Aged Care Quality Bulletin #45 – September 2022 | Aged Care Quality and Safety Commission

Elderly couple both with glasses laughing

Commissioner’s message

Turning challenges into opportunities is something that I think many of us in the aged care sector – wherever we work – have become better at over the last couple of years. The looming commencement dates for a range of important reforms is concentrating everyone’s minds on critical implementation pathways, whether you’re a provider or the regulator.

The Commission has been especially focused on the vital preparatory work for the new provider obligations coming into effect from 1 December, following the recent passage of the Aged Care and Other Legislation Amendment (Royal Commission Response) Act 2022.

The sector’s keen interest in learning more about these new obligations was evident in the number of participants – over 2,600 – who attended one or other of 2 introductory webinars that the Commission recently hosted to outline the aged care reforms which have the strongest regulatory implications.

We also had a good turn-up to the first of 3 webinars we held on the introduction of the Serious Incident Response Scheme in home services. Future webinars will focus on the introduction of a Code of Conduct for aged care and new governance responsibilities for providers.

You can view the full webinar schedule, registration details and webinar recordings on our www.agedcarequality.gov.au/reforms webpage.

Also published are answers to the questions we have received prior to and during each of the webinars we have hosted to date that could not be addressed due to time constraints. These Q&As will continue to be updated as more questions are received. Webinar participants are free to send through questions about the session topic while the webinar is live, and we’re happy to receive questions outside those times through our Aged Care Reform email inbox at agedcarereform@agedcarequality.gov.au.

We have also released 2 new fact sheets to help explain the aged care reforms. The ‘Aged care reforms – an overview’ fact sheet sets out each of the reform measures in the Royal Commission Response Act, and what they mean for approved providers and services. The ‘Aged care reforms – a regulatory perspective’ fact sheet provides an overview of the key aged care reforms that commence from 1 December 2022 to help providers understand and prepare for these new obligations. Both fact sheets include a matrix that will help providers easily identify which reforms impact them. Translated copies of my letter to consumers about the reforms, dated 31 August 2022, are now also available in 15 languages on our website.

We will continue to support the sector with a range of online resources, online learning modules through the free Aged Care Learning Information Solution (Alis), and webinars. I encourage you to stay up to date by regularly visiting our www.agedcarequality.gov.au/reforms webpage for the latest information and resources.

Update on preparations for reforms with regulatory implications

Introducing the Serious Incident Response Scheme (SIRS) in home services

From 1 December 2022, the SIRS will commence in home care and flexible care delivered in a home or community setting.

The first of 3 webinars on SIRS in home services was hosted by the Commission on 26 September 2022. You can access the recording via our www.agedcarequality.gov.au/reforms webpage. Two further webinars are scheduled in October with registrations opening one week before each event:

Tuesday 18 October at 4:00–5:00 pm AEDT (SIRS reportable incidents)
Monday 7 November at 4:00–5:00 pm AEDT (Reporting under the SIRS).

We are also developing a suite of resources to support home services providers, their workforce and aged care recipients to understand their rights and responsibilities under the SIRS. Guidance documents for providers and consumers outlining the new provisions are being fine-tuned based on feedback obtained through small workshops involving providers and consumer representatives, to ensure that the material is fit for purpose. These documents should be ready for release in coming weeks.

New Code of Conduct for Aged Care

From 1 December 2022, a Code of Conduct for Aged Care (the Code) will be introduced to improve safety and wellbeing for aged care consumers and to boost trust in services.

You can read the Code on page 8 of the exposure draft of the Aged Care Quality and Safety Commission Amendment (Code of Conduct and Banning Orders) Rules 2022. The Department of Health and Aged Care is starting a public consultation on the Code exposure draft on 4 October.

The Code sets out standards of expected behaviour that apply equally to:

approved aged care providers of residential, home care and flexible care services
their governing persons (for example, board members and Chief Executive Officers)
aged care workers who are:
- employed or otherwise engaged (including on a voluntary basis) by the provider
- employed or otherwise engaged (including on a voluntary basis) by a contractor or subcontractor of the provider to provide care or other services to consumers.

The Code will not apply to services provided under the Commonwealth Home Support Programme (CHSP) or the National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NATSIFACP).

Among the resources being developed by the Commission to support the sector to prepare for the commencement of the Code is a primary guidance document for providers. Feedback obtained on a draft of this document through workshops with providers, workers and consumers is assisting in the finalisation of this resource which will be published shortly.

We are also hosting 2 webinars on the Code and registrations will open one week before each event:

Friday 7 October at 1:30–2:30 pm AEDT (for approved providers) – register to attend this session
Friday 11 November at 2:00–3:00 pm AEDT (for aged care workers).

Strengthening provider governance

From 1 December 2022, there will be new governance responsibilities for approved providers.

For providers approved before 1 December 2022, these include:

changes to the reporting requirements for material changes
assessment of suitability of their key personnel
reporting annually on provider operations.

Additional requirements will also commence on 1 December 2023:

requirements regarding the composition and skills of governing bodies
establishing and continuing a quality advisory body
offering consumers and their representatives (every 12 months) the opportunity to establish one or more consumer advisory bodies.

Providers approved on or after 1 December 2022 will be required to meet all new provider governance requirements from their date of approval.

Detailed guidance documents will be available to assist providers to implement the requirements.

We are also hosting a webinar on provider governance on Thursday 27 October at 3:00–4:00 pm AEDT with registrations opening one week before the event.

New consent arrangements for restrictive practices

The Australian Government is amending the Quality of Care Principles 2014 to provide greater clarity on informed consent for the use of restrictive practices in residential aged care. A draft of the Quality of Care Amendment (Restrictive Practices) Principles 2022 was recently released for public review and consultation, and the consultation period has now closed. The timing of commencement of the new provisions will be determined by parliamentary processes.

The proposed changes are aimed at strengthening protections for care recipients from abuse associated with the unregulated use of restrictive practices and reduce the risk of unwarranted use of restrictive practices.

Under the current arrangements, if the care recipient lacks legal capacity, informed consent must be sought from and given by the ‘restrictive practices substitute decision-maker’ before the restrictive practice can be used. The proposed changes to the Quality of Care Principles 2014 set out a hierarchy of persons or bodies authorised to give informed consent for a residential aged care recipient. This only applies if the care recipient cannot make an informed consent decision themselves.

The amendment seeks to provide greater certainty in states and territories where laws do not allow another person or body to give informed consent to the use of restrictive practices on behalf of a care recipient. Without this clarity, aged care service providers could not use restrictive practices in certain circumstances where they were appropriate.

Importantly, this amendment will not affect informed consent already given by an individual or body authorised to make an informed consent decision on the use of restrictive practices under the law of the state or territory in which the care recipient is receiving aged care.

For further information visit the minimising the use of restrictive practices landing page on our website. We will update our related resources as further information becomes available.

Consultation process on draft revised Quality Standards

The Department of Health and Aged Care has just released advice that public consultations on the draft revised Aged Care Quality Standards are commencing on 17 October and will run until 25 November 2022.

As all providers are aware, organisations providing Commonwealth-subsidised aged care services in Australia are required to comply with the Quality Standards, which focus on outcomes for consumers and the level of care expected from providers.

The consultation process now to be undertaken on the draft revised Standards follows a process of review and revision that commenced in March 2021, in response to recommendations in the final report of the Aged Care Royal Commission.

Consultation activities will include an introductory webinar, release of consultation papers together with a submission process, a survey, a range of public forums and online focus groups.

Given the importance of the Quality Standards to both consumers and providers, it is strongly recommended that people visit the Department’s Aged Care Engagement Hub for information on how you can participate or to make any enquiries about the public consultation process.

Important SIRS reporting form changes on 3 October

As noted in the July Quality Bulletin, any reportable incidents of unlawful sexual contact or inappropriate sexual conduct under the Serious Incident Response Scheme (SIRS) for residential aged care services must be notified to the Commission as Priority 1 reportable incidents.

From Monday 3 October 2022, the SIRS reporting form in the My Aged Care Service and Support Portal was changed to align with this requirement.

The change on the portal means that residential aged care providers can only choose Priority 1 when reporting these types of incidents to us.

There are also changes to questions about the psychological or physical impacts of incidents.

From 3 October, you will need to provide a rationale for your assessment if you said there was no impact from an incident. This will help the Commission to understand why you believe there has been no impact.

These SIRS reporting changes are part of a major upgrade to the My Aged Care system. If you have any SIRS queries, call us on 1800 081 549 or email us at sirs@agedcarequality.gov.au.

More site audits being undertaken

If you are not yet a regular reader of the Commission’s quarterly reports on sector performance, now is a good time to start.

Our Sector performance report – April-June 2022, available on our website, includes data on all 4 quarters for 2021–22, and provides a view of provider performance as understood through our regulatory activities over the previous financial year.

In the April–June quarter, we had greater access to residential care services and home services following the disruptions of COVID-19 and the flooding events in New South Wales and Queensland. This increased access, combined with more available trained and registered quality assessors, is reflected in a near doubling of residential aged care site audits. During this period, we conducted 316 audits compared with 163 the previous quarter. Similarly, quality audits of home services increased from 65 to 104.

With respect to findings of non-compliance, the key areas for improvement continue to be:

Quality Standard 8 (Organisational governance) and Quality Standard 7 (Human resources) as the common areas across both residential and home services providers
Quality Standard 2 (Ongoing assessment and planning with consumers) for home services providers
Quality Standard 3 (Personal care and clinical care) for residential aged care providers.

These findings are also reflected in the 2,642 complaints about services received in the April–June quarter. Medication management, personal and oral hygiene, and staffing sufficiency remained the 3 most complained about issues in residential care. Complaints about communication, fees and charges, and management of finances were the most common for in-home services.

Assistance and support for providers to improve their performance in these areas is readily available. For example, Board members and executives have an open invitation to join over 2,000 of their colleagues who have already enrolled in our Governing for Reform in Aged Care program and to register for the workshops available through this program. Providers of home services are also encouraged to access our recently published guidance and complete the risk checklist tool in the ‘Quality and safety in home services – 5 key areas of risk’ resource.

Quality and safety in home services risks in focus – clinical care

In the past 2 months, we have focused on organisation governance risk and care planning and assessment. This month we focus on clinical care as the third part of our series on the 5 key risks in the delivery of home services.

What’s the problem?

Poor clinical governance can result in poor outcomes for aged care recipients (even where clinical care is not being delivered). Some providers that don’t provide clinical care misunderstand their obligations to consider clinical care matters or issues that may relate or impact the home care and services they deliver.

What has the Commission found?

Through our quality assessment and monitoring activities between 1 January 2021 and 31 August 2022, almost 42% of home service providers assessed against Aged Care Quality Standard 3: Personal care and clinical care were found to be non-compliant with one or more requirements of this standard.

Use these questions to understand and inform your home services performance

1. How do you know those delivering clinical care have access to all relevant consumer information to inform delivery of care and services?

You must ensure that all staff delivering clinical care have access to relevant and up-to-date information about the consumer’s background, circumstances, needs, goals and preferences. This information should be sufficiently detailed and specific so that staff not familiar with the consumer can understand what is required and any risks associated with their clinical condition.

You should continue to engage with the consumer and any relevant third parties, including informal supports and health professionals, to understand how effectively clinical care is being delivered, identify areas for improvement and ensure that care is delivered in a safe and appropriate manner. This is critical to ensure there are no misunderstandings or ‘gaps’ in the consumer’s care.

2. How do you know that the workers delivering clinical care are qualified, competent, appropriately trained and supported to effectively perform their role?

You need to have systems and processes in place to ensure that the staff delivering care are appropriately qualified, trained and equipped to deliver services in line with the consumer’s needs, goals and preferences. You need to ensure that staff are aware of and understand current relevant national clinical care guidance and can apply this.

You are responsible for having systems in place to ensure staff are trained to recognise signs of decline or deterioration in mental, emotional, or physical function. Staff must be competent and appropriately supported to deliver care and services. You also need to have systems available to assess the capability of staff (and contractors) to identify any deficits and to ensure that staff are continuously improving their knowledge, skills and competencies.

3. What clinical data or information do you receive that helps you to monitor whether care and services are being delivered safely, effectively and in line with best practice?

If your staff deliver clinical care, or even if this is not the case but clinical care is subsidised through your consumers’ packages, you, as a home services provider, are required to have effective clinical governance to establish an integrated set of leadership behaviours, policies, procedures, responsibilities, relationships, planning, monitoring and improvement mechanisms. This is necessary to support safe, quality clinical care and good clinical outcomes for every consumer.

More information

To find out more about this key risk, read Chapter 4 of our ‘Quality and safety in home services – 5 key areas of risk’ resource.

We also have a new workshop for providers of home services on the 5 key areas of risk. It includes practical examples of how to manage and consider these areas of risk within a service setting. To learn more and register for this workshop, visit the workshop webpage.

Everybody has a story: Delivering culturally inclusive care

Australia is a culturally, linguistically and spiritually diverse nation and is home to the world’s oldest continuous cultures. Australians speak more than 300 languages and identify with more than 120 faiths and spiritualities.

Our new online learning module, ‘Everybody has a story: Delivering culturally inclusive care’, was created in partnership with the Centre for Cultural Diversity in Aging.

This module will help aged care workers provide tailored care that meets each consumer’s unique social, cultural, spiritual and linguistic needs. 

The module is available through our Aged Care Learning Information Solution, Alis. It is recommended for every individual who engages with consumers in their care, particularly those working in care and clinical roles. 

We are currently trialling expanded free access to Alis, and all workers of Commonwealth-funded aged care providers can access our learning content free of charge.

Recognising the signs of sepsis early can save lives

The Commission reminds providers that your staff and carers must be alert to the signs of sepsis in residents and care recipients to ensure it is detected and managed in time.

Sepsis is the body’s response to life-threatening infection. Up to one-third of people who develop sepsis will die. Those who survive are more likely to experience physical, cognitive and mental health issues.

Due to the serious nature of sepsis, rapid recognition and treatment is critical. When sepsis is caught early (within hours), the risk of death decreases.

The risk of dying from severe sepsis, or septic shock, rises as we get older, so it is important for aged care staff to keep alert to the signs of sepsis.

These signs include:

rapid heart rate
tiredness
difficulty breathing or rapid breathing
sleepiness
fever and chills
low body temperature
low blood pressure
little or no urine output
blotchy skin
not eating or drinking much
confusion
looking generally unwell.

Not all of these signs need to be present for the diagnosis to be sepsis. If a resident or care recipient is experiencing any of the above symptoms, sepsis should be considered. A more detailed clinical assessment should be undertaken immediately, with any concerns resulting in escalation to urgent medical review or transfer to hospital so that potentially life-saving treatment can be commenced as soon as possible.

Remember, sepsis is a medical emergency – similar to stroke and heart attack – so every minute counts.

For more information, visit the Australian Commission on Safety and Quality in Health Care website.

Prudential Disclosure Standard – new fact sheet available

Residential aged care providers who hold refundable deposits must comply with the Prudential Standards, which include the Disclosure Standard.

The Disclosure Standard requires providers to report certain details to their consumers and the government. Providers must report their use and management of consumers’ refundable deposits, including compliance with the Prudential Standards.

A new fact sheet is now available to help you meet your disclosure obligations.

If you’re a provider that had a standard financial year for 2021–22, you have 2 disclosure reports to complete by 31 October 2022.

1) Information to the government

You must submit an Annual Prudential Compliance Statement (APCS) via the My Aged Care provider portal, which will go to the Department of Health and Aged Care and the Commission. The APCS is part of the Aged Care Financial Report (ACFR). The APCS and ACFR are due 31 October.

A complete APCS includes your responses and the auditor statement. Submitting your APCS late will result in non-compliance with the Disclosure Standard.

Your completed APCS outlines your compliance with your prudential responsibilities during the reporting period. If you have been non-compliant in any of your prudential obligations, you must report this. This should include the non-compliance circumstance, and steps taken to ensure ongoing compliance.

The Commission may engage with you on information in your APCS to:

clarify declarations or statements
seek supporting evidence
provide education and raise awareness on the Prudential Standards.

2) Providing information to consumers

Consumers who pay a refundable deposit for their care must receive from you annual information about their investment by 31 October. This includes a copy of their refundable deposit entry, and a written statement that a consumer can request information about their refundable deposit at any time. Our new fact sheet covers this requirement in further detail.

Aged care scholarship applications close soon

The Australian College of Nursing (ACN) invites applications for a range of undergraduate and postgraduate aged care, nursing and midwifery course scholarships.

Up to 400 scholarships are available for personal care workers and nurses, and up to 100 allied health scholarships for dementia-related qualifications.

Applications close on 10 October 2022.

The purpose of these scholarships is to develop skills for aged care nurses in leadership and clinical management skills. They also aim to improve expertise in areas such as palliative care, dementia care, and infection prevention and control.

The scholarships are administered by the ACN for the Department of Health and Aged Care. You don’t need to be an ACN member to apply.

These scholarships are open to a variety of applicants, including:

students undertaking an eligible course which starts, or is continuing, in 2023
enrolled nurses wanting to become registered nurses
personal care workers interested in becoming enrolled nurses
aged care workers interested in mental health nursing and allied health
a guaranteed number of scholarships for Aboriginal and Torres Strait Islander peoples.

Find out more on the ACN website.

Webinar on upcoming changes to Specialisation Verification

The Department of Health and Aged Care is hosting a free webinar on Tuesday 11 October 2022 from 1:00–2:30 pm AEDT for the aged care sector.

The webinar will cover the Specialisation Verification Framework and upcoming application process improvements, including:

the intent and scope of the framework
the benefits for older people and providers in verifying specialisation claims
the new online application process for verifying specialisation claims via the My Aged Care (MAC) Service and Support Portal
the appearance of verified specialisations on MAC versus unverified specialisations
the timeline for removing unverified claims from provider profiles on MAC (early 2023).

You can register for the webinar via the department’s website.

You can submit questions during the webinar. If you are unable to attend, a recording will be made available on the department’s website.