As this extraordinary year draws to a close, we are all reflecting on the terrible toll that the pandemic has had, both here and abroad. Nowhere has its impact been more pronounced and more devastating than in aged care services.
The challenges experienced by the aged care sector, and the demands placed on consumers, aged care workers and providers, have been unparalleled. The work of the Royal Commission into Aged Care Quality and Safety has contributed to ongoing public scrutiny of and commentary on the performance of providers, and the Commission as regulator. And through all of this, the momentum for positive reforms has continued as we all strive to improve the quality and safety of care, and deliver the best possible care experiences and outcomes for older Australians.
2021 will bring fresh opportunities and challenges. Optimistically, we should regard it as a year filled with enormous promise in relation to aged care reform and also offering the potential of vanquishing the COVID-19 threat as new vaccines become available.
I wish you all a safe holiday period and look forward to working with you over the coming 12 months.
Outbreak Management Planning
Accompanying the release of the Commission’s Outbreak Management Planning guidance, we recently hosted a webinar on this topic that was open to all residential aged care services providers. The webinar, which can be viewed here, provided an overview of the resource and also addressed some of the lessons learned by the Commission and providers who experienced a COVID-19 outbreak at their residential service.
The Commission has also produced a video for providers to support their workers, care recipients, families and visitors to prevent, prepare for and manage outbreaks of COVID-19, which can be viewed via our website.
Serious Incident Response Scheme
As foreshadowed in the last edition of the Quality Bulletin, the Serious Incident Response Scheme (SIRS) is a new Commonwealth government initiative aimed at reducing the risk of incidents of abuse and neglect in residential aged care services, and improving services’ response to such incidents. Subject to decisions by the Federal Parliament, the SIRS is expected to commence from April 2021.
The scheme requires residential aged care providers to identify, record, manage, resolve and report all serious incidents that occur, or are alleged or suspected to have occurred. Serious incidents will encompass a wider range of events than are currently included in the compulsory reporting arrangements, which will be replaced by the new scheme.
Aged care providers will be required to have in place an effective incident management system to manage all incidents, respond to incidents, and take steps to make sure they do not happen again.
The Commission will be responsible for administering the SIRS and will receive incident reports from aged care providers. The Commission is in the process of developing guidance materials and other resources to support aged care providers to understand what is expected of them.
Arrangements for reaccreditation site audits
As advised in previous Bulletins, one of the consequences of the pandemic has been the need to defer a number of site audits for reaccreditation. The Commission reinstated its program of site audits from August 2020 and we are taking a number of steps to catch up on the backlog of deferred audits. We are doing this work alongside our ongoing risk-based assessment and monitoring regulatory activities.
Our primary aim is to conduct as many site audits as possible in the “normal” way, i.e. as an unannounced site audit undertaken at any time between receipt of a valid application for reaccreditation and accreditation expiry. The assessment team will undertake the audit whilst applying the Commission’s COVID-safe processes in the field.
A number of residential services which would have been scheduled for a site audit during the pandemic have received a determination of ‘exceptional circumstances’ issued by a delegate of the Department of Health, which has the effect of deeming the service to have met accreditation requirements (for up to 6 months) until such time as a site audit takes place and a decision on reaccreditation (including the period of accreditation) is made.
Where a service is the subject of such a determination, a delegate of the Department of Health provides advice within the month before the expiry of accreditation.
Factors considered by the Commission in identifying residential services for this treatment include the provider’s and service’s overall risk profile, compliance history, current and previous complaints, operating environment risks, and any other regulatory intelligence available. Residential services with a high risk profile are excluded from consideration for an exceptional circumstances determination. Further, the Commission maintains monitoring surveillance of all services subject to an exceptional circumstances determination.
A service under an exceptional circumstances determination can generally expect to have an unannounced site audit within the exceptional circumstance period. In rare situations which the Commission seeks to avoid, a further exceptional circumstances determination may be issued by the Department of Health for a limited period.
An alternative option available to the Commission, and only considered for selected lower risk profile services, is to conduct an ‘own motion’ reconsideration of the original accreditation period. This process allows a Commission delegate to consider whether it is suitable to extend the accreditation period for the provider with respect to the identified service, and if so, to decide on a new, longer accreditation period. If a service is subject to an own motion reconsideration, the Commission will provide advice several months prior to accreditation expiry.
Where audits have been deferred, the Commission will continue to monitor approved providers and undertake unannounced site visits in accordance with the Commission’s regulatory strategy and the Commission’s assessment of risk.
Visitor access campaign
The Commission is targeting visitor access in residential aged care for particular attention from December 2020 to support the transition of the aged care sector into a COVID-normal operating environment. Providers’ adherence to public health orders issued by states and territories is essential but some residential services are adopting a more restrictive regime than required, which is effectively denying some family members safe, reasonable access to their loved one in care.
The Commission’s campaign to address this will provide resources and guidance for aged care consumers, their families and approved providers to safely manage visitor access. It will also feature targeted regulatory activities to ensure that the Commission maintains appropriate regulatory oversight of the aged care sector.
Making sure that people receiving aged care are safe from the COVID-19 virus as far as possible is vitally important. Best practice infection prevention and control measures including regular training and practice drills for staff should now be the norm for all aged care services. Of equal importance is supporting the physical, social and emotional wellbeing of residents in aged care facilities and ensuring that they have regular access to family and friends.
The Commission’s visitor access campaign includes:
- Residential service visitor access survey – on 16 December 2020 all residential aged care services were invited to respond to the visitor access survey. The survey asks services to reflect on their current arrangements and inform the Commission of their planning and processes for safely managing visitor access in a COVID-normal world. Responses are due by 24 December 2020 where possible, although the survey formally closes on 19 January 2021.
- Visitor access case studies – case studies will provide real-life (de-identified) cases of complaints about visitor access and how they can be resolved to the satisfaction of residents, families and services.
- Focused regulatory activities – the Commission’s ongoing regulatory program will have a focus on visitor access.
- Best practice resources – the Commission will continue to update its website with information, resources and links about best practice visitor access.
Find out more about supporting safe visitor access on the Commission visitor access webpage.
Partnerships in care
Having a person-centred approach to the delivery of services and the day-to-day care of residents in an aged care service involves knowing which people are most important to each individual receiving care, and recognising those relationships. For residents who have a strong bond with someone outside the service, this may involve a provider establishing an agreement with the resident for that external individual to be recognised as a “partner in care” whose regular physical presence is vital to the resident’s wellbeing.
Where a resident chooses to have a partner in care, that person may be involved in the delivery of services to, and the day-to-day care of, a resident. Partners in care can assist in a range of activities, from personal care to physical activity and exercise, from assistance with meals to companionship, conversation and social engagement, and more besides.
To assist providers in safely implementing partnerships in care at a service while COVID-19 remains an ongoing risk, the Commission has produced a fact sheet which you can view and download on our website.
Infection prevention and control (IPC) lead
The importance of infection prevention and control cannot be overstated when it comes to aged care, and particularly in our current operating environment. To ensure that residential aged care providers are better prepared to respond to infectious diseases, including COVID-19 and influenza, they must appoint at least one nursing staff member as an infection prevention and control (IPC) lead.
The Commission expects that, in accordance with the Aged Care Quality Standards, each residential aged care provider will develop and implement an effective infection prevention and control program. To support providers, the Commission has updated the Aged Care Quality Standards Guidance and Resources for Providers to reflect the IPC lead requirements, including those for specific infection control training for residential aged care providers.
Read more in the Commission’s new IPC lead update for providers.
Pharmacy outreach project update
The Commission’s pharmacy outreach project called ‘Better Use of Medicine in Aged Care’ aims to reduce (and ultimately eliminate) the inappropriate use of medicines in aged care settings. Medications identified with a higher risk of inappropriate use include psychotropic medicines and antimicrobial medicines.
This year, we supported many services in remote locations to reduce psychotropic medicines and improve medication management and knowledge within their services through pharmacist visits. More information about this project, including some provider resources, can be accessed here.
The next focus for the pharmacy project is on antimicrobial stewardship in relation to the Aged Care Quality Standards. The recent AC NAPS survey report and the Royal Commission into the Quality and Safety of Aged Care both highlighted ongoing widespread overuse and inappropriate use of antimicrobials, such as antibiotics, antivirals and antifungals, in aged care services. As part of this project, we will work with providers to understand how antimicrobial stewardship operates in aged care services and also seek provider input into how the Commission can better support and guide best practice.
Online learning with Alis
The Commission’s Aged Care Learning Information Solution, or Alis, extends the reach and opens up access to the Commission’s education programs for aged care services. Once you have an account within the platform, all you will need is a device and an internet connection to access Alis anywhere at any time.
The learning modules within Alis can help you to:
- understand the intent and application of the Quality Standards
- be familiar with some of the key concepts within the Quality Standards
- understand the importance of working with consumers
- demonstrate compliance with the Quality Standards.
All Commonwealth-funded aged care service providers can access four free registrations until the end of March 2021. These licences will allow you to access the platform and evaluate the benefits of Alis. You can also purchase more registrations to support your organisation’s ongoing professional development.
To find out more or to register for Alis, visit https://learning.agedcarequality.gov.au/
Department of Health COVID Resources
The Department of Health has just released new posters and a video to complement their COVID-19 campaign resources.
Two posters aimed at providing information for providers about routine environmental cleaning and disinfection principles are available below:
Also have a look at their new “Living the new normal” resources, which includes a 30 second video on continuing to make COVID-safe choices to help our communities:
Commission operations between Christmas and New Year
Between Christmas and New Year, the Commission will prioritise responding to urgent issues (especially relating to COVID-19 risks and any outbreaks), and will defer routine activities. Normal business hours and full operations will resume on Monday 4 January 2021.
If you have a complaint relating to an aged care service, you can use our online complaints webform during this period.
If you’re calling on behalf of an approved provider to report an allegation of a reportable assault or a missing resident, please call 1800 081 549 or use our compulsory reporting webforms.
If the call is in relation to an emergency, please call 000.