Aged Care Quality Bulletin #30 – June 2021 | Aged Care Quality and Safety Commission

Commissioner’s message

Just as this edition of the Bulletin is going to press, National Cabinet has decided that COVID-19 vaccination will be mandatory for residential aged care workers, with staff required to have at least the first of 2 doses by mid-September. To facilitate this process, the Commonwealth Government will establish a fund to assist aged care providers to financially support casual workers to access the vaccination. Additional information about these provisions will be provided shortly by the Department of Health.

The additional COVID-19-related restrictions that have been introduced in a number of states and territories in recent days and weeks is a timely reminder for providers of the importance of refreshing and rehearsing your outbreak management plan.

An outbreak management plan is invaluable not just in the event of a COVID-19 outbreak, but equally importantly, at times of emerging or heightened risk of community transmission. Increasing vaccination coverage of staff, aged care residents and consumers receiving home care will significantly reduce, but not eliminate, the risks of potential viral transmission. There are also risks to consumers’ well-being from lockdown provisions that prevent some family members from visiting in person. It is vital that all providers understand and make suitable provisions to mitigate all these risks.

To assist you in addressing your obligations in this regard, it is strongly recommended that providers refer to the Commission’s ‘Outbreak management in aged care’ guide. In this edition, we focus particularly on the importance of ensuring that your outbreak communication plan is up to date.

Other issues addressed in this Bulletin include the ongoing work the Commission is doing with the sector to support the implementation of the Serious Incident Response Scheme (SIRS), and also the legislative amendments to come into effect from 1 July to clarify and strengthen providers’ obligations to minimise restrictive practices. These latter measures will include additional powers for the Commission to address inappropriate use of restrictive practices in residential care and short-term restorative care in a residential care setting.

Also effective from 1 July are the changes to the National Aged Care Mandatory Quality Indicator Program, which include the introduction of 2 new indicators about which residential aged care providers will need to collect data and report.

The SIRS, new restrictive practices measures and additional quality indicators are all part of the Government’s response to the findings and recommendations of the Royal Commission, which identified an urgent need to lift the quality, safety and outcomes of care across the aged care sector. All of us have an important role to play in contributing to the achievement of this worthwhile goal.

Is your outbreak communication plan up to date?

As part of your outbreak management planning, it is essential for residential aged care providers to have a communication plan in place that provides effective, consistent and timely information to all relevant parties at times of heightened risk and also during an outbreak – including with residents and their families/representatives, as well as staff, external support providers and government agencies.

From our 2020 ‘Lessons learned’ interviews, we found that when an outbreak occurs, having a team to communicate important information to residents and family members/ representatives was very effective. This allowed providers to be proactive and keep residents and others well informed, which tended to result in fewer complaints.

It was noted that families/representatives most often preferred:

a single point of contact and, where possible, for this to be a clinical member of staff
to speak with someone who could provide details about how the outbreak was being managed at the service
transparent and honest information sharing, especially when there was bad news or events leading to deviations from the outbreak management plan.

As a provider, it is essential that you communicate consistently and transparently with your staff as well – not just in an outbreak but also in situations of emerging risk. You must clearly define roles, responsibilities and expectations for everyone in the service in the case of a lockdown that may or may not be accompanied by an outbreak at the service. It’s also important to stay connected with external service providers who support your service, such as general practitioners, allied health professionals, and lifestyle and community support services.

To ensure effective communication with your staff and other service providers, you should:

regularly provide information to, and respond to questions and feedback from your staff
undertake test runs of the communication plan
prepare communication templates to advise residents and their families/ representatives, staff and external service providers
review and update your contact lists for residents’ families/representatives, staff and external service providers
make sure your service has devices and resources to manage communication on and off-site.

It is also strongly recommended that you make external service providers and government agencies aware of, and even include them in, your outbreak management plan. This gives you an opportunity to test your plan and receive essential feedback to identify any gaps and scope for improvement.

There are a range of COVID-19 resources available on our website for providers and for consumers, in addition to the COVID-19 information provided by the Department of Health. You should also routinely monitor advice from your local state or territory health department.

SIRS insights – valuable provider roundtable feedback and first Commission report

Early experiences of the Serious Incident Response Scheme (SIRS) have been shared by residential aged care providers at a virtual roundtable with the Commission.

Ten providers drawn from regional and metropolitan Australia participated in a roundtable convened by the Commission on 9 June. They shared their feedback about SIRS implementation challenges, ideas for improvement, and early benefits from the scheme. Provider peak organisations were also represented.

Notwithstanding the acknowledged hurdles associated with implementing any new scheme, many providers agreed that the SIRS is a positive step in improving the provision of quality and safe care. One provider commented, ‘SIRS has encouraged us to review our own systems. Our own investigations are improving, and we are taking more effort to understand why incidents have occurred.’

The feedback from the roundtable is helping us to further improve our resources to support to the sector. We will also host a follow-up roundtable later in the year to gain further valuable provider insights. You can read the summary report of the SIRS provider roundtable on our website.

The Commission has also published its first SIRS insight report based on notifications submitted during the initial 6 weeks of the scheme. This analysis aims to help inform the sector about SIRS reporting and the regulatory treatment of notifications. We encourage providers to examine their own reporting patterns and arrangements in comparison with sector averages. The first report in our new SIRS insight series is available on SIRS reports page of our website.

Additionally, in the coming weeks, providers will notice a new feature on the My Aged Care SIRS portal. Providers will receive an email alert if there are draft (incomplete) notifications sitting in the portal with no action for more than 7 days. There will also be a new ‘follow-ups’ tile so providers can review copies of all email alerts sent.

All the early lessons learned from the introduction of the SIRS in residential aged care will be invaluable as work gets underway to plan the expansion of the SIRS into home and community care from 1 July 2022. Providers of home services for aged care consumers are already required to have an effective incident management system in place in accordance with Standard 8 of the Aged Care Quality Standards. Extending that requirement to include reporting of particular serious incidents to the Commission will be an important step in further protecting home service recipients from harm and strengthening provider accountability. We’ll keep you updated on this expansion of the SIRS in future editions of this bulletin.

New SIRS modules now available in Alis

Two more modules focusing on incident management obligations that are an important part of the Serious Incident Response Scheme (SIRS) are now available in Alis, our Aged Care Learning Information Solution.

The new ‘SIRS: Moments that matter – Your role in incident management’ and ‘SIRS: Recognising and responding to incidents’ modules provide information about how to recognise and respond to incidents within residential aged care services.

The content of both modules is tailored for those directly involved in the provision of care and support to residents. It will help ensure that staff understand the actions they should take if they witness an incident, or if they believe that an incident or near miss may have occurred.

These modules bring the suite of SIRS modules in Alis to 3, following the release of the first module, ‘Being aware: Introduction to the SIRS’, in March. More modules will be added soon.

To help you access all the modules on Alis, all Commonwealth-funded aged care services can obtain up to 4 free registrations to our online learning platform until 31 October 2021. You can also purchase additional registrations, if needed.

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

Amendments to restrictive practices legislation

In response to the final report of the Royal Commission into Aged Care Quality and Safety, and the findings of the independent review of legislative provisions governing the use of restraint in residential aged care, the Australian Government has introduced measures to clarify and strengthen the regulation around the use of restrictive practices in residential aged care and short-term restorative care in a residential care setting.

These measures are contained in legislative amendments to the Aged Care Act 1997 and Quality of Care Principles 2014 which commence from 1 July 2021, and which clarify the limited circumstances in which restrictive practices can be used in relation to a consumer, including for use in an emergency.

In addition, the amendments:

introduce the term ‘restrictive practices’ to describe all forms of ‘restraint’
make changes to the types and definitions of restrictive practices that may be used or applied and align these with those used in the disability sector under the National Disability Insurance Scheme Act 2018 and National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018. These definitions include chemical restraint, environmental restraint, mechanical restraint, physical restraint, and seclusion
clarify existing provider requirements regarding consent, monitoring and evaluation, and that any restrictive practice is used as a last resort
include provisions for strengthening regulation of use of restrictive practices to enable the Commission to issue a regulatory notice when non-compliance with the amended Quality of Care Principles is identified.

From 1 September 2021, the amended Aged Care Act and Quality of Care Principles require providers to comply with responsibilities relating to behaviour support plans. This includes a requirement for providers to have a behaviour support plan in place for each consumer who requires, or may require, the use of restrictive practices. The amended Quality of Care Principles outline the requirements of the behaviour support plan and include information on assessment, monitoring, review, evaluation and provision of consent. The behaviour support plan will build on existing strategies that a provider has in place to support person-centred care for each of their consumers.

The amendments also introduce additional powers for the Commission to respond to the inappropriate use of restrictive practices. From 1 July 2021, the Commission may issue a Restrictive Practices Compliance Notice where a provider may not be complying with its responsibilities in relation to the use of restrictive practices. The Commission continues to take a risk-based approach to all compliance actions. For more information on the Commission’s approach to compliance and enforcement, including use of regulatory powers, refer to our Compliance and enforcement policy.

The Commission has issued a Regulatory Bulletin which outlines the new regulatory requirements. We will also be holding a number of webinars during July and August to support providers to build on and improve their current practice.

The Commission has a number of resources available to assist providers with their requirements regarding appropriate use of restrictive practices. The Commission is also developing and/or revising additional resources including the restrictive practices scenarios, the decision-making tool and guidance around consent. These resources will be available on the Commission website shortly.

Aged Care Quality Standards guidance resources, including those to support provision of consent, minimising restrictive practices and behaviour support planning, are already available on our website.

The Commission is also working with the Department of Health, alongside Dementia Support Australia, to provide specific resources for behaviour support planning. These resources will be made available once finalised.

Further information on the legislative reforms is available on the Department of Health website.

Guidance materials available for upcoming Quality Indicator Program changes

In just a few days’ time, the updated and expanded National Aged Care Mandatory Quality Indicator Program (QI Program) will commence.

From 1 July, approved providers of residential aged care are required to report quarterly on new or revised quality indicators across 5 crucial clinical areas. From this date, you must start collecting the following data, as detailed in the Department of Health’s National Aged Care Mandatory Quality Indicator Program Manual – 2.0 – Part A – Final draft:

Quality indicator	Data required
Pressure injuries (revised)	Percentage of care recipients with pressure injuries, reported against 6 pressure injury stages
Physical restraint (revised)	Percentage of care recipients who were physically restrained
Unplanned weight loss (revised)	Percentage of care recipients who experienced significant unplanned weight loss (5% or more) Percentage of care recipients who experienced consecutive unplanned weight loss
Falls and major injury (new)	Percentage of care recipients who experienced one or more falls Percentage of care recipients who experienced one or more falls resulting in major injury
Medication management (new)	Percentage of care recipients who were prescribed 9 or more medications Percentage of care recipients who received antipsychotic medications

A suite of guidance materials is now available on the Department of Health website to help you understand and prepare for the changes to the QI Program, including:

Part C of the QI Program Manual
data recording templates
information sheets
frequently asked questions
a poster.

If you have any questions about the QI Program expansion, contact the My Aged Care service provider and assessor helpline on 1800 836 799.

Updates from the Chief Clinical Advisor

Heater burns

The Commission continues to receive reports of serious burns to residents from hydronic heaters which are commonly used in residential aged care. These heaters can pose significant risks to consumers in certain circumstances, resulting in severe pain, disfigurement and worse. Providers are strongly urged to revisit the alert we issued in our August 2019 Quality Bulletin. Please review the risks associated with these heaters within your services, because heating temperatures, furniture placement, room layouts and resident vulnerabilities may have changed since your last review.

Antimicrobial stewardship and urinary tract infections

A healthy person’s urinary tract can be host to a variety of micro-organisms which can be detected using tests such as urine culture or dipsticks. Asymptomatic bacteriuria (ASB) – where bacteria is detected in the urine of a person who does not have any symptoms or signs of urinary tract infection (UTI) – is very common in people living in aged care homes. In fact, it is reported in up to 50% of all residents and in almost 100% of residents with a urinary catheter.

It is important for clinicians working in aged care to understand that treating ASB in older people (typically with an antibiotic) does not reduce their future risk of developing a UTI with symptoms, and may increase risk by disrupting the bladder microbiome. Further, antibiotics can have unwanted side effects and their unnecessary use can contribute to development of antibiotic resistance.

 A key take-away message here is that routine or regular use of urine dipstick tests (or urine cultures) with aged care residents (especially where there is no clinical indication of infection) is known to contribute to overdiagnosis of UTIs.

Urine dipsticks do not diagnose UTI – this is best done by clinical assessment. The Australian Commission on Safety and Quality in Health Care has developed a fact sheet presenting the clinical guidelines for approaching suspected UTIs in aged care facility residents.

Recent aged care and NDIS worker screening requirements changes

Residential aged care providers (and multi-purpose services) providing permanent residential aged care who also support participants in the National Disability Insurance Scheme (NDIS) have responsibilities under both the Aged Care Act 1997 and the National Disability Insurance Scheme Act 2013.

One provider responsibility addressed by both Acts relates to worker screening checks. Under aged care legislation, an approved provider has to comply with police certificate requirements, while under NDIS legislation, a registered provider has to comply with the NDIS Worker Screening Check requirements for workers in risk-assessed roles. A risk-assessed role is a worker or volunteer who provides direct delivery of care to an NDIS participant.

Recognising that there was unnecessary duplication in these responsibilities, Federal Parliament has amended aged care legislation effective from 16 June 2021 to enable an aged care provider to accept a clearance obtained through the NDIS Worker Screening Check process as an alternative to the police certificate requirements for a particular worker.

This means that staff and volunteers in a risk-assessed role who are supporting NDIS participants in a residential aged care service do not require an NDIS worker screening clearance if they hold a current aged care police certificate issued prior to 1 February 2021. These workers will require an NDIS worker screening clearance when their police certificate expires.

These changes are aimed at reducing the regulatory burden for aged care providers who are also registered NDIS providers by reducing the need to maintain 2 worker screening arrangements, without reducing the protection for consumers.

Further information on NDIS worker screening requirements is available on the Department of Health website.

Further information on risk-assessed roles and NDIS Worker Screening Check requirements is available on the NDIS Commission website.

New online education workshops now open for registrations

In response to sector feedback, the Commission has developed 3 online education workshops which are now open for registrations.

The ‘Monitor and assess the performance of your service: aged care home services’ and ‘Monitor and assess the performance of your service: aged care residential services’ workshops are designed to support aged care providers in developing their knowledge, skills and practical understanding of monitoring and assessing their own performance, to ensure that the services they deliver are in line with the Aged Care Quality Standards. These workshops have been developed as new, condensed versions of the ‘Assessing the Standards’ workshops. They’ve also been tailored for each intended audience, with some of the content relating to risk areas, relevant guidance, examples and discussion points being specific to home services and residential services.

The ‘Getting to know the Standards – information session’ provides an overview of the Aged Care Quality Standards, relevant guidance material and helpful templates. This education session has been redeveloped based on the ‘Getting to know the Standards’ and ‘Preparing for the Standards’ workshops previously delivered by the Commission and the former Australian Aged Care Quality Agency.

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