Aged Care Quality Bulletin #46 – October 2022 | Aged Care Quality and Safety Commission

Elderly couple on bench talking to a worker who is kneeling

Commissioner’s message

I recently presented at the Aged and Community Care Providers Association’s (ACCPA) National Conference 2022 – It’s up to us! It was a great opportunity to engage directly with many sector leaders on the key reforms being introduced in the coming weeks and months, and on the Commission’s role and how we are supporting the sector. The conference focused on empowering aged care leaders to understand and adapt to the changes in aged care, and it was terrific to see the energy and enthusiasm for embracing these changes.

Aged care in Australia is undergoing important and wide-ranging reform to ensure that senior Australians have access to safe and quality aged care that meets their needs. Ensuring that these reforms are implemented effectively requires our collective commitment.

As we approach the ‘go live’ date for a number of the reforms (1 December), the Commission remains focused on doing all we can to support the sector to get ready. This includes preparing for a new Code of Conduct for Aged Care, strengthening provider governance and the expansion of the Serious Incident Response Scheme (SIRS) to encompass home services.

Our webinar series on the reforms continues to attract large numbers of participants, reflecting the high level of interest across the sector in understanding what providers need to do differently or for the first time. As the subordinate legislation for the respective reforms becomes available, we are quickly finalising a range of guidance resources for the sector. Further information on the reforms is provided in this newsletter and I encourage you to regularly check our National aged care reforms webpage.

In recent times, the Commission has also been concentrating on preparing ourselves for the reforms. Our work as the national regulator is critical to ensuring the safety, security, dignity and wellbeing of every older person accessing aged care services.

On 14 October, the Minister for Aged Care, the Hon Anika Wells MP, released the terms of reference for the independent capability review of the Commission. The review is part of the Government’s overall focus on Australia’s aged care system. You can view the terms of reference on the Department of Health and Aged Care’s website. We have also produced a fact sheet which provides more detail.

I very much welcome this review which I expect will support us on our journey to become a world-class national regulator of aged care. In short, the review aims to ensure that we are well placed to fulfil our current and future responsibilities. The Commission is committed to supporting the work of the independent reviewer, Mr David Tune AO PSM, as he conducts the review and prepares a report for Government.

Importantly, our work will continue unabated while the capability review is underway. We will stay focused on undertaking all of our regulatory functions including offering support and guidance to the sector in the lead up to, and beyond the commencement of, the December reforms.

Finally, in the context of National Carers Week (which was last week, 16–22 October), I want to pay tribute to the many Australians who provide care, companionship and support for loved ones accessing aged care services. Social engagement and continuity of close relationships through the support of carers have a profoundly positive effect on the wellbeing of aged care residents.

Last week we launched new online learning modules, providing a rich source of information to support families and friends of aged care residents as a ‘partner in care’. You can read more about these modules, and updated resources supporting providers to establish Partnerships in Care programs at their services, in this issue.

Update on sector reforms with regulatory implications

Introducing the SIRS in home services

From 1 December 2022, the Serious Incident Response Scheme (SIRS) will be extended from residential aged care to home care and flexible care delivered in a home or community setting.

This includes providers of Home Care Packages (HCP), Short-Term Restorative Care at home, Commonwealth Home Support Programme (CHSP), National Aboriginal and Torres Strait Islander Flexible Aged Care (NATSIFAC), Multi-Purpose Services (MPS) Program and Transition Care Program (TCP) services.

The exposure draft of the subordinate legislation for the scheme’s extension is being developed by the Department of Health and Aged Care. This draft will include details about how the SIRS will apply to home services. Once this draft is available, we will publish a link to it from our National aged care reforms webpage and the provider guidance resources will be released for the sector.

UPDATE: On Monday 31 October 2022, the Department of Health and Aged Care has released the Exposure Draft and Explanatory Statement of the Aged Care Legislation Amendment (Incident Management and Reporting) Instrument 2022. This draft subordinate legislation includes details about how the SIRS will apply to home services. Further information on the opportunity to comment on the documents for 14 days until 5:00 pm (AEDT) 13 November 2022 is on the Department’s webpage on SIRS.

The Commission has published the draft guidelines on SIRS for home services providers.

Please be advised that any information and resources the Commission is providing you with in relation to the commencement of the SIRS for home services are dependent on the finalisation of the exposed draft subordinate legislation. Until the Aged Care Legislation Amendment (Incident Management and Reporting) Instrument 2022 is registered and dependent resource materials are reviewed for consistency and cleared for final publication, the information they contain should be considered draft only.

National roadshow

To support the sector in the lead-up to 1 December, Commission staff are meeting with home services providers in capital cities around the country. These provider engagement sessions have been held in Brisbane, Perth and Melbourne so far, with sessions coming up shortly in Adelaide, Canberra, Darwin, Hobart, and Sydney. These sessions are proving popular, with participants welcoming the in-person engagement. Key themes discussed at the sessions have included existing requirements under the Aged Care Quality Standards for providers to have an effective incident management system, the information and guidance that will be made available to support providers to comply with their new SIRS obligations, and reporting through the My Aged Care portal. Providers can register their interest in participating in future face-to-face or virtual sessions by emailing sirs@agedcarequality.gov.au.

Webinars

We held the first webinar about the SIRS for home services, with a focus on incident management systems, on 26 September. The webinar recording and the presentation slides referred to during the webinar are both available via our agedcarequality.gov.au/reforms webpage.

We have rescheduled our remaining 2 webinars following advice from the Department of Health and Aged Care about the expected release date of the subordinate legislation. The new dates are:

Webinar 2 – SIRS reportable incidents
Date: Thursday 3 November
Time: 3:30–4:30 pm AEDT
Registration: Register to attend via this link: SIRS reportable incidents webinar

Webinar 3 – Reporting under the SIRS
Date: Wednesday 16 November
Time: 3:30–4:30 pm AEDT
Registration: The link to the registration page will be published on our Reforms webpage at least one week before the live event.

You can submit questions for the panel Q&A sessions before and during these webinars.

Both webinars will be recorded and made available shortly after the live events for on-demand viewing.

Other resources

The Effective serious incident investigations guidance for providers is designed to assist all providers of aged care services (both residential and home services providers) to conduct investigations into serious incidents. It promotes best-practice approaches associated with conducting an investigation and outlines steps to take when responding to actual, alleged and suspected incidents.

More information

If you have any SIRS queries, call us on 1800 081 549 or send us an email at sirs@agedcarequality.gov.au.

New Code of Conduct for Aged Care

The new Code of Conduct for Aged Care (the Code) aims to improve safety and wellbeing for people receiving aged care and to boost trust in services. The Code sets out the behaviours expected of approved providers of residential, home care and flexible aged care services, their governing persons and workers. The Commission has been given the necessary power to enforce the Code.

Additional information to help the sector prepare for the introduction of the Code is now available.

Exposure draft and guidance resources

The exposure draft of the Code has been released by the Department of Health and Aged Care and a consultation process has been undertaken. Guidance resources on the Code for providers, workers and consumers will be available shortly.

Webinars

Approved providers were offered an introduction to the Code in a webinar held on 7 October. You can access the recording via our agedcarequality.gov.au/reforms webpage.

All aged care workers – including students and volunteers – will soon have an opportunity to learn about the Code in a webinar specifically tailored to their needs:

Date: Friday 11 November
Time: 2:00–3:00 pm AEDT
Registration: Register to attend via this link: Code of Conduct for Aged Care: Aged care worker webinar

The webinar will provide an overview of what the Code is; the responsibilities of workers, their providers and governing persons; the Commission’s role; and how workers can prepare for the introduction of the Code.

You can submit questions for the panel Q&A session before and during the webinar.

The webinar will be recorded and made available shortly after the live event for on-demand viewing.

An email invitation will be issued to all approved providers, unions and industry peak bodies, requesting it be shared broadly to their workforce and members, and encouraging them to attend.

Strengthening provider governance

Webinar

We are hosting a webinar for all aged care providers about their new regulatory requirements in relation to governance:

Date: Monday 7 November 2022
Time: 3:00–4:00 pm AEDT
Registration: Register to attend via this link: Strengthening provider governance in aged care – a regulatory perspective webinar

You can submit questions for the panel Q&A session before and during the webinar.

The webinar will be recorded and made available shortly after the live event for on-demand viewing.

Key update – material changes notification timeframes

The commencement dates for the provider governance reforms are determined by a provider’s approval date. To assist providers, we have recently updated our Provider governance webpage to provide clarification on these dates.

One reform that will take effect on 1 December 2022 for all aged care providers is the change in material changes notification timeframes. From this date, all providers will be required to notify the Commission of material changes within 14 days of the change. Currently, and up to 30 November 2022, providers are required to notify changes within 28 days.

A material change is one that is substantial or considerable in nature. For example, if the approved provider:

is no longer an incorporated organisation
is unable to meet any of the home, flexible or residential care standards
is unable to manage its financial responsibilities including subsidies and care recipients’ fees and payments
makes a change which may affect the rights of aged care recipients
makes substantial changes to its organisational or governance structure such as:
- entering into a subcontract arrangement with a third party for delivery of clinical care
- using a management company to manage the day-to-day responsibilities of the organisation
makes a change to its key personnel.

Other resources

All providers are encouraged to view our Provider governance webpage to ensure they are prepared to implement these reforms as they commence.

Transition care services to be regulated from 1 December

Transition care is a form of flexible aged care. Its purpose is to allow people to recover in residential, home-based or community settings (or a mix of these) after a hospital stay. This type of care can last up to 12 weeks. More information about the Transition Care Programme is available on the Department of Health and Aged Care website.

Legislative amendments are expected to come into effect on 1 December 2022 which will see the regulatory functions for transition care services move to the Commission. This will ensure that there are clearer legislative protections afforded to transition care recipients. 

These legislative amendments will enable the Commission to undertake quality reviews of transition care services provided in home care settings, and monitor transition care services provided in residential and home care settings. However, the changes do not introduce accreditation for transition care services – rather, they strengthen the Commission’s ability to monitor these services.

These amendments will affect a small number of providers, and the Commission has existing regulatory relationships with most of these services.

The amendments do not cover transition care provided in hospitals or in other non-hospital facilities or community services managed and staffed by state or territory governments, or where transition care is delivered in home care settings by state or territory government run services/employees.

More information on the amendments will be provided soon on the Department of Health and Aged Care website.

Revised Quality Standards public consultation underway

The Department of Health and Aged Care is undertaking a public consultation process to understand the opinions of older Australians and the aged care sector on the draft revised Aged Care Quality Standards.

In response to a recommendation by the Royal Commission into Aged Care Quality and Safety, the department commenced a review of the Quality Standards in March 2021. Revised Quality Standards have since been drafted, in consultation with a range of stakeholders, including the Commission. You can read the detailed or summary version of the draft revised standards on the department’s website.

Consultation on the draft revised Quality Standards commenced on 17 October with a 2-hour webinar and the release of consultation documents. The consultation period will run until 25 November 2022, and will include a range of forums to seek feedback from the public, as well as online focus groups and a survey.

Visit the department’s Aged Care Engagement Hub to find out how you can participate in the consultation or to watch the consultation launch webinar recording. If you’d like to promote the consultation process through your communication channels, a stakeholder toolkit is also available.

Any enquiries regarding these consultations can be directed to the department through its Engagement Hub.

Quality and safety in home services – risks in focus: vulnerable consumers

In this fourth part of our article series about the 5 key risks in the delivery of home services, this month we focus on vulnerable consumers.

What’s the problem?

Failure to identify and appropriately support and monitor vulnerable consumers can lead to particularly poor outcomes for consumers who are already at risk. Consumers who are most at risk, or are vulnerable, may have a combination of characteristics including social or logistical isolation, limited mobility, cognitive impairment or communication difficulties. Providers need to be aware of risk indicators that make someone vulnerable.

What has the Commission found?

The Commission has observed that some providers don’t have appropriate mechanisms in place to identify, monitor and protect their more vulnerable consumers.

The Commission’s sector performance report for April to June 2022 indicates that lack of consultation or communication was the top complaint issue received about home services. It is important to note that consumers lodged 47% of all complaints for this period, with the balance being raised on behalf of consumers (such as by a consumer’s nominated representative or family members). In order to protect your most vulnerable consumers, you need to consider how you communicate with consumers who may not have the support network of family or other representatives to speak up and advocate on their behalf.

To ensure that your most vulnerable consumers are protected, you can start by considering your responsibility to have effective governance systems and processes as a requirement under Aged Care Quality Standard 8: Organisational governance. Without adequate monitoring and support for vulnerable consumers, there can be significant negative impacts on their health, safety and wellbeing.

In the Commission’s quality assessment and monitoring activities between 1 January 2021 and 31 August 2022, 42% of providers of home services assessed against Quality Standard 8(3)(c) effective organisation wide governance systems, and 41% assessed against Standard 8(3)(d) effective risk management systems and practices, were found to be non-compliant with these requirements.

Use these questions to understand and inform your home care services performance.

1. How many consumers are awaiting a higher level of care and how does your organisation work with these consumers to ensure that they get the care and services they need in the meantime?

For consumers who are particularly vulnerable, it is even more important that you have effective systems and processes to enable you to identify potential risks and incidents, and put in place strategies to mitigate any risks to the consumer’s health, safety and wellbeing – particularly during periods where consumers are waiting for a higher level of care and additional care is required. It is important that you work with consumers awaiting a higher level of care to ensure that their prioritised care needs continue to be met while they’re waiting.

2. How do you know that all workers delivering care and services are able to recognise and respond to abuse, neglect and exploitation?

You should have mechanisms in place to ensure that staff delivering services act in accordance with ethical and professional expectations (and the new Code of Conduct from 1 December), including treating consumers with dignity and respect, respecting consumer privacy and ensuring staff do not exploit consumers in any way.

You should review the training you provide for staff to help them identify and appropriately respond to abuse, neglect and exploitation. Your staff should have the skills to communicate with consumers and their nominated representatives to identify changes in consumer behaviour, as well as document and investigate any areas of concern with adequate follow-up. You should also ensure that your staff are trained and skilled to recognise signs of physical, mental or emotional deterioration (even if your staff do not provide clinical care).

In addition, under the current Aged Care Quality Standards, you are responsible for ensuring that an effective incident management system is in place to identify, respond to and manage any incidents that occur during the course of delivering care and services to consumers. This is especially important as the Serious Incident Response Scheme (SIRS) will apply to home care and flexible care delivered in a home or community setting from 1 December 2022.

3. How do you encourage and support consumers to report any concerns or instances of abuse, neglect or exploitation?

Consumers who experience challenges communicating (for example, because they speak a different language from their care staff, are cognitively impaired, or visually or hearing impaired) may require additional support to communicate their needs, make decisions about their care and services, and to provide feedback and make complaints about their care and services.

You can support vulnerable consumers by helping them to report concerns, instances of abuse and ensure adequate handling of complaints. You should ensure that you have mechanisms in place for gathering complaints in your service and for assessing if your processes are effective for all of your consumers to access.

More information

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

Partnerships in care resources

During National Carers Week (16–22 October), the Commission launched new interactive online learning modules to support families and friends of aged care residents to continue to provide care and companionship as a ‘partner in care’.

A partner in care may help with a range of different activities, even during periods of an infectious disease outbreak. This could include participating in exercise, offering assistance with meals, engaging in leisure activities, enjoying companionship, conversation and social engagement or supporting someone who is nearing the end of their life.

We also have updated resources to encourage and help aged care providers to establish ‘Partnerships in care’ programs at their services. These updated resources build on the relaxation of public health advice about visitation access for aged care residents, along with the Industry Code for Visiting Residential Aged Care Homes.

The new and updated partnerships in care resources are available on our website.

Update on Commission’s response to SCHADS Award changes

On 1 July 2022, changes to the Social, Community, Home care and Disability Services Industry (SCHADS) Award came into effect. The Award covers home care which meant that some home service providers who employ home care workers were directly impacted by the changes.

On 26 August 2022, the Aged Care Quality and Safety Commissioner sent a letter to home service providers reminding them of their ongoing legal responsibility to ensure the safe and effective delivery of quality care and services.

The Commissioner advised providers that any changes made to the care and services delivered as part of a home care package, including altering care arrangements to accommodate the SCHADS Award changes, cannot adversely impact the quality and safe delivery of care and services to a consumer.

Commission’s regulatory response

Since the Award changes came into effect, the Commission has been actively engaging with providers through targeted risk-based activities to ensure the continued quality and safe delivery of care to consumers. This has included telephone surveys and performance assessments against the Aged Care Quality Standards.

The Commission has found some providers to be non-compliant with the Quality Standards where they have sought to accommodate the requirements of the SCHADS Award but then failed to support consumers to exercise choice about their care and services, and failed to deliver care and services that meet their consumers’ assessed care and service needs.

Case study: detecting non-compliance

In one of these recent targeted assessment contacts with a provider, the issues detected by the Commission included:

The provider could not demonstrate that their consumers were provided with information that was current, accurate and timely to ensure that they understood what impacts the Award changes would have on the care and services they receive.
There was a lack of consultation with consumers regarding the provider’s proposed changes to care and services arrangements.
Multiple consumers confirmed that changes were made that did not align with their care and services plan, individualised budget and/or home care agreement and without the consumers providing their informed consent.
Some consumers were pressured into receiving care in two-hour service blocks that did not align with their assessed care needs.
The provider did not provide consumers with a revised budget that reflected changes to their service duration or frequency.
The provider cancelled shifts that were essential to the care needs of some consumers, without adequately consulting with the consumer or their nominated representative. Some of these cancelled shifts meant consumers were not getting the care and services they required in line with their assessed care needs.
The provider was not responsive in addressing the ongoing concerns raised by consumers who were negatively impacted by the changes made to the provision of their care and services.
The provider could not demonstrate that its governing body had the necessary oversight to monitor the impacts of the Award changes and ensure the delivery of safe and quality care and services for consumers, in line with their available package funding.

In response to these findings, the provider confirmed that in attempting to manage their obligations under the SCHADS Award, they had misunderstood their other obligations under the Quality Standards and relevant aged care law.

The Commission has taken compliance action with regard to the provider in response to the non-compliance found.

The Commission will continue to target providers where there are concerns that they may not be complying with their responsibilities.

Complaints

The Commission has received complaints from consumers and their nominated representatives regarding the SCHADS Award changes. Consumers are encouraged to engage with our complaints process if they have any concerns with their home services provider.

Measures of good practice: food, dining and nutrition webinar for residential providers – 17 November

To complement the first set of resources on food, dining and nutrition that were recently released by the Commission, we are holding a series of related webinars.

The first of these webinars focused on the dining experience and resident choice. A recording of that event is now available on our YouTube channel.

All residential aged care providers and their workforces are encouraged to attend our second webinar in this series on good practice approaches:

Date: Thursday 17 November
Time: 1:30–2:30 pm AEDT
Registration: Register to attend via this link: Food, dining and nutrition webinar 2 – Measures of good practice

This webinar will focus on:

the key principles of the dining experience and consumer choice
what the Commission looks for when assessing against food elements of the Aged Care Quality Standards
a case study on how providers are ensuring an enjoyable dining experience for residents.

You can submit questions for the panel Q&A session before and during the webinar.

The webinar will be recorded and made available shortly after the live event for on-demand viewing.

Our range of food, dining and nutrition resources for providers and for consumers are available to download from our website. We’ll be releasing the next set of resources soon and the webinar series will continue into 2023.

Upcoming key dates for financial reporting

On 1 July 2022, the Government introduced more frequent reporting obligations for aged care providers. In addition to the existing Aged Care Financial Reporting (ACFR) obligations, providers are now also required to submit Quarterly Financial Reports (QFR) and publish a General Purpose Financial Report (GPFR).

Submission of financial reports

The ACFR for the reporting period 2021–22 is due on 31 October 2022.

The QFR for the reporting period 1 July–30 September 2022 is due on 4 November 2022.

Providers are expected to submit the ACFR and QFR via the Department of Health and Aged Care’s Forms Administration website.

Failing to lodge a complete ACFR and/or QFR by the due date may result in regulatory action by the Commission.

Publishing a GPFR

Under s37B of the Accountability Principles 2014, providers who lodge a General Purpose Financial Report (GPFR) with the Department of Health and Aged Care must now publish their GPFR and associated audit opinion.

These documents must be published within 5 months after the end of providers’ financial year. This gives providers one month to publish their GPFR after their ACFR is due. It must be published on the providers’ website, or if the provider does not have a website, on another website accessible to the public.

Further information on these reporting requirements, including the recordings of recent webinars hosted by the Department of Health and Aged Care, is available on the Forms Administration website.