Aged Care Quality Bulletin #59 - November 2023

Commissioner’s message

For the aged care sector in particular, the start of summer this year has been accompanied by warnings of heightened health risks not just from forecast heatwaves but also from infectious disease outbreaks.

COVID-19 case numbers have been steadily rising across Australia and, as we know only too well, the virus is good at finding its way into aged care homes. To help keep people safe in your care, providers are encouraged to ensure that vaccinations for older people and staff are up to date and to review your infection prevention and control (IPC) processes and protocols. We have a wide range of resources that can help you prepare for and manage an outbreak in your service. Our IPC online tools also give you access to key guidance and resources based on the state or territory you are working in.

We are also entering a high-risk season for heat-related issues. The unprecedented high temperatures across Australia during spring, and confirmation of an El Niño weather event for the 2023–24 summer, foreshadow the likelihood of multiple heatwaves in coming months.

In preparation for this, we recently published a clinical alert on caring for older people in hot weather. It is vital that providers understand and plan for the risks that heatwaves pose for older people. Frail older people are at higher risk of hospitalisation and even death when exposed to extreme heat. The alert provides advice on how to prioritise and monitor those most at risk and lists the symptoms of heat stroke and heat exhaustion. I would also like to draw your attention to our article below on the importance of keeping people in your care hydrated during summer and some tips on how to do that.

In November we released our first annual Complaints Report for providers. The report explores the complaints we receive about aged care services. In the main, the complaints come from people who use the services, their families and representatives, staff and community members. The report provides insights and includes case studies to help providers assess their complaints processes.

I hope you have had the opportunity to visit our new website, released earlier in November. The feedback we have received to date has been overwhelmingly positive and we are committed to continuing to refine and improve the website.

Importantly, registrations are now open for our National Aged Care Provider Conference 2024 for providers of residential, home and Commonwealth Home Support Programme services. You can read more about the conference and how to register in this issue. I encourage you to join us for this event.

National Aged Care Provider Conference 2024

Aged care in Australia is on the cusp of entering a new era with the anticipated introduction of a new Aged Care Act, new regulatory framework and strengthened Aged Care Quality Standards, ensuring a person centred approach to the delivery of care.

To understand the upcoming reforms and what they will mean in practice, we are hosting a special national conference on Tuesday 23 to Wednesday 24 April 2024 at the Adelaide Convention Centre.

This free conference will bring together residential and home services providers to explore and share how the sector can best be prepared, and to look at how the sector is continuously improving to deliver safe, quality aged care. You can view the program here.

Registration is now open!

Registration to attend the conference is free for providers of residential care, home care, Commonwealth Home Support Programme services, and National Aboriginal and Torres Strait Islander Flexible Aged Care Program services.

The Commission will confirm your registration by email. Registrations are capped at 1,000 attendees.

Register today

Pre-conference workshops – limited availability

Ahead of the conference, on Monday 22 April, a series of parallel workshops will be held at the Adelaide Convention Centre. The workshops offer an opportunity to participate in an informal conversation with peers and Commission executive to discuss and share experiences and ideas across a range of thematic areas.

The workshops are capped at 25 people each and you can reserve a place at one or more workshops on a 'first come, first served' basis if you are registered to attend the conference.

Registering for one or more of the workshops can be done at the same time as you register for the conference. We recommend you get in quickly! There is no cost for attending the workshops.

Conference dinner

A ticketed conference dinner will be held on Tuesday 23 April, offering the opportunity to network with colleagues, enjoy great South Australian food and hear from a special keynote speaker.  

The dinner is $143.00 per head. Tickets can be paid for at the time of registration.  

You can find more information on our conference 2024 page.

Our reports

First annual Complaints Report

We recently published our first report exploring the complaints we receive about aged care services: Complaints about aged care services – Insights for providers.

The report uses information we collect and provides key insights from the complaints we manage and resolve each year. The first part of the report provides an overview of the complaints we received about residential and home services between 1 July 2022 and 30 June 2023. The second part uses case studies and guided questions to help you and your staff assess your own complaints handling processes to support continuous improvement.

The report highlights the importance of effective complaints handling, which leads to better care for older people. This makes good business sense for providers who can fine-tune services to meet individual needs and preferences.

Under the Aged Care Act 1997 and the Aged Care Quality Standards (Quality Standards), every service must have an internal complaints resolution process. Standard 6 of the Quality Standards makes it clear that people receiving aged care have a right to feel safe and be supported to give feedback and make complaints. It also states that providers must take appropriate action to respond to complaints.

You can find more information and guidance on handling complaints in our Better practice guide to complaints handling in aged care services.

SIRS Insights report: Unexplained absence from care

In November we released the second of our Serious Incident Response Scheme (SIRS) Insights reports. The reports use information we have gathered through SIRS.  

The latest report looks at unexplained absence from care. While this is one of the lower reported incident types – just over 1,700 SIRS notifications in the 12 months to March 2023 – it can be high-risk for older people. 

The report uses a case study approach developed from notifications of unexplained absence from care. The case studies aim to support providers to take action and update processes across all levels of their services to prevent and reduce such incidents. We have included questions for boards and senior leadership to help guide consideration and actions when an incident occurs.  

Some key issues in the case studies include: 

• the importance of keeping residents safe, particularly when they’re new to the service or there temporarily receiving respite care 
• the challenges that providers can face in keeping residents safe while still respecting their legal rights to freedom of movement  
• how risk management strategies to keep a resident safe can unintentionally restrict the freedom of movement of others 
• how each physical environment is different and can have its own risks. And that providers need to thoroughly consider these for each of their services 
• how individual care plans and a person-centred approach can help identify and address the reasons why a resident wants to leave the service. 

In producing this report, we consulted with key sector stakeholders – the Aged and Community Care Providers Association, COTA Australia and the Older Persons Advocacy Network. 

Read more about the SIRS.

Aged care reforms update

Provider governance reforms: Are you ready?

In late 2022, the Aged Care Act 1997 and the Aged Care Quality and Safety Commission Act 2018 were amended to strengthen the governance arrangements of approved providers. These amendments introduced specific changes aimed at improving leadership and culture, and increasing transparency and accountability.

We have issued a regulatory bulletin on Strengthening provider governance responsibilities – governing body requirements to support providers in meeting the new requirements.

From 1 December 2023, all approved providers will be required to:

• ensure that their governing bodies are made up of a majority of independent non-executive members who have a mix of skills and experience, and that at least one member has experience in providing clinical care
• set up and continue a quality care advisory body
• offer consumers and their representatives at least annually the opportunity to establish one or more consumer advisory bodies 
• prioritise people receiving aged care (rather than the interests of the holding company) if the organisation is a wholly owned subsidiary
• ensure that their staff have the appropriate qualifications, skills and experience.

Approved providers should already be:

• assessing the suitability of key personnel at least once a year
• notifying the Commission of material changes, including those relating to key personnel, within 14 days
• submitting their completed annual Provider Operations Report to the Department of Health and Aged Care by 31 October each year, with 2023 being the inaugural submission.

Refer to the additional information on the Strengthening governance webpage regarding each requirement.

Strengthening Quality Standards Pilot update 

We have recently completed our strengthened Aged Care Quality Standards pilot. The pilot involved 40 providers that were representative of the aged care sector. We are now evaluating the findings from the pilot to see how our new assessment methodology and the strengthened standards work in practice.  

We encourage you to visit our Quality Standards Pilot page for more information about the pilot. We will share information on the pilot outcomes with the sector early in 2024.    

We’re now holding workshops with providers, including some who took part in the pilot and other stakeholders, to develop a first draft of guidance materials to support providers to implement the strengthened Standards. The guidance will be a practical tool that providers can use in the workplace. 

We will be releasing the first draft of guidance materials in early 2024 for broader consultation with people receiving aged care, their carers, other providers and peak bodies. Visit our Stronger Standards, Better Aged Care Program page for updates on the pilot and the wider consultation process.

Up to Standard video series 

We’re committed to helping aged care providers prepare for the strengthened Aged Care Quality Standards, anticipated to apply under the new Aged Care Act from 1 July 2024.  

To answer the most common questions we have received on the strengthened Standards, we’ve developed the video series Up to Standard.  

Each episode features answers to questions and the latest updates on the strengthened Standards. 

In Episode 1, Tara Pamula, Executive Director Education, Engagement and Communication, discusses when the strengthened Aged Care Standards will commence and the role of the Commission. 

If you have any other questions or feedback about the Standards, please email us at agedcarereform@agedcarequality.gov.au to help us make sure the sector is prepared.

Updated Regulatory Bulletin on restrictive practices

We have recently updated our Regulatory Bulletin covering regulation of restrictive practices and the role of the Senior Practitioner, Restrictive Practices. The changes to the Bulletin include:

• more clarity on the meaning of ‘restrictive practices substitute-decision maker’
• responsibilities for providers around restrictive practices nominees
• a consent hierarchy
• immunity provision under state and territory laws when using informed consent under Commonwealth laws.

The Bulletin helps services understand how specific requirements and processes fit into the aged care regulatory framework.

General Practice in Aged Care Incentive

The Australian Government is investing $112 million over 4 years in the General Practice in Aged Care Incentive (GPACI). This will support every aged care resident to receive quality primary care services from a regular GP and practice.

From 1 August 2024, GPs and practices registered in MyMedicare will receive an incentive for providing their registered patients who live in residential aged care facilities with regular visits and better care planning. This will help improve continuity of care and reduce avoidable hospitalisations for aged care residents. Residents will need to be registered in MyMedicare and the GP linked to the patient’s registered practice for GPs to access the GPACI.

Practices and GPs can register their residential aged care patients in MyMedicare from 1 October 2023. Residents will be able to register for MyMedicare by completing a registration form from their GP or using Medicare Online. Residents don’t need to physically go to a general practice to register. More information on GPACI including eligibility will be provided to practices in the coming months.

You can find more information on MyMedicare.

Aged care worker pay rise survey

The Department of Health and Aged Care is inviting workers and organisations from the aged care sector to complete a short survey to tell the department what the 15% pay rise has meant to you. For example:

• has it helped you to attract more workers to aged care? 
• does it make you want to stay working in the sector?
• do you feel more valued and rewarded for the work you do? 

The survey is open until 8 December 2023 and should take around 10 minutes to complete.

Take the Aged Care Wage Increase Satisfaction Survey.

Your feedback will help the department to evaluate and understand the impact of the wage increase on the sector.

Please share the survey link with your colleagues and networks.

Food, nutrition and dining

Celebrating with food 

The importance of food can’t be overstated. Along with the obvious nutritional benefits for physical health, food plays an important role in our mental wellbeing.  

Celebrating the holiday season 

In many cultures, food is central to identity and celebration. Understanding how a resident’s religious and cultural beliefs influence their food and dining preferences is important to supporting their overall wellbeing and quality of life.  

Supporting holiday food traditions and offering ways to take part in celebrations is vital. 

Key things to consider: 

• Who celebrates the holiday season and who doesn’t? 
• How do people celebrate? What are their traditions? 
• How is food included? 
• Have you thought about the dining experience? 
• How can you include residents in planning and preparation? Have you asked for thoughts and ideas, feedback on previous celebrations or included residents in menu planning? 

What about those who don’t celebrate in December? 

It’s important to remember that not all Australians celebrate Christmas. Recognising and catering to people from culturally diverse backgrounds and with different religious beliefs supports quality of life for all residents.  

Key things to consider: 

• What are the religious and cultural food preferences of each resident? Remember not to make assumptions about a resident’s likes and preferences. 
• For those who don’t celebrate in December, would they still like to be included? 
• If they don’t want to be included, what other options will be available to them (like alternative food choices and dining location)? 
• What other cultural and religious dates and holidays are important throughout the year? How is food included? Which residents celebrate these days? 
• How can you include these celebrations into your activities and food service? 

A useful tool to assist staff in exploring and recording residents’ food and dining preferences is our ‘My food and dining preferences’ fact sheet.

Respecting cultural requirements and ensuring these needs are addressed is part of both the Aged Care Quality Standards and Charter of Rights.  

We have resources to support providers and their staff in providing an enjoyable and nutritious dining experience for the older people in their care.

Education resources

An enjoyable food and dining experience is vital to the health, wellbeing and quality of life of people living in aged care.  

We have created new editable resources designed for use by provider learning and development staff and managers during training and stand-up meetings. These resources include: 

• Food, nutrition and dining: a reflection on practice, a PowerPoint template for providers to use with their direct care staff 
• Food, nutrition and dining stand-up discussion notes for providers to use with both corporate and direct care staff. 

These resources: 

• encourage conversations about what ‘best practice’ looks like 
• guide reflection and education about how these concepts apply in practice 
• address the 4 main priority areas related to food, nutrition and dining, including dining experiences, resident choice, managing swallowing difficulties and oral health.

Colouring, conversation, creativity and care

A suite of colouring resources is now available to provide a multifaceted creative experience for older Australians living in residential or home aged care settings, and for the people who care for them.

Produced to complement our Food, Nutrition and Dining resources, the colouring resources aim to promote discussions about food and the life events and celebrations that are centred on food, its preparation and consumption.

This collection of themed illustrations is inspired by older Australians and their connection to food – preparing it, eating it, and using it to celebrate special occasions. These instructions are designed to inspire and assist aged care workers to encourage the people they care for to engage in the activities.

Each of these artwork themes includes an engagement page with a story designed to enhance connection to the various themes. Invite participants to close their eyes or look at the artwork as you read the short story aloud to them.

These artworks can be printed out in colour on A4, A3, or even A2 paper and then used as part of an activity session, or displayed as wall art.

Clinical update

Summer clinical alert: Caring for older people in hot weather

The high temperatures across Australia during spring and confirmation of El Niño for the 2023–24 summer make it likely that there will be multiple heatwaves in coming months. 

Both residential and home services aged care providers need to be aware that older people, especially those with comorbidities such as heart disease, are more likely to suffer from severe clinical and physical problems associated with extreme heat events. Older people living in the community can be at an even higher risk of heat exhaustion or stress, especially those who live alone with no regular contact from others.  

In October the Commissioner, Janet Anderson PSM, issued a letter to providers on preparing for the high-risk weather season. The information in the letter will support your planning and preparation for the high-risk weather season and the continuity of care and services to older Australians.  

Last month the Commission's Chief Clinical Advisor, Dr Melanie Wroth MB BS FRACP, issued an important summer clinical alert. The alert includes advice and information about monitoring and caring for older people during the summer to prevent dehydration, heat exhaustion or stress and heat stroke.

Keep your fluids up!

The end of year in Australia means warmer weather which can mean an increased risk of dehydration. Dehydration happens when the amount of fluid you drink is less than what is lost. 

Older people, including those living in aged care homes, are more at risk of dehydration. This can quickly lead to serious and dangerous clinical outcomes.   

Residents living in aged care homes can be more at risk of dehydration if they:

• have advanced cognitive impairment
• are receiving medication that increases fluid loss
• have impaired mobility or dexterity.

Those who are at higher risk may need extra observation and support. 

Ways to help people stay hydrated: 

• Make sure fluids are always available and accessible. Always put drinks in reach and use assistive equipment when needed. 
• Frequently offer a choice of drinks during the day, including the resident’s preferred options, and during medication rounds. As well as water, fluids to support hydration may include tea, coffee, milk and juice-based drinks. Alcohol should be limited. 
• Offer a choice of foods high in fluid, such as soup, ice cream, jelly, custard, yoghurt, and fruits like melon, apples and pears. 
• Use fluid balance charts for residents at risk of dehydration. Know the typical volume of fluid held in standard glassware, crockery and high fluid content foods to help make your records accurate. 
• Make sure that all food and fluids offered to support hydration meet a person’s requirements for texture-modified foods and thickened fluids. 

For professional advice on nutrition and hydration care for older people, call our Food, Nutrition and Dining Hotline on 1800 844 044, Monday to Friday 9 am to 5 pm AEDT.

More information:

• Caring for older people in hot weather
• Providing food and dining choice
• Preventing Urinary Tract Infections: Recognising dehydration

Webinars

Our 2023 webinar program

Our program of monthly sector webinars has now wrapped up for the year. We covered a wide range of topics designed to support the sector to meet changing requirements and encourage ongoing improvement. You can find recordings of each webinar on our website and YouTube channel.

In 2023, more than 11,000 people attended our webinars and the recordings have been viewed more than 20,000 times. Topics covered during the year included:

• handling complaints
• 24/7 registered nurse responsibility
• provider governance
• site audits.

We will be running the webinar program again next year and welcome any suggestions you have for topics you’d like us to cover. You can send your suggestions to communications@agedcarequality.gov.au.

Recording available – Staffing obligations and mandatory care minutes

The recording is now available from our Staffing obligations and mandatory care minutes webinar on 21 November. This webinar focused on recent changes to providers’ obligations regarding staffing. This included the new requirement that all residential aged care services have a registered nurse (RN) on-site and on duty 24 hours a day, 7 days a week (from 1 July 2023) and the requirement that all residential aged care services meet care minute targets for RNs, enrolled nurses, assistants in nursing and personal care workers (from 1 October 2023).

Our panel included:

• Janet Anderson PSM, Aged Care Quality and Safety Commissioner
• Peter Edwards, Executive Director Compliance Management Group, Aged Care Quality and Safety Commission
• Dr Melanie Wroth, Chief Clinical Advisor, Aged Care Quality and Safety Commission
• Danni Campbell-Manley, State Manager Victoria, Aged and Community Care Providers Association (ACCPA)
• Thea Connelly, First Assistant Secretary, Home and Residential Division, Department of Health and Aged Care.

New Aged Care Act and Support at Home program updates 

Thursday 14 December, 2:00–3:30 pm AEDT 

The Department of Health and Aged Care is hosting a webinar about key aged care reforms for both residential and home care services. 

This webinar will include updates on: 

• the development of the new Aged Care Act  
• a new model for regulating aged care 
• the strengthened Aged Care Quality Standards  
• in-home aged care reforms, including the new Support at Home program. 

These updates are relevant to: 

• aged care providers and workers 
• sector peaks, associations and unions 
• older people, their families and carers. 

The webinar will include a live question-and-answer session. You can pre-submit a question when you register.

A recording will also be available on the department’s website soon after the live event.

Register to attend.

Training and resources

Online workshops for approved providers

The Commission regularly hosts online workshops for approved providers of residential aged care and home services.

Visit our Workshops webpage for further information and registration details.

 New resources

• RB 2023-23 Strengthening provider governance responsibilities – governing body requirements
• Colouring, conversation, creativity and care
• Complaints about aged care services – Insights for providers report 2023
• Letter to providers on Complaints about Aged Care Services Report
• SIRS Insights Series – Unexplained absence from care
• Financial and Prudential Regulatory Insights – November 2023