As we move into the cooler months and the COVID-19 pandemic is still a reality, ongoing vigilance by providers in relation to infection prevention and control (IPC) measures is key. This is the case, even as the vaccination program continues to be rolled out Australia-wide. Under the Aged Care Quality Standards, all providers have an explicit obligation to have infection control and prevention programs in place for the purposes of preventing and responding to infectious diseases, including COVID-19 and influenza. In this edition, we provide advice on updated Standards guidance to reflect onsite IPC lead requirements in residential aged care services. We also share findings from our visitor access survey, which is a reminder to ensure that consumers are well-supported to enjoy regular engagement with family and friends at this time. In addition, information is provided on lessons learned about fit-for-purpose leadership in a pandemic from Victorian providers who experienced an outbreak. The Serious Incident Response Scheme (SIRS) has now been in effect for almost one month and we’re continuing our communication and education efforts to help residential aged care providers better understand the new scheme and their responsibilities. Earlier this month we released fact sheets on each of the 8 types of reportable incidents that providers must record in their incident management system and report to the Commission via the My Aged Care Provider Portal. These resources provide comprehensive guidance on each incident type, possible signs of those incidents having occurred, how you can respond to them, as well as some examples of what would constitute a reportable incident in that category. These fact sheets are all available on our SIRS resources webpage. I encourage all residential aged care services to bookmark and visit this page, as well as our SIRS frequently asked questions page, as we continue to update these pages regularly. Another important reporting obligation for all Commonwealth-subsidised residential aged care service providers is the National Aged Care Mandatory Quality Indicator Program (QI Program). As you’re no doubt aware, reporting quarterly on 3 quality indicators under the QI Program became compulsory on 1 July 2019. Importantly, the program is about to be updated and expanded. From 1 July 2021, 2 additional quality indicators are being introduced. See below for details of the program and new reporting requirements. Antimicrobial stewardship is another clinically-related topic that deserves attention, and in this edition, we share our current work on this. To assist approved providers of residential care, we also provide information about our planned prudential campaign in May 2021 to help providers better understand permitted uses of refundable accommodation deposits, with particular reference to loans. All aged care providers have an explicit obligation under Aged Care Quality Standards 3 and 8 to have infection prevention and control (IPC) programs in place so that they are well placed to reduce the risk of, and respond to, infectious diseases including COVID-19 and influenza. Of course, these programs will vary depending on the nature of care and services provided. All residential services should now have a dedicated, onsite clinical IPC lead. Embedding an IPC lead in each service is intended to build enduring capability in this vital area of practice. IPC leads must be based at their nominated facility to provide advice and oversight as part of ongoing, day-to-day operations, and champion continuous improvement in IPC across the service. The Commission expects that, in accordance with the Quality Standards, each residential aged care provider will develop and implement an effective IPC program. To support providers, the Commission has updated the ‘Guidance and resources for providers to support the Aged Care Quality Standards’ to reflect the IPC lead requirements, including those for specific infection control training for residential aged care providers. As part of its risk-based approach, the Commission will continue to assess IPC practices as part of its normal program of monitoring activities, including site visits and other contacts. Visitor access also continues to be an important focus in our COVID-normal operating environment. The Commission conducted a visitor access survey of residential aged care services between 16 December 2020 and 19 January 2021. The survey revealed a number of areas that services should focus on to improve outcomes for residents, their families/representatives and staff in a COVID-normal world. The full survey report is now available on our website and presents a summary of the findings, the detailed results of each survey question and key messages for providers. The survey found that the vast majority of services had appropriate visitor access processes in place, and were focused on ensuring visitor access, and the health and wellbeing of residents in aged care facilities. Services did this while actively monitoring and complying with their local public health directions. This is a positive finding given the survey response period was over the December/January period, which is traditionally one of the busiest periods of the year. At that time, Australia also had several active COVID-19 outbreaks with public health directions in some states/territories changing over the course of a week. However, while a majority of services indicated a willingness to manage visitor access safely, there was a greater reluctance to allow residents to leave the service and return without restrictions. Further, while a high proportion of services allowed in-person visits, many were not enabling remote visits or facilitating contact between residents and families/ representatives during periods when public health directions mandated lockdowns. For the health and wellbeing of residents, it is vital that they have an opportunity for ongoing connection with their families/representatives, even when physical contact is restricted. Services are encouraged to reflect on these survey findings and the rights of residents as articulated through the Charter of Aged Care Rights. During outbreaks and other emergency situations, it is essential to have effective leadership and clearly defined roles for all staff involved in a service. The Commission interviewed providers who experienced COVID-19 outbreaks in 2020 and found that an important lesson learned was to use a ‘command and control’ style of leadership. Providers found having a single point of command resulted in: Providers also shared that having staff members with diverse skills, such as infection control and clinical expertise, helped greatly with outbreak management. The Commission recommends that all aged care providers read the ‘“We saw the best in people”: Lessons learned…’ report, which is available on our website. The report reflects the experiences of 34 providers who experienced a COVID-19 outbreak in at least one of their Victorian residential aged care services in the latter part of 2020. All providers of aged care services across Australia are encouraged to improve emergency readiness and maintain vigilance in a COVID-normal environment. The SIRS has now been in operation for almost a month and it is apparent that residential aged care providers are working hard to implement and fine-tune their approach to fulfilling their new obligations under the scheme. We have been reviewing initial reporting data, as well as feedback received from the sector, to identify areas for improvement in both the reporting process and the supporting resources available to the sector. Key issues identified in the first weeks of operation include: In response to these issues and other constructive feedback received, the Commission is continuing to refine and update the advice and information available to the sector over the coming weeks. For more information on the SIRS, visit the Commission’s dedicated SIRS webpage. In the last edition of the Quality Bulletin, we provided information about antimicrobial medications (which include antibiotics, antivirals and antifungals) and how effective infection prevention and control (IPC) measures and antimicrobial stewardship (AMS) interventions improve infectious disease outcomes and help to address the problem of antimicrobial resistance. In this edition, we’re outlining the Commission’s current work on AMS. The Commission is currently focusing on the issue of AMS as it relates to: The 3 most common reasons for antimicrobial use in residential aged care are: Inappropriate antimicrobial use includes: Other causes of inappropriate antimicrobial use can relate to: The Commission is currently reviewing AMS resources and fact sheets that will be suitable for residential aged care settings with the assistance of Dr Lyn-li Lim (an infectious diseases and AMS physician), the Australian Commission for Safety and Quality in Health Care and the National Centre of Antimicrobial Stewardship/VICNISS. Other resources As we outlined in our November 2020 edition, the National Aged Care Mandatory Quality Indicator Program (QI Program) is being updated and expanded to include new quality indicators from 1 July 2021. This is an important reporting process in the residential aged care sector which is still maturing, with approved providers and services being expected to use these indicators to oversee and assess aspects of quality of care which may affect consumers’ health and wellbeing. In short, the QI Program supports you to measure, monitor, compare and improve the quality of your services. You can then identify trends in your performance over time and compare yourselves against national averages. Ultimately, this leads to better quality of care and quality of life for consumers, and the program’s expansion will enhance this even further. The quality indicators that apply for residential aged care providers from 1 July 2021 include: We’re reminding all approved providers of residential aged care services that your quality indicator collection and reporting requirements will change over the coming months: To help you prepare for your new reporting obligations, the quality indicator data elements summary which outlines the data elements for implementation from 1 July, is now available on the Department of Health website. More information about the QI Program is also available on the department’s website, and additional guidance materials about the expanded program (including Part A of the QI Program Manual, quick reference guides, data recording templates and instructions, and frequently asked questions) will be released in the lead-up to 1 July. If you have any questions about the expansion of the QI Program, contact the My Aged Care service provider and assessor helpline on 1800 836 799. Residential aged care approved providers holding refundable accommodation deposits (RADs) must comply with the Prudential Standards and only use these deposits as permitted under the Aged Care Act 1997 (the Act) and the Fees and Payments Principles 2014 (the Principles). Approved providers must implement and maintain governance arrangements that ensure RADs are used only as permitted and refunded to care recipients correctly. For example, providers can use RADs to make loans if: An analysis of prudential information indicates that some providers are using RADs to make loans, however, our data does not specify the purpose of the loan. In light of this, the Commission will run a targeted campaign to help providers better understand how they can use RADs and comply with the Governance Standard. The campaign will be conducted in May 2021 and will involve a site visit to selected approved providers based on Commission data. The campaign will determine whether providers are compliant with their statutory obligations for loan agreements using RADs, including that they are managed in accordance with the Governance Standard. If the review identifies non-compliance, the Commission may consider regulatory action. Following the changes to the COVID-19 vaccine rollout earlier this month, these resources have been updated on the Department of Health website: Please continue to refer to the Department of Health website for up-to-date information on the COVID-19 vaccine. Commissioner’s message
Infection prevention and control still a key focus
Visitor access survey report findings
Moving to ‘command and control’ leadership during an outbreak
Serious Incident Response Scheme (SIRS) update
Our current work on antimicrobial stewardship
Expanded quality indicator reporting obligations from 1 July
Prudential campaign – permitted uses of refundable accommodation deposits
Updated information about the COVID-19 vaccine rollout