The pandemic continues to present significant risks for all Australians, and particularly for frail, vulnerable individuals in aged care. COVID-19 is keeping the entire aged care sector on high alert, including the Commission.
Regrettably, among the lives lost to this virus are a number of people living in residential aged care.
Since the start of the COVID-19 pandemic in 2020, the Commission’s attention has been squarely focused on working with health authorities to ensure that aged care providers are taking all reasonable precautions to minimise risk to older Australians in their care. Our efforts have also been directed at ensuring that providers are fully prepared to respond promptly, decisively and effectively if their consumers and/or staff are exposed to the virus.
Throughout the pandemic, we have continued to review and refine our regulatory approach and closely monitor providers, especially as the different COVID variants have emerged. This has included:
- undertaking more infection control monitoring spot checks
- continuing to conduct site visits to residential services to support and ensure provider outbreak readiness
- resolving complaints, and engaging more closely with services where concerns have been raised
- proactively contacting providers to ensure they have an outbreak management plan that is well-rehearsed and up-to-date
- continuing to assess and investigate serious incident notifications
- holding providers to account by taking compliance and enforcement action wherever necessary.
We have also developed resources to assist providers in anticipating and responding to COVID-19 risks. The Commission’s online learning platform, Alis, has 2 modules designed to support providers with their outbreak management planning – ‘Introduction to outbreak management planning’ and ‘Leading outbreak management planning’. To access the online learning content or to register for Alis, go to learning.agedcarequality.gov.au.
All Australians want those receiving aged care to be safe, well looked after, and to enjoy good quality of life. The pandemic has made those objectives more difficult to achieve – it has challenged all aged care providers and services. Everyone, including the Commission, has learned lessons from their experiences over the last 24 months, and it is imperative that we all continue to apply those lessons to build our capability and lift our performance.
Governing for reform capability program commences in March
If you are a member of a governing body or a leader in the aged care sector, the Commission is asking you to put governance at the top of your professional development ‘must do’ list this year. With major reform occurring in the aged care sector, it has never been more important for aged care providers to be ‘match fit’ and ready to respond to new obligations and opportunities.
The ‘Governing for Reform in Aged Care Program’ will support leaders to enhance their organisation’s corporate and clinical governance and to lift its overall performance. The program combines learning through webinars, facilitated workshops, online learning modules and resources, and is being led by the Commission in partnership with KPMG.
This is a unique opportunity for members of governing bodies and leaders in aged care to position their organisations at the forefront of reform and help to rebuild trust and confidence with older people, their families, and the broader community.
Don’t miss out – program learning activities will commence this month, so register your interest now.
The essential elements of an effective incident management system
Aged care providers have a responsibility to provide safe and quality care and services to older Australians.
As part of this responsibility, and as required under Aged Care Quality Standard 8: Organisational governance, all providers must have risk management systems and practices in place for preventing and managing incidents. This includes having an incident management system (IMS).
Why is an IMS important?
Effective incident management is a fundamental part of providing safe and high quality care and services, and underpins providers’ continuous quality improvement.
What is an effective IMS?
An IMS isn’t just a spreadsheet recording each incident impacting a consumer – it’s a comprehensive approach to preventing, managing and learning from incidents.
To be effective, your IMS must enable and support the following 6 actions:
- ensuring leadership and a safety culture
- responding to incidents
- recording and reporting incidents
- analysing incidents
- implementing remedial actions
- closing the loop.
We’ll look at each of these elements in a focused Quality Bulletin article over the next few months. In this article, we’ll focus on the first element.
IMS essential element #1 – Ensure leadership and a safety culture
A critical enabler for effective incident management is ensuring that your leadership supports and is committed to your IMS. This requires visible support for effective incident management at all levels of the organisation including by the board or governing body, chief executive officer (or similar role) and the entire leadership team.
Another enabler is that you build and maintain an organisational culture of safe, inclusive and quality care delivery which requires and encourages incidents and near misses to be reported, and promotes understanding, learning and improvement in the care and services provided to consumers.
Effective organisation-wide governance is about how your organisation applies and controls authority below the level of the governing body, which is also critical for supporting your IMS. Your governance system should cover issues such as information management, regulatory compliance, workforce governance, and feedback and complaints.
As part of your IMS, you must establish written policies and procedures to be followed in identifying, managing and resolving incidents. These must be made available to consumers and staff, and to consumers’ family, carers, representatives and advocates. They should describe matters such as:
- the roles and responsibilities of staff in incident management
- how incidents are identified, recorded, reported, analysed and investigated
- what support can be provided to those affected by an incident
- when remedial action might be required.
It is also important that you support and educate staff to understand and use your IMS because your system won’t be effective if staff:
- don’t know what is required or expected of them
- are too scared to report incidents or near misses
- view incident management as a process disconnected from their role.
Finally, you should also encourage consumers, their family and representatives to actively report incidents as another way of creating an open and transparent environment in which consumers feel safe to make a report.
For more information about developing and embedding an IMS in your service, read our ‘Effective incident management systems: Best practice guidance’.
Reminder about changes to the SIRS online reporting form
As explained in the January edition of the Quality Bulletin, improvements to the Serious Incident Response Scheme (SIRS) reporting form in the My Aged Care provider portal were made on Monday 28 February.
As well as improvements to the form, providers can now submit multiple Priority 2 (P2) incident notifications at the same time, using a new bulk upload function.
In their SIRS notifications through the My Aged Care Portal, providers must now indicate if they are reporting a Priority 1 (P1) or a Priority 2 (P2) incident. Reportable incidents must be classified as either a P1 or P2 based on the circumstances of the incident – including incident type, whether there are reasonable grounds to report the incident to the police, and whether the incident caused (or could reasonably have been expected to cause) harm and/or discomfort to the affected consumer. Our SIRS decision support tool can guide providers through a series of questions about an incident to help with the classification of incidents.
As a reminder, some of the other improvements that have been made to the SIRS reporting form include:
- descriptive help text to prompt providers to include necessary details in their notifications
- text changes to clarify the phrase ‘could reasonably have been expected to have caused’ a residential consumer physical or psychological injury or discomfort that requires medical or physiological treatment to resolve
- additional guidance text and considerations to 4 key questions to encourage providers to provide more detailed information to the Commission in relation to incidents. SIRS notification response examples are available on the Commission website.
The Department of Health has updated its ‘Quick Reference Guide: How to access and use the Serious Incident Response Scheme (SIRS) portal’ to reflect these latest changes to the SIRS reporting form.
Update on the regulation of restrictive practices
Following the introduction of amendments to the Quality of Care Principles 2014, commencing 1 July and 1 September 2021, the Commission has been asked to clarify how it will regulate providers in relation to their responsibilities under the amended Principles when restrictive practices are used without consent.
This issue specifically relates to the scenario where a resident:
- cannot consent to the use of the restrictive practice, and
- either lives in a state where there isn’t currently state-based legislation that facilitates the appointment of an alternate decision maker, or
- there is a significant delay due to the need to approach a tribunal for a decision.
It does not apply to situations where a resident is able to consent to the restrictive practice, but has decided not to.
Until this matter is addressed through legislative amendment at either the Commonwealth or state/territory levels, the Commission will be guided by the position outlined in the updated Regulatory Bulletin RB2021-13, ‘Regulation of restrictive practices and the role of the Senior Practitioner, Restrictive Practices’.
Where suitable legislative arrangements exist in states and territories to appoint an alternate decision maker, these arrangements should continue to be relied upon.
Proposed legislative amendments are currently before the Australian Parliament. If passed, they will establish arrangements allowing for certain persons or bodies to give consent if, under state or territory laws, no one is able to provide that consent as a ‘restrictive practices substitute decision maker’.
These amendments are proposed as an interim measure to give protections to vulnerable consumers, and are expected to be in place only until individual states and territories work to establish or strengthen relevant consent provisions through legislative changes at the state/territory level.
The Commission has updated the Senior Practitioner, Restrictive Practices information and added frequently asked questions 2, 2a, 2b, and 2c in the latest version of the Regulatory Bulletin RB2021-13. Further information will be provided to the sector following the passage of any legislation amendments.
Upcoming campaign on residential care provider investment management strategies
During March and April, the Commission will be running a targeted campaign to help residential aged care providers better understand their obligations when investing refundable deposit balances.
Providers of residential aged care or flexible care services holding refundable deposits or accommodation bonds must comply with the Prudential Standards and only use these deposits as permitted under the Aged Care Act 1997 and the Fees and Payments Principles 2014 No.2 (Principles).
Providers can invest refundable deposits and accommodation bonds in specified financial products to generate additional income. However, if investments are made in financial products (other than a deposit-taking facility), then providers must implement and maintain an investment management strategy to ensure appropriate arrangements are in place to assess and manage the risk.
An investment management strategy is required if a provider invests in any of the following:
- debentures, stocks or bonds issued by the Commonwealth, states or territories
- securities (unless excluded in the Principles and as at January 2022 no exclusions exist)
- registered managed investment schemes, including interest in the scheme, a legal or equitable right or interest in an interest in the scheme, or an option to acquire, by way of issue, an interest or right covered by sections 52N-1(3)(d)(i) or (ii) of the Aged Care Act
- unregistered managed investment schemes established for investment in residential or flexible care
- Religious Charitable Development Funds.
Providers must ensure that all investments are made according to the approved investment management strategy. The requirements of these strategies are set out in section 50(2) of the Principles.
As part of our targeted campaign, we will conduct virtual audits with selected providers. The campaign will determine whether providers are compliant with their requirements in relation to their investment management strategy, prudential governance arrangements and liquidity management. If the review identifies non-compliance, the Commission may consider regulatory action.
To help residential aged care providers with their prudential obligations, we have developed fact sheets on investment management strategies, and the Liquidity Standard within the Prudential Standards.
Do you have a concern or complaint about your care?
It’s important that both aged care providers and aged care recipients understand what to do if there are any concerns or complaints about the care or services being delivered. The Commission also asks that providers share the below information with their residents or care recipients.
If you are receiving care and services from an aged care provider funded by the Australian Government, and you are concerned about some aspect of that care, the Commission can help.
In the first instance, we encourage you – if you are comfortable to do so – to raise your concern directly with your service provider. They are expected to pay close attention and work with you to resolve your concern. If you are not comfortable to talk directly with your service provider or your service provider has not resolved your concerns, the Commission offers a complaints service free of charge.
Your concern or complaint may relate to any aspect of your care or services, including whether your needs and choices are respected, the quality of personal or clinical care you receive, choice of activities, food, communication, fees and charges or the physical environment.
Anyone can raise a concern with us or make a complaint over the phone, in writing or online. This includes people receiving aged care, partners, family, representatives, friends, health professionals, advocates, aged care staff and volunteers.
When you contact us, we will listen and ask questions to understand the issues and your expectations. We’ll let you know if your concern or complaint is an issue that we can help you with, and we’ll explain our complaints process, the resolution options available and what can be achieved. We will work with you and the service provider to achieve a suitable outcome.
You don’t have to provide your name when you make a complaint, but if you don’t, this can limit what we can do to help. We can explain the differences between open, anonymous and confidential complaints when you contact us. You can also find more information about these options on our Complaints process page.
And if you need support with making a complaint, an advocate may be able to help. Advocacy is free, independent and confidential. You can call the Older Persons Advocacy Network (OPAN) on 1800 700 600.
Visit our website to read our updated brochure about what to do if you have a concern or complaint, which is available in 25 languages.
Providers are also encouraged to order free hard copies of this brochure in English or other languages via our Order resources page and to make these available at their service as well as distributing them to care recipients.