the application of heat packs has been received favourably by residents also had a positive impact on ACFI income, as has the introduction of a gym service to promote general fitness, which has had a positive impact on pain symptoms.

The multidisciplinary team has also developed a culture of "get it right and document it". In the past there was a tendency to assume that things were being done but much more care is now taken to document ongoing assessments and to build these into the care program. The system is now more coordinated and structured.

In the past few weeks Benetas Broughton Hall has had an unannounced support visit from the Aged Care Standards and Accreditation Agency and a visit from the Commonwealth ACFI validation team. In both instances the review teams were complimentary of the systems for assessment, documentation and the delivery of care. For the team at Broughton Hall, this is extremely satisfying.