Aged Care Quality Bulletin #48 – December 2022 | Aged Care Quality and Safety Commission

Commissioner’s message

This final edition of the Bulletin for 2022 provides an important opportunity to acknowledge the heavy lifting done by aged care providers across the course of this year. Ensuring your ongoing vigilance and readiness to respond to COVID-19 has been a major, but by no means the only, challenge you have faced. Keeping pace with the ambitious sector-wide reform agenda being pursued by the Federal Government has also placed demands on all stakeholders in the sector.

Focusing on COVID-19 first, it is vital for providers to make good use of all the lessons learned during earlier waves of this virus. The Commission’s Chief Clinical Advisor Dr Melanie Wroth wrote to all providers at the end of November reinforcing the importance of good infection prevention and control (IPC) processes.

The Minister this week released the COVID-19 plan for 2023 that includes a Statement of Expectations on COVID-19 management in aged care settings reinforcing the need for strong IPC processes alongside the focus on human rights, including acute and primary care services, continuity of care and lifestyle support, and ongoing access to visitors.

I know this time of the year can be a busy one for visitors, and it’s important to recognise the physical, social and psychological benefits they can deliver for consumers (and aged care staff), and the need for providers to enable family and friends to visit residents whenever possible, while taking suitable precautions to minimise the risk of infection.

Moving on to the reform agenda, 1 December turned out to be a particular milestone in our shared reform journey, with a number of reforms ‘going live’ on that date which have regulatory implications. This includes the introduction of SIRS in home services, commencement of a Code of Conduct for aged care providers, workers and governing persons, the establishment of new provider governance obligations, and greater clarity on who can provide informed consent for the use of restrictive practices, where an aged care consumer lacks the capacity to consent on their own behalf. Each of these reforms will contribute to greater accountability and transparency in the sector and, over time, to improved overall performance and a better consumer experience.

Being aware of how hard so many aged providers have worked to get ready for these reforms, I commend your commitment and determination.

Of course, this is not the end of the changes that are designed to transform aged care. In the balance of this financial year, there are several further initiatives being pursued. Later this month, the Department of Health and Aged Care will publish Star Ratings for residential aged care homes on My Aged Care. From 1 January 2023, administrative charges for home care packages will be capped and exit fees banned, and from 1 July 2023, residential aged care homes will be required to have a registered nurse onsite and on duty 24 hours a day, 7 days a week. Alongside these initiatives, work continues towards finalisation and implementation of the revised Aged Care Quality Standards.

These reforms will change and improve the way that aged care is delivered in Australia. They underpin and support our shared goal of improving the quality of aged care so that every single older Australian can receive the care they need and deserve.

This week, we held the last of our reform-focused webinars for 2022. In the webinar, we included a quick ‘round up’ on the recently-commenced reforms and looked at what lies ahead in terms of the reforms still to come. If you didn’t get a chance to watch the live broadcast, I encourage you to watch the webinar recording which will be available on our website soon to hear the latest on the sector reforms and the extensive resources available to support you.

I wish you a safe and happy festive season, and I look forward to continuing our important work together in 2023.

Aged care reform update

SIRS in home services

Following the introduction on 1 December of the Serious Incident Response Scheme (SIRS) in home services, home service providers have started submitting SIRS notifications to the Commission.

In response to the small proportion of notifications we have received that do not fall within the scope of the scheme, the Commission’s SIRS team is working with those providers to help them better understand their reporting obligations and what constitutes a serious incident that is reportable under the SIRS.

This is also what we did when SIRS commenced in residential aged care services in April 2021. The number of out-of-scope notifications has declined for residential services as providers have gained confidence and experience with reporting serious incidents to the Commission – and we would expect the same thing to happen for home services.

A useful tool that can help providers is the SIRS decision support tool, which is available for both residential and home services providers. When using this tool, providers are asked a series of questions about an incident to help them decide whether it must be reported to the Commission.

Home services providers and their workers are encouraged to keep in mind:

Only incidents occurring on or after 1 December 2022 are reportable for SIRS in home services.
Reportable incidents are those that align with one of the 8 specified categories and are incidents that have occurred in connection with the provision of care and services to consumers.
If you identify an incident in connection with the care and services provided by another provider, you should raise this with that provider or by submitting a complaint to the Commission. This does not include circumstances where the other provider is your sub-contractor.
You must report allegations and suspicions of serious incidents.
You should consider all concerns raised by your consumers, their representatives or your staff to determine if a serious incident report needs to be submitted.

More information

Key resources available on our website include:

SIRS guidance for providers of home services for further detail and useful examples of the SIRS in practice
the SIRS for home services reportable incidents workflow which outlines the steps to take when an incident occurs in a home or community setting
a fact sheet about the SIRS reporting responsibilities for home services providers and their staff
a fact sheet for home services care recipients about the SIRS.

Visit our SIRS and our SIRS home services resources pages for providers for more information and resources.

If you have an enquiry, you can contact the SIRS team via email at sirs@agedcarequality.gov.au or by phone on 1800 081 549.

Code of Conduct for Aged Care

A new online learning module ‘Know your Code’ is now available on the Commission’s free online leading platform Alis, to assist approved providers, their governing persons and workers to understand the Code of Conduct for Aged Care (the Code), introduced on 1 December.

The module is the latest addition to a large suite of Code resources available on our provider, worker and consumer webpages, including fact sheets, videos, a self-assessment quiz and posters.

‘Know your Code’ explores practical examples and scenarios that help explain the expected behaviours under the Code, as well as the Commission’s regulatory role.

The module is available to learners in care, clinical, leadership and governance roles. Specifically, it is targeted to those who have responsibilities under the Code, including:

approved providers of residential, home and flexible care services (including the Transition Care Program, Multi-Purpose Services Program and Short-Term Restorative Care Program)
governing persons of approved providers (for example, board members and Chief Executive Officers)
aged care workers of approved providers (including volunteers, students, contractors and subcontractors of the provider).

The module is available now in the Alis Courses tab.

New consent arrangements for restrictive practices

As outlined in the September 2022 Quality Bulletin, the Government has proposed (and Parliament has now agreed to) an amendment of the Quality of Care Principles 2014. The amendments clarify who can provide informed consent for the use of a restrictive practice where an aged care consumer lacks the capacity to consent on their own behalf. These amendments took effect on 1 December 2022.

The amendments set out a hierarchy of consent to identify the appropriate individual or body to provide consent. The hierarchy can only be used when a mechanism under state and territory laws to appoint a restrictive practices substitute decision maker is not available, or a substitute decision maker has not already been appointed.

The consent hierarchy is an interim measure to allow time for state and territory governments to make amendments to their consent and guardianship laws and will be in place until 1 December 2024.

Providers are encouraged to familiarise themselves with the recent amendments. More information is available on the Department of Health and Aged Care website, including a fact sheet.

The Commission will continue to review, update and develop resources and education tools for providers to support their understanding of obligations regarding use of restrictive practices, behaviour support plans and appropriate consent. For more information, read the information for providers and consumers, and access the provider resources on our website.

Regulation of Transition Care Programme

As outlined in the October 2022 Quality Bulletin, legislative amendments enabling the Commission to undertake quality reviews of transition care services commenced on 1 December.

More information on these changes is available on the Department of Health and Aged Care website.

A look back at the Governing for Reform program in 2022

It has been a year since the Commission invited approved providers to register and participate in the Governing for Reform in Aged Care Program.

Since then, over 3,400 governing body members and executives have enrolled in the program – which is a really good take-up over 12 months.

Participation has helped providers to improve their governance capability, equip themselves with the skills to respond to new obligations and identify opportunities to improve the quality and safety of care delivered to older Australians.

The Commission thanks everyone who has participated to date for their engagement with the program – and of course, we also renew our invitation to those who are still thinking about enrolling. There is still time and plenty of learning opportunities await you. Here’s where you can sign up.

Below is a snapshot of what the program has achieved over the past year.

Governing for reform in Aged Care program - A year in review infographic for 2022

If you have a positive food story to tell, we want to hear it

As part of the Commission’s focus on improving food, nutrition and the dining experience in residential aged care, we have been asking providers to share positive stories and case studies that share approaches that have led to effective change in their services. We are also interested in creative, innovative suggestions on improving food, nutrition and dining in aged care.

We will be sharing positive stories and case studies over the next 12 months in this newsletter. If you have stories, case studies or ideas to share with us, please send them to info@agedcarequality.gov.au.

Here is our first story from a provider:

Meals that evoke residents’ memories

An Indigenous residential aged care home has a standing agenda item at its residents’ meetings dedicated to the food and the dining experience.

As most of the residents grew up in camp or mission locations, they expressed their wish for more barbeques at the home, as they love the smell of the fire and smoke and the memories this evokes.

The residents said kangaroo tail was everyone’s favourite food to barbeque. They also said that they loved tinned bully beef (or corned beef) with damper, as this reminded them of a treat they enjoyed when they were younger.

Both of these meals are now regularly served at the home. When staff can access them, kangaroo tails are bought and kept in the freezer. When they’re not available at all, oxtail is cooked in the fire instead.

These meals have become a treasured and meaningful experience for residents – and one that is not just about the food. Residents take a long time to eat these meals and savour every mouthful, while sitting together around the raised fire pit and sharing memories.

From the Chief Clinical Advisor – Summer alert

The recent La Niña weather phenomenon may be easing but the effects of adverse weather events remain. In addition, the current COVID-19 wave presents challenges across the country, especially as people come together over the holiday season.

With summer now upon us, it is time to reconsider the risks this season brings for older Australians.

Aged care providers should clearly understand the risks that are specific to their locations, buildings, spaces and individual residents, particularly as we experience hotter temperatures.

People at risk include those:

with dementia who may not recognise that they are heating up
who are very frail or have a low body mass who may heat up more easily
who struggle to maintain good hydration
with mobility problems who cannot move themselves into shade or a cooler space, or who can’t remove their outer clothing or bedding.

Locations to be aware of include:

buildings or internal areas that cannot be air conditioned or cooled
outdoor areas which change from shade to full sun as the sun moves across the day, or are not able to benefit from cooling breezes
indoor areas where the sun shines through glass.

Strategies enabling staff to manage these risks should be clearly communicated.

Staff should be aware of the ambient temperature at different times and locations, and of the clothing that people are wearing.

Appropriate improved ventilation is one of a number of controls that can be used to limit the spread of respiratory diseases, such as COVID-19 in indoor environments. While increasing the introduction of outdoor air can improve ventilation and cooling, this may not always be appropriate in hot or humid weather, or during periods of low outdoor air quality.

During the warmer summer period, staff should be reminded to:

monitor the fluid intake of vulnerable residents
encourage more frequent drinking of fluids
be aware if toileting becomes less frequent as this is a sign of poor hydration
respond as a priority to residents saying they are, or appear, hot or thirsty
remind and assist residents with sunscreen, hats and protective clothing if sun exposure is possible
offer tepid sponging or showering
be aware of the signs of overheating, including red or very pale skin, or confusion, as a clinical emergency.

The Department of Health and Aged Care has checklists about caring for older people in warmer weather, specifically for residential aged care and for home care service providers.

Safe Work Australia and the Australian Health Protection Principal Committee also have useful information on ventilation.

New guiding principles to improve medication management in aged care

The Department of Health and Aged Care, in collaboration with the Australian Commission on Safety and Quality in Health Care (ACSQHC), has updated the national guiding principles to improve the quality and safety of medication management for all Australians.

These include: 

The guiding principles support the Government’s response to improved medication management in aged care, which was a major focus of the Royal Commission into Aged Care Quality and Safety. 

The new guiding principles cover: 

clinical governance and leadership
responsibility for medication management
accountability for medication management
safety and quality systems
medication reconciliation 
review of current medicines
medication management plan
sharing decision making and information about medicines with the individual receiving care
collaborating and communicating medicines-related information with other healthcare professionals
ongoing access to medicines.

These documents promote best practice. The application of these principles must consider relevant national, state and territory legislative requirements, profession-specific licensing/registration, codes of practice, guidelines and standards, and aged care quality and accreditation standards and requirements.

The ACSQHC collaborated with the Commission and the Australian Digital Health Agency to ensure alignment and consistency of the updated publications with related policy initiatives.

National Dementia Action Plan public consultation now open

The Department of Health and Aged Care is seeking your feedback to inform a National Dementia Action Plan.

The National Dementia Action Plan is a joint initiative between the Australian Government and state and territory governments. It is a 10-year plan to ensure that people living with dementia, their families and carers are at the centre of all action on dementia.

It will also mean better coordinated approaches to dementia risk reduction and early diagnosis, and improvements in services for people living with dementia and their carers.

You can read the National Dementia Action Plan consultation paper, including translated versions, and find out how to have your say by visiting the Department of Health and Aged Care’s Consultation Hub.

The public consultation closes on 31 January 2023.

OPAN launches new self-advocacy toolkit

A new resource from the Older Persons Advocacy Network (OPAN) is available to help people receiving aged care services speak up about issues or concerns.

This self-advocacy toolkit aims to make it easier to access information on a range of topics, including:

a person’s aged care rights and options
tips on solving common aged care problems
how to recognise abuse and keep safe
where to get help on making decisions
aged care costs.

The toolkit contains checklists, videos and a variety of resources to support care recipients.

The information and resources in the toolkit are available to download and print.

To explore the new toolkit, visit the OPAN website.

New and updated Commission resources

Financial and Prudential Regulatory Insights

New: Why are the prudential standards important? (December 2022)

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Aged Care Quality Bulletin #48 – December 2022

Commissioner’s message

Aged care reform update

SIRS in home services

Code of Conduct for Aged Care

New consent arrangements for restrictive practices

Regulation of Transition Care Programme

A look back at the Governing for Reform program in 2022

If you have a positive food story to tell, we want to hear it

Meals that evoke residents’ memories

From the Chief Clinical Advisor – Summer alert

New guiding principles to improve medication management in aged care

National Dementia Action Plan public consultation now open

OPAN launches new self-advocacy toolkit

New and updated Commission resources

Guides

Fact sheets

Videos

Online tools

Self-assessment quiz

Frequently asked questions

Posters

Clinical alert

Financial and Prudential Regulatory Insights

Complaints about aged care services last month