Aged Care Quality Bulletin #32 – August 2021 | Aged Care Quality and Safety Commission

Group of ethnically diverse elders smiling

Commissioner’s message

As we draw closer to the warmer months, COVID-19 continues to challenge aged care consumers, staff and providers.

While the number of COVID-19 cases and consequent restrictions have eased in some parts of the country, the reality for millions of people, particularly in New South Wales and Victoria, is that times are uncertain with case numbers not yet stabilising and lockdowns being extended. At the same time, the significant and continuing increase in vaccination levels across the population and especially in aged care, together with growing confidence in rapid testing capability, are cause for optimism.

The Commission is monitoring levels of community transmission of COVID-19 in each state and territory, and adjusting our regulatory activities to changing local circumstances to ensure that we continue to hold aged care providers to account for providing safe, quality care to older Australians during these extraordinary times.

We have stepped up our targeted activities (including telephone assessment contacts) to ensure that providers in the lockdown areas in particular maintain their focus on delivering consumer-centred quality care, and are also prepared in the event of an outbreak. We are also continuing to undertake site visits to residential aged care services in a lockdown area where there’s an assessment of heightened risk to the safety, health or well-being of residents. The full program of site-based re-accreditation audits has been temporarily paused in the Greater Sydney area in response to expert health advice regarding COVID-19 preventative measures, aimed to minimise infection risks to aged care residents and staff of aged care services.

For more information about our regulatory response to NSW aged care providers in lockdown areas, read our advice to the sector released on 3 August.

All providers are aware that from 17 September 2021, residential aged care workers will be required to have received a minimum first dose of a COVID-19 vaccination. As a further protection for aged care consumers and staff, the Commission has introduced the same requirement for all of our staff who visit aged care services as part of their work. It is important that we all do everything we can to mitigate the transmission and impact risks of COVID-19. For more information, please read my letter of 16 August to approved providers about this.

Finally, we continue to make available to the sector important information and valued resources about provider responsibilities, both new and existing. As outlined in this Quality Bulletin, we’ve released 2 new Alis modules about outbreak management planning and held our second webinar about the restrictive practices legislated changes. I also take this opportunity to remind providers that there are sessions still available for our online education workshop about the Aged Care Quality Standards, and managing and assessing the performance of your services. I encourage you to access the publications and resources available on our website.

Delivery of care during an outbreak and upcoming webinar

In the event of an outbreak at your residential aged care service, the way you deliver care and services to residents will need to change. Residents may need to be relocated to different areas within the facility, have limited or no access to designated areas, and extra precautions might need to be put in place to care for residents. Also, the Public Health Unit may advise that some of your staff must be furloughed as close contacts, and this may impact the way in which you provide care.

All of these matters, and many others, must be anticipated and planned for in your outbreak management planning. Importantly, factors such as increased anxiety, isolation, limited movement and reduced contact with family and representatives may affect a resident’s health and well-being. For this reason, it is essential that your care planning documentation for every consumer is up to date, comprehensive and considers the potential risks and impact of COVID-19 for that individual.

Your care and services plan for each consumer should also include sufficient detail to enable staff unfamiliar with residents – particularly residents with high-risk clinical conditions, cognitive impairment or wandering behaviours – to deliver care in line with individual needs, goals and preferences. You should consider and make provision for resident identification methods, such as wristbands.

During an outbreak, increased monitoring of each care recipient’s health and well-being is essential to recognise and respond to any deterioration in their condition. A core component of your outbreak management planning should be a dynamic risk assessment of your staffing and capability, the service environment, equipment, systems, processes and practices that affect the delivery of personal and clinical care to ensure that care can still be delivered to required standards if an outbreak occurs.

Also, make sure you have in place a system so that any deterioration or clinical changes in a resident can be escalated quickly. Health professionals should continue to attend the service to provide care to residents during an outbreak (in line with relevant public health orders), and telehealth options may also be considered.

There is more COVID-19 information and guidance for services providers on our website.

Upcoming webinar to help residential aged care providers respond to a COVID-19 outbreak

To help residential aged care providers prepare and take effective action in readiness for a COVID-19 outbreak, we are hosting a free webinar on Monday 30 August at 5 pm (AEST) to review the lessons learned during 2020, how they apply in 2021 and, importantly, how they can be adapted to ensure you are ready if an outbreak occurs in your service.

Register to attend this event today.

New outbreak management planning modules in Alis

Effective outbreak management planning can help you prevent or significantly reduce the likelihood of an outbreak occurring in your service. To support providers with their outbreak management planning, 2 new online learning modules are now available in Alis, our Aged Care Learning Information Solution:

Introduction to outbreak management planning is a short introductory module for all staff working in residential aged care. It contains information about why outbreak management is important.
Leading outbreak management planning is a module for everyone who leads a team in residential aged care. It contains information about your responsibilities to effectively plan and lead your aged care service’s response to outbreaks and suspected outbreaks.

To help you access the modules, all Commonwealth-funded aged care services can obtain up to 4 free registrations to Alis until 31 October 2021. If needed, you can also purchase additional registrations.

To access the new modules or to register for Alis, go to learning.agedcarequality.gov.au.

Supporting providers with their restrictive practices obligations

Legislative amendments took effect on 1 July 2021 to clarify and strengthen provider obligations regarding any use of restrictive practices in residential aged care settings. Under the new legal provisions, from 1 September, residential aged care providers are required to comply with responsibilities relating to behaviour support plans for all residents who have restrictive practices used, or considered, as part of their care. These responsibilities were highlighted in the June 2021 and July 2021 editions of our Aged Care Quality Bulletin, and were the focus of our latest webinar.

On 23 August, our Commissioner, Janet Anderson, and Chief Clinical Advisor, Dr Melanie Wroth, were joined by Maree McCabe AM, Chief Executive Officer of Dementia Australia for the Commission’s second webinar on the restrictive practices legislative amendments. Maree is a member of the Aged Care Quality and Safety Advisory Council, which provides advice to the Commissioner on her legislated functions. Topics discussed in the webinar included behaviour support plan requirements, how to engage with and understand residents and their changed behaviours, and how to use the gathered information to inform behaviour support planning and overall care. A recording of the webinar is available on the Commission’s website.

Dementia Support Australia has developed a suite of resources to assist providers with behaviour support planning. These will be released soon and we will update our Restrictive practices resources web page as they become available. Dementia Support Australia’s Dementia Behaviour Management Advisory Service and Severe Behaviour Response Team also continue to be valuable resources for providers requiring assistance when responding to residents’ changed behaviours and we encourage you to engage with these groups as you support residents in your care.

The Commission has developed further resources to assist providers to understand their responsibilities and minimise the use of restrictive practices. These include updated and new scenarios covering all 5 types of restrictive practices, frequently asked questions about consent and a fact sheet, and an overview of restrictive practices. A fact sheet on behaviour support planning will be released shortly.

We have also released a Regulatory Bulletin on how we will regulate the use of restrictive practices. Please use the available resources and regularly check our website for new material.

Next milestone in rollout of SIRS – reporting of Priority 2 incidents

The next major milestone for the Serious Incident Response Scheme (SIRS) is mandatory reporting of Priority 2 reportable incidents in residential care settings, which begins from 1 October this year.

A Priority 2 notification is a reportable incident that does not meet the criteria for a Priority 1 reportable incident. To assist providers’ assessment of what constitutes a reportable incident Priority 1 or Priority 2, please refer to our SIRS guidelines for residential aged care providers.

Under the SIRS guidelines, a Priority 2 reportable incident must be reported to the Aged Care Quality and Safety Commission within 30 days of a provider becoming aware of the incident.

The SIRS was introduced on 1 April 2021 to help improve the safety and well-being of consumers through requiring providers to have effective incident management systems. Also from 1 April, providers of residential care and flexible care in a residential setting have been required to report to the Commission all incidents assessed as Priority 1 reportable incidents.

From the 1 October, providers will also be required to report Priority 2 incidents using the SIRS tile on the My Aged Care Provider Portal.

Please note that all incidents (including those not reportable to the Commission under the SIRS) should be recorded by the service in their incident management system.

For more information on the SIRS and incident management requirements, visit our SIRS web page.

For more information on the My Aged Care Provider Portal, including easy-to-use guides, visit the Department of Health website.

From the Chief Clinical Advisor

Antimicrobial stewardship news

On 18 August, the Older Persons Advocacy Network (OPAN) hosted a webinar which focused on antimicrobial stewardship in aged care – ‘Using antibiotics well – do I need a drug for every bug?’. Panellists Dr Lyn-li Lim, Infectious Diseases Physician, A/Prof Noleen Bennett, Senior Infection Control Consultant, Dr Lisa Rogers, General Practitioner, and Ms Ivana McBride, Infection and Prevention Control Lead, Warrawee Aged Care Service, St George, each provided information and advice from their perspective and area of expertise. If you missed it, the webinar is available on the OPAN website.

The Australian Commission on Safety and Quality in Health Care has recently published an online learning module – ‘Basics on infection prevention and control for aged care’. The module provides a foundation in infection prevention and control for aged care workers. Registration is available through the National Hand Hygiene Initiative learning management system. The module may be used when inducting new staff, or as an annual update.

Stay up to date with developments at the Commission’s new Antimicrobial stewardship web page.

Advance care planning

Advance care planning promotes individuals having control over and making choices about their future health care, and nominating a person of their choice to support them and speak on their behalf when they are unable to.

Advance Care Planning Australia (ACPA) is funded by the Australian Government to provide free support services to community and residential aged care recipients, their loved ones, and service providers.

ACPA services give access to:

advance care planning information and forms via www.advancecareplanning.org.au
a free national advance care planning support service for aged care recipients (including those living in residential care), carers or substitute decision-makers, and service providers via 1300 208 582 or a call back and referral form
a free online ACPA Learning hub
free volunteer-led information sessions for aged care recipients, carers or substitute decision-makers
an Advance Care Planning: Aged Care Implementation Guide (2021).

In 2022, ACPA will be making available an Advance Care Planning Improvement Toolkit to promote quality improvement and support service providers in meeting the Aged Care Quality Standards relating to advance care planning. If you would like to contribute to the development or evaluation of this toolkit, please email ACPA at acpa@austin.org.au.

Informed consent for medication

The Commission has received many enquiries about informed consent. We remind you of the resources produced by OPAN to help aged care residents or home care recipients, families and carers to understand the role of the consumer and others in the decision-making process for medication prescribing. Many people, including providers, have commented that they have found these resources extremely helpful in building their knowledge and understanding in an engaging way. Please consider distributing this link to aged care recipients and families, or even showing them and your staff the short animation.

Check your staff’s registrations regularly

Providers are reminded that they have a responsibility to check the registration and other relevant credentials of professionals working in their organisation, including nursing, medical and allied health staff working as registered professionals. Because registration status can change, providers should check this regularly. For example, there have been instances of the following scenarios which represent risks to both providers and consumers:

the registration of an individual inadvertently lapsing
an unqualified person ‘holding out’ or misrepresenting themselves as a qualified professional
a person who has been deregistered or suspended failing to notify their employer and continuing to work
a provider who has checked paper credentials which have later been identified as forged
a provider and labour hire agency both assuming the other is checking the registration status of agency staff.

To check the registration status for all professions registered with Australian Health Practitioner Regulation Agency (Ahpra), visit the Ahpra website.

Changes to the way we seek your feedback on our complaints process

The Commission is improving the way we seek feedback from providers on our complaints process.

From 1 September, the feedback survey will:

move from the Survey Monkey platform to a third-party specialist survey supplier, Orima
be sent out closer to the date the complaint is finalised
more clearly identify the complaint that feedback is being sought about.

In addition, the survey questions and the rating scale have been simplified and refocused, so it will now take less time (around 5 minutes) to complete this survey. A reminder will be sent approximately one week after the initial invitation to provide feedback. The new version of the survey will also allow providers to download a copy of the completed survey for their records and future reference.

If you require any additional information on these changes, please get in touch with us via our Contact us web page.

Reminder – Commission online workshop sessions still available

The Commission has developed 3 online educational workshops which are now open for registration with dates available throughout the rest of August and September. New session dates will also be available over the coming months, so keep an eye out!

Since the start of July, we have run 15 workshops with almost 220 participants, and 99% of the participants who provided feedback indicated that they would recommend the workshops to others to complete.

The Understanding the Quality Standards – information session provides an overview of the Aged Care Quality Standards, relevant guidance material and helpful templates.

The Monitor and assess the performance of your service: aged care home services and Monitor and assess the performance of your service: aged care residential services workshops focus on developing knowledge, skills and practical understanding to support you to monitor and assess the performance of your own service. This will help you to ensure that the services you deliver are in line with the Quality Standards. These 2 workshops have been tailored for each intended audience, with some of the content relating to risk areas, relevant guidance, examples and discussion points being specific to home services and residential services.

More information about these workshops and how to register is available on the Workshops page of our website.