Aged Care Quality Bulletin #36 – December 2021 | Aged Care Quality and Safety Commission

Group of ethnically diverse elders smiling

Commissioner’s message

It has been a tough year for individuals receiving aged care and those providing care. Just when we thought we’d turned the corner with rising COVID-19 vaccination rates and easing community restrictions, the highly transmissible Omicron variant has reminded us that the pandemic continues to present real risks that must be understood and managed by everyone.

I acknowledge and truly appreciate providers’ ongoing efforts to keeping their consumers safe and free from harm during the pandemic. This has not been easy, and many lessons have been learned along the way.

And 2021 has encompassed so much more than COVID-19. Two of the major milestones in this busy year were the commencement in April of the Serious Incident Response Scheme and the introduction in July of clearer, stronger provider obligations in relation to minimising restrictive practices. In between these 2 initiatives was the Government’s comprehensive response to the Royal Commission’s final report. The 5-pillar reform plan released in May sets the direction and pace for much-needed transformative changes that aim to overhaul the aged care sector and improve every older person’s experiences and outcomes of care. The Aged Care Quality and Safety Commission shares with all consumers and providers a keen interest in ensuring the success of these reforms.

I wish you all a safe and peaceful holiday period and look forward to continuing to work with you next year to protect and enhance the safety, health, wellbeing and quality of life of all aged care recipients.

Creating a quality experience for aged care residents

On a recent pharmacy outreach visit to a regional aged care service, Commission staff noted that the approach to behaviour support and management at the service resulted in a significant reduction in wandering, anxiety, agitation, aggression and boredom among residents. The introduction of new activities and the increased level of resident engagement had led to a notable reduction in the use of sedative medications.

Some of the interventions the service had implemented to enable and empower residents to engage in purposeful activities included:

offering art projects and activities. For example, encouraging residents to create vibrant, colourful pictures that are hung in a montage style around the building
introducing Happy Hour at 4 pm every day to boost social interaction among residents
enabling residents to interact with tame animals such as rabbits, birds, lambs and a Shetland pony to help decrease depression and improve self-esteem. Dementia Support Australia notes that interacting with animals has many positive effects on physical, social, emotional, motivational and cognitive functioning
encouraging families to bring their pet into the centre when visiting their relative
pairing personal care workers and support staff with individual residents so that they engage one-on-one with the resident on every shift they work. If employees observe changes in the resident/s with whom they are paired, they report these to nursing staff
hosting bus trips around the local community to enable residents to reminisce and share stories about their lives and the history of the town. For example, residents are taken to locations that relate to their past employment such as farms or the local wharf
residents going on coffee dates within walking distance of the centre with the physiotherapist and another staff member, which provides an opportunity for exercise and can also decrease agitation
facilitating resident involvement in day-to-day aspects of their lives including assisting with laundry, embroidery, sewing repairs, directing the bus driver, gardening, painting and general maintenance work around the facility
hosting regular barbeques or providing hot pies and chips on a Saturday during football season
celebrating cultural diversity to acknowledge the varied cultural backgrounds of residents
forming an Indigenous art group for the large percentage of the facility’s population who identify as Aboriginal.

Commission staff observed that the service also encouraged staff and residents to form closer relationships by treating each other like family, which improved the quality of care.

Staff were also encouraged and supported to respond to residents who may be displaying challenging behaviours. Examples included redirecting residents to activities of interest, stopping for a conversation or simply offering the resident their preferred beverage.

Commission staff noted that these simple but effective alternative behaviour strategies created a happier, more engaging environment for residents and reduced the need for sedatives and other restrictive practices.

For more information about alternative behaviour strategies, visit our Minimising the use of restrictive practices web page.

Governing for Reform in Aged Care

The Commission is leading a national educational program aimed at supporting members of governing bodies and senior leaders of aged care providers to strengthen their governance arrangements and meet a range of new legislative obligations which are expected to come into effect next year.

Launched on Monday 20 December by Senator the Hon. Richard Colbeck, Minister for Senior Australians and Aged Care Services, the educational program is being developed and delivered in partnership with KPMG from early 2022 through to at least June 2023. The program is designed to strengthen organisational and clinical governance capability across the aged care sector to ensure that all providers are well placed to participate in, and progress, the urgent calls for change in the sector.

In a letter from the Commissioner on 20 December, governing bodies and leaders of approved providers have been invited to register their interest online to participate in the program. Those who register will also receive ongoing updates throughout the Governing for Reform in Aged Care program. Respondents have also been invited to complete an online survey to assist with the program content development and delivery.

Are vitamins included in the polypharmacy quality indicator?

The Quality Indicator Program (QI Program) expanded from 3 to 5 indicators on 1 July this year, with the 2 new quality indicators being:

falls and major injuries
medication management, including
- antipsychotics
- polypharmacy.

For the purposes of the QI Program, polypharmacy is defined as the prescription of 9 or more medications to an aged care resident.

The Commission has received a number of enquiries about whether supplements such as vitamins, minerals and herbal items should be included in a resident’s medication count for reporting in the QI Program.

Our advice is that vitamins or minerals administered non-orally, such as through a needle via an injection or infusion, should be counted as part of the polypharmacy quality indicator.

However, oral vitamin or mineral supplements (taken by mouth) should not be counted, irrespective of whether they:

are prescription or non-prescription medicines
are used with the intent to prevent, diagnose, cure, control or alleviate disease or enhance a person’s physical or mental wellbeing
contain active ingredients.

This advice is for the purpose of counting medications for reporting in relation to the polypharmacy quality indicator. It does not affect the criteria your service uses to manage medication-related risks for each of your residents, for example, in residential medication management reviews and Quality Use of Medicines activities.

Information for providers on the QI Program is available on our website.

New safety protocols for field visits

As lockdown restrictions have progressively eased in New South Wales, Victoria and the Australian Capital Territory, the Commission has been increasing the number of reaccreditation site audits conducted at residential aged care services, and quality audits at home services.

We have added a number of specific COVID-safe protocols to existing risk control measures for field visits to increase protection and reduce risks for residents, aged care workers and our field staff during the course of our regulatory activities. These include:

ensuring that all Commission field staff:
- are fully vaccinated against COVID-19
- participate in an infection control hygiene briefing and personal protective equipment (PPE) training
- adhere to PPE requirements during a field visit, including any specific requirements of relevant state/territory authorities
- conduct a self-assessment prior to undertaking a field visit to ensure they have no signs or symptoms of COVID-19
- conduct a risk assessment prior to entering an aged care service
- have access to expert clinical advice from an infectious disease physician to guide their field visit practices and provide advice on individual circumstances
having a dedicated COVID-19 team to support and coordinate any questions, concerns or potential exposures.

We are seeking to introduce rapid antigen testing from the beginning of 2022 as a further risk control measure for field staff prior to entering a service, and to assist with early detection of COVID-19. In the meantime, our field staff will continue to undertake a rapid antigen test as required by services where this process is in place for staff and visitors.

COVID-19 update – Outbreak preparedness and vaccinations for home services workers

Outbreak preparedness and staying vigilant

As mentioned in our article about operating in a COVID-normal world in the last edition of the Quality Bulletin, residential aged care providers must address both the needs of residents to maintain contact with their families and loved ones and the need to manage the risks of transmission of COVID-19.

Alongside this imperative are the equally important needs for diligent maintenance of infection prevention and control measures, and thorough preparation for a potential outbreak.

To support providers in these efforts, we have developed a new resource that summarises the lessons learned from more than 350 COVID-19 outbreaks at residential aged care services in 2021. For more information, read Commissioner Janet Anderson’s letter of 22 December to residential approved providers.

Mandatory vaccination requirements for home services workers

Following on from the announcement of mandatory COVID-19 vaccinations for residential aged care workers from mid-September, information has now been released regarding vaccinations for home services aged care workers. The Australian Health Protection Principal Committee has recommended that home services workers receive their first vaccine dose by 30 November 2021 and the second dose by 31 December 2021.

However, in order for this recommendation to become a requirement, each state and territory has to incorporate it in a public health order for local release. For this reason, it is important for all home services providers to keep a close eye on the public health orders issued in your state or territory, to ensure that you are compliant with all requirements.

Having a vaccinated aged care workforce is essential to mitigating the risk of transmission and impact of COVID-19, so it is important that you do everything you can to facilitate vaccination of both workers and consumers.

Have your say on how we communicate with the home services sector

Are you a home service provider, worker or recipient, or a carer or family member of a home services recipient? We want to hear from you.

As part of the Commission’s ongoing effort to improve the way we communicate and engage with aged care home services, we have teamed up with the University of Technology Sydney (UTS) to conduct research focused on enhancing our communications with different groups in this part of the sector. Our aim is to ensure that home services providers can receive and use important and up-to-date information, including about our regulatory activities and the aged care reforms being introduced in 2022 and beyond.

To learn more about the research, to provide feedback using an anonymous online survey, or to register to join a small group discussion with the UTS researchers, please visit the Home Services Consultation website at www.homeservicesconsultation.uts.edu.au or email homeservicesconsultation@uts.edu.au.

We want to hear from as many people as possible including:

different types of home service providers and services
rural, remote and metropolitan based providers
home care workers
recipients of care from culturally and linguistically diverse and Aboriginal and /or Torres Strait Islander communities
family members or carers of recipients receiving different levels of care including specialist care.

Please get involved by visiting the consultation website and provide your valuable feedback before 11 February 2022.

From the Chief Clinical Advisor – Summer alert

Notwithstanding the current La Niña weather phenomenon, it is that time of year again! Please be alert to the risks of heat and sun exposure when caring for older people.

At particular risk are people:

with dementia who may not recognise or communicate that they are heating up
who are very frail or have a low body mass who may heat up more easily
who struggle to maintain good hydration
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 are:

buildings or internal areas that cannot be air conditioned or cooled
outdoor areas sheltered from breezes or exposed to the sun (consider how this changes throughout the day)
indoor areas where the sun can reach or heat up through glass
vehicles.

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

Staff should also be aware that elderly people can quickly suffer discomfort and the clinical consequences of overheating and sunburn. Workers should be aware of movements in the ambient temperature over the course of a day in different locations, and of the clothing people are wearing.

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

monitor the fluid intake of vulnerable residents
encourage more frequent drinking of fluids
be aware if toileting becomes less frequent, as this is a sign of poor hydration
respond as a priority to residents appearing to be, or saying they are, hot or thirsty
remind and assist residents with sunscreen, hats and light-coloured 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 Department of Health has checklists about caring for older people in warmer weather specifically for residential aged care and for home care service providers.

Medication-related complaints in residential aged care

As outlined in the May 2021 edition of the Quality Bulletin, Associate Professor Juanita Breen from our Pharmacy Unit completed research into medication-related complaints received by the Commission from consumers between July 2019 and June 2020. The slides from a recent presentation A/Prof Breen gave about her research are now available on our website.

It is recommended that providers undertake similar analysis of data gathered through their own incident management, complaint and consumer engagement processes to identify medication management themes and areas to target for improvement. This can also be presented and reviewed at a service’s Medication Advisory Committee to assist with the governance of medication management.

Alis – the year in review

The Commission’s Aged Care Learning Information Solution – Alis – was launched to the sector in February 2020. Since this time more than 2,240 aged care service providers and 6,400 learners have signed up to use the platform and access the Commission’s online educational programs anywhere and at any time.

Initially the content within Alis focussed on the Aged Care Quality Standards and the key concepts within these Standards. During 2021, we added 15 new online learning modules covering topics such as the Serious Incident Response Scheme (SIRS), outbreak management planning and consumer engagement. Feedback received from learners has included comments that the learning content ‘reinforced my knowledge and understanding’ and provided ‘helpful information especially for care and service staff’.

In 2022, we will be making some enhancements to the Alis platform based on the detailed feedback received from users in our recent survey. We will also be publishing new learning programs including (and extending beyond) restrictive practices and the introduction of the SIRS for home services.

To assist aged care workers to access the Alis content, the Commission has extended current eligibility arrangements until 1 July 2022. This means that all Commonwealth-funded aged care providers can enjoy another 6 months of free access to 4 Alis registrations. You can also purchase additional Alis registrations to support your staff’s ongoing professional development.

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

If you would like more information, email the Sector Education team at education@agedcarequality.gov.au