Aged Care Quality Bulletin #52 - April 2023 | Aged Care Quality and Safety Commission

Group of ethnically diverse elders smiling

Commissioner’s message

An important focus of our engagement to support the sector this month has been the new workforce-related responsibilities for residential aged care services including 24/7 registered nurse cover (from July) and care minutes (from October). Our regulatory bulletin and recent webinar outline clinical care expectations and how we will regulate workforce responsibilities. In my letter to approved providers of residential aged care services, I addressed recent misinformation in the media and made clear that the Commission will adopt a fair and sensible approach to assessing and responding to compliance issues that takes into account workforce challenges and the quality and safety of care being delivered to residents around the clock.

My key message is that a provider that is non-compliant with a specific responsibility but can evidence its ongoing efforts to comply, is providing safe and quality care to consumers, and is effectively managing risks, is unlikely to be subject to escalated enforcement action by the Commission in the absence of other concerns about compliance or performance.

Our next monthly webinar on 16 May will focus on complaints handling and I encourage all approved providers to attend. Details of our webinar program, including upcoming events, recordings and how to register, are available on our website.

Last month, we highlighted the release of our Enriching life through care national report and the companion case studies report which showcases many innovative and creative examples shared by providers about how they are improving aged care across the country. If you haven’t already done so, I encourage you to read and share these resources.

Further opportunities to hear from other providers will be available at our upcoming National Aged Care Provider Conference on 8-9 June in Melbourne, themed ‘Working together – our journey through aged care reform and regulation’.

This conference is for senior leaders of approved aged care providers of residential and home care services, including members of governing bodies and senior executives from across the country. There is no registration fee. If you have not already done so, I encourage approved providers of residential and home care services to register your expression of interest to attend. If you are a Commonwealth Home Support Programme (CHSP) provider that is not an approved provider, we will be running a separate and specific engagement for you later in the year.

To maximise the number of approved providers participating in the conference, individual providers are welcome to send up to two representatives. Each representative will need to complete their own Expression of Interest form. Invitations to attend (which will involve a formal registration process) will be emailed out individually in the week commencing 1 May 2023. Stay up to date on our conference webpage.

Finally, the independent Capability Review of the Aged Care Quality and Safety Commission has now been received by the government, with Minister Anika Wells MP indicating that the report’s contents and recommendations are being considered, and the report is expected to be released in due course.

The Capability Review, which was a recommendation of the Royal Commission into Aged Care Quality and Safety, aims to ensure that the Commission is best placed to be a world class regulator.

The review examined the capability of the Commission, reviewing our legislative foundations, resources, workforce, skills and support to meet the changing regulatory needs of the aged care sector.

The Commission welcomed the Capability Review and as we await the report’s release and Government’s response, we are continuing to focus on strengthening our capability, effectiveness and accountability as we work towards best practice regulation of aged care to protect and support the wellbeing of older Australians.

Aged care reforms update

Workforce-related responsibilities – 24/7 RN cover and care minutes

A key finding from the Royal Commission into Aged Care Quality and Safety was how critical the number, qualifications and skills of staff are to the quality of residential aged care.

In response, the Government is bringing in new responsibilities for residential aged care providers, including to have a registered nurse on-duty and on-site 24/7 from 1 July 2023, and to meet mandatory targets of minutes of care delivered to residents from 1 October 2023.

These are some of the most important reforms that are being implemented. The 24/7 RN and care minutes responsibilities aim to give older people living in residential care confidence that they will receive the care, especially the clinical care, that they need.

To support approved providers to understand these new responsibilities and the regulatory approach that will be taken by the Commission, earlier this month we released a regulatory bulletin and held a webinar with panellists from the Commission and the Department of Health and Aged Care. In addition, the Commissioner wrote to all residential aged care providers.

Some providers can apply to the department for a 12-month exemption to the 24/7 RN requirement. Providers eligible to apply for an exemption are those operating a residential service with no more than 30 places in a rural or remote area designated as Modified Monash Model area 5, 6 or 7. The department has identified and been in contact with all these providers.

The department will only grant an exemption if a provider can show that they have adequate alternative clinical care arrangements in place to make sure that the needs of residents are met when there is not an RN on site. In short, providers with an exemption must still meet all their responsibilities around quality care delivery, and associated reporting requirements.

If providers don’t have an RN on site and on duty 24/7 from 1 July this year, it is essential that they have strategies in place to make sure that residents are safe and receive the care that they need. It is also essential that providers are doing all they can to recruit and retain the staff they need.

Where facilities are not meeting the 24/7 RN responsibility, the Commission will consider the steps that a provider has taken to fulfil their responsibilities. This will include the efforts made to recruit and retain RNs, and the clinical governance and clinical care arrangements they have put in place to ensure that the clinical needs of residents are met.

Where providers can demonstrate that they are actively working to comply with their responsibilities, the actions we take will be different from a situation where a provider is unable to demonstrate a suitable response, or deliberately avoids meeting their obligations and may be placing residents at risk of harm.

Importantly, if providers are non-compliant with the 24/7 RN responsibility but can show ongoing efforts to comply, and they are providing safe and quality care to residents at all times, the Commission is unlikely to take enforcement action. Our focus will be, as it always is, on residents, and ensuring that they are receiving safe and quality care.

Stay up to date by visiting our 24/7 registered nurse cover and care minutes web page.

Strengthened Quality Standards update

The Commission’s pilot of the strengthened Aged Care Quality Standards is now well underway. Our implementation partner, Ernst and Young Partnership Australia (EY Australia) commenced the on-site pilot audits in early April, beginning with testing of the strengthened Standard 5 Clinical Care. Findings from these initial audits will inform the broader pilot audit program as EY Australia rolls these out across May, June and July. These later audits will cover all 7 of the draft strengthened Standards.

The outcomes of the pilot audits will inform feedback to the Department on the content and applicability of the revised Standards, as well as inform development of supporting guidance and resources for the sector.

The Commission has published separate fact sheets regarding the Pilot for providers and consumers, available at agedcarequality.gov.au/reforms#strengthened-aged-care-quality-standards.

We are committed to working closely with the sector to support the implementation of the strengthened Standards and the pilot is the first in a series of sector engagement opportunities. We encourage you to visit our website regularly for information and updates, and engage with us to share your feedback, suggestions and questions by emailing agedcarereform@agedcarequality.gov.au.

For further information, visit Strengthened Quality Standards pilot project on our website.

New model for regulating aged care - consultation now open

A new model for regulating aged care is being developed for implementation as part of the proposed new Aged Care Act.

The Department of Health and Aged Care has now released A new model for regulating Aged Care, Consultation Paper No.2: Details of the proposed new model and is inviting feedback on its contents by 23 June 2023. Webinars and workshops will be organised, and people can provide feedback on the Consultation Paper via a short (15-minute) survey, a detailed survey and/or a written submission. To assist people to prepare a submission, there are questions at the end of each chapter in the consultation paper.

Visit the department’s Aged Care Engagement Hub to learn more about the regulatory model consultation including to read the paper, share your feedback, and register to attend a webinar and workshops.

Quarterly Financial Report: Q3 due 5 May 2023

Providers have several reporting obligations under the Accountability Principles (2014) in the Aged Care Act.

To support you to track your financial reporting obligations, the Commission has developed the Aged Care Financial Reports Calendar 2023.

The next Quarterly Financial Report (QFR) for the reporting period 1 January 2023 to 31 March 2023 (Quarter 3) is due by Friday 5 May 2023. You can log into the Forms Administration portal anytime from 1 April 2023 to submit your QFR on time.

Your QFR must be complete and up to date when lodged. Timely access to information assists the government to track emerging financial risks that could impact quality of care.

Please make sure that your key personnel details are up to-date. Incorrect key personnel details could impact your ability to lodge your QFR on time. You can update key personnel details by completing the Notification Form (s9-2A).

Failure to lodge a complete QFR by the due date may result in regulatory action by the Commission.

Further information on QFR is available on the Forms Administration website. If you are having difficulty with the portal, please contact Forms Administration.

Clinical update

Planning for winter: cold and flu season

The annual cold and flu season is now starting, and COVID-19 remains prevalent in Australia with cases continuing to occur across the community. It is important for older and vulnerable Australians to be protected as much as possible from contracting these viruses, which includes getting the 2023 flu vaccine and a COVID-19 booster, if one is due.

Viral detection through testing is particularly important in aged care homes so that outbreaks can be contained and well managed. While COVID-19 and other respiratory viruses can be indistinguishable in terms of their symptoms, they need to be managed differently.

For residential aged care providers, it’s useful to know that both the COVID-19 booster and the flu shot can be given at the same time. Remember to check that the flu vaccine is the correct one for the age of the person.

It is also important for all residential aged care staff to be offered a flu shot each year, and for staff to be reminded and supported to access the vaccines.

Earlier this month, approved providers received a joint letter from the Commissioner and the Commonwealth Chief Medical Officer, Professor Paul Kelly on the need to be vigilant and maintain COVIDSafe behaviours.

Early access to COVID-19 oral anti-virals saves lives. Providers are reminded of the need to ensure that staff are adequately educated and trained in the necessary infection control practices and procedures, to help safeguard older and vulnerable Australians.

Further information is available at:

Falls awareness month

The Aged Care Quality and Safety Commission is a proud supporter of the 2023 April Falls campaign: Better Balance for Fall Prevention. The campaign aims to encourage older Australians to become more active which has many benefits, including reducing the incidence of falls and injury.

For more information, visit the NSW Fall Prevention and Healthy Ageing Network.

Webinars

Upcoming webinars hosted by the Commission are:

Complaints Handling

16 May 2023 | 1:00pm – 2:00pm AEST

This webinar will offer you an insight into the provider’s responsibilities on complaints handling and the processes the Commission takes to resolve complaints.

Registrations will open from 2 May via our webinars page.

Stronger Standards, Better Aged Care

20 June 2023 | 1:00pm – 2:00pm AEST

This webinar will provide an overview of our Stronger Standards, Better Aged Care (SSBAC) program and discuss what we are doing to prepare the sector in the lead up to the introduction of the strengthened Quality Standards next year.

Registrations will open on 6 June via our webinars page.

Webinar recordings now available

The webinar recording and presentation slides of the webinar ‘Regulation of workforce related responsibilities including 24/7 on site registered nurse and care minutes’, held on 18 April, are now available.

Food and nutrition

Providers and aged care staff each have a role to play in delivering the right dining experience for every resident in their care. Thoughtful actions, even small ones, can lead to significant resident satisfaction.

Presentation and temperature of food and drinks can positively influence resident satisfaction. Residents tell us that they are less likely to eat meals that are not hot or cold enough (e.g., lukewarm soup or melted ice cream). Other factors that can affect the dining experience within aged care services include the environment, service, ambience, aromas, company, time provided to eat and serving size.

The fourth story in our food, dining and nutrition ‘success stories’ series talks about temperature of meals. If you have stories, case studies or ideas to share with us, please send them to info@agedcarequality.gov.au.

More ideas on how to improve meals, nutrition and the dining experience for older people at residential aged care services can be found in the Residential aged care food services discussion paper and the Analysis of food and dining experiences in residential aged care survey final report.

Dining experience - hot toast and fresh coffee

While delivering hot toast and fresh coffee or tea may seem simple enough, for some services the distance from the kitchen to the dining room or individual rooms can be challenging. It can result in food and drinks being served hot, sometimes lukewarm or cold depending on the length of time it takes for staff to transport the meals.

A facility manager at a small residential aged care service considered residents’ feedback which highlighted the importance of serving foods and drinks at the right temperature. Residents were not satisfied with the temperature of the coffee and toast served during breakfast - the coffee was lukewarm, and the toast looked soggy and unappealing. The facility manager looked at solutions to ensure that residents would have a good experience to start their day.

Most of the residents at this service elect to have breakfast in their rooms as it enables them choice over when they eat and when they get up.

After exploring options, the management team agreed to purchase a breakfast cart with a coffee machine and a toaster. This was specially designed for the delivery of breakfast to residents’ rooms in a timely manner and at an appropriate temperature. The aroma of the freshly made coffee and hot toast also resulted in improved resident appetite and create a positive atmosphere.

There is no 'one-size-fits-all' approach to food delivery, timing and temperature management. What works well in one service may not work well in others, and this case study highlights how simple and creative solutions can deliver a great dining experience for residents. Temperature of meals can also be maintained using aluminium foil, warm plates, bain maries, hot box trolleys, soup warmers, thermoses and eskies.

Governing for reform

Service Excellence: Driving towards Innovation and Change: webinar recording

The Governing for Reform in Aged Care Program webinar, held on 26 April discussed how to deliver excellence in practice.

Panel members included: Ann Shelly, Chair of the Enero Group; Cameron Holland, Chief Executive Officer at Ryman Healthcare Australia; and Elizabeth Drozd, Chief Executive Officer at Australian Multicultural Community Services.

The webinar covered:

the importance of moving away from a compliance mindset and driving towards innovation and excellence, and
the role of executive leaders and governing body members in building a culture of excellence and driving continuous improvement in the operation of aged care services.

These webinars are delivered online and free for program participants only. To enrol and find out more, visit the Governing for Reform program website.

Training and resources

‘Welcome to Aged Care’ online learning modules

This month we released a series of online learning modules for staff who are new to the aged care sector.

The ‘Welcome to Aged Care’ series provides aged care staff with an overview of the Commission, the obligations that aged care staff and providers have in providing safe and quality care to older Australians, and the resources available to support their work.

The modules are:

Introduction to the Aged Care Quality and Safety Commission
Introduction to the Charter of Aged Care Rights
Introduction to complaints.

Access to the Commission’s online learning platform is free for all staff of Commonwealth-funded aged care providers.  For further information and to register for the Commission’s online Aged Care Learning Information Solution (Alis), visit the Commission’s website.

Financial and Prudential Regulatory Insights

In the April edition of Financial and Prudential Regulatory Insights, the Commission’s Peter Edwards discussed why reporting obligations matter, financial governance and building a more transparent sector.

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