Aged Care Quality Bulletin #51 - March 2023 | Aged Care Quality and Safety Commission

Group of ethnically diverse elders smiling

Commissioner’s message

As we approach the cooler months, we know that colds, influenza and COVID-19 will again be circulating. To help minimise the risk of transmission of these infectious diseases, it remains important to ensure effective infection and prevention control (IPC) practices in all aged care services.

Under the Aged Care Quality Standards (Quality Standards) in the Aged Care Act 1997, every aged care provider is responsible for ensuring that they have sufficient staff with the necessary knowledge and skills to provide safe, respectful, and quality care and services.

Providers are also responsible for ensuring that staff have the necessary training, including in infection control practices and procedures, and in the appropriate use of personal protective equipment (PPE) including gloves, face masks, face shields and gowns.

The Department of Health and Aged Care and the Commission co-hosted a webinar on effective IPC practices on 16 March. We discussed the importance of effective IPC behaviours to assist in ensuring the delivery of timely IPC and quality care. The webinar recording, which includes an important message from the Minister for Aged Care, the Hon Anika Wells MP, is now available.

The Commission plans to deliver a range of IPC-focused tools and resources over the coming months to support you in your management of IPC. We will be engaging with the sector to understand any gaps or emerging needs, gather feedback, and ensure that what we’re providing by way of guidance and support is adding value. Keep an eye out for further updates.

It is great to see so many providers attending our monthly sector webinars, with more than 1,400 registrations for this month’s webinar on early lessons learned from SIRS in home services. Next month, on 18 April our sector webinar will focus on the regulation of workforce related responsibilities including 24/7 on-site registered nurses and care minutes. On 16 May, we will delve into the sector performance data we publish each quarter to share what we are observing in the sector. Details of our webinar program, including upcoming events, recordings and how to register, are available on our website.

I encourage you to stay up to date with information on our upcoming national aged care provider conference, themed ‘Working together – our journey through aged care reform and regulation’, on 8-9 June in Melbourne. Registrations will open in April and the exciting program and key speaker information will soon be available. I look forward to seeing you there!

In addition to updates on aged care reforms, in this issue you can read about 3 key reports published this month by the Commission. First, the Enriching life through care national report of our roundtables with providers in every jurisdiction, which provides a comprehensive picture of the sector’s challenges and experiences in improving the aged care experience for consumers. This report also reflects valuable feedback we heard from the sector on their experience of engaging with the Commission and how we are responding to the issues raised. The companion case studies report showcases many innovative and creative examples shared by providers on how they are improving aged care across the country.

The Unreasonable use of force: Notifications of resident to resident incidents report is the first in new series of Serious Incident Response Scheme (SIRS) Insights reports. The report uses case studies to provide insights and guidance to help providers and their staff to better understand how to prevent and respond to these incidents, including assessing impact.

The latest aged care sector performance report for the October to December 2022 quarter provides important insights to help providers consider areas for improvement in their overall operations and the delivery of care.

We at the Commission want to hear from you. I encourage you to get involved and stay connected with us through our Consultation and Engagement Hub.

Commission reports

Enriching life through care

Following our successful provider roundtable series in 2022, the Enriching Life Through Care National Roundtable Program Final Report details key observations and learnings generously shared by more than 320 representatives from a diverse range of residential, in-home and community aged care services.

The roundtables gave us an opportunity to connect with senior sector leaders and hear directly how providers are responding to consumer expectations for a different and better aged care experience. The forums also provided a valued networking opportunity for participants.

The roundtable discussions focused on 3 aspects: understanding and enabling a great aged care experience; measuring performance in aged care; and, engaging with continuous improvement. The report provides a useful summary and highlights many areas of shared interest across the sector.

Importantly, the roundtables also provided greater insight into providers’ experiences of engaging with the Commission. These observations are detailed in the report under 4 themes together with the steps we are taking in response:

Connecting with the Commission and sharing good practice
Building capability through communication and education
Re-accreditation audits for residential aged care and quality audits for home services
Reflecting back how we understand sector performance.

We welcome your feedback on the report at agedcarereform@agedcarequality.gov.au.

The Enriching life through care – case studies report, released with the final report, showcases practical and creative examples generously shared by participants on how providers are transforming the aged care experience for older Australians.

We encourage providers to continue to share examples of good practice as part of our collective efforts to support ongoing capability uplift and innovation. You can keep up to date with new initiatives and share your experiences and learnings on our Consultation and Engagement Hub.

SIRS Insights – unreasonable use of force in residential aged care

Many serious incidents that occur in aged care are preventable. Improvements in providers’ response to the risks and impacts of serious incidents is crucial to reduce harm to consumers and prevent reoccurrence.

The Unreasonable use of force: Notifications of resident to resident incidents report is the first in a new series to explore the 8 types of reportable incidents under the Serious Incident Response Scheme (SIRS).

The unreasonable use of force incident type accounts for nearly two-thirds of all incidents notified to the Commission by residential aged care providers in the first 15 months of the SIRS (1 April 2021 to 30 June 2022).

Most of these incidents (86%) involved interactions between residents, and these incidents are the subject of this Insights report. Providers reported severe cognitive impairment for more than half of affected residents and more than 60 per cent of residents using unreasonable force.

The SIRS data also tells us that aged care residents involved in incidents of unreasonable use of force are much more likely to have severe cognitive impairment than those involved in other serious incident types. This can be very challenging for providers however such incidents should not be considered unavoidable. The report is an important tool to assist providers to identify and mitigate risks to consumers in their service.

The report uses case studies to provide insights and guidance to help providers and their staff to better understand how to prevent and respond to these incidents, including assessing impact. Guided questions from each case study can be used to facilitate team workshops to identify learnings that can be applied to your service. There are also questions targeted for boards and senior leaders to underscore the need for oversight and responsive decision-making when an incident occurs.

Providers are encouraged to use the report as a learning tool to reflect on incidents at their own services and the changes that can be made to reduce the chance of incidents recurring.

Further information and resources on SIRS is available on the Commission’s website.

Providers can also register to participate in SIRS online workshops.

Sector performance – latest insights

The Commission’s latest aged care sector performance report covering the October to December 2022 quarter is now available. It includes information, data and insights from the Commission’s quality regulatory and complaints functions on sector-wide performance to help providers consider areas for improvement.

Information to note from the Quarter 2 – 2022-23 sector performance report includes:

The Commission resolved 2,344 complaints relating to 5,251 issues in this period.
Consistent with previous quarters, the main areas the Commission identified as requiring improvement were:
- Quality Standard 3 (Safe and effective personal and clinical care) in residential care, and
- Quality Standard 8 (Effective organisation wide governance systems) in home services.
The 3 most complained about issues in residential care relate to staffing, medication management and administration, and personal and oral hygiene.
- Residential care recipient complaints mainly related to the quality and variety of food provided. Family members’ complaints were focused on falls prevention, post-fall management and medication management.
In home services, the 3 most complained about issues continued to be lack of consultation and communication, issues relating to fees and charges, and consistent client care and coordination.
Guidance for home services providers is available to support their understanding of these issues: 5 Key Areas of Risk and Home services pricing and agreements.
Assessment and monitoring activities increased over the past two quarters, with 742 residential care site audits conducted in Quarters 1 and 2 in 2022-23, compared with 479 in the previous 2 quarters.
Compliance and enforcement actions increased in Quarter 2 with:
- 112 directions where the risk to consumers was considered low to medium
- 78 non-compliance notices (medium to high risk), and
- 10 notices to agree and 5 sanctions (high to severe risk).

Aged care reforms update

24/7 registered nurse responsibility in residential aged care

From 1 July 2023, approved providers of residential aged care must have at least one registered nurse on-site and on duty at each residential facility at all times.

In the February issue, we provided information on the release of the exposure draft and explanatory statement by the Department of Health and Aged Care, including details on provider reporting requirements and the criteria for exemptions.

All residential aged care providers are encouraged to attend the Commission’s webinar from 1.00pm – 2.00pm AEST on 18 April where we will discuss how we will regulate the 24/7 registered nurse responsibility. Registrations are now open.

The Commission will also shortly be releasing a regulatory bulletin and fact sheets for providers and consumers on how we will regulate these requirements.

The Department has updated the Care minutes and 24/7 registered nurse responsibility guide. It provides information on care minutes targets and the 24/7 registered nurse responsibility. The updated guide:

clarifies the roles of approved providers, residential care services and residential facilities
explains how the 24/7 registered nurse responsibility applies when multiple services are at one facility, and when one service has multiple facilities
provides information on 24/7 registered nurse reporting and exemptions.

Strengthened Quality Standards Pilot Project update

The Commission’s pilot of the strengthened Aged Care Quality Standards is now underway.

To test how the draft strengthened standards will work in practice, the pilot will involve a sample of 40 providers representing diverse service types, sizes, locations and people receiving aged care. Thank you to all providers that nominated to participate.

We have engaged Ernst and Young Partnership Australia (EY Australia) to assist in the implementation of the pilot. EY Australia is now shortlisting providers to participate. If you were selected to take part in the pilot, EY Australia will contact you directly in March or April.

The pilot is the first in a series of engagement opportunities that the Commission will be providing for the sector. We plan to use multiple channels to seek input and feedback as we work towards implementation of the strengthened Standards. This will include webinars, workshops and other forums. If you volunteered for the pilot but were not selected, there will be plenty of other opportunities to get involved.

We will provide more updates to keep you informed on the pilot’s progress. We also welcome your questions and feedback at agedcarereform@agedcarequality.gov.au.

Code of Conduct for Aged Care

The Code of Conduct for Aged Care (the Code), in effect since 1 December 2022, aims to improve safety and well-being for people receiving aged care and to boost trust in services. It describes the behaviour expected of aged care providers, their workers and governing persons.

Approved providers and their aged care workers (including volunteers, contractors and subcontractors) and governing persons (e.g. board members and Chief Executive Officers) have responsibilities under the law to comply with the Code.

Approved providers have a further responsibility to take reasonable steps to make sure that their aged care workers and governing persons also comply with the Code.

The Commission is responsible for overseeing compliance with the Code and has a range of regulatory powers to prevent, detect and respond to non-compliance. This includes using data and intelligence holdings (including personal information) to identify patterns of possible non-compliance with the Code that require further assessment and response by the Commission.

The Commission has developed a range of resources, including detailed guidance, to assist you to understand your responsibilities under the Code:

Code of Conduct providers page for information for aged care providers
Code of Conduct workers page for information for aged care workers
Code of Conduct consumers resources for information for aged care consumers.

Translated fact sheets on the Code of Conduct are now available in 25 languages for workers and for consumers.

Prudential Governance Standard: Targeted review

The Prudential Governance Standard requires residential aged care providers that hold a refundable deposit to appropriately manage risk. It does this by ensuring that providers have processes and controls are in place through a governance system.

In April 2023, the Commission will conduct a targeted review of approved providers to gauge compliance with this standard. The review aims to:

increase provider understanding of the Prudential Governance Standard
increase compliance with governance system requirements
increase protection of resident’s refundable deposits
identify any link between non-compliance with Quality Standard 8(c) and non-compliance with the Prudential Governance Standard.

The Commission will contact selected providers in the coming weeks. Further information on targeted reviews is available on our website.

Quality indicators for residential aged care

The Commission participated in a webinar hosted by the Department of Health and Aged Care on 28 March on the new quality indicators in residential aged care. The webinar recording will be available shortly on the Department’s website.

The webinar provided information to assist providers to collect and report on 6 new quality indicators to monitor and drive quality improvement, which will be introduced from 1 April 2023:

activities of daily living
incontinence care
hospitalisation
workforce
consumer experience
quality of life.

Resources are available for residential aged care providers on the Department’s website.

Webinars

Regulation of workforce related responsibilities including 24/7 on site registered nurse and care minutes

18 April 2023 | 1:00pm – 2:00pm AEST

This webinar is for residential aged care providers to learn about how the Commission will regulate the 24/7 registered nurse responsibility in residential aged care from 1 July 2023. Panellists will include Commission and Department of Health and Aged Care representatives.

Registrations are now open.

Sector performance reports

16 May 2023 | 1:00pm – 2:00pm AEST

This webinar will offer all aged care providers a deep dive into what the quarterly sector performance data is telling us.

Registrations will open in late April. Stay up-to-date at our webinars page.

Webinar recordings now available

The recording of the ‘Early lessons from SIRS in home services’ held on 21 March is now available.
The ‘Swallowing, texture-modified diets and nutrition’ webinar for approved providers and staff in residential aged care was held on 17 March. You can view the recording and presentation slides.
The Department of Health and Aged Care and the Commission co-hosted a COVID-19 aged care webinar on 16 March that focused on the importance of effective infection and prevention control practices. You can view the webinar on the Department’s website.

Governing for reform

The second series of the Governing for Reform in Aged Care Program Conversations to Transform Aged Care podcasts is now available.

The new podcast series explores leadership, resilience, the convergence of clinical and corporate governance and governing in regional and rural settings. Tune in and hear Dr Cathy Balding explore the interplay of clinical and corporate governance, and Gus McLachlan AO discuss leadership as a driver for positive change. With 7 new episodes, there is plenty to listen to and learn from!

You can stream both podcast series, rated 4.8 out of 5 stars on Apple Podcasts, on major streaming platforms. Simply search for “Governing for Reform” in the search bar.

As part of the Governing for Reform in Aged Care Program, the Commission hosted the ‘Exploring the role of governing bodies and executives in leading digital adoption’ webinar on 1 March. Panellists discussed the role of governing bodies and executives in leading digital adoption. To access the recording and to attend future webinars, enrol at FACE TO FACE COURSE (agedcarequality.gov.au).

Participation in the program includes the opportunity to attend virtual workshops with your peers that will support you to navigate and strengthen your corporate and clinical governance. To enrol and find out more, visit the Governing for Reform program website.

Get involved

Consultation and engagement hub: we want to hear from you

We are committed to improving how we regulate aged care, and make sure the information we produce is useful and easy to understand. To find out about opportunities for you to consult and engage with us at the Commission, you can register your interest to get involved, subscribe or provide feedback through our Consultation and Engagement Hub.

Elder Abuse Survey – closing 7 April

The Australian Institute of Family Studies and the National Aging Research Institute (NARI) invite your feedback on elder abuse to help shape future planning and prevention. The community survey will inform an evaluation of Australia’s first National Plan to Respond to the Abuse of Older Australians (Elder Abuse) 2019-2023 and help drive responses to reduce and prevent the abuse of older Australians.

You can complete the online survey up until 7 April 2023. Anyone over the age of 18 is encouraged to participate. Your anonymous feedback will assist in understanding:

what people know about elder abuse
what support services and info they are aware of
ways to improve awareness and responses to prevent elder abuse.

Training and resources

Swallowing and nutrition resources - now available

A new suite of resources to support residents who experience difficulty swallowing is now available. These resources are part of a larger set of Commission resources on Food, Dining and Nutrition that aim to support high-quality, enjoyable food and dining experiences for aged care residents.

The provider and worker resources will help to build the capability of residential aged care services to identify and act early on areas that impact consumers’ eating and nutrition. The resident resources aim to inform and educate consumers and their families on what they can expect, their rights and how to raise concerns.

These tailored resources are available on our website.

Providers are encouraged to print the fact sheets and discuss them with workers and residents, and ensure that posters are displayed in central locations.

New code of conduct training resource

The Code of Conduct for Aged Care – training PowerPoint presentation is available for trainers to download, customise and use to teach their workers about the Code. The training resource:

offers an overview of the Code
supports an exploration of the Code and its 8 elements
is designed to support reflective discussions about the Code and how it applies in practice.

Financial and Prudential Standards - why money management matters

In the March edition of Financial and Prudential Regulatory Insights, the Commission’s Peter Edwards discussed the complementary roles of the Commission and the Department of Health and Aged Care in supporting sector transformation.

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

Subscribe to the Financial and Regulatory Insights to receive monthly updates.

SIRS home online workshop – 20 April

Registrations are now open for home services providers to participate in a 3.5 hour interactive virtual workshop on the Serious Incident Response Scheme (SIRS) in home care on 20 April 2023.

This workshop complements the guidance and resources on the SIRS and the Effective IMS workshops, and includes practical activities to help participants understand their role and responsibility to meet the requirements of the SIRS.

The workshop will support participants to:

understand and recognise the importance of having an effective incident management system (IMS)
know providers’ roles and responsibilities under SIRS
know providers’ roles in responding to incidents under SIRS
be able to apply techniques and tips for better prevention, management and reporting of incidents.

To register or to find about upcoming workshops, visit our Workshops web page.

Online workshops for all approved providers

The Commission regularly hosts online workshops for all aged care providers. Our workshops include the latest information and resources to ensure that providers have access to guidance and support aligned with legislative changes and the regulatory focus of the Commission.

Upcoming workshops include ‘Monitor and assess the performance of your service’, ‘Quality and safety in home services - 5 key risk areas' and ‘Effective Incident Management Systems (IMS)’. Visit the Workshops web page for further information and registration details.