In response to the Royal Commission into Aged Care Quality and Safety, the Australian Government committed to a wide-ranging and ambitious series of reforms in aged care over the next 5 years.
There are 2 areas of reform that are currently the subject of public consultation. One relates to the alignment of regulation of Commonwealth-funded care and supports – aged care, disability support and veterans’ care – to improve protections, and ensure consistent quality and safety for consumers and participants. The other is a proposal to establish a common code of conduct for the care and support sector. This aims to ensure that older people, people with a disability, and entitled veterans and war widows who receive Commonwealth-subsidised care, supports and services can have confidence in the workforce delivering that assistance.
The public consultation on these 2 reforms is being led by the Department of Health, and more information about them is included in this edition of the Quality Bulletin. I encourage all providers to read the consultation papers and take the time to provide feedback and have your say on these important reforms.
Preparing for an emergency event
The COVID-19 pandemic has emphasised for everyone in the aged care sector the critical importance of planning and preparing for potential high-impact events to reduce the risk of their occurrence, and to respond quickly and decisively when they do occur.
Recent experiences of bushfires and flooding events across a number of states and territories have further demonstrated the value of advance planning and preparation. This is also highlighted in key findings of the Royal Commission into National Natural Disaster Arrangements report.
Emergency events are likely to present high risks for aged care services, particularly residential aged care where consumers have higher care needs, when accompanied by:
- a requirement for the evacuation of services at short notice
- staff shortages as staff are unable to travel to work due to their own personal circumstances
- critical infrastructure issues including power and information communication systems failures
- restricted access to essential supplies.
The Aged Care Quality Standards require approved providers to demonstrate effective risk management systems and practices including the management of high-impact risk associated with the care of consumers (Standard 3 and Standard 8). The Commission monitors approved provider preparation for emergency events through our assessment and monitoring processes.
Preparing and planning for emergency events can significantly lessen the impact on aged care consumers and staff. A range of Department of Health resources are available to provide guidance to approved providers to prepare for, and assist with, service continuity in an emergency event.
You can also read our Commissioner Janet Anderson’s recent letter to residential approved providers about emergency events planning.
Aged care services operating in a COVID-normal world
The high proportion of Australians now fully vaccinated means we are gradually adjusting to a COVID-normal world as restrictions are lifted on most activities outside our homes.
For residential aged care services, this means that – subject to any public health orders in place – families should be able to visit their loved ones in care, and aged care residents should be able to leave their facility and return to it under the same rules that apply to people living in their own homes in the community.
As is now widely acknowledged, the impacts of COVID-19 have extended beyond physical health. Restricted visitor access increases the risk of social isolation for aged care consumers and can lead to a rapid decline in their wellbeing and quality of life, particularly where the restrictions are prolonged.
Providers have a responsibility to facilitate visitors’ safe access to people living in residential aged care to support their residents’ social and emotional health and wellbeing, and this will be especially important over the approaching holiday period.
In a COVID-normal world, infection prevention and control precautions continue to be necessary and important, and any local public health order must be followed diligently. However, where there is no public health order, the policies and practices of a residential aged care service must enable and facilitate residents and their families spending time together safely.
Approved provider application fee now applies
Following our recent public consultation, organisations seeking approved provider status must now pay a fee to have their application assessed by the Commission.
The fee applies to:
- new applicants for approved provider status
- existing approved providers seeking approval to provide additional services or to change the types of services they provide.
Organisations must provide all relevant documentation and evidence requested when submitting their application, otherwise additional fees will be charged.
Organisations can apply to have an application fee waived if they are seeking approval to provide residential, home or flexible aged care and services which meet certain conditions.
The Commission’s Cost Recovery Implementation Statement (CRIS) – Applications for approved aged care provider status 2021–22 outlines the new arrangement of fees, charges and waivers. These cost recovery arrangements will be reviewed in November 2022, prior to the 2022–23 CRIS being released.
Visit our Becoming an approved aged care provider web page for more information on submitting an application and the fee waiver process.
To read a summary of the feedback we received during the public consultation process and frequently asked questions, visit the Approved provider application fee web page.
Have your say on current Department of Health public consultations
Aligning regulation across the care and support sector
Australia’s care and support sector and the broader community are invited to have their say on the Australian Government’s proposals to align regulation across aged care, National Disability Insurance Scheme (NDIS) funded disability support and veterans’ care services. The Government announced its commitment to regulatory alignment as part of the 2021–22 Budget.
Aligning regulation for these services aims to strengthen protections for consumers and participants, ensuring the quality and safety of their care. It will also seek to make it easier for service providers and workers to deliver care and support to consumers and participants of the different services.
The Department of Health (DOH), Department of Social Services and Department of Veterans’ Affairs are leading this regulatory alignment reform program, with the support of a cross-agency taskforce led by the DOH.
A consultation paper has been released to inform the next steps in this project. Providers, consumers, families, carers, workers and the broader community are now invited to have their say.
You can provide your views through written submissions, via online workshops, focus groups and surveys. Written submissions close on Friday 17 December.
To get started, visit the DOH Consultation Hub – Aligning Regulation across Care and Support Sector – Consultation Stage 2. For more information, visit the DOH website or email RegulatoryAlignmentTaskforce@health.gov.au.
Care and support sector code of conduct
DOH is also consulting with stakeholders on the development of an enforceable care and support sector code of conduct applicable to providers and workers across aged care, veterans’ care and disability support services.
Following preliminary engagement with key representatives in the care and support sector, a draft code has been prepared based on the existing NDIS Code of Conduct.
DOH has released a consultation paper outlining the purpose of the draft code and how it is intended to work. The paper seeks views from a range of stakeholders across the care and support sector on areas where the draft code may need to be further adapted or adjusted to ensure it is fit for purpose.
Stakeholders are invited to submit their feedback on the consultation paper by completing the online questionnaire by Friday 10 December.
Further information is available on the DOH Consultation Hub – Care and Support Sector Code of Conduct Consultation. If you have any questions, contact the DOH Worker Regulation Section on 02 6289 5981 or WorkerRegulationSe@Health.gov.au.
Important updates for home services providers
Guidance on home service delivery risks soon to be released
Home services providers will soon receive a communication from the Commissioner notifying you of the release of new resources – provider guidance on service delivery risks in home services and a new risk checklist tool.
These resources will assist governing bodies of home service providers to critically examine their organisation’s performance and consumer outcomes against 5 key risk areas:
- organisational governance
- care planning and assessment
- clinical care
- vulnerable consumers
- management of package funds.
The risk checklist tool will help home service providers to identify and manage these key risks to ensure quality consumer experiences and outcomes. The risk review process will help give providers confidence that they are aware of and can manage the key risks to meet their regulatory requirements on an ongoing basis.
Please keep an eye out in upcoming editions of Quality Bulletin for deep-dive information on each of the key risks and performance data to enhance your understanding.
Changes to home services performance assessments
As part of our commitment to ensuring our engagement with providers is targeted, efficient and effective, the Commission has enhanced the way it undertakes quality audits and some assessment contact activities in the home services setting.
Changes being introduced by the Commission in the way we undertake performance assessments and pre-site visit activities for home services include:
- requirements for providers to submit specific organisational and consumer information to the Commission ahead of the site visit to enable a pre-site review of the information
- engagement with consumers and home service provider staff via telephone and teleconference ahead of the site visit.
Further information will be available on our website soon.
From the Chief Clinical Advisor – antimicrobial stewardship and catheters
Urinary indwelling catheters (IDC), including suprapubic catheters, are a significant cause of infection in aged care residents and a frequent reason for the prescription of antibiotics. This can be minimised by good catheter management and care, which requires up-to-date policies and clear processes which are overseen, monitored and audited through sound clinical governance arrangements.
Below are some practice points for clinicians to follow.
Many urethral IDCs are not required for long-term use
If there is no information available about the original indication for insertion and the reason for ongoing need of an IDC, then this information should be sought. Examples where a urethral IDC is inserted in a hospital setting with likely short-term intent include during an acute illness for the monitoring of fluids, to facilitate post-operative management and where urinary retention developed while the person was unwell. Catheter removal and trial of voiding can be undertaken where clinically appropriate, as this will reduce the risk of infection in the older person and promote better quality of life, comfort and independent function.
It is noted that this does not apply to suprapubic catheters which are inserted with a view to long-term need and would usually require specialist review if there were problems.
Understand the results of dipstick or culture testing
Clinicians should be aware that testing long-term catheter specimens with a urine dipstick or with urine culture will result in almost 100% of samples identifying nitrites, leukocytes or bacterial growth. What does this mean?
- If the testing was ‘routine’ or performed for a person with no urinary symptoms or signs of infection, the test has picked up a condition known as asymptomatic bacteriuria (ASB). Antibiotic treatment of ASB is unnecessary. ASB does not represent early detection of infection and antibiotic treatment does not reduce future risk of infection. Antibiotic treatment of ASB can result in unintended harms including increasing the person’s risk of side effects from antibiotics and the risk of future urinary tract infections being caused by antibiotic-resistant bacteria. For more information, read the Australian Commission on Safety and Quality in Health Care’s fact sheet on ASB.
- If a person is suspected of having a catheter-associated urinary tract infection, clinicians should follow clinical guidelines for this assessment. Consider the diagnosis in catheterised patients with symptoms and signs including fever, rigors, acute mental state change, flank pain, new blood in urine or pelvic discomfort. If any of these symptoms or signs is present, the resident may have a catheter-associated urinary tract infection. The next steps are to carefully assess the resident to exclude any alternative sources of the symptoms and signs, and escalate their care as appropriate depending on their clinical condition. Our Clinical pathway for older people in aged care homes: Suspected urinary tract infections (UTI) – with catheter form outlines recommendations on next actions including to:
- review the ongoing need for an IDC and/or need for IDC change
- collect urine for culture in a pathology laboratory. The result usually takes 2–3 days to return. An appropriately collected sample is useful to guide the best ongoing antibiotic choice, especially if the resident is slower to improve
- assess hydration (and encourage fluid intake if dehydrated)
- follow recommendations on antibiotic prescribing in the antibiotic Therapeutic Guidelines
- not investigate (with urinalysis or urine culture) catheterised patients with non-specific symptoms for catheter-associated urinary tract infection. This is an important recommendation from the Therapeutic Guidelines. Some examples of non-specific symptoms including urine with changed appearance (for example, it may be darker) and non-specific clinical syndromes such as new dizziness.
Treatment of ASB with antibiotics will not prevent future infections and contributes to antimicrobial resistance. Our ‘Do you need antibiotics?’ flyer helps residents, carers and families understand this. Clinicians and providers can also use this resource when discussing antibiotics with their residents.
Residential services should have appropriate processes in place
Appropriate processes include:
- Where residents have had a diagnosis of recurrent UTIs when the correct diagnosis was ongoing ASB, this needs review and amendment of the clinical record.
- Prescribing for catheter-associated urinary tract infections should only occur on clinical grounds and should be informed by guidelines in relation to antibiotic choice, dose and duration of treatment. Duration or end-dates for antibiotics should be visible on the medication chart. Antibiotic allergy information should be easily visible, up-to-date and accurate.
- Urine culture laboratory testing should be performed when catheter-associated urinary tract infection is suspected. Pathology results should prompt a review of organism and sensitivity to guide the narrowing of spectrum of antibiotic prescribed, or changing the antibiotic where appropriate. The responsibility for checking and acting on microbiology results – either residential care staff or the general practitioner – should be clear, with follow-up and communication mechanisms established.
For further information, read the Australia and New Zealand Urological Nurses Society’s urinary catheter guidelines.
Share your feedback about Alis with us
Since we launched our Aged Care Learning Information Solution – Alis – in February 2020, more than 2,200 aged care service providers and more than 5,900 learners have signed up to use the platform to access the Commission’s educational programs anywhere and at any time.
We’re now inviting all registered users of Alis to share their feedback about our learning platform via an online survey.
The survey has questions about your experience using the platform, your views regarding the learning modules and about the registration fees. It should take around 10 minutes to complete and your response can be anonymous if you wish.
Please take the time to share your views with us by Friday 10 December – your feedback will help us continue to improve the learning platform.
If you would like more information about Alis, email the Sector Education team at email@example.com.
New Commission workshop on the Serious Incident Response Scheme
The Commission has developed an online educational workshop focusing on the Serious Incident Response Scheme (SIRS).
This workshop is designed to help providers of residential aged care services understand what the SIRS is, what their roles and responsibilities are in the prevention and management of incidents, and provides useful tips on how providers can improve the quality of their written reports.
This workshop is now open for registration. New session dates will also be available over the coming months, so keep an eye out!
More information about all our workshops and how to register is available on our Workshops web page.
New guidance on electronic residential medication chart management systems
Is electronic prescribing an option for your residential care facility?
Practical new resources are now available from the Australian Commission on Safety and Quality in Health Care (ACSQHC) to support residential care facilities that are considering implementing an electronic National Residential Medication Chart (eNRMC) management system.
eNRMC systems will support the streamlining of medication management workflows and electronic prescribing for residents in your care facility. You are encouraged to use the 2 guidance documents identified below to support your implementation journey.
Guidance for residential care facilities
The Electronic National Residential Medication Chart Medication Management Systems – Your guide to safe implementation in residential care facilities will help you navigate the fundamentals of eNRMC medication management systems, what they do and how they work.
It also provides an overview of legislative, regulatory and policy requirements, and outlines how facilities can develop a system that best meets their specific needs and workflows. A complementary workbook steps out the project journey into actionable, practical components.
Guidance for software vendors
The Electronic National Residential Medication Chart Medication Management Systems – Software vendor information resource supports software vendors in working towards system optimisation.
Residential care providers can also use this resource to support discussions with software vendors regarding the unique workflows and electronic medication management requirements of your services.
Access these new resources on the ACSQHC’s eNRMC web page.
New and updated Commission resources
- New: Regulatory Bulletin: Plan for Continuous Improvement requirements (RB 2021-15) – Providers are required to have continuous improvement systems and processes in place to assess, monitor and improve the quality and safety of care and services. The Commission may direct a provider to revise their Plan for Continuous Improvement to ensure they are compliant with the Aged Care Quality Standards.