Aged Care Quality Bulletin #47 – November 2022

Four elderly people sitting on a couch laughing

Commissioner's message

We are all now counting down to ‘go live’ for several key aged care reforms aimed at improving the consumers’ experience of, and confidence in, safe, quality aged care.

Over the past 3 months, I have hosted 8 webinars to support the sector to prepare for the upcoming regulatory changes, particularly in relation to the expansion of the Serious Incident Response Scheme (SIRS) into home services, the introduction of a new Code of Conduct for Aged Care and the strengthening of provider governance.

More than 10,000 participants have tuned in to these webinars as live events, which reflects the sector’s strong interest in these reforms and a determination to learn as much as possible about them in order to prepare for their introduction.

We have received hundreds of questions seeking further information, and have responded to some during the webinars and the balance via a Q&A sheet published on our website. I encourage you to refer to the suite of webinar Q&As on our website to get more detail on each of these reforms.

Of course our support for providers will continue through and beyond 1 December, with our communication, engagement and education activities being vital tools in our regulatory toolbox. In this issue, you will read more about the range of guidance and education resources already available to support your preparation for 1 December.

I also encourage all approved providers to attend our last webinar for the year, at 3:00 pm (AEDT) on Thursday 15 December 2022. In this webinar, we will provide further detail about the current and upcoming reforms and talk more about the role of our assessors in the context of the reforms. Registrations will open at least one week before the event – keep an eye on our reforms webpage for the link to register to attend. I encourage you all to join us for this webinar. In the meantime, you can catch up on any of the reform webinars via our aged care reforms webpage.

Update on sector reforms commencing 1 December

Introducing the SIRS in home services

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

This will include providers of Home Care Package, Short-Term Restorative Care at home, Commonwealth Home Support Programme, National Aboriginal and Torres Strait Islander Flexible Aged Care, Multi-Purpose Services Program and Transition Care Program services.

On 31 October, the Department of Health and Aged Care released the exposure draft and explanatory statement of the Aged Care Legislation Amendment (Incident Management and Reporting) Instrument 2022. The consultation period closed on 13 November, and the legislative instrument is now in the process of being registered.

Once that process is completed, we will finalise our SIRS guidelines for home services providers, which are currently available in draft form. We encourage you to read these guidelines which describe the home service providers’ SIRS responsibilities and the range of incidents that must be reported to the Commission.

We have completed our 3-part webinar series on the SIRS for home services. The recordings of these webinars are now available:

Aged care providers notify the Commission of SIRS reportable incidents through the My Aged Care Service and Support portal. A user guide for home services providers and staff, ‘How to access and use the Service and Support Portal for Serious Incident Response Scheme (SIRS): In-Home Care’, is now available on the department’s website.

In addition, 3 videos are available which provide practical demonstrations on how to use the My Aged Care Service and Support portal to report serious incidents to the Commission:

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

Code of Conduct for Aged Care

A suite of guidance materials is now available on our website to help the sector prepare for the introduction of the Code of Conduct for Aged Care (the Code) on 1 December 2022.

Located on the relevant provider, worker and consumer Code webpages are guidance documents, fact sheets, frequently asked questions, a provider readiness checklist and a video. Additional support materials continue to be developed and will be released as they are ready.

The Code of Conduct 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.

We have held 2 webinars about the Code. An introduction to the Code was presented in a webinar specifically tailored to aged care workers on 11 November. You can access the recording and PowerPoint slides via our reforms webpage.

Our webinar for aged care providers was held on 7 October. That recording and the slides are also accessible via our reforms webpage.

Strengthening provider governance

To assist providers to understand the new provider governance requirements, the Commission has released a guidance document and hosted a webinar. Providers are also encouraged to review the Commission’s national aged care reforms webpage.

From 1 December 2022, there will be new governance responsibilities for approved providers. This includes providers of residential aged care, home care packages, short-term restorative care both at home and in residential aged care settings, multi-purpose services and transition care.

Existing approved providers will be required to:

  • assess the suitability of their key personnel at least once a year
  • notify the Commission of changes that materially impact the provider’s suitability, and any changes to key personnel, within 14 days of the change
  • provide annual information on their operations to the Department of Health and Aged Care.

Existing providers should also commence planning to meet their obligations commencing 1 December 2023:

  • ensuring their governing body is made up of a majority of independent non-executive members that have the mix of skills and experience to deliver safe and high-quality care, and that at least one member has experience in providing clinical care
  • setting up and continuing a quality care advisory body
  • offering, at least annually, to set up one or more consumer advisory bodies
  • requiring the governing body to ensure staff members have the appropriate qualifications, skills or experience to provide relevant care and services and are given opportunities to develop their capability to provide those services.

There are also responsibilities that apply to certain providers and key personnel:

  • for certain providers that are a wholly-owned subsidiary of another body corporate that is not an approved provider – the provider must ensure that their constitution does not authorise a director of the provider to act in good faith in the best interests of the holding company
  • for key personnel of providers which are corporations – these key personnel must notify the provider if their circumstances related to the ‘suitability matters’ under the legislation change.

Providers approved after 1 December 2022 are required to meet all the new requirements from the date they are approved.

For organisations that applied for approved provider status before 1 December 2022, and where a decision on the application is still pending, the new governing and advisory body responsibilities will not apply until 1 December 2023.

New Star Ratings for residential aged care

The Royal Commission into Aged Care Quality and Safety highlighted the need for information about service quality to be available for people seeking and receiving aged care, and recommended developing and publishing a Star Ratings system.

The Department of Health and Aged Care hosted a webinar on the Star Ratings on 18 November and will be available shortly on the department’s website.

Star Ratings are expected to be published for residential aged care homes on My Aged Care from December 2022. The system is clear, transparent and fair. As individual service Star Ratings improve, it is expected that the quality of the residential aged care sector will also improve.

Star Ratings are calculated using an overall 5-star quality rating based on 4 sub-categories:

  • residents’ experience
  • compliance
  • staffing
  • quality measures.

The compliance rating is based on decisions of regulatory compliance by the Commission, where an aged care home is not meeting its responsibilities, including against the Aged Care Quality Standards. It reflects the home’s current compliance status and is based on the type of compliance action or period without a regulatory compliance decision.

In preparation for the commencement of star ratings, the Commission has been reviewing all compliance activity. Where indicated, this has involved an onsite performance assessment or audit. We have undertaken this review to provide consumers and the sector with assurance that all compliance actions that remain open with the Commission from 1 December 2022 are based on a current assessment of compliance risk.

The other 3 components of the overall star ratings are determined by the Department of Health and Aged Care.

More information on Star Ratings and the 4 sub-categories is available on the department’s website.

Governing for Reform in Aged Care program – podcast series available

The Governing for Reform in Aged Care program’s podcast series – ‘Conversations to transform aged care’ – is now available to stream.

This learning tool allows anyone with an interest in aged care reform leadership to listen to, reflect on and gain insights from relevant subject matter and industry experts across a multitude of sectors.

The series can be downloaded from Apple Podcasts, Google Podcasts and Spotify.

In addition to listening to the series, governing body members and aged care executives of providers of residential and home care services are also encouraged to enrol in the Governing for Reform in Aged Care program.

Enrolling in the program is free. It provides an opportunity for aged care leaders to get ahead of the aged care reforms, implementing best practice in aged care organisational and clinical governance and ensuring the provision of safe and high-quality care to consumers. Participation in the program provides access to highly specialised learning materials and supports, including workshops, online learning modules and resources, networking opportunities, coaching and webinars.

You can learn more and enrol on the program website.

Quality and safety in home services – risk in focus: management of package funds

Over the past 4 months, we have focused on key risks in the delivery of home services. In this final part of our series, we look at the management of package funds.

What’s the problem?

The Commission has received numerous complaints about providers’ inappropriate use and/or management of consumers’ Home Care Package (HCP) funds, as well as poor communication with consumers about their fees and charges. As outlined in a recent article, the issues include:

  • failing to adequately consult or engage with consumers and seek their mutual consent to any changes to fees and charges
  • charging consumers for care and services that they do not receive
  • failing to provide consumers with appropriate support to understand their HCP budgets and monthly statements
  • charging excessive or unreasonable package management or care management fees
  • failing to clearly and accurately reflect the services provided to consumers, the cost of each service instance and package management fees in monthly statements
  • charging consumers for additional care and services without proper agreement.

What has the Commission found?

The Commission’s April–June 2022 sector performance report indicates that lack of consultation or communication, fees and charges, and management of finances were the top 3 complaint issues for home services received during this period. Importantly, 6 of the top 10 issues related to financial issues.

Providers are responsible for ensuring HCP funds are being spent appropriately, that consumers understand what they are being charged for and that they are being charged appropriately. To ensure that consumers are provided with all relevant information, providers can start by considering their responsibilities under the Aged Care Quality Standards, particularly Standard 1: Consumer dignity and choice which states that information provided to each consumer is current, accurate, timely and communicated in a way that is clear, easy to understand and enables them to exercise choice.

Providers should also consider their responsibilities under Part 3 of the User Rights Principles 2014 relating to home care agreements and the rights of consumers under the Charter of Aged Care Rights.

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

1. How do you know that your consumers understand their HCP budget and monthly statements?

It is expected that you help consumers to understand their monthly statement, explain any charges they query and discuss any changes to fees and charges with consumers before these are made.

2. What is the decision-making process for determining whether the care or services sought by a consumer are within scope and aligned with the intent of the HCP program?

The care and services you provide to consumers must be within the scope of the specified care and services (set out in Schedule 3 of the Quality of Care Principles 2014) and the inclusions and exclusions framework set out in the Home Care Packages Program Operational Manual.

3. How do you ensure that consumers are only being charged for services they actually receive, and that unspent funds are not building up when the services are needed now?

You must only charge consumers for care and services (and other costs such as care management and package management) that have actually been provided. For example, you must ensure that consumers aren’t charged where an instance of service has been skipped or missed, where the duration of a service is shortened or where items are purchased on behalf of a consumer that actually cost less than expected.

Further, any changes to fees and charges must be explained and agreed with consumers before they are made.

Important note

Some of these issues relate to care management and package management charges. The Australian Government’s commitment to improve pricing transparency and reduce excessive administrative charges has resulted in capping care management and package management charges, as well as revising the definition of these services. It is important to be mindful of your responsibilities as a provider in relation to adequate consultation and mutual consent when changing any Home Care Agreement to comply with these new legislative changes.

More information

To find out more about this key risk, read Chapter 6 of our Quality and safety in home services – 5 key areas of risk resource.

Quality improvement initiative improves antibiotic use

To Dip or Not to Dip is a quality improvement initiative developed in the United Kingdom that effectively and safely reduced antibiotic use for urinary tract infection (UTI) in aged care residents.

The Commission adapted this initiative and included supporting material with our antimicrobial stewardship (AMS) resources, which we launched in October 2021.

More recently, we completed a 9-month project to evaluate the effectiveness of the To Dip or Not to Dip initiative in the Australian setting. The findings showed improved antibiotic use, with increased staff confidence in not using urine dipsticks to diagnose UTI, and increased recognition of asymptomatic bacteriuria (ASB), a condition often mistaken for UTI that does not require antibiotics.

Taking antibiotics when not appropriate promotes antibiotic resistance. Antimicrobial-resistant organisms can result in infections that are more difficult to treat and lead to the use of alternative antibiotics with greater side effects.

AMS is the careful and responsible management of medications used to treat or prevent infections. It involves activities that promote and support best practice antimicrobial prescribing and use. Aged care providers, nurses, doctors, pharmacists, carers and consumers can all contribute to good AMS practice.

Appropriate AMS practice ensures that antibiotics are used only when they are needed. This includes stopping antibiotics as soon as they are no longer needed or effective.

If your service would like to implement the To Dip or Not to Dip quality improvement initiative, please email pharmacyunit@agedcarequality.gov.au and include ‘TDONTD’ in the subject line.

More information and resources on To Dip or Not to Dip and AMS are available on our website.

We also encourage all residential aged care providers to share the related Do you need antibiotics? consumer resource with your residents, their families and carers.

New financial and prudential regulatory insights series

This month we have launched a new series, Financial and prudential regulatory insights with Peter Edwards.

Peter is the Commission’s Executive Director Financial and Prudential Regulation. He has a deep appreciation of the challenges of delivering care and the importance of strong governance to ensure that care is delivered safely and to the highest possible standard. Peter’s legal background and many years of working in regulatory environments, coupled with his earlier experience working in nursing and clinical leadership roles, means that he has a deep well of knowledge and experience to draw from.

In this monthly series, Peter will share insights aimed at demystifying financial and prudential regulation in aged care and exploring how it can support better outcomes for people receiving aged care services.

All aged care providers are encouraged to share the monthly series with their chief financial officers (CFOs) and other financial managers, management and director-level staff.

To subscribe or to suggest topics you would like Peter to cover in future posts, contact prudential@agedcarequality.gov.au and include ‘Insights’ in the subject line.

Improving food and nutrition in residential aged care

A good food, dining and nutrition experience supports a resident’s quality of life, their health and wellbeing. Over the past 2 years, the Commission has embarked on a journey aimed at improving the experience of food and nutrition in residential aged care.

As outlined in our August edition, we are engaging with the aged care sector and the community on this important topic and releasing resources for providers and consumers about dining, including a new Alis module and 2 videos - one for providers and one for consumers.

We held our second webinar in the Food, Dining and Nutrition series on 17 November this year. This webinar featured a case study and an interview with residential aged care provider, Whiddon. The links between person-centred care, food, nutrition, dining and health were discussed, and Whiddon’s journey to deliver good food and nutrition was shared. The webinar recording is now available on our YouTube channel.

Earlier this month, the Commission also participated in the Lantern Conference 2022. At this event, providers shared innovative food and dining practices, including how to recruit and retain talent. Attendees also heard about the benefits of including residents in the preparation of meals.

Alongside other government representatives and industry leaders, the Commission’s Chief Clinical Advisor Dr Melanie Wroth discussed key initiatives underway to further improve food, dining and nutrition in aged care. Dr Wroth also provided an overview of the Commission’s quality assessment and monitoring of meals and the dining experience against the Aged Care Quality Standards.

Our range of food, dining and nutrition resources for providers and for consumers is available on our website. Further resources on swallowing and oral health will be released shortly.

Five new Alis modules now available

We have released 5 new online learning modules on Alis, our Aged Care Learning Information Solution. Aged care providers and workers can access Alis for free, anywhere and at any time.

Incident management system modules

We have released 4 new Alis modules which provide an overview of incident management systems (IMS):

  • What is an IMS?
  • Creating an IMS
  • Implementing an IMS
  • Complaints and your IMS.

These 10-minute modules cover the elements of an effective IMS, the benefits to your service, the importance of a safety culture and workforce training, and the crucial link between an effective complaints handling system and your IMS. The content is relevant to aged care services in both residential and home settings.

Getting the dining experience right module

This module is part of our food, dining and nutrition suite of resources. It is for staff who work in residential aged care services, including care staff, cooks, chefs and food service staff. It introduces the key concepts and resources that will support staff to create an enjoyable dining experience that improves the wellbeing and quality of life for residents, including:

  • the importance of the dining experience for consumer wellbeing
  • some practical tips and suggestions to support a positive dining experience.

Free access to Alis

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

Log in to Alis at learning.agedcarequality.gov.au.

Applications open for Aged Care Registered Nurses’ Payment

Applications are now open for the Australian Government’s Aged Care Registered Nurses’ Payment. Aged care providers can apply on behalf of their eligible staff through a non-competitive grant process on the Grant Connect website.

Applications close on 14 December 2022.

This payment recognises the contribution that registered nurses make in providing quality care for older Australians.

The Aged Care Registered Nurses’ Payment is available to registered nurses working in residential aged care, in-home care and Commonwealth Home Support Programme settings.

Payments for either 6 months or 12 months of employment will be available to registered nurses who work for the same aged care provider over the eligibility periods.

More information on the Aged Care Registered Nurses’ Payment and its eligibility criteria is available on the Department of Health and Aged Care website.

Enquiries about the payment, including eligibility requirements and the grant application process, can be made by contacting the department on (02) 6289 5600 or grant.atm@health.gov.au.

New and updated Commission resources

Reform webinar recordings

SIRS reporting videos

Food, dining and nutrition resources

Alis IMS modules

Fact sheets

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Acknowledgement of Country

In the spirit of reconciliation, the Aged Care Quality and Safety Commission acknowledges the Traditional Custodians of Country throughout Australia and their connections to land, water and community. We pay our respect to their Elders, past, present and emerging and extend that respect to all Aboriginal and Torres Strait Islander peoples.