As we come to the end of 2019, it’s timely to reflect briefly on some of the highlights of the Commission’s first year of operation.
The establishment on 1 January 2019 of the Aged Care Quality and Safety Commission from a merger of the Aged Care Complaints Commissioner and Australian Aged Care Quality Agency significantly improved information sharing between the formerly completely separate complaints resolution and quality assessment functions, strengthening the regulatory intelligence that supports the Commission’s identification and responses to risk. Over the course of the year, we have also worked to increase transparency on sector performance through our reports and publications.
In May we welcomed our new Chief Clinical Advisor, Dr Melanie Wroth who has strengthened our capability in supporting the Commission and sector on clinical issues in aged care.
1 July was an important milestone in aged care reform in Australia, marking the commencement of the new Aged Care Quality Standards and the Charter of Aged Care Rights. The lead up to July saw significant effort by aged care providers and the Commission to prepare for the introduction of these new provisions, and the enthusiasm shown by many providers to embrace the new Standards has been encouraging.
Throughout the year we have continued our efforts in making available education, guidance and resources for providers regarding the Quality Standards, including specific information in the areas of clinical governance, open disclosure, minimising restraints, consumer engagement and supporting consumers from diverse backgrounds. We will be evaluating and further reflecting on lessons learned from the introduction of the new Standards early in 2020.
Engagement with the Royal Commission into Aged Care Quality and Safety has been a key priority for the Commission during 2019, as it has also been for many providers. In response to specific requests and taking advantage of opportunities, we have provided to the Royal Commission numerous documents, witnesses and submissions, and closely followed hearings and other activities so we can learn from the initial findings. Supporting the important work of the Royal Commission will continue to be a priority for us in 2020.
The Commission has also established processes for ongoing engagement with key stakeholders in the sector, and in particular with provider and consumer peak organisations. This is an area we plan to give further attention to in the coming year, to ensure timely and effective consultation on key reforms.
The passage of the Aged Care Legislation Amendment (New Commissioner Functions) Bill through Parliament this month enables the transfer to the Commission of additional aged care regulatory functions from the Department of Health, with effect from 1 January 2020.
These legislative amendments fully implement the Government’s decision to make the Commission the single end-to-end regulator of aged care services, and the primary point of contact for consumers and providers in relation to quality and safety.
The changes will give the Commission a wider range of regulatory tools to support our work, including responsibility for approving providers, receiving compulsory reports, home care investigations, and determining compliance requirements to be imposed on providers (such as sanctions). The changes also provide the opportunity for us to remove duplication and streamline our processes under the new Rules (created through subordinate legislation).
Our website will be updated shortly to reflect our expanded responsibilities. Some changes to content will be made from 1 January 2020, and a further content review will take place early in the year to ensure that all necessary information is easily accessible.
I will close this “look back” by acknowledging the commitment and diligence demonstrated by many providers over the course of this challenging year in the aged care sector. As I have said in many public forums since January, while the Commission (as regulator) and aged care providers (as regulated entities) have different responsibilities, we share a common interest and set of goals – to improve the experiences and outcomes of aged care consumers, and to support them to live their best lives. And that is surely worth our best efforts.
I wish you all a peaceful Christmas and a happy New Year, and look forward to ongoing engagement with you as we navigate through 2020.
New independent analysis of consumers’ aged care experiences
The Aged Care Quality and Safety Commission has partnered with the Australian Institute of Health and Welfare (AIHW) to analyse the experiences of older Australians living in residential aged care.
As providers are aware, the Commission interviews consumers about their experiences when conducting visits to residential services. We interview a random sample of residents and ask a set of standardised questions. When a sufficient sample size exists, we publish a Consumer Experience Report (CER) for the service on our website following these visits.
In a first for the Commission, we provided CER data for a 2-year period from 2017-2018 and 2018-2019 to the AIHW to conduct the independent analysis. During the period covered by the report, CERs were conducted in 2,070 residential aged care services (75% of the total number of services).
The CER results were further analysed by the type of organisation providing the service, by service size and remoteness level, and by characteristics of their resident populations providing new insights into the lived experience of people in residential aged care.
While the results indicate that consumers generally have a positive view of their experiences in residential aged care, a significant minority have less positive experiences from which we can learn.
The proportion of consumers born in English-speaking countries in a particular residential service was the factor most associated with positive reporting of consumer experience. Service size and organisation type were also associated with positive responses. Consumers in smaller services or those operated by not-for-profit organisations were more likely to report positively than those in larger or privately-operated residential aged care services.
AIHW’s report provides a sector-wide view of the lived experience of people in residential aged care and provides a deeper understanding of the factors related to positive experiences, as well as providing the opportunity to track changes over time.
Read the full report on the AIHW website.
Changes to our Assessment methodology now in effect
In addition to the changes to our assessment methodology announced in October’s Quality Bulletin, a new requirement relating to key documents also came into effect on Monday 9 December 2019.
Providers will now be requested to make key documents and information available at the commencement of performance assessments. There is an information sheet on the key documents in the Resources section of our website. It is expected that these documents will be provided to the Assessment Team within one hour of the conclusion of the entry meeting. Early access to this information by the team supports increased effectiveness of time on site.
The other changes announced in October included the introduction of evidence domains for the purpose of collecting and organising evidence during a performance assessment. The use of evidence domains will guide who the Assessment Teams select for interview, the questions asked, the observations made, the documents reviewed, which types of evidence are pursued and lines of inquiry.
Also announced was that structured consumer experience interviews and consumer experience reports (CERs) will now be undertaken and published as a compliance monitoring assessment contact. CERs will no longer be undertaken as part of a re-accreditation site audit or other performance assessment for residential services which means that a CER is no longer published from a site audit.
The Regulatory Bulletin on Performance Assessment Methodology has been updated to reflect the changes listed above.
From the Chief Clinical Advisor
Pharmacy outreach program
The Commission has recently launched a multi-faceted project aimed at reducing the inappropriate use of medication in residential aged care. The project has commenced with a pharmacy outreach program.
The Commission is working with accredited pharmacists to provide tailored education and information in residential aged care services in remote and very remote areas of Australia.
Eleven pharmacists have been engaged and initial orientation and training was delivered in Canberra in the first week of December. The training included Dr Juanita Breen’s validated ‘train the trainer’ RedUSe program, which will equip the pharmacists to train champion nurses and community pharmacists in the remotest areas. The orientation and training also included Dementia Support Australia information and resources and details of The Aged Care National Antimicrobial Survey to encourage education and participation in the remote facilities.
The project will seek and record input from aged care services, community pharmacists, aged care consumers and prescribers on barriers and challenges to safe medication use in remote and very remote aged care settings. This feedback will be collated and used to inform future work of the Commission in response to identified issues.
Use of Androcur (cyproterone)
Providers are reminded to be alert to the use of Androcur (cyproterone) and other hormones to manage inappropriate sexual behaviours. While these substances are not classed as psychotropics and are sometimes used medically to manage prostate cancer, they constitute chemical restraint when used for the purpose of influencing a person’s behaviour and they must only be used as a last resort. The use of these hormones has the potential for a number of adverse side effects.
As providers are aware, the Quality of Care Principles 2014 contains strict requirements and high thresholds in relation to the use of chemical restraint and providers must ensure that they understand these requirements and act accordingly. Providers will need to acquaint themselves with relevant state and territory requirements in relation to consent if hormones are to be used for behaviour management (for example in NSW, only the NSW Civil and Administrative Tribunal (NCAT) can consent to use of hormones under these circumstances).
Dr Melanie Wroth, Chief Clinical Advisor
New storyboards illustrate the Standards
The Commission has recently developed a series of storyboards to assist consumers, staff and other people interacting with aged care services within a rural and remote context to better understand the application of the Quality Standards in a day-to-day context.
Each of the storyboards shows an illustrated scenario that explains how each of the Standards apply, and they have been written with a rural and remote context in mind. As well as a storyboard for the Standards, there are two key concept additional storyboards that illustrate ‘Dignity of risk’ and ‘Open disclosure’.
The storyboards can be used by facilitators when training staff, or by aged care services to help explain the concepts underpinning the Quality Standards to consumers or their representatives.
In total, there are 11 storyboards available, which can be downloaded as a single pack or individually from the Commission’s website. There is also an accompanying guide that explains each storyboard in detail to assist facilitators or to provide more detailed understanding of the context for each story.
You can access the Storyboards and User Guide in the Resources section of our website.
Assessing the Standards workshops
Last month we brought you news of new workshops being conducted by the Commission on ‘Assessing the Standards’ for residential and home care services.
Booking details are now available on our website for these workshops. The new workshops will focus on helping providers to understand the accreditation or quality review process, how to be prepared for these processes and how to use the self-assessment tools available to gather and analyse evidence.
Commission website updates
The latest Sector Performance data, covering the July – September period, is now live on the Commission’s website. This is the first performance data collected under the new Quality Standards, which came into effect on 1 July 2019.
What Matters Most – Supporting older people to work out what is right for them
Palliative Care Australia has launched a suite of resources to encourage early conversations about What Matters Most to older people accessing aged care services. These resources were developed with the support of the Australian Government through the Dementia and Aged Care Services Fund.
The resources are designed to be used by health or aged care workers to support consumers, including people living with dementia, to work out what is right for them if they were very unwell or at the end of their life. Using the resources will assist aged care workers to better deliver person-centred care and support consumers to make informed choices about their care.
Over the next few weeks, all aged care providers will be sent a set of the What Matters Most resources which includes:
- A Discussion Starter written from the perspective of the older person, with questions about the person, about their health and about what they might want at the end of their life.
- A Health and Aged Care Worker Facilitator Guide to assist workers to prepare for and facilitate these important conversations with older people, including information on supported decision making; and
- A set of Discussion Cards that can be used as an ice-breaker or for prompts when working through the other materials to help a person think about What Matters Most to them.
A limited number of the hard copy resources will be available free from Palliative Care Australia, however aged care providers will need to cover the cost of postage.
The Discussion Starter and Card sets will also be available in Croatian, Greek, Hindi, Italian, Maltese, Modern Standard Arabic, Polish, Simplified Chinese, Spanish and Vietnamese and be available to download from the Dying to Talk website by the end of the year.
For more information visit dyingtotalk.org.au or phone Palliative Care Australia on 02 6232 0700.