Commissioner’s message
The commencement of the new Serious Incident Response Scheme (SIRS) on 1 April is an important and significant development for the aged care sector and for aged care consumers. I appreciate the time and effort that providers have put into getting ready for this, and I have no doubt that this scheme will help to protect older Australians in care from the risk of harm and, over time, will improve their experience of aged care.
Over the last month the Commission has continued to deliver a range of information and resources to assist providers in understanding your new obligations under the scheme. Our education and engagement activities during March have included 3 further one-hour webinars, the release of new fact sheets, guides and frequently asked questions to explain various aspects of the new scheme, and new modules about SIRS in Alis (our online learning platform). You can find this material on our website.
The Australian Government’s initial response to the final report of the Royal Commission into Aged Care Quality and Safety, released on 1 March 2021, reaffirmed its commitment to transforming the aged care system, and set out funded reform initiatives within 5 pillars.
For the Commission, the initial package includes the establishment of a new Senior Practitioner role with responsibility for ensuring that residential aged care services are doing everything possible to minimise restrictive practices. The Commission will also receive funding to lead work with the sector to lift provider capability.
We welcome the Royal Commission’s final report and look forward to continuing to work closely with the Department of Health, other agencies and key stakeholders to deliver on the Government’s reforms and plans for the aged care sector.
Serious Incident Response Scheme (SIRS) update
The Serious Incident Response Scheme (SIRS), a new Commonwealth initiative which aims to reduce the risk of abuse and neglect in aged care services, commences on 1 April 2021.
In preparation for the scheme’s commencement, the Commission has developed a range of resources to help providers understand and implement their new obligations.
Comprehensive guidelines to assist providers to implement the requirements of the SIRS are available on the Commission’s website:
- ‘Serious Incident Response Scheme: Guidelines for residential aged care providers’ describe the responsibilities of providers in relation to SIRS.
- ‘Effective incident management systems: Best practice guidance’ provides information to help providers develop and embed a best-practice incident management system which enables them to respond to and manage specific incidents and near misses in their services.
A number of shorter fact sheets have also been developed on the same topics (introduction to SIRS; effective incident management system).
The Commission’s series of free webinars (4 to date) has delivered need-to-know information to providers and given participants the chance to ask any questions they may have about the SIRS. The webinars have introduced the new scheme, provided an overview of the components of an effective incident management system, and looked at reporting requirements under the scheme. Recordings of these webinars can be accessed and watched through the Resources section of our main SIRS webpage. A fifth webinar to be held in early April will be advertised shortly.
The SIRS frequently asked questions webpage is also being updated regularly to answer questions that providers have regarding the scheme.
For more information and access to resources, visit the Commission’s SIRS page.
New SIRS module available now on Alis
The first in a series of new modules about the Serious Incident Response Scheme (SIRS) is now available on Alis, our Aged Care Learning Information Solution.
The first module provides introductory information about the scheme, including about incident management and reportable incident obligations. It also has a short survey for your completion both before and after you complete the module, to allow you to self-assess your knowledge and understanding of the SIRS requirements.
To assist you with accessing both the SIRS modules and the existing Aged Care Quality Standards modules, all Commonwealth-funded aged care services can access 4 free registrations to our online learning platform until 31 October 2021. You can also purchase additional Alis registrations, if needed.
To access the new SIRS modules or to register for Alis, go to learning.agedcarequality.gov.au.
Antimicrobial stewardship
Antimicrobial medications include antibiotics, antivirals and antifungals. Effective infection prevention and control (IPC) measures and antimicrobial stewardship (AMS) interventions improve infectious disease outcomes and help to address the problem of antimicrobial resistance (for example, where a specific antibiotic medication may have no impact on an infection caused by a particular bacteria which has developed resistance to that medication).
The recent 2019 Aged Care National Antimicrobial Prescribing Survey Report and the final report of the Royal Commission into Aged Care Quality and Safety both point to very concerning, ongoing levels of inappropriate antimicrobial use in Australian residential aged care services. Inappropriate antimicrobial use can contribute to antimicrobial resistance.
Under Standard 3: Personal care and clinical care of the Aged Care Quality Standards, aged care providers are required to demonstrate practices to promote appropriate antibiotic prescribing and use to support optimal care and reduce the risk of increasing resistance to antibiotics. IPC management and AMS are also broadly captured in a number of the other Quality Standards as well.
Providers should review and strengthen their AMS policies, programs and strategies to ensure that accountability for antimicrobial use sits at the highest level of management, which takes responsibility for ensuring that an AMS program is developed and implemented, and its outcomes evaluated.
AMS programs should promote the use of current evidence-based guidelines for the management of infections in consumers, and provide easy access to guidelines for staff and visiting health professionals.
Consumer involvement and information
Remember that aged care residents are no different from any other person in terms of having a role to play in this process, including a right to be included in discussions about their medication management. Antibiotic use is not without potential harms to the consumer including:
- risk of developing multi-resistant organisms which potentially cannot be effectively treated by antimicrobials
- side effects such as loss of appetite and diarrhoea
- allergies, which may be severe
- disruption of normal flora – which means ‘good’ bugs can be destroyed along with the pathogens (‘bad’ bugs) and increased risk of Clostridioides difficile infection and fungal infections such as thrush
- drug interactions between some antimicrobials and other drugs.
The Commission has worked with the Older Persons Advocacy Network (OPAN) to develop some ‘Medication: It’s your choice. It’s your right.’ consumer resources, which are also suitable to help management, staff and prescribers better understand the consumer’s role, and that of their substitute decision-makers where applicable, in medication prescription, management and consent.
Further information about AMS will be provided in the April edition of the Quality Bulletin.
Infection prevention and control requirements
As detailed in the December 2020 edition of the Quality Bulletin, to ensure that residential aged care providers are better prepared to respond to infectious diseases, including COVID-19 and influenza, all residential aged care services are now required to have a dedicated, onsite clinical Infection Prevention and Control (IPC) lead.
Embedding an IPC lead in each service is intended to build enduring capability in relation to infection prevention and control. IPC leads must be based at their nominated facility to provide advice and oversight as part of ongoing, day-to-day operations, and champion continuous improvement in infection prevention and control across the service.
The Commission expects that, in accordance with the Aged Care Quality Standards, each residential aged care provider will develop and implement an effective infection prevention and control program. To support providers, the Commission has updated the 'Guidance and resources for providers to support the Aged Care Quality Standards' handbook to reflect the IPC lead requirements, including those for specific infection control training for residential aged care providers.
Read more in the Commission’s IPC lead update for providers.
COVID-19 restrictions on residents
The Commission continues to receive a small number of complaints about COVID-19 restrictions on aged care facility residents preventing them from being able to leave the home to attend appointments, access the community or take part in social events. This includes complaints about residents being required to isolate in their rooms for 14 days after having attended an event or appointment outside the service.
Such restrictions are inconsistent with the rights of aged care residents, including their rights under the Charter of Aged Care Rights. Providers should only impose restrictions on a resident’s right to move freely within or outside a service where required under a public health directive. Any other restrictions may constitute restraint and should be managed in accordance with the Quality of Care Principles which place obligations on providers to minimise the use of restraints.
The Australian Health Protection Principal Committee’s (AHPPC) 'Coronavirus (COVID-19) – National aged care guidance – aged care visitation guidelines' provide guidance to aged care providers on the management of visitation and other restrictions according to the 3 escalation tiers based on the level of COVID-19 transmission within the community.
When the Commission receives a complaint related to COVID-19 restrictions, we ask the provider to explain their current approach based on the AHPPC guidance and any public health directive currently in force. If the restrictions imposed by the provider exceed the guidelines and any health directive, we draw that to the provider’s attention and seek to resolve the situation to the complainant’s satisfaction. A provider in this circumstance that is unwilling to adjust their restrictions may be the subject of a proportionate regulatory response.
A recent case demonstrates our approach. The Commission received a complaint from the daughter of a 95-year-old resident of a residential service in Sydney who was being required to isolate in his room for 14 days after visiting his family. A Complaints Officer contacted the Service Manager who told her that this was the provider’s policy, based on advice from the public health unit. The Complaints Officer explained the escalation tiers in the AHPCC advice and pointed out that there had been no community transmission in New South Wales for around 40 days, at that stage. The Service Manager took this back to the provider’s management and, as a result, the provider reviewed its policy and removed this requirement. The provider then undertook to communicate this policy change to all families. The resident’s daughter was very happy that she would be able to take her father home so he could enjoy time with his family.
For further guidance on management of restrictions related to COVID-19, please also refer to the resources available on our COVID-19 provider resources webpage.
Time to review your outbreak management plan
Even as increasing number of aged care residents across Australia are receiving the first round of COVID-19 vaccines, it’s important that providers remain vigilant against the threat of COVID-19 and other transmissible viruses.
Providers can demonstrate their vigilance and preparedness by routinely testing their outbreak management plans (OMP). OMPs should be reviewed regularly to ensure:
- they are up to date, reflecting the level of risk at the service
- all staff are familiar with outbreak management procedures
- staff are reminded not to become complacent
- there are plans in place to maintain continuity of care for residents.
During the pandemic, many providers organised a trial run of all possible aspects of their OMPs. Testing your plan may help highlight areas that need improvement. For example, one provider became aware of the additional resourcing needed to address the increased communication requirements during an outbreak, such as communicating with residents, families, internal staff and responding to media enquiries.
Find out more about outbreak management planning in aged care on our website.
Consultation with aged care facilities about residents’ hearing health
In the 2020–21 budget, the Australian Government allocated $21 million over 5 years to implement key initiatives from the Roadmap for Hearing Health to improve the lives of the millions of Australians affected by hearing loss.
This includes funding to scope, develop and test measures for residential aged care staff to better identify and support aged care residents with hearing loss.
The Department of Health is supporting this initiative by starting a project that involves a gap analysis of processes and workforce training in hearing health in aged care facilities. A best-practice model will then be developed based on recommendations from the gap analysis.
If you’re interested in being consulted as part of this project, you can email the Department at ACworkforceprograms@health.gov.au
COVID-19 vaccination resources
- The Department of Health has published a decision guide to help people who are frail or very old, including those living in residential aged care facilities and their representatives, to make an informed decision about getting a COVID-19 vaccine.
- The Department of Health has updated the consent form for COVID-19 vaccinations. It now captures the individual’s name and Medicare number on each page. The department is requesting that residential aged care facilities ensure that all future consent records use the updated form.
- The Department of Health has updated its policy on excess dose usage for COVID-19 vaccines at residential aged care facilities. Once residents have been vaccinated, vaccine workforce providers should allocate excess doses based on a series of prioritisation principles.
