Aged Care Quality Bulletin #23 – November 2020 | Aged Care Quality and Safety Commission

Commissioner's message

As we see reassuring progress on opening up state borders and the prospect of a COVID-19 vaccine becoming available in 2021, it would be easy to lower our guard against the pandemic. But that must not happen. For aged care services, operating in a ‘COVID normal’ world means remaining alert and ready, exercising constant vigilance in relation to infection prevention and control measures that should now be part of everyday routines.

The Commission’s focus on COVID-19 preparedness continues with the release of a new resource to support outbreak management planning in residential aged care. The link to this document is provided in the relevant section below.

Also in this bulletin, we foreshadow the introduction in early 2021 of the Serious Incident Response Scheme, followed by additional quality indicators that will be introduced from July. These new measures are aimed at strengthening providers’ focus on managing and mitigating risks of harm to individuals receiving aged care.

Meals, nutrition and the dining experience for aged care residents is a topic that has attracted growing interest in recent times. In light of its importance to consumers’ wellbeing and quality of life, the Commission has convened an Expert Advisory Group to support activities designed to assist providers to improve their performance in this area, and to meet the relevant requirements in the Aged Care Quality Standards with regard to food and meals.

The coming summer months will in all likelihood present their usual mix of delights and challenges, with the latter including the risks of extreme heat, bushfires, and in the northern parts of Australia, the potential for damaging cyclones. It’s incumbent on all providers to take a responsible approach and manage risk appropriately.

From the Chief Clinical Advisor: Be aware of the risks of heat and sun exposure

The Commission’s Chief Clinical Advisor is reminding aged care providers to be alert to the risks of heat and sun exposure when caring for older people.

People at particular risk include:

those with dementia who may not recognise that they are heating up
those who are very frail or have a low body mass who may heat up more easily
those who struggle to maintain good hydration
those with mobility problems who cannot move themselves to a shady area or cooler space, or who can’t remove outer clothing or bedding.

Locations at particular risk:

buildings or internal areas that cannot be air conditioned or cooled
outdoor areas which the sun can move to, or which are sheltered from breezes
indoor areas where the sun can reach through glass.

Aged care providers should clearly understand the risks pertaining to their buildings, spaces and their individual residents. Strategies to enable staff to manage these risks should be communicated.

Staff should be aware that elderly people can quickly suffer discomfort and clinical consequences of overheating and sunburn. Staff should be aware of the ambient temperature rising in different times and locations, and of the clothing that people are wearing.

In hotter weather and in heatwaves, staff should be reminded to:

monitor fluid intake of vulnerable residents
encourage more frequent drinking of fluids
be aware if toileting becomes less frequent as a sign of poor hydration
respond as a priority to residents saying they are, or appear, hot or thirsty
remind and assist residents with sunscreen, hats and protective clothing if sun exposure is possible
offer tepid sponging or showering
be aware of the signs of overheating, including red or very pale skin, or confusion, as a clinical emergency.

The following fact sheets published by the Commonwealth Department of Health include helpful checklists:

Residential Aged Care - Caring for Older People in Warmer Weather
Home Care/CHSP - Caring for Older People in Warmer Weather

Outbreak management planning resource

The Commission has developed a new resource designed to provide practical guidance for residential aged care providers to support their staff, consumers, families and visitors to prevent, prepare for and manage outbreaks of COVID-19. The document provides guidance for providers based on best practice outbreak management planning and has been developed through engagement with peak bodies, and state and territory health authorities.

In the context of the Aged Care Quality Standards requirements relating to outbreak management planning and preparation, the guidance provides practical, action-oriented guidance and tips to help providers understand the relevant considerations in optimising infection prevention and control and being ‘COVID-ready’ while ensuring the psychosocial wellbeing of residents.

The Commission’s quality assessors are already assessing providers’ compliance with the Aged Care Quality Standards in relation to preventing, preparing for and managing an outbreak. This guidance will provide further advice and prompting for providers to check whether they have taken all necessary steps to ensure that they are minimising the risk of an outbreak and are ready to respond rapidly and decisively in the event that the COVID-19 virus enters their facility.

The resource is informed by the Commission’s experience engaging with providers, workers and consumers managing outbreaks and provides examples of the types of things that need to be planned and practised well in advance of any community transmission or COVID-19 outbreak. Training and information materials are also being developed to support the embedding of the guidance for providers and quality assessors.

The Outbreak management planning in aged care resource can be found on the Commission’s website.

Compulsory Reporting Webforms live on Commission website

In the last Quality Bulletin, there was information regarding the forthcoming release of webforms to facilitate compulsory reporting. These webforms are now live on the Commission’s website. For more information, refer to the Compulsory reporting for approved providers of residential aged care services page on our website.

The new webforms make it easier to submit reports to the Commission and allow the Commission to process the information more efficiently.

Once a submission has been made, a receipt number will automatically be issued and a compulsory reporting officer will be in contact to provide a notification case number and to request any further information that may be required.

Serious Incident Response Scheme to commence in 2021

The Serious Incident Response Scheme (SIRS) is a new initiative to help reduce incidents of abuse and neglect in Australian Government-subsidised residential aged care services. Subject to parliamentary processes, SIRS is expected to commence in early 2021 and will replace the current compulsory reporting arrangements.

The new scheme will explicitly require aged care providers to take action to prevent and reduce serious incidents as well as manage incidents more effectively to reduce risk. It will also introduce a new requirement for providers to report a broader range of incidents to the Commission than is currently required under compulsory reporting obligations in relation to assaults. This will include incidents of abuse and aggression between consumers, including where the resident who is alleged or suspected of having committed, or actually commits, the incident has a cognitive or mental impairment.

Aged care providers are expected to have an effective incident management system in place to reduce serious injuries and other incidents, and preventable deaths. The success of SIRS will rely on such systems, and it is recommended that providers act now to review and strengthen their existing incident management system in the lead-up to the new scheme.

An incident management system is a set of processes and procedures used to manage and respond to incidents. This system should support an aged care provider and their staff to take action when there is an alleged, suspected or witnessed incident.

These actions include:

identification and immediate internal reporting of the allegation, suspicion or witnessed incident
action to remove consumer/s from harm and to reduce or address the impact on any consumer/s
documenting the incident
further investigation if warranted
reporting to external authorities within statutory timeframes, including the police and the Commission.

All providers must meet the requirements of the Aged Care Quality Standards which detail the standards of care a consumer can expect as an aged care resident. This includes for example, the requirement that aged care providers must practice open disclosure and have a process to implement open disclosure when things go wrong. This can relate to incidents as outlined as part of the SIRS or other matters.

The Commission will be responsible for administering the SIRS and will receive incident reports from aged care providers. The Commission will provide information and education and is working to develop guidance materials and other resources to support aged care providers with understanding the requirements.

In the coming weeks, Fact Sheets for providers and consumers will be published on the Commission’s website. These will provide further details, including the definition of a serious incident under SIRS and how the scheme fits in with, and complements, other regulatory requirements including the Aged Care Quality Standards, the Charter of Aged Care Rights and the expectations around open disclosure.

Under the SIRS, the Commission will have the power to take proportionate regulatory action where appropriate to address non-compliance with provider responsibilities.

COVID‐19 in a Sydney nursing home: a case study and lessons learned

The Medical Journal of Australia (MJA) has published an important article that examines the COVID-19 outbreak at BaptistCare Dorothy Henderson Lodge in Sydney. Including a timeline of events, the article steps through the major challenges that occurred during the outbreak and details the lessons learned. It also examines the issue of embedding infection control practices into the culture of residential aged care facilities.

You can read the article on the MJA website.

New quality indicators to be introduced in 2021

Residential aged care services must submit quality indicator information every three months through the My Aged Care website, as part of the National Aged Care Mandatory Quality Indicator Program (QI Program).

On 1 October 2020, the Commission became responsible for key activities around the QI Program including education and communication for providers, consumer information and managing non-compliance by providers who do not submit data.

From 1 July 2021, new and updated quality indicators will be included in the program, following an extensive trial overseen by the Department of Health to test their relevance, appropriateness and feasibility.

Alongside the updated quality indicators of pressure injuries, use of physical restraint, and unplanned weight loss, the two new indicators are falls and major injury, and medication management.

The new and updated indicators use the most up-to-date evidence, are easier to collect and, importantly, are reported more simply as the percentage of care recipients affected. A principal objective of the indicators is to enable providers to measure and monitor their performance and support continuous quality improvement. Over time, it is expected that the indicators will also be used to help develop national benchmarks in the specified areas of care.

Further information about the QI Program is available on the Department of Health’s website.

Improving meals, nutrition and the dining experience

The Commission is embarking on a targeted campaign over the next 12 months to improve meals, nutrition and the dining experience for consumers in residential aged care settings.

To guide us in this important work, we have convened an Expert Advisory Group which brings together wide-ranging expertise including in the areas of consumer advocacy, cultural and linguistic diversity, nutrition, food preparation and service, speech pathology, dementia care, wound care, and dental and oral health.

Our aim is to identify and pursue strategies to assist providers to: deliver high quality, enjoyable dining experiences for aged care residents; build staff capability to identify and act early on areas that impact on eating; and meet the Aged Care Quality Standard on dignity of choice in regards to food and meals.

The Commission is keen to learn from the experience of providers in this area and to showcase examples of innovative ideas and best practice. Interested providers are invited to contact the Commission via email to contribute their ideas and/or share their experiences.

New Alis Module: Clinical Governance

The Commission has just released a new interactive online learning module focusing on Clinical Governance. This module is now available in Alis.

Under Standard 8, Requirement (3)(e) of the Aged Care Quality Standards, aged care services that provide clinical care are required to demonstrate the effective use of a clinical governance framework. This module has been developed from a range of Commission resources to support aged care providers to comply with this requirement. It does so by providing information to help learners understand the key concepts of clinical governance and how to apply these concepts in their service.

The Clinical Governance module provides interactive learning through a range of case studies, videos and knowledge checks.

Completion of the Clinical Governance module will help you to develop knowledge of: