The Interim Report of the Royal Commission into Aged Care Quality and Safety, released on 31 October, presents a sobering and challenging analysis of Australia’s aged care system and throws into sharp relief the areas where the system is seen to be falling well short of community expectations.
The Commission welcomes the Interim Report as a vital contribution to raising awareness about the needs of vulnerable older Australians. The report’s appraisal of current approaches to the funding, delivery and regulation of aged care demands our collective attention, and points to a range of opportunities to improve consumers’ experiences and outcomes of care.
Alongside other stakeholders in the aged care system, the Commission will now reflect carefully on the contents of the Interim Report and give careful consideration to its implications for what we do and how we do it.
We look forward to discussing the Interim Report with aged care providers over coming months, and hearing your views on its contents.
Getting to know the Standards – Standard 3, Personal care and clinical care
Standard 3 is featured this month, in our regular look at each of the Quality Standards, the overarching principles and requirements, along with links to supporting information including guides, resources and case studies.
The consumer outcome for Standard 3 is:
I get personal care, clinical care, or both personal care and clinical care, that is safe and right for me.
Standard 3 applies to all services delivering personal and clinical care specified in the Quality of Care Principles, 2014, and is intended to ensure safe, effective and quality delivery of personal and clinical care in line with consumer and community expectations.
It is widely recognised that provision of all forms of social care, including aged care, is accompanied by a level of risk for consumers, and it is incumbent upon aged care providers to understand and appropriately manage that risk with, and for, every consumer.
While service providers typically appreciate the value of delivering good outcomes for consumers, harmful events that could have been prevented continue to happen in aged care service delivery. Standard 3 highlights areas where organisations need to do more to ensure consumers are safe and receive the best possible care and services.
It’s important to remember that the guidance for Standard 3 is not clinical advice – it doesn’t lay out a ‘how to’ approach. Organisations should develop their own approach, in line with best practice, that meets individual consumers’ needs, goals and preferences and is supported by policies and procedures to deliver care and treatment for consumers.
It is strongly recommended that organisations make use of the reflective questions for each requirement of Standard 3, along with the associated examples of actions and evidence.
Improvements in quality assessment methodology
During the first three months of implementation of the Quality Standards (July-September 2019), the Aged Care Quality and Safety Commission conducted over 500 assessment and monitoring activities with aged care services.
The Commission has previously indicated that as we better understand the performance of the sector against the Quality Standards, adjustments would be made to the assessment approach to ensure the improved outcomes for consumers sought from the Quality Standards are delivered.
The Commission has identified some improvements to how performance assessments are conducted under our assessment methodology. These changes apply to the assessment team’s evidence collection against Standards requirements during a site visit.
What can providers expect on site?
The assessment team will structure the conduct of the performance assessment into “evidence domains” which will assist them to organise the site visit in a way that obtains sufficient evidence across all requirements for the Standards. The evidence domains are:
- Domain 1 – Dignity, respect, choice and complaints (Standards 1 and 6)
- Domain 2 – Care planning and personal and clinical care (Standards 2 and 3)
- Domain 3 – Lifestyle and service environment (Standards 4 and 5)
- Domain 4 – Governance and human resources (Standards 7 and 8)
- Quality Assessors will undertake more purposeful sampling for interviews with consumers when assessing requirements under the Quality Standards. To support their assessment against the Quality Standards, we are expecting assessors to collect sufficient evidence from consumers, staff and service records to understand outcomes for the most vulnerable consumers.
- The structured consumer experience interviews (CEIs) and consumer experience reporting for residential aged care will be applied in monitoring visits (assessment contacts) rather than re-accreditation audits.
The Commission is providing quality assessors with additional training and tools outlining this approach to evidence collection during the performance assessment. These improvements will be progressively implemented in assessments of residential aged care services commencing from November 2019; and in-home services from early 2020.
Further information will be communicated in an updated Regulatory Bulletin on the Commission’s Assessment Methodology.
Diversity in action
Last week the Commission had a booth at the 4th National LGBTI Ageing and Aged Care Conference, an event that aims to help aged, health and human service providers develop their knowledge, skills and practice to meet the needs of LGBT&I consumers.
The Government’s Aged Care Diversity Framework seeks to embed diversity in the design and delivery of aged care, support action to address actual or perceived barriers, and enable consumers and carers to be partners in this process.
A number of action plans have been developed to assist government and aged care service providers to address specific barriers and challenges faced by older people with diverse characteristics and life experiences.
Alongside a plan that presents actions common to all older people, there are action plans for:
- older Aboriginal and Torres Strait Islander peoples
- older people from Culturally and Linguistically Diverse Backgrounds
- older lesbian, gay, bisexual, trans and gender diverse, and intersex elders.
Each of these plans contains actions to address barriers and challenges faced by each group, along with case studies, links to existing resources and a separate consumer facing document.
New video on Open Disclosure
A new educational video has been produced providing information about open disclosure for aged care service providers. This resource is a collaboration between the Commission and online training services provider, Altura Learning.
Open disclosure is about aged care staff having honest, open conversations with consumers when something goes wrong that has harmed or had the potential to cause harm to a consumer. The process also involves addressing any immediate needs or concerns and providing support, apologising, and explaining the steps which will be taken to prevent it happening again.
This means that providers must have systems and processes that support consumers and staff to report incidents, support the review of feedback and complaints, and support staff with actioning suitable responses.
The Commission has released an Open Disclosure Framework and Guidance document which provides practical guidance to providers to support implementation of open disclosure practices, including case studies designed to illustrate how to apply an open disclosure framework.
You can view the Open Disclosure video on the Commission’s website.
Understanding the Charter of Aged Care Rights
The Older Persons Advocacy Network (OPAN) has been contracted by the Department of Health to run a series of free, educational events across the country to inform consumers, carers and families, and providers about the new Charter of Aged Care Rights. The Charter, which came into effect on 1 July 2019, places consumers at the centre of their care by supporting them to express their needs and recognising their fundamental right to be treated with dignity and respect.
Providers are responsible for supporting consumers to understand the Charter and ensuring consumers or their representatives are given a reasonable opportunity to sign a copy of the Charter. These educational events will help increase understanding of the Charter, including how it aligns with the Quality Standards, what does signing the Charter mean, and the consumer’s right not to sign.
As well as the events for consumers, OPAN is running two webinars targeted at the aged care workforce, on Monday 4 November.
Webinar on accountabilities of governing bodies in aged care
There is still time to register for, and participate in, the Commission’s forthcoming webinar on the accountabilities of governing bodies in aged care.
If you’re a board member, director, executive or senior manager at a residential aged care or home service, the webinar will help you to understand your regulatory and legislative obligations, covering topics including:
- the intent of the Aged Care Quality Standards
- your accountabilities under Standard 8 on Organisational Governance
- the main components of clinical governance and how it applies in different care settings
During the webinar, participants will hear from, and be able to ask questions of, our expert panel from the Commission, including Commissioner Janet Anderson PSM, Chief Clinical Advisor Dr Melanie Wroth and Executive Director Quality Assessment and Monitoring Operations, Ann Wunsch.
Date/time: Monday 4 November, 8.30am AEDT
Registration link: Accountabilities of governing bodies in aged care.
Did you know?
In recent months, the Commission has received a number of signed Charters of Aged Care Rights, sent in by providers.
Please remember, there is no requirement for providers to send signed copies to the Commission. Providers must give a copy, signed by the provider, to consumers and assist them to understand the Charter. Consumers or their representatives must also be given a reasonable opportunity to sign a copy of the Charter. Signing a copy allows them to acknowledge they have received the Charter and had assistance to understand it.
Accounting and Business Advisory Services now available
Approved aged care providers with a National Approved Provider System ID can now apply for free independent business advisory services to help them review their operations and access advice on business management and financial strategies.
Two tiers of services will be available, both targeting the identification of strategies to help improve the provider’s business management and operations:
- Tier 1 services will be delivered through a desktop review
- Tier 2 services will be delivered by both desktop review and time spent on site at the provider’s premises.
The services, entirely paid for by the Australian Government, are intended to target providers at risk from financial stress such as providers operating in rural and remote locations and smaller providers.
PricewaterhouseCoopers will deliver the independent advisory services with services available until 30 June 2021. Service providers can apply to access the business advisory services.