The Aged Care Act 2024 (the Aged Care Act) focuses on upholding the rights of older people receiving care. This is captured in the Statement of Rights and includes:
- having access to safe, quality aged care and services
- being supported to make choices
- having an active role in decisions.
Sometimes things can go wrong with an older person’s care. When this happens, it’s important that providers have open, honest and empathic conversations about what happened with the older person, and if appropriate, their supporters.
This is called open disclosure.
It can be unsettling for older people when something goes wrong with their care, and fixing the issue alone isn’t enough to restore trust. When done well, open disclosure makes the older person feel heard and safe – which is part of the Statement of Rights.
Provider obligations
Open disclosure is a provider obligation. Providers must practise it when:
- you receive a complaint or feedback about an older person’s care
- an incident that involved an older person has happened or could have happened
- you find out that something’s gone wrong with an older person’s care through any other means.
Providers also need to:
- embed open disclosure into their incident management and complaints systems
- make sure their policies and procedures include and support the open disclosure process.
How to practise open disclosure
When something goes wrong with an older person’s care and services, providers must practise open disclosure. This includes situations where an incident or possible incident has happened, or a complaint has been made about an older person’s care.
There are five elements of open disclosure. Providers need to:
- acknowledge what went wrong, and how it impacted (or could have impacted) the older person. Speak with and listen to the older person to understand their experience
- apologise to the older person for what went wrong and how they were impacted
- find out what happened, why it happened, and how you can stop it from happening again
- explain what happened and why to the older person, in a way that they understand.
- communicate openly and respectfully throughout the open disclosure process. Make sure you follow up with the older person to explain the changes that will be made to systems, processes and practices to stop it happening again.
Open disclosure is not a one-off discussion. The process can involve multiple conversations, internal reviews and improvements to systems, processes, and practices, and following up with the older person. The older person’s family, kin, carers, supporters and authorised decision-makers can be involved too, if the older person wants.
When to practise open disclosure
Some examples of situations that require providers to practise open disclosure are outlined below. Although these situations are examples and aren’t based on any real experiences, they describe some of the kinds of incidents or errors that should be disclosed, explained and apologised for.
A slippery floor
Barry lives in a residential aged care facility. One evening, when Barry stepped out of his room for dinner, he noticed the floor was wet. It turned out that the cleaner has just mopped the hallway, two hours later than the usual schedule. Even though he had held on to the handrail and walked slowly, Barry slipped and fell on the ground.
A nurse rushed over to check on him. Barry was able to stand up with assistance, and there were no visible injuries on his body.
When asked, Barry said his hip was a bit sore but otherwise felt okay. He continued to walk towards the dining hall.
A missed home visit
Trevor is a rostering manager at a home care service. As he planned the roster for the coming week, he found out that one of the aged care workers had missed their shift to attend to Lynette at her home on Monday (it’s now Thursday).
Trevor quickly realised the worker missed their shift because he’d accidentally sent the updated schedule to the wrong email address.
Lynette hadn’t made a complaint about the missed visit.
A service complaint
Debra lives in a residential aged care facility. After returning to her room from lunch, Debra requested to be transferred out of her wheelchair. Her care worker was busy assisting someone else and didn’t help her.
The next day, Debra complained to the service manager about the service. She said it’s happened twice that week. She also said that sitting for extended periods in the wheelchair gives her muscle cramps and lower back pain.
Inconsistent Support at Home fees
Maria is unhappy that her Support at Home provider has taken so long to send her monthly statements this year.
When she finally receives her statement, she is concerned that some of the fees are different to the ones she agreed to with her provider in her service agreement. Then, when she compares this statement with a previous statement, she sees that some of the fees have increased.
She isn’t sure why the fees have increased and is worried she’s been charged too much.
Supporting aged care workers
When open disclosure doesn't happen, trust in the provider shrinks and the relationship with the older person, their family or supporters can suffer.
You can support your workers to understand and confidently practise open disclosure by:
- modelling, supporting and promoting the use of open disclosure
- embedding open disclosure into your policies, processes and procedures
- giving your workers training and resources to help them practise open disclosure.
- creating a workplace culture of openness and honesty by encouraging workers to speak up. This encourages workers to practise open disclosure and learn from mistakes
Resources
For more information, see:
- Aged Care Open Disclosure Framework and Guidance – full-length, practical guide to open disclosure
- What is open disclosure? – this video explains open disclosure and what older people can expect from their provider in the process
- Open disclosure poster and fact sheet – for older people.