Guidance and resources for providers to support the Aged Care Quality Standards

New content added to: 

• Standard 7 – requirement (3)(a)

  Reflective questions
  
  What processes does the organisation use to enable volunteer Managers to give feedback on the number of volunteers and mix of skills needed to support person centred care?

  Examples of actions and evidence

  Consumers 
  
  Consumers say that they have access to volunteers to feel supported and connected.

  Workforce
  
  Volunteers are aware of, and have access to, available training to support them to perform their roles.
  
   

• Standard 7| Requirement (3)(c)

  Examples of actions and evidence 

  Consumers  
  
  Consumers feel supported and connected through volunteers 

  Workforce and others 
  
  Volunteers are aware of, and have access to, available training to support them to perform their roles.  

  Organisation 
  
  Volunteers feel supported by the organisation to perform their volunteer roles. 

  Organisations are proactive in ensuring volunteers have access to training to support the role they undertake in supporting the consumer 

New additional resources for:

• Advance care planning
• Diversity
• Governance
• Medication safety
• Spiritual care
• Workforce

Resources revised and updated for: 

• Consent
• Reportable incidents

Summary of edits

• Added resources for:
  • Managing infection-related risks
    
     
• New content added to:
  • Standard 3 – requirement (3)(g)

    Intent of this Standard
    
    Update to reflect COVID-19 vaccination and antiviral medication best practice.

    Reflective questions
    
    What are the influenza and COVID-19 immunisation rates for consumers and the workforce in residential services? How does this information inform infection prevention and control planning?

    Are there agreed processes for access to other providers, organisations or individuals, such as general practitioners, nurse practitioners or Public Health Units and community pharmacies for timely prescriptions in the event of an outbreak?
    
     

  • Standard 7 – requirement (3)(a)

    Reflective questions
    
    How does the organisation identify short or long-term shortages in the capacity or skills of its workforce, and how are these shortages addressed?

    How does the organisation identify contingencies for an outbreak, including finding staff through labour hire agencies and within the wider organisation?

    How does the organisation use influenza and coronavirus (COVID-19) vaccination rates to inform workforce planning?
    
     

  • Standard 8 – requirement (3)(b)

    Reflective questions
    
    Has the governing body communicated the importance of their workers being vaccinated against influenza and coronavirus (COVID-19) to promote the key role vaccination plays in the delivery of safe, inclusive and quality care and services?

    What priorities and strategic directions has the governing body set and communicated to the organisation for safe, inclusive and quality care and services? How are priorities reviewed and communicated during emergencies and disasters, including during infectious outbreaks?

    How does the governing body promote timely access to precautionary infection control measures including COVID-19 vaccinations and, in the event of an outbreak, timely access to prescriptions.
    
     

  • Standard 8 – requirement (3)(c)

    Reflective questions
    
    Does the organisation have effective governance systems relating to regulatory compliance, which includes compliance with jurisdictional public health orders, and record-keeping and reporting requirements under the Accountability Principles 2014 and Records Principles 2014?

The publication was updated to reflect the new requirements that were introduced when the Serious Incident Response Scheme launched on 1 April 2021.

7 December 2020

All of the below updates are related to the Guidance Resources page:

• Managing infection-related risks
• New resource heading
• Emergency planning

Summary of edits

All of the below updates are related to, Guidance Resources page:

Peak body organisations included for:

• Advance care planning
• Advocacy
• Continence
• Dementia
• Diversity
• Managing hearing loss
• Managing hydration and nutrition
• Managing pain
• Managing vision
• Preventing and managing pressure injuries

New additional resources for:

• Continence
• Governance
• Managing restrictive practices

Resources revised and updated for: 

• Preventing and managing falls

Summary of edits

All of the below updates are related to, the Guidance Resources page:

New additional resources for:

• Managing infection-related risks

Summary of edits

• New content added to:
  
   
  • Standard 1 – requirement (3)(f)

    Intent of this Standard
    
    The Privacy Act 1988 and the Aged Care Act 1997 both permit the disclosure and sharing of health information if the information is necessary to provide health services to individuals, for example, between aged care services and hospital services.

    Reflective questions
    
    What practical steps does the organisation take to ensure accurate health information is safely transferred to those providing health care?
    
     

  • Standard 2 – Purpose and scope of the Standard
    
    Assessment and care planning is expected to provide access to advance care planning including the completion of legally binding advance care directives, and end of life planning, if the consumer wants this.

    Organisations need to document the outcomes of all assessments and discussions with the consumer in a care and services plan and set an agreed review date. Care and services plans may include advance care planning, advance care directives, and end of life planning documents.
    
     

  • Standard 2 – requirement (3)(a)

    Intent of this requirement
    
    Where consumers have lost their decision making capacity and have an advance care directive in place, health professionals have obligations to access and enact the advance care directive. It should be available at the point of care and shared across service providers.

    Reflective questions
    
    How does the organisation define advance care planning policy and ensure consumers are using quality and complete statutory advance care directive forms?

    Examples of actions and evidence

    Workforce:
    
    The workforce can describe advance care planning and advance care directives.

    Evidence that advance care directive documentation informs end-of-life care and decisions.

    Organisation:

    Evidence of how the organisation makes sure the workforce has undertaken advance care planning training and has policy to inform advance care directive documentation; ensuring documentation is accurate, up-to-date, complete, shared and stored with relevant healthcare providers.
    
     

  • Standard 2 – requirement (3)(b)

    Intent of this requirement
    
    As part of advance care planning, consumers may wish to complete an advance care directive detailing their care preferences or appointment of a substitute decision-maker. Advance care directives are legally binding documents, which can only be completed by a competent consumer who still has decision-making capacity.

    If a consumer is unable to document an advance care directive due to lack of decision making capacity, a medically driven document outlining the plan of care in relation to emergency treatment or severe clinical deterioration can be useful (e.g. acute resuscitation plan, do not resuscitate order). This document should be developed in consultation with the substitute decision-maker of a consumer without decision making capacity.

    Where a consumer lacks the capacity to make decisions, providers will need to check if they have previously appointed a substitute decision-maker (e.g. attorney, guardian). All states and territories have a default decision-maker (e.g. partner, eldest child, or carer) with the exception of the Northern Territory. If no substitute decision-maker can be identified, they will require a court or tribunal appointed guardian to make medical decisions.

    Examples of actions and evidence
    
    Consumers have access to advance care planning and end-of-life planning.

    If a consumer chooses to complete an advance care directive, it is done while they still have decision making capacity.  

    The workforce can describe advance care planning and understand the substitute decision-maker should be consulted in medical decisions including consent, refusal and/or withdrawal of treatment.  

    Advance care directive documentation should be accurate, up-to-date, complete, shared and stored with relevant care and service providers.
    
     

  • Standard 2 – requirement (3)(d)

    Intent of this requirement
    
    Care and services plans may include advance care planning, advance care directives, or end of life planning documents.
    
     

  • Glossary – Advance care directive:
    
    A written advance care planning document completed and signed by a competent consumer who still has decision-making capacity. In Australia, advance care directives are recognised by specific legislation or common law. Advance care directives can record the person’s preferences for future care and/or appoint a substitute decision-maker to make decisions about the person’s health care.
    
     
  • Glossary – Advance care planning:
    
    The process of planning for future health and personal care, whereby the person’s values, beliefs and preferences are made known so they guide decision-making at a future time when that person cannot make or communication their decisions.
    
     
  • Standard 5 – requirement (3)(b)

    Intent of this requirement
    
    The service environment is expected to promote the free movement of consumers (including to access outdoor areas). It may be important that the service environment is secure or access to certain areas are restricted to help create a safe service environment for consumers.

    Arrangements to protect consumers require assessment, documentation in care and services plans, informed consent from the consumer and regular monitoring and review, in line with best practice and legislation.
    
     

• New Resources for:
  • Advance care planning
  • Clinical care
  • Consumer-centred care
  • Medication safety
    
     
• New online format to increase navigation and accessibility

Summary of edits

• New legislation:
  • Aged Care Legislation Amendment (Quality Indicator Program) Principles 2019
• New Resources for:
  • Clinical Governance
  • End of life care
  • Nutrition
  • Open disclosure
  • Spiritual well-being
• New Case studies for consumers receiving care and services in rural and remote locations
• Minor edits and updates to broken links

Summary of edits

• Glossary

  • Update to entry for Consumer-centred care - Care and services that are designed around an individual's needs, preference and background. It includes partnership between consumers and providers.

Summary of edits:

• New legislation:
  • Aged Care Quality Act 1997 (Cth), User Rights Amendment (Charter of Aged Care Rights) Principles 2019
  • Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019
• New content added to:
  • Standard 3 - Requirement (3)(b):
    
    "“minimising restrictive practices – These interventions have high potential for harm and are practices that organisations can avoid with positive changes in how they assess, plan and deliver personal and clinical care for consumers. If an organisation uses restrictive practices such as physical or chemical restraint, these are expected to be consistent with best practice and used as a last resort, for as short a time as possible and comply with relevant legislation.” 
  • Standard 8 - Requirement (3)(d):
    
    "Records show how staff are trained and supported to assess or evaluate the use of restraints in order to minimise or eliminate their use."
  • Standard 8 - Requirement (3)(d):
    
    "Evidence of how the organisation monitors and reports on the use of restraints."
  • Standard 8 - Requirement (3)(e):
    
    "(ii) Minimising the use of restraint
    
    Restraint means any practice, device or action that interferes with a consumer’s ability to make a decision or restricts a consumer’s free movement. Where restraint is clinically necessary to prevent harm, the organisation should have systems to manage how restraints are used. This is in accordance with legislation and the organisation’s policies on reporting the use of restraints.” 
  • Standard 8 - Requirement (3)(e):
    
    "Evidence of appropriate authorisation and consent for the use of restraints in compliance with legislation."
  • Glossary - Restrictive practices:
    
    "The use of interventions and practices that have the effect of restricting the rights or freedom of movement of a person with disability. These primarily include restraint and seclusion.
    
    Chemical restraint means a restraint that is, or that involves, the use of medication or a chemical substance for the purpose of influencing a person’s behaviour, other than medication prescribed for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition. Physical restraint means any restraint other than: (a) a chemical restraint; or (b) the use of medication prescribed for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition. This guidance adopts the general principle that restrictive practices are only implemented as a last resort; are implemented for the least amount of time possible; are recorded, monitored and reviewed; have tight safeguards in place that are focused on minimising risk to consumers, staff, and others; and are undertaken with a focus on ensuring decency, humanity and respect at all stages."
  • Glossary - Clinical governance:
    
    "An integrated set of leadership, behaviours, policies, procedures, responsibilities, relationships and monitoring and improvement mechanisms that are directed towards ensuring good clinical outcomes. Effective clinical governance systems ensure that everyone – from unregulated care providers, to employed or external regulated health practitioners, to managers and members of governing bodies such as boards – is accountable to consumers and the community for the delivery of clinical care that is safe, effective, integrated, high quality and continuously improving.” 
• Minor edits and updates to broken links.

Summary of edits:

• Add Resources for:
  • Advocacy
  • Diversity
  • Consumer-centred care
  • Governance
  • Managing hearing loss
  • Managing pain
  • Managing vision
• New content added to:
  • Standard 1 – Purpose and scope of the Standards:
    
    "They are also expected to be responsive, inclusive and sensitive to consumers who are Aboriginal and Torres Strait Islander. The consumer defines their own identity and this should be respected and not questioned."
  • Standard 3 – Requirement (3) (d):
    
    Inclusion of "changes" or deterioration in the health or function of a consumer.
• Minor edits and updates to broken links.

Summary of edits:

• Add Resources for:
  • Antimicrobial stewardship
  • Complaints management
  • Governance
• New content added to:
  • Standard 3 – Requirement (3)(b) - Intent of this Requirement:
    
    "Although antipsychotic medicines may be appropriate for adults with severe mental health issues or long-term mental illness, there is concern that these medicines are being prescribed inappropriately in people aged 65 years and over for their sedative effects - that is, as a form of chemical restraint for people with psychological and behavioural symptoms of dementia or delirium."
  • Standard 4 – Purpose and scope of the Standard:
    
    "Care and services are expected to be delivered in a way that enables all a person's needs to be met. This includes making sure that enough time is allocated to allow staff to provide care and treatment in accordance with the person's assessed needs and preferences. There should be policies and procedures that support staff to deliver care and treatment in accordance with the requirements detailed in the care and services plan."
• Minor edits and updates to broken links.

Summary of edits:

• Rebranding for the Aged Care Quality and Safety Commission

Summary of edits:

• Removal of Draft to reflect Aged Care Quality Standards passing into law
• Updated numbering to reflect legislation

Guidance and Resources for providers first released.