Aged Care Quality Bulletin #49 – January 2023

Elderly couple both with glasses laughing

Commissioner’s message

The opening weeks of the year are often a good time to reflect on current priorities and what’s up ahead. There’s no doubt that everyone working in aged care continues to have a “full dance card” with many issues clamouring for attention. Realistically, that’s not going to change and the challenge for us all is to identify and distinguish the important and the urgent priorities, and then assemble the necessary resources (time, attention, staff, policies and procedures) to address them. Definitely easier said than done!

Since our last issue, we have released 3 Regulatory Bulletins to assist services to understand how specific requirements and processes fit within the overarching aged care regulatory framework. I encourage you to read the Regulatory Bulletins and review your practices accordingly.

The reform program continues this year. We will see the new Quality Indicators commencing from 1 April, the introduction of the residential care 24/7 registered nursing requirements from 1 July, further work on the strengthened Quality Standards, and ongoing activities to embed the 1 December 2022 reforms.

A key part of our regulatory role is to support providers to understand their obligations through relevant and fit-for-purpose guidance, information and education that is accessible and engaging.  We continue to review, evaluate and develop our efforts and products in this regard to make sure that they are hitting the mark and achieving the best possible results.

Building on the series of very well attended reform webinars we hosted in 2022, we will be holding monthly webinars for the sector across 2023. The webinars will cover a range of regulatory topics to support providers, services, workers and consumers.

Our first two webinars for 2023 are:

  • Site audits in residential aged care – 11:30am–12:30pm AEDT on Tuesday 21 February. Registrations for this webinar are now open.
  • Early lessons learned: from SIRS in home services – 1:00pm–2:00pm AEDT on Tuesday 21 March.

The schedule of monthly webinars will be published on the website in the coming weeks. Stay up to date by regularly visiting the Commission's Webinars page.

You will also see changes in how we communicate with you based on sector feedback, including a different approach to the monthly Quality Bulletin and a redesign of our website.  As we introduce changes, it would be great to know what you think so please send us your feedback via agedcarereforms@agedcarequality.gov.au.  

The Commission is determined to listen to, talk with, and work together with consumers and providers to improve the quality and range of information and resources we produce. This will enable us to better equip the sector to rise to our shared goal of every older Australian in aged care receiving the services that meet and exceed their expectations.

To keep up to date with changes and the resources available, I encourage you to follow us on our social media accounts:

Last but by no means least, I can advise that recruitment is underway to fill the newly established position of Complaints Commissioner within the Commission. Following appointment to this role, which will report to the Aged Care Quality and Safety Commissioner, we are looking forward to increasing our engagement with both consumers and providers to explore the benefits and best means of harnessing constructive feedback on care experiences to drive continuous improvement.

I look forward to continuing our important work together in 2023.

Strengthened Quality Standards 

Following the Department of Health and Aged Care’s (the Department) public consultation on the draft revised Quality Standards last year, the Department is now considering the feedback from that consultation process.

Given the many differences between the current Quality Standards and the draft revised Standards, the Commission will need to adjust the way we assess performance to take account of the changes. This will involve us undertaking a pilot program to test a redesigned audit methodology across different service types and sizes. Our plan is to include a small group of volunteer providers in this pilot program. We will use the insights gained through the pilot to design audit processes that will fairly and objectively assess performance, identify any areas of non-compliance, and equally importantly, assist providers to address those areas and reach confidently for improved performance.

The Commission has just published the Strengthened Aged Care Quality Standards pilot program – Provider fact sheet which includes details of how providers can apply to participate. Our aim is to select a sample of providers (from among those who apply) that is representative of the aged care sector, including considerations of service type, size and location, and diversity of older people.  

We are committed to engaging across the sector as we work towards implementation of the revised Quality Standards. The pilot program is the first in a series of engagement opportunities for the sector. Look out for the latest information by visiting our website regularly.

Send your feedback, suggestions and questions by emailing the Commission at agedcarereform@agedcarequality.gov.au. 

Star Ratings for Residential Aged Care – the Compliance Rating

As you would be aware, Star Ratings for residential aged care were published on the My Aged Care portal on 19 December 2022. Star Ratings apply to residential aged care services and are calculated from a combination of four measures.

The Department of Health and Aged Care is responsible for the Quality Measures, Residents’ Experience and Staffing Minutes Rating. The Commission is responsible for the Compliance Rating measure. The table below explains the relationship between the Commission’s compliance decisions and the ratings.

Rating

Decision Type

Significant Improvement needed

★

Notice of Decision to impose Sanction (NDIS)

Notice of Requirement to Agree (NTA)

Issuance of Infringement Notice - Victimisation

Issuance of Infringement Notice - Compliance Notice

Improvement needed 

★★

Notice to Remedy (NTR) 

Compliance Notice – Code of Conduct (CCCN)*

Compliance Notice – Incident Management (IMCN)*

Compliance Notice – Restrictive practices (RPCN)* 

Acceptable 

★★★

When the Commission is satisfied that all non-compliance has been resolved i.e. (no current non-compliance for up to 1 year)  

OR 

Direction to revise plan for continuous improvement that is currently active (PCI)

Good  

★★★★

No non-compliance for a 1-3 year period***

Excellent 

★★★★★

No non-compliance for 3 years** AND has been granted accreditation for a 3-year period***

Null status

☆☆☆☆☆

(no stars)

Change in Service Ownership, Commencing Homes/Services, Merged Services

* Only Compliance Notices issued in response to the approved provider’s non-compliance with its responsibility, will be published (that is, under paragraph (a) of the relevant subsection in Section 74EE of the Commission Act).

** Where the accreditation decision was following a site audit

*** Where the service has been operated by the same approved provider by at least that same duration

Providers that are unsure or disagree with their published Compliance Rating are encouraged to contact the Commission:

For enquiries regarding the overall Star Ratings, or the measures relating to Residents’ Experience, Quality Measures or Staffing minutes, providers should contact the Department of Health and Aged Care:

Sector Performance – latest insights

The Commission’s Sector Performance Report (SPR) continues to deliver valuable insights that help providers understand sector-wide performance and identify their own key areas for improvement.

Information to note from the Quarter 1 (2022-23) SPR (July to September 2022) includes:

  • The annual notified incident rate (per 10,000 occupied bed days) for Serious Incident Response Scheme (SIRS) notifications, has been published for the first time. This will allow providers to benchmark their own SIRS reporting against sector-wide rates and monitor changes over time.
  • The 3 most complained about issues in residential care continued to be medication management and administration, personal and oral hygiene, and workforce.  
  • Financial issues, consultation and communication continued to be the most complained about issues in home services. Complaints about domestic assistance also increased.
  • The Commission increased the number of residential site audits and home services quality audits undertaken in Q1, which provides some context for overall increases in findings of non-compliance in residential services (over the previous 12 months) and home services (over the previous quarter). 
  • The main areas identified for improvement in home services were in Quality Standard 3 (Safe and effective personal and clinical care) and in Quality Standard 8 (Effective organisation wide governance systems).

Food, dining and nutrition – the consumer voice

Food and dining should be enjoyable, respectful, safe and based on what people living in residential aged care like and don’t like.

Standard 6 of the Quality Standards highlights the opportunities available to providers to enhance the consumer’s experience of food and dining by listening carefully to their feedback and acting on it.  Just as positive feedback can reinforce things that work well, complaints can help identify what is needed to improve care and services. The Commission has a role to play here too, in receiving complaints and working on the complainant’s behalf to ensure that their concerns are addressed.

In the course of our complaints resolution process, the Commission works with the complainant and the service provider to help them come to an agreement on how issues can be resolved and what action will be taken. The aim is to resolve complaints quickly and effectively, and to assist aged care providers to improve the quality of their services.

The Food and dining – your choices matter fact sheet for consumers is now available to explain the Commission’s role in helping to address and resolve their concerns if the food provided doesn’t meet their expectations. 

The Commission will be sharing “success stories” and case studies of consumers’ food, nutrition and dining experiences over the next 12 months. If you have stories, case studies or ideas to share, please send them to info@agedcarequality.gov.au. 

Case study: Consumer voice - Improving food, dining, nutrition through resolving complaints

A person receiving aged care services contacted the Commission raising concerns about the food provided at her residential aged care service.

The complainant was dissatisfied about the lack of variety in the service’s menu and that the food served did not match the menu. She also expressed her wish for lamb cutlets to be on the menu. The complainant told the Commission that other residents were also dissatisfied with the lack of choice about the food offered at meal times.

The complaints officer explored the consumer’s concerns with her and helped her to work out what she would like the provider to do differently.

The Commission then contacted the service to discuss the issues raised, assess the risk involved and talk through how the service could help fix the problem.

The service’s manager was open to this conversation and willing to identify actions that the service would take to improve things. The manager acknowledged that sometimes the food served didn’t match the descriptions in the menu. They also explained that lamb cutlets were not currently served because a number of residents weren’t able to eat them safely. However, the manager proposed having a BBQ once a week which would enable the consumer to have items of her choice. 

The manager also advised that the service was in the process of creating a new menu to provide more variety to residents. Following the complaint, the service sought further input from the complainant in this process. The service also consulted a dietitian to ensure that the menu met the dietary needs of residents.

Based on the information provided by the service provider, the Commission was satisfied with the actions taken by the service. The complaints officer advised the complainant of the outcome and she confirmed that she was satisfied also.

For another case study, refer to Meals that evoke residents’ memories.

Banning Orders Regulatory Bulletin

The Commission now has the power to make a banning order against an individual. This is a very serious regulatory decision which must be made in accordance with statutory provisions.  Information on individuals who have been issued a banning order is contained in the Aged Care Banning Order Register which is published in the Commission website.

To assist providers in understanding this new power, the Commission has released the Banning Orders Regulatory Bulletin. The Bulletin provides guidance on banning orders, when the Commission will make an order and how we decide whether to issue a banning order. The Bulletin also includes information on the consequences of breaching an order, varying and revoking an order and publishing information on banning orders.

From 1 December 2022, the Commission may make a banning order under section 74GB(1) or 74GB(3) of the Aged Care Quality and Safety Commission Act against an individual to prohibit or restrict them from being involved in the provision of any type of aged care or specified types of aged care, or from engaging in specified activities as an aged care worker or governing person of an approved provider.

A banning order may be made against current or former aged care workers or governing persons of an approved provider, or individuals not previously involved in aged care through an approved provider.

Further information is available on our website.

Home Care Packages Program: Changes to Administration and Management Charges Regulatory Bulletin

Caps now apply to administration and management charges in the Home Care Packages (HCP) Program.

From 1 January 2023, the amount a provider can charge for care management and package management is capped at 20 per cent and 15 per cent of the package level respectively. Additionally, providers are no longer able to charge exit amounts or charge separately for costs associated with third party services.

The Changes to Administration and Management Charges in the Home Care Packages Program Regulatory Bulletin outlines these changes and describes how the Commission will regulate them.

Providers are encouraged to visit Care management and care plans for Home Care packages on the Department of Health and Aged Care’s website for further information.

Provider Performance Information Regulatory Bulletin

The Commission has updated its regulatory bulletin on publication of provider performance information, which sets out the performance information that the Commission publishes about providers. Transparency of this information supports consumer choice, promotes continuous improvement and performance benchmarking with providers, and gives visibility to the Commission’s work.

The updated Regulatory Bulletin 2023-18 Publication of provider performance information includes an overview on the publication of information relating to Star Ratings, with a specific focus on the Compliance Rating sub-category.

The Regulatory Bulletin explains what provider performance information the Commission publishes on our website. This includes performance reports, accreditation and re-accreditation decisions, reconsideration decisions and Administrative Appeals Tribunal (AAT) decisions. The Commission also publishes other information on the Commission’s website and the My Aged Care website about the outcomes of its regulatory and complaints functions including the Service Compliance Rating; non-compliance decisions; complaints directions; and sector performance data.

Quarterly Financial Report: Quarter 2 submissions due 14 February 

Providers have a number of reporting obligations under the Accountability Principles (2014) in the Aged Care Act. You must lodge your Quarterly Financial Report (QFR) in a timely manner to meet your responsibilities as an approved provider.

Quarterly Financial Reports for the reporting period 1 October 2022 to 31 December 2022 (Quarter 2) are due by Tuesday 14 February 2023, and should be submitted through the Forms Administration portal. 

Failure to lodge a QFR by the due date may result in regulatory action by the Commission. The Commission will closely monitor providers who fail to submit their Quarter 2 submission or submit it late.

Further information on QFR, including the webinar held by the Department of Health and Aged Care on 8 December 2022, is available on the Forms Administration website.

Training, fact sheets and resources

Webinar - Governing for Reform in Aged Care

The Governing for Reform in Aged Care Program is hosting the Improving Clinical Governance Culture webinar at 12:00pm-1:00pm AEDT on Wednesday 1 February 2023.

The panel includes Dr Melanie Wroth, the Commission’s Chief Clinical Adviser, Dr Julie Phillips and Professor Marie Bismark. They will discuss the importance of building a good clinical governance culture within an organisation, and the role of executive or governing body members in leading and managing clinical governance effectively.

This online and free webinar is available for Governing for Reform Program participants only.

Register for the webinar or learn more about the Governing for Reform in Aged Care Program.

Virtual workshops

The Commission regularly hosts virtual workshops. Current workshops include ‘Monitor and assess the performance of your service’, ‘Quality and safety in home services - 5 key risk areas' and ‘Effective Incident Management Systems (IMS)’. Workshops are available for residential aged care and home services providers.

Visit the Workshops website for further information.

Code of Conduct for Aged Care online learning

The ‘Know your Code’ online learning module assists providers to understand their obligations in relation to the Code of Conduct for Aged Care. The learning is available on the Commission's Aged Care Learning Information Solution – Alis.

Code of Conduct for Aged Care – introductory video for providers and workers

The Code of Conduct for Aged Care – introductory video for providers and workers introduces the Code to aged care workers and approved aged care providers. The video takes less than 4 minutes to watch and provides a valuable overview of the Code.

Financial and Prudential Regulatory Insights

Stay up to date with financial and prudential regulation information by subscribing to the Commission’s Financial and Prudential Regulatory Insights. In the January issue, Peter Edwards, Executive Director, Financial and Prudential Regulation considers the Commission’s expanding role in financial viability. Contact prudential@agedcarequality.gov.au to subscribe to receive the monthly updates.

Webinar recording

The recording, presentation slides and resource summaries from the webinar ‘Aged care sector reforms – current status and what’s next?’ held on 15 December 2022, are available at the Commission's reform website. 

Resources

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Tuesday, 31 January 2023 - 1:18pm
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