Aged Care Quality Bulletin #44 – August 2022 | Aged Care Quality and Safety Commission

Group of ethnically diverse elders smiling

Commissioner’s message

The Labor Federal Government’s aged care reform program is quickly gaining momentum.

The new Aged Care and Other Legislation Amendment (Royal Commission Response) Act 2022 implements 9 measures to improve accountability and transparency, and responds to 17 recommendations of the Royal Commission into Aged Care Quality and Safety.

I recently wrote to approved providers and to consumers about the upcoming changes. The Commission will be actively supporting providers to understand and prepare for the new obligations. This will include publishing guidance resources (after consulting on content), as well as offering education on what is expected of providers under the new provisions.

The requirements and obligations introduced under the new Act focus on improving transparency and accountability, and protecting the dignity of older Australians who deserve safe, quality care in residential, in-home and community settings.

Measures applying from 1 December 2022 include: expanding the Serious Incident Response Scheme (SIRS) into home care, introducing a Code of Conduct for providers, workers and governing persons, and strengthening provider governance.

Alongside the work the Commission will do with providers are the activities we will be undertaking to support older Australians, their families and carers to learn about the changes and what they can expect from them. The Commission’s new Consumers and Families Panel will play a vital role in helping us to appreciate what is important to older people and how we can better support them to gain the full benefits of the changes taking place.

Staying with the focus on consumers, this month the Commission launched our Food and Nutrition campaign aimed at promoting better meals and dining experiences for aged care residents. As part of this campaign, we have produced resources to support residents in aged care facilities to be aware of their right to make informed choices about what they eat and drink, and the setting in which that occurs.

The Royal Commission identified food and nutrition, together with governance, diversity and dementia as key areas of concern and recommended a review of the Aged Care Quality Standards. The government’s review of the Quality Standards is expected to be completed this year.

For further information on the work of the Commission, I encourage you to review our just-released Corporate Plan 2022–23. The plan captures our priorities as the national aged care regulator, identifying 3 key activities with 14 performance measures through to 2025–26.

National reform program aims to deliver a better experience of aged care

The new Aged Care and Other Legislation Amendment (Royal Commission Response) Act 2022 introduces new requirements for approved providers and expands the role, powers and functions of the Aged Care Quality and Safety Commission.

The Explanatory Memorandum to the Act provides a useful summary of the new requirements for approved providers, including those outlined below which apply from 1 December 2022:

New governance responsibilities will apply to approved providers in relation to the membership of their governing body, the establishment of a clinical advisory body, and the requirement to offer to establish a consumer advisory body, as well as measures to improve leadership and culture.

To assist and support governing bodies and senior leaders of approved providers to fully capitalise on the opportunities presented in the new legislation, the Commission is delivering – in partnership with KPMG – the Governing for Reform in Aged Care program. This flexible learning program is proving to be popular and is attracting an increasing number of participants. Find out more or enrol now on the program website.

A Code of Conduct will apply to approved aged care providers, their governing persons (for example, board members and Chief Executive Officers) and aged care workers. Providers will be required to take reasonable steps to ensure that their workforce and governing persons comply with the provisions of the Code.
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 measure introduces new responsibilities for providers of these services to manage and prevent incidents, and to notify the Commission of reportable incidents. It also extends the Commission’s role to regulating SIRS in home services.

Home care providers can begin preparing now by ensuring that your incident management system (IMS) is effective. Your IMS should include a set of protocols, processes and standard operating procedures that staff are trained to use, and where adherence is subject to oversight.

The Commission’s resource, ‘Effective incident management systems: Best practice guidance’, offers practical information to help you ensure that you have embedded a best-practice IMS within your service. Introductory online learning modules including ‘Elements of Effective Incident Management Systems’ are also available within the Aged Care Learning Information Solution – Alis.

We will support the sector to prepare for these changes through:

online resources such as guidance materials, fact sheets, videos and posters
free online learning programs through Alis
webinars on key reform measures that will aim to answer your questions.

Register now! Introductory webinar on aged care reforms on 8 and 13 September 2022

We are hosting a series of webinars to help the sector prepare for the changes taking place in aged care from a regulatory perspective, with at least one webinar to be offered each month. Each webinar will include a Q&A session.

Approved aged care providers and services are invited to attend a special live webinar, ‘Introduction to aged care reforms – a regulatory perspective’, hosted by the Aged Care Quality and Safety Commission. It will focus on:

the new regulatory requirements for approved providers
how the Commission will consult with the sector and provide support and guidance.

This free webinar will be held on 2 separate dates to give all providers and services the opportunity to participate in live discussion:

1:00 pm–2:00 pm (AEST) on Thursday 8 September 2022
2:00 pm–3:00 pm (AEST) on Tuesday 13 September 2022

Participants can register on their preferred date of 8 September 2022 or 13 September 2022 using the below links.

Thursday 8 September 2022
Time: 1:00 pm–2:00 pm AEST (12:30 pm–1:30 pm SA/NT, 11:00 am–12:00 pm WA)
Registration: Please register to attend via this link: Introduction to aged care sector reforms – a regulatory perspective (8 September)

Tuesday 13 September 2022
Time: 2:00 pm–3:00 pm AEST (1:30 pm–2:30 pm SA/NT, 12:00 pm–1:00 pm WA)
Registration: Please register to attend via this link: Introduction to aged care sector reforms – a regulatory perspective (13 September)

Regular updates on the reforms, and on our education and engagement activity, will be provided through the monthly Quality Bulletin and on our National aged care reforms webpage.

New resources to improve food and nutrition for aged care residents

On 29 August 2022, the Commission launched Food, Dining and Nutrition resources to support the delivery of high-quality, enjoyable food and dining experiences for aged care residents. The first set of resources is now available on our website.

The resources for providers outline the steps they should take to help ensure that residents can enjoy and exercise choice in their food and dining experience.

The resources for residents explain what they can expect and how they can be active participants in their food and dining experience, exercise choice and be aware of ways to resolve issues.

New Alis modules and short videos on food and dining are planned for release in late 2022 and early 2023. These will support aged care staff to identify and act early on the priority areas that impact eating, including swallowing and oral health.

These priority areas were identified and developed by the Commission’s Food and Nutrition Expert Advisory Group, with draft versions of the resources tested with providers and consumers. This group has expertise in consumer advocacy, cultural and linguistic diversity, nutrition, food preparation and service, speech pathology, dementia care, nursing and wound care, and dental and oral health.

To better understand the issues and identify best practice, we took an in-depth look at the resident experience. We analysed food-related complaints we received over 3 years and interviewed 350 residents about their food and dining experience. This work is helping to identify innovative solutions and models to improve residents’ overall experience and wellbeing.

A series of targeted webinars will be held for selected providers. The purpose of these targeted webinars is to support providers to strengthen their capability to deliver high-quality food and dining experiences. These webinars will inform further engagement and education activities for the sector.

The Commission actively monitors and responds to issues related to food and nutrition, in both home care and residential care through:

monitoring provider performance through the Commission’s risk profiling, using data reported through the National Aged Care Mandatory Quality Indicator Program and in relation to the Basic Daily Fee supplement, our complaints data, and quality assessment and monitoring data
assessing provider performance and acting where providers are found not to be complying with the relevant Aged Care Quality Standards
resolving complaints (taking into account provider compliance with the Quality of Care Principles 2014 and the Quality Standards).

For more information, visit the Food, dining and nutrition campaign page for providers on our website.

Quality and safety in home services – risks in focus: Care planning and assessment

The Commissioner recently wrote to approved providers of in-home and community aged care services on changes to the Social, Community, Home Care and Disability Services (SCHADS) Award. These changes took effect from 1 July 2022 and arose from decisions made by the Fair Work Commission.

Recognising that some providers were reviewing care arrangements to take account of the SCHADS Award changes, the Commission reminded providers of their ongoing responsibilities to ensure the safe and effective delivery of quality care and services in accordance with the requirements of the Aged Care Act 1997, the Quality of Care Principles 2014 and the User Rights Principles 2014.

In the July Quality Bulletin, we focused on the topic of organisational governance risk. This month’s focus for home services’ risks is care planning and assessment.

Failure to undertake appropriate assessment and care planning can deprive older Australians of the care and services they need in their home and in the community.

What has the Commission found?

Through our quality assessment and monitoring activities between 1 January 2021 and 31 July 2022, we found that 59% of those home service providers assessed against Aged Care Quality Standard 2: Ongoing assessment and planning with consumers were found to be non-compliant with one or more requirements of this standard.

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

1. How do you ensure that care recipients and other key partners in care are appropriately engaged in assessment and care planning?

In assessing a person’s care needs and identifying the care and services they require, you should identify their partners in care and, where necessary, seek the person’s consent to engage with them. Engaging with older Australians and their key care partners helps you to identify and clarify any assumptions, which in turn will help you to prioritise the care and services that should be provided under their home care package.

2. How do you know that staff delivering care and services have access to current detailed information to enable them to deliver care and services in accordance with the care recipient’s needs, goals and preferences?

You are responsible for undertaking assessments to inform the delivery of care and services. While the care recipient’s Aged Care Assessment Team (ACAT) or Regional Assessment Service (RAS) assessment are an important source of information, you must undertake your own assessment of their needs, goals and preferences and work with the care recipient to develop a detailed and individualised care plan.

Your assessment must be comprehensive and identify all the risks associated with a consumer’s environmental, physical, mental or emotional condition or capacity. You must ensure up-to-date information is clearly documented in care plans and these are consistently communicated within your service, and with others where responsibility for care is shared.

3. How do you ensure the workforce can recognise signs and symptoms of deterioration in a consumer’s mental health, cognitive or physical condition, functions or capacity and respond appropriately?

You should consider the training you provide to staff to help them recognise and respond to signs of deterioration. Your staff should understand your expectations about how to respond to signs of deterioration they see and how to escalate these observations within your service. When signs and symptoms of deterioration are recognised, it is important to consider if this information should trigger a reassessment of care needs.

More information

To find out more about this key risk, read Chapter 3 of our ‘Quality and safety in home services – 5 key areas of risk’ resource.

Best-practice feedback and complaints handling – training available

A training module on ‘Best-practice feedback and complaints handling’ is now available on our free Aged Care Learning Information Solution – Alis.

We encourage all aged care services to support their staff to complete this important module.

Aged Care Quality Standard 6: Feedback and complaints requires providers to support and encourage consumers to provide feedback and raise complaints.

In addition to completing the free training module, we encourage all aged care services to:

communicate regularly about your complaints process with the people receiving your care services
help consumers to feel confident that action will be taken if they make a complaint by providing examples of successful complaint outcomes
ensure that consumers know how to contact the Older Persons Advocacy Network (OPAN) for free, independent advocacy support
inform consumers about the Commission and provide our 1800 951 822 number if people need help to resolve an issue
make sure staff understand your complaints process and know what to do
access the Commission’s resources, including:

Why is this training important?

The Royal Commission into Aged Care Quality and Safety found that people may be hesitant to raise complaints or concerns with their provider because they:

do not know how to
think it will not make a difference
fear they will be treated differently.

Taking some of the simple steps outlined above can help overcome some of these barriers for people who access aged care services.

Governing for Reform in Aged Care program

Since its launch 5 months ago, over 1,700 governing body members and executives of approved providers from across the sector have enrolled in the Governing for Reform in Aged Care program.

Participants have found the program to be beneficial in strengthening and uplifting their governance capabilities. One participant told us:

I participated in an Aged Care Quality and Safety Commission Governing for Reform in Aged Care workshop today. It was an excellent session which really reiterated for us why we became involved in aged care and our role in the proper governance of an aged care facility. I loved the concept of ‘active curiosity’ in leadership in aged care and it’s certainly something I’ll consciously carry forward as a Director. Thanks to the ladies who participated in today’s session for sharing with all of us, it was truly a wonderful session to be part of!

The Governing for Reform program provides training and skill development to enhance the capability of leaders in the context of post-Royal Commission reforms. Join your peers and position yourself at the forefront of reform and rebuild trust and confidence with your consumers, their families, and the broader community.

The program has been designed to support you to navigate and strengthen your corporate and clinical governance across 4 core capability domains:

Placing older Australians at the centre of care
Obligations and accountabilities
Effective governance
Leading the transformation.

Each month the program will spotlight one of 4 capabilities, giving you the opportunity to attend associated virtual events and workshops, download podcasts and toolkits as well as complete aligned online learning modules.

To enrol and find out more, visit the Governing for Reform program website.

Register now for educational workshops – updated courses available

The Commission is running educational workshops during September 2022, with more sessions to be released in the coming months.

We recently revised the content of our educational workshops to ensure the sessions deliver the best value to participants.

For example, we:

split the Serious Incident Response Scheme (SIRS) residential care workshop into 2 shorter workshops. There is now a 2.5-hour Effective incident management systems (IMS) workshop for both home services and residential services providers, and a 3.5-hour condensed SIRS workshop covering the 8 reportable incident types for residential service providers.
included new risk guidance in the Monitor and assess the performance of your service: aged care home services workshop.
extended the Understanding the Quality Standards – information session to 2 hours so there is more time for questions and collaboration.

To find out more about our workshops and to register, visit our Workshops webpage.

Consultation – aged care on-site pharmacists

The Department of Health and Aged Care is seeking feedback on the planned introduction of on-site pharmacists in residential aged care homes.

The Department is particularly interested in receiving feedback on:

funding models for employment of on-site pharmacists
the role of on-site pharmacists
training requirements
pharmacists and provider reporting, including the development of quality indicators
how to transition from current arrangements.

The consultation period closes on Friday 16 September 2022. Further information is at Aged care on-site pharmacists on the Department’s Consultation Hub.

Aged Care Financial Report 2021–22 – new fact sheet available

All approved providers have financial reporting responsibilities under the Aged Care Act 1997 and the Accountability Principles 2014. This reporting ensures that providers are transparent about their financial management and allows the government to identify emerging financial risks in the sector.

All providers must submit an annual Aged Care Financial Report (ACFR) through the My Aged Care online portal. This must be done within 4 months of the end of the financial year.

A new fact sheet is now available to assist you in preparing your ACFR.

If you’re a provider who had a standard financial year for 2021–22, your ACFR is due by 31 October 2022.

If you’re a provider who operates on a non-standard financial year basis, you should have already sought approval from the Department of Health and Aged Care to submit your ACFR on an alternative date.

To meet your financial reporting obligations, you should:

audit your accounts early in the new financial year
log in to the online portal early to check you have access and no technical issues
download the Excel version of the ACFR from the online portal and start filling in the data as soon as possible
have your correct delegate sign the ACFR declaration
ensure you have completed all parts of the ACFR relevant to your business
check all documents are complete and have been uploaded
submit your completed ACFR on or before 31 October 2022.

Extensions cannot be granted to lodge a report outside the legislated period. That means that if you don’t submit your ACFR by the due date, you are non-compliant with your responsibilities under the Accountability Principles. Depending on your reasons for running late, this may result in regulatory action by the Commission.

Further information on the annual ACFR can be found on the Department of Health and Aged Care website.