Commissioner’s message
Before outlining the contents of this Bulletin, I have some exciting news to share. The Commission is hosting a national aged care conference titled ‘Working together – our journey through aged care reform and regulation’, which will be held at the Melbourne Convention and Exhibition Centre on 8-9 June 2023. For now, please save the date! Also, look out for all the details in the March issue of the Quality Bulletin and stay up to date by regularly visiting our website.
In other news, the Commission held our first webinar for 2023 - ‘Site audits in residential aged care’ - in February. It was fantastic to see the high level of interest and attendance with over 2,000 registrations being received.
The webinar provided a pragmatic walk through of the approach taken by quality assessors when auditing a residential service, which in turn highlighted the range of areas that require ongoing attention by a service so that the manager and staff can be confident of coming through an unannounced audit well.
Our next webinar on 21 March will be on ‘Early lessons learned from SIRS in home services’. Registrations for this webinar are now open. I’d also like to draw your attention to online interactive workshops being hosted by the Commission on SIRS in home care.
As everyone in the aged care sector continues to bed down the reforms that commenced in December 2022, we are also anticipating what is up ahead of us. The requirement for services to have a registered nurse onsite 24/7 commences on 1 July 2023, and you can read more about this key reform in this issue.
Last month I provided an update on the pilot program that the Commission is running to test the draft strengthened Quality Standards and our proposed audit methodology. The expressions of interest we have received from the many services keen to participate in the pilot is welcome confirmation of the value that providers see in this exercise. If you haven’t yet registered your interest and would like to be considered for participation, please email agedcarereform@agedcarequality.gov.au. Further information about the pilot can be found on our website.
I think I have mentioned previously that the Commission is progressing a major project to renew our website and make it more user-friendly. While that work is progressing, we continue to add content to ensure that it remains a valued “go to” site for the latest information. In this regard, in February we introduced a Consultation and Engagement Hub where you can keep up to date on these sorts of activities and find out how you can get involved.
I hope you enjoy this month’s bulletin and would welcome any feedback or suggestions you might like to offer about content for future editions.
Aged care reform update
24/7 registered nurse requirement from 1 July 2023
From 1 July 2023, approved providers must have at least one RN on-site and on duty 24 hours a day, 7 days a week, at each residential facility. This requirement has been introduced in legislation in response to a recommendation by the Royal Commission into Aged Care Quality and Safety.
The 24/7 RN requirement reduces the risk of resident harm by ensuring that qualified and experienced care staff are always available to identify and address potential risks. This also gives residents better access to the highest level of clinical care to meet their individual needs, and:
- allows RNs to manage some issues as first responders
- prevents unnecessary trips to hospital emergency rooms.
Logically, residential services are keen to find out as much as possible about their reporting obligations regarding the new 24/7 onsite registered nurse (RN) requirement that commences from 1 July 2023. A related area of interest involves eligibility for exemption and the process for applying for an exemption.
These issues are addressed in an exposure draft of the subordinate legislation that has now been released by the Department of Health and Aged Care. The exposure draft and explanatory statement is available for comments which can be made to the Department by emailing anaccoperations@health.gov.au by 13 March 2023.
Reporting
In summary, providers will be required to report monthly on all periods of 30 minutes or more where an RN is not onsite and on duty.
The Commission will work closely with the Department of Health and Aged Care to consider the reporting, including as part of risk profiling which informs our decisions on risk-based monitoring activities. Where there are concerns with a provider’s compliance, the Commission may take further regulatory action including monitoring a service’s performance, directing a provider to take specific action/s, and/or taking enforcement action.
Exemptions
Eligible residential facilities with 30 or less operational beds in Modified Monash Model (MMM) 5,6 or 7 locations may be granted an exemption from the 24/7 RN requirement for up to 12 months from 1 July 2023.
To be considered for an exemption, residential facilities must:
- apply for an exemption to the Department of Health and Aged Care (Department)
- provide evidence that they have taken reasonable steps to ensure that the clinical care needs of the care recipients in the facility will be met during the period for which the exemption is in force. In considering the provider’s application, the Department will seek advice from the Commission on the steps taken by the applicant, and about other matters such as the applicant’s compliance history.
Exempt residential facilities may opt out of the exemption at any time by making a request to the Department.
Funding supplement
Support will be available from the Department to help meet this requirement from 1 July 2023.
Residential facilities with an average of 60 residents or fewer (based on occupied beds) which are not exempt from the 24/7 RN responsibility, will be eligible for a funding supplement to employ extra RNs to deliver 24/7 RN care.
Further information
The Department has released a Care minutes and 24/7 registered nurse requirements guide. It provides information about care minutes targets and definitions, the 24/7 RN responsibility from 1 July 2023, and mandatory care minutes responsibilities from 1 October 2023.
Provider obligations to exercise due diligence when engaging workers
Recently, the Commission became aware that the Australian Health Practitioner Regulation Agency (Ahpra) had taken action against an aged care worker purporting to be a registered occupational therapist, who was providing services to older Australians in residential aged care. More information about this case can be found in the Ahpra media release here.
This is a timely reminder for approved providers to exercise due diligence when engaging workers to ensure that your workforce is appropriately skilled and qualified to carry out their roles. This includes having effective recruitment and selection processes with appropriate checks being undertaken for successful applicants, including confirming the accuracy of records provided with or following the application.
Aged Care Quality Standard 7 - Human resources requires providers to have a workforce that is sufficient, and is skilled and qualified to provide safe, respectful and quality care and services. Under this standard, providers are expected to have recruitment practices in place to ensure that workers engaged in their aged care services are suitable and appropriate for the role. Further information on the Quality Standards is available on the Commission website.
Aged care workers should give accurate information to the provider about their qualifications, skills, experience and competencies, and notify the provider of information that may hinder their ability to ensure that consumers receive safe and competent care.
Working outside of scope of practice or providing inaccurate information to the provider during recruitment are behaviours that are not consistent with the Aged Care Code of Conduct (the Code). The Commission can take compliance and enforcement action directly against aged care workers and governing persons who do not comply with the Code. In severe cases, compliance and enforcement action may result in aged care workers or governing persons being banned from working in the aged care sector.
The introduction of new governance responsibilities from December 2022 clarified providers’ obligations regarding key personnel. More information about this can be found on the reforms webpage, including guidance for approved providers.
Ahpra works in partnership with the National Boards of 16 professions registered to provide health services in Australia, and maintains a list of every registered practitioner to ensure that they are suitably trained and qualified.
Approved aged care providers are encouraged to check Ahpra’s public register to verify the registration of successful job applicants before they commence employment with an aged care service, and then regularly throughout their employment to ensure that registration has been maintained.
Home services pricing and agreements - Navigating changes the right way
There are many reasons why care arrangements for consumers may need to change. When there is a need to change care arrangements, providers have responsibilities they must meet.
Our complaints data highlights that lack of communication and consultation about care, fees and charges are frequently raised as issues of concern by consumers who receive home services. At the centre of many of these complaints, there has often been a change to care arrangements. These issues consistently trend as our most common complaints in the home services sector. The Commission has an important role to play in addressing complaint issues. To help providers improve their communication and consultation about pricing and agreements, we have released new resources.
For Providers
The Home service pricing and agreements – Navigating changes the right way provider guidance is now available to help providers to continue to meet their responsibilities. This guidance will assist providers in navigating the right way to:
- ensure reasonable and transparent pricing
- consult with consumers and gain mutual consent before making changes to agreements
- deliver care and services consistent with consumer needs, goals and preferences
- cease home services
Expansion of the Quality Indicators program
From 1 April 2023, the Department of Health and Aged Care is further expanding the National Quality Indicator (QI) Program. This is part of the Australian Government’s response to the Royal Commission into Aged Care Quality and Safety. These changes are being implemented through the 2021–22 budget measure Empowering consumers of aged care with information to exercise choice.
Six new quality indicators will be introduced for residential aged care:
- activities of daily living
- incontinence care
- hospitalisation
- workforce
- consumer experience
- quality of life.
A suite of resources is available for residential aged care providers to support consistent data collection and quality improvement activities relating to the new quality indicators. These resources are available on the Department’s website.
Residential aged care - applications for re-accreditation
An approved provider of an accredited residential service, or previously accredited service, must apply to the Aged Care Quality and Safety Commission (the Commission) for re-accreditation well before accreditation expiry. The Commission gives providers a reminder before the end of the service's period of accreditation.
Please remember that you need to submit your application for re-accreditation as soon as you are eligible. Our website provides a detailed description of the process of applying for re-accreditation.
For consumers - strengthening provider governance
A new webpage for consumers explaining the Strengthening Provider Governance reforms are now available. Providers are encouraged to share these resources with their workforce and consumers.
The resources provide an overview of the new governance responsibilities of approved providers. They include information on the role of Consumer Advisory Body/ies and how consumers can expect to participate.
Reminder – guidance documents available
Approved providers and aged care workers are reminded that detailed guidance documents are available to support implementation of the 1 December 2022 reforms.
These are:
- Provider responsibilities relating to governance – Guidance for approved providers
- Code of Conduct for Aged Care: Guidance for approved providers and Code of Conduct for Aged Care: Guidance for aged care workers and governing persons
- Serious Incident Response Scheme: Guidelines for providers of home services
An extensive range of supplementary resources including fact sheets, videos and more is available on our website.
Webinars
Site audits in residential aged care – recording now available!
The first of our scheduled monthly webinars, ‘Site audits in residential aged care’, was held on 21 February 2022. The recording and speaker presentations are available on our website’s webinar page.
We talked about the Commission’s assessment of the Aged Care Quality Standards, including the assessment methodology and what assessors look for when undertaking a site audit.
The webinar included a focus on the key risks observed by quality assessors when undertaking these audits.
Jason Binder, Managing Director, Respect Aged Care presented on what his organisation does at board, staff and consumer level in preparation for reaccreditation.
Webinar - Food, dining and nutrition – Swallowing and nutrition
17 March 2023 | 1.30pm – 2.45pm AEDT
The third webinar in the Commission’s food, dining and nutrition series will be held on the 17 March on swallowing and nutrition for approved providers and staff.
Panellists include:
- Dr Melanie Wroth, the Commission’s Chief Clinical Advisor
- Kym Torresi, Senior Advisor Aged Care, Speech Pathology Australia, and
- Ngaire Hobbins, Accredited Practising Dietitian.
In this webinar, our expert speakers will:
- speak about the causes and impacts of swallowing problems
- explore the use of texture modified diets (TMDs) and consumer choice
- consider how to maintain good nutrition with TMDs
- discuss preventive and collaborative approaches to swallowing difficulties and nutrition.
Registrations are now open.
You can submit questions for the panel Q&A session before and during the webinar. The webinar will be recorded and made available for on-demand viewing. The recordings of previous webinars are available on our YouTube Channel:
Webinar#1 - Dining and Consumer Choice
Webinar#2 - A case study in food, dining and nutrition
Webinar - Early lessons learned from SIRS in home services
21 March | 1.00 pm – 2.00 pm AEDT
The webinar will focus on the importance of quality reporting and share insights learned since 1 December 2022.
Hosted by the Aged Care Quality and Safety Commissioner, Janet Anderson PSM, panellists include:
- Ann Wunsch, Executive Director, Executive Director, Approvals & Serious Incident Notifications, Aged Care Quality and Safety Commission
- Dr Melanie Wroth, Chief Clinical Officer, Aged Care Quality and Safety Commission.
The live webinar will include a Q&A session and we encourage you to submit questions in advance through the registration link.
Registrations are now open.
Governing for reforms
Webinar – Exploring the role of governing bodies and executives in leading digital adoption
As part of the Governing for Reform in Aged Care Program, the Commission is hosting the ‘Exploring the role of governing bodies and executives in leading digital adoption’ webinar from 12:00 pm – 1:00 pm AEDT on Wednesday 1 March 2023.
Join the following expert panellists for a discussion on the role of governing bodies and executives in leading digital adoption:
- Angela Ryan, Non-executive Director at Australasian Institute of Digital Health
- Nathan Betteridge, Co-founder and Director at Five Good Friends
- Julianne Parkinson, Chief Executive Officer at the Global Centre for Modern Ageing.
This webinar is exclusive to Governing for Reform in Aged Care Program participants. Click the link to enrol in the Program and register to join the webinar: FACE TO FACE COURSE (agedcarequality.gov.au)
Workshops - Governing for Reform in Aged Care
Participation in the Governing for Reform in Aged Care program includes the opportunity to attend virtual workshops with your peers. The workshops will support you to navigate and strengthen your corporate and clinical governance.
To enrol and find out more, visit the Governing for Reform program website.
Food, dining and nutrition – dining with dignity
Being treated with dignity and respect is essential to a person’s quality of life. This does not change after a person enters a residential aged care service. Standard 1 of the Aged Care Quality Standards – Consumer dignity and choice - captures the importance of a consumer’s sense of self.
When it comes to food, dining and nutrition, empowering residents to dine with dignity and ensuring a safe and enjoyable mealtime experience is as important as providing them with nutrition and hydration to maintain good health and quality of life.
As part of our food, dining and nutrition “success stories” series, this month’s case study focuses on dining with dignity.
We would welcome your case studies or ideas on best practice aged care that we can share broadly with the sector as part of our collective goal of continuous learning and improvement. You can send your case studies and ideas to info@agedcarequality.gov.au.
Case study: Dining with dignity – texture modified meals
A resident at a small residential aged care service has swallowing difficulties. The resident is unable to swallow certain foods or liquids as there is a high risk that their condition can cause the food or drink to enter their airway instead of their oesophagus.
The resident is required to have texture modified diets (TMD). This means that the texture of the foods and the thickness of drinks need to be adjusted to make them easier and safer to swallow. The resident did not want to eat in front of others as they felt embarrassed about the texture modified meals provided. They felt that the meals looked sloppy and unappetising, and very different from the food that other residents were eating.
This had a significant impact on the resident’s physical and mental wellbeing. The resident was unhappy and frustrated, and they began to lose weight and were at risk of malnutrition.
To support the resident, the service came up with a strategy to make the texture modified meals more attractive and appetising by changing the way the food was prepared and presented.
The food served to the resident with TMD is now moulded to look like the solid food that is served to other residents who do not have swallowing difficulties. For example, pureed carrot is presented in the shape of a carrot instead of scoops.
As a result, the resident is now happy to eat with the others, their health has improved, and they have regained the weight they lost.
For other case studies, refer to Consumer voice - Improving food, dining, nutrition through resolving complaints and Meals that evoke residents’ memories.
Consumer fact sheet: your choices matter
A Food and dining – your choices matter fact sheet is available for residents living in residential aged care, their family members and advocates.
The fact sheet explains how the Commission can help residents raise concerns about their food and dining experience in residential aged care.
If residents are not satisfied with the food offered or their dining experience and feel uncomfortable talking to their service, they can contact the Commission.
More information for providers and residents is available at our website.
Seniors and ageing well expo
Earlier this month, we joined with the Department of Health and Aged Care to attend the annual Seniors Festival Expo in Sydney, New South Wales and the Care and Ageing Well Expo in Melbourne, Victoria.
Our booth was well attended by visitors to the expos and it was a great opportunity to assist members of the public them with their enquiries.
Follow us on Facebook to stay up to date with what’s happening across the aged care sector: @AgedCareQuality.
Training and resources
Financial and Prudential Standards - why money management matters
In the February edition of Financial and Prudential Regulatory Insights, the Commission’s Peter Edwards discusses the link between provider financial health and the delivery of safe, high quality care.
Aged care providers are encouraged to share the monthly Insights with their chief financial officers (CFOs) and other financial managers, management and director level staff.
Subscribe to the Financial and Regulatory Insights to receive monthly updates.
SIRS online workshop – 7 and 21 March
Registrations are now open to participate in a 3.5 hour interactive virtual workshop on the Serious Incident Response Scheme (SIRS) in home care. The next workshops will be held on 7 and 21 March and are hosted by the Commission.
These workshops complement the guidance and resources on the SIRS and the Effective IMS workshops and are specific to home services aged care providers.
The interactive workshops include practical activities to help participants understand their role and responsibility to meet the requirements of the SIRS. The workshops focus on provider obligations using examples to understand reporting requirements and processes.
Through active participation in this workshop, participants will:
- understand and recognise the importance of having an effective incident management system (IMS)
- know providers’ roles and responsibilities under SIRS
- know providers’ roles in responding to incidents under SIRS
- be able to apply techniques and tips for better prevention, management and reporting of incidents.
There is a registration fee of $50 (excluding GST) per person.
New session dates will also be available over the coming months, so keep an eye out! More information about these workshops and how to register is available on the Workshops page of our website.
Online workshops for home and residential service providers
The Commission regularly hosts online workshops for all aged care providers.
Our workshops include the latest information and resources to ensure that providers have access to resources aligned with legislative changes and the regulatory focus of the Commission.
Upcoming workshops include ‘Monitor and assess the performance of your service’, ‘Quality and safety in home services - 5 key risk areas' and ‘Effective Incident Management Systems (IMS)’.
Workshops are available for all approved providers. Visit the Workshops webpage for further information.
Resources
The following resources have been published or updated:
New
- Provider guidance – Home services pricing and agreements
- Consumer Advisory Bodies
- Get involved – for providers
- Financial and prudential regulatory Insights – February 2023
- Strengthening Provider Governance - consumer video
