I recently had the opportunity to deliver the keynote address at the Quality in Aged Care conference in Sydney (co-hosted by COTA and ACSA), where the new Quality Standards received considerable attention.
The introduction of the Standards is a significant change in understanding quality and safety in aged care services, putting the consumer’s experiences of care in the spotlight.
The new Standards encourage a stronger focus on care in practice and consumer outcomes, and point to a new way of engaging with consumers that is already leading to different conversations.
The Standards emphasise the importance of developing a partnership with individual consumers. They also underscore provider responsibilities to identify and mitigate risks and at the same time support consumer choices and preferences as far as possible in relation to key aspects of the consumers’ daily lives.
Understandably, there is a great deal of interest around the Commission’s potential response when the Standards are not met. Compliance with the new Standards has been required since 1 July 2019. When we find non-compliance, we tailor our response depending on the assessed risk and, in the absence of serious risk of (or actual) harm to a consumer’s safety, health and well-being, the key focus is on improvement. A Timetable for Improvement gives a provider the opportunity to understand, prioritise and act promptly on areas for improvement in discussion with their consumers.
Findings of non-compliance can lead to a decision to vary the accreditation period. If there is a serious risk finding or continued non-compliance, sanctions under the Aged Care Act may apply.
The Commission has produced and published on our website a range of resources to help services assess themselves against the new Standards and ensure that they are compliant. Additionally, we are working with the Department of Health to progress further reforms including a Serious Incident Response Scheme and a Differentiated Performance Rating System. These initiatives, and in-house projects including an online education tool and consumer engagement resources will continue to drive improvement across the sector and ensure that delivering improved outcomes for consumers remains at the centre of everything we do.
Getting to know the Standards – Standard 1, Consumer Dignity and Choice
Each month, we’ll take a look at one of the Quality Standards, its overarching principles and requirements, along with links to supporting information, including guides, resources and case studies.
Standard 1, Consumer Dignity and Choice, is a foundation standard that supports all the other Standards and is essential to providing consumer-centred care. Each of the Standards has a stated consumer outcome - for Standard 1 it is:
“I am treated with dignity and respect, and can maintain my identity. I can make informed choices about my care services, and live the life I choose.”
Standard 1 reflects seven important concepts – these recognise the importance of a consumer’s sense of self, their ability to act independently, make their own choices and take part in their community.
As with all the Standards, Standard 1 also has associated requirements, the details of which are included in our guidance material. The material includes explanations of the intent of the requirements, reflective questions to help providers understand their responsibilities, and examples of action and evidence.
Additionally, the Commission is building a library of case studies featuring examples of the kind of issues covered by the Standards, including suggested courses of action that providers can take to arrive at an appropriate solution that suits the consumer and complies with the relevant Standard.
- Standard 1 – Consumer dignity and choice
- Standard 1 – Guidance and resources
- Case Studies – Standard 1 is a foundational standard, essential for delivering consumer-centred care and services. Therefore, while Standard 1 has some relevance to all cases studies, those drafted with Standard 1 in the forefront are in the Dignity of risk and Respecting identify, culture and diversity sections.
Publication of Serious Risk decisions
The Commission has commenced publishing details on our website of serious risk decisions relating to visits from 1 July 2019. This is part of our ongoing commitment to transparency.
The Commission will always notify the provider when a serious risk decision is being considered. As part of this process, we will also seek feedback from the provider on the content that will be published on the website where a serious risk decision is made. This is an opportunity for the provider to give feedback on what is to be published to ensure it accurately reflects the decision and the underlying reasons. If you are notified of a serious risk consideration, please ensure you review the proposed content for publication in addition to your feedback on the consideration.
New ways of collecting feedback about home services
Following a two-stage pilot process on the consumer experience in home services, the Commission is now collecting feedback from consumers receiving care and services from home care services, Commonwealth Home Support Programme services and flexible care services through which short-term restorative care is provided in a home care setting. During a quality review or assessment contact site visit to a home service, consumers may be asked a standard set of questions, as part of a consumer experience survey that aims to understand consumer sentiment about the quality of care and services they receive.
The new approach for home services extends the consumer experience structured interviews that have been carried out during performance assessments of residential services since May 2017.
Home service providers are generally given written notice of the date(s) of the quality review or assessment contact site visit. The written notice to the provider also includes a letter from the Commission to be forwarded to consumers of the service and their nominated representatives telling them about the visit to the service. The letter invites consumers to provide feedback about the quality of care and services they receive. Participation is voluntary, and there are four options for consumers - to attend in person on the date(s) of the site visit, provide feedback over the phone, complete the survey online, or choose not to participate this time.
The survey consists of 13 questions that cover aspects of the Aged Care Quality Standards, such as whether consumers are treated with respect, do staff follow up when issues are raised, the frequency that services are updated, and how services could be improved. You can view the questions on our website. The survey feedback will be treated as strictly confidential and as such the Commission has asked the independent research company Lonergan to conduct the survey on our behalf.
The Commission worked closely with La Trobe University to conduct the pilot testing, which validated the questions and highlighted that the telephone interview is the preferred mode for consumers. Visit our website to view the La Trobe report on the pilot testing as well as background information on consumer experience reviews for home services.
Heater Burn Alert - Residential aged care beds placed next to heaters
Hydronic heaters (where hot water is circulated in a heater to warm the room) are commonly used in residential aged care services, usually mounted on walls. Generally, they are safe, economical and efficient.
The Commission is aware of several incidents over the last few years where this type of heater has been implicated in a resident experiencing serious burns. The circumstances have related to a bed being placed close to this heater, and to regulation of the temperature of individual heaters. The risks include a resident rolling, sliding or falling onto a heater or becoming wedged between the heater and the bed. A person who might be unable to move themselves off or away could lie directly against the heat for some time before staff become aware.
The coroner in Victoria made several recommendations in relation to this in June 2016, followed by an Industry Alert issued by the Commonwealth Department of Health in September 2016. Since then there have been more incidents of severe burns.
This alert is to recommend that all residential aged care services with these types of heaters review the associated risks in relation to their consumers.
Some suggestions to consider include:
• Ensuring that beds are positioned away from heaters
• Considering installing guards to prevent residents being able to come into direct contact with any hot surface
• Monitoring heat settings on individual heaters and consider limiting the maximum temperature
Assessment contact risk screening questions
At the start of an assessment contact, assessment teams will ask a series of questions to determine the focus of the assessment contact and to identify key areas of risk. These questions can be found on our website, under the heading ‘Assessment contact risk screening questions’ on the Assessment contacts page.
New case studies
Seven new case studies have been added to the Guidance material to support providers’ understanding of the Quality Standards in practice.
They provide examples of consumers receiving care and services in rural and remote locations, and include home care and community care settings. Click here to view the case studies.
Guide to Assessment of Commonwealth Home Support Program (CHSP) services
The Commission has developed a new guide to help providers understand which of the Aged Care Quality Standards apply to their service.
For example, Standards 1, 2, 6, 7 and 8 apply to all providers, whereas Standards 3, 4, and 5 may apply to some CHSP providers, depending on the type of care and services being delivered.
AAIC Satellite Symposium Conference
As part of the year-round learning opportunities offered by AAIC, global researchers will discuss brain health and dementia risk, developments in Alzheimer’s and dementia clinical research, the role of psychosocial, care and non-pharmacological interventions in Alzheimer’s and other dementias, epidemiology, advances in biomarkers, emerging areas of investigation and more. Find out more about the conference.
Walking safely with dementia
A new resource to assist people living with dementia to walk safely and maintain their independence is now available from Dementia Australia. The 'Walking Safely with Dementia' resource is being launched to coincide with National Missing Persons Week, which ran from 4-10 August 2019. According to a study from the US Alzheimer's Association, it is estimated that 60 per cent of people with Alzheimer's disease (the most common form of dementia) will become lost at least once and becoming lost is often the first symptom experienced by someone living with dementia.
The 'Walking Safely with Dementia' guide offers information, tips and strategies for people living with dementia, their families and carers and suggests ways we, as a community, can help if a person becomes lost or disorientated.
The Department of Health is seeking feedback on a Serious Incident Response Scheme (SIRS) for residential aged care.
This consultation aims to assist in the development of the finer details of a SIRS and inform further advice to government on structure and operation, legislative requirements and resourcing implications.
Submissions are now open on the department’s Consultation Hub. Feedback on the consultation paper should be submitted by 4 October 2019.
Serious Incident Response Scheme (SIRS)
KPMG will complete a research study into the prevalence of resident on resident incidents in residential aged care nationally, which are exempt from reporting under the current compulsory reporting scheme. The study will take place in September 2019 for a four week period and inform design of the SIRS definitions and threshold settings.
To register for the study or for more information, please contact KPMG at firstname.lastname@example.org or on 1800 789 576.