Aged Care Quality Bulletin #66 - June 2024
In this issue
Commissioner’s message
The recent rise in COVID-19 and influenza cases in residential aged care services is a cause for concern around the country. That concern has been heightened by the worryingly low rates of up-to-date COVID vaccination among residents in many aged care homes (refer the Department of Health and Aged Care publication of resident COVID-19 vaccination rates by service). Residents lacking this vital protection are at greater risk of serious illness and even death.
Last month, the Chief Medical Officer and I wrote to all Board Chairs of residential aged care providers regarding their responsibilities to ensure that infection prevention and control measures (including access to vaccination and anti-virals) are in place to protect the people in their care. We advised that the Commission is being proactive in holding providers accountable for their actions in this regard.
This month, the Commission released a new Regulatory Bulletin for all approved residential aged care providers. It explains approved providers’ responsibilities relating to COVID-19 vaccinations and infection prevention and control (IPC). It details how the Commission is regulating these responsibilities and responding to providers found to be non-compliant.
Providers are on notice to ensure their residents’ timely access to COVID-19 vaccinations and to have robust IPC measures in place to prevent outbreaks.
I am also writing separately to providers with low resident COVID-19 vaccination rates, and the Commission will be conducting unannounced site visits to services in this cohort to determine why they are in this situation and what the provider is doing to address concerns.
If providers are found to be exposing residents to a heightened risk of harm and are unwilling or incapable of addressing this, then we will take enforcement actions that may include sanctions and civil penalties.
Vaccination is the best way to protect older people who are particularly vulnerable to serious illness, hospitalisation or death from COVID-19. Residential providers must make sure their residents are supported to make informed decisions to consent to vaccination when they are eligible, and to have timely access to COVID-19 vaccinations. They must also have robust infection prevention and control measures in place to reduce the risk of an outbreak.
If you want to set up a vaccination clinic in your facility, you can find the help you need through your local Primary Health Network or your Department of Health and Aged Care state or territory office.
This is not a time for complacency. All residential aged care providers should be self-auditing to ensure that they are prepared by using the IPC operational readiness and IPC governance self-assessment checklists.
Aged care reform update
Regulating mandatory care minutes targets
Mandatory care minutes targets are an important responsibility for residential providers to meet.
Data from providers’ quarterly reports shows that many providers still have a way to go to achieve their care minutes targets. Our current regulatory focus is on the services and providers that are the furthest from meeting their targets.
To understand how providers are performing against care minutes targets, we analyse data and risk. This makes sure that we are focusing our regulatory efforts where they will have the biggest impact. We have developed education and engagement activities based on our risk analysis, including:
targeted communication to providers that reported that they had shortfalls against one or both mandatory care minutes targets (Quarter 2 – October to December 2023)
direct engagement with providers with more than one service falling short of care minutes targets
monitoring visits to services with the largest shortfalls.
We know that some providers find it difficult to attract and retain the skilled, competent workforce they need. Through our direct engagement and monitoring activities, we will be looking at how a provider is working to overcome these challenges and meet their care minutes targets.
We are less tolerant of a provider’s non-compliance if their shortfalls in care minutes are because of poor planning and business decisions.
For information on the Commission’s regulatory approach to care minutes, read the Regulatory Bulletin on workforce-related responsibilities.
You can find more information about care minutes responsibilities on our website. The Department of Health and Aged Care also has resources to help you calculate and report your care minutes.
Changes to 24/7 registered nurse reporting from 1 July
The Australian Government is improving 24/7 registered nurse (RN) reporting processes and reviewing 24/7 RN supplement eligibility. These changes will help improve the care for residents in aged care homes.
From 1 July 2024, there will be changes to how providers report on 24/7 RN coverage and to the RN supplement. This will improve the quality of the information the Department of Health and Aged Care collects about RN coverage in residential aged care homes.
The changes from 1 July include:
improved reporting functions on the Government Provider Management System (GPMS) to help the department understand issues around delivering the 24/7 RN responsibility
an increase in the minimum RN coverage threshold that providers need to provide to 87.5%, or more than 21 hours a day, to be able to receive the full 24/7 RN supplement. This change encourages aged care homes to increase their RN coverage
a new, reduced 24/7 RN supplement for aged care homes that have up to 30 residents and provide between 50% and 87.5% RN coverage. This new supplement is 50% of the full supplement.
You can find more information on:
Section 6.4.4 of the Care minutes and 24/7 registered nurse responsibility guide
Model pack for care time reporting assessments
The Department of Health and Aged Care has created a model pack to help providers prepare for their care time reporting assessments.
Care time reporting assessments test or confirm the accuracy of the information that providers have reported in their Quarterly Financial Report and 24/7 registered nurse report.
The model pack shows providers how to correctly present information and documents to respond to a Notice of requirement to give information or documents from the department.
Helping providers understand their reporting requirements will mean they need to spend less time preparing the reports. It will also improve the quality of the data in the reports. Accurate reporting makes sure that providers receive the right amount of funding.
Learn more about the model pack on the department’s care time reporting assessments webpage.
3G network closure – what should providers be doing?
Australia’s mobile network operators are switching off their 3G networks. Some networks have already shut down, with the rest closing in August or September 2024, depending on the mobile network operator. Any device using the 3G network will no longer be able to connect or make calls.
3G devices that are affected include:
medical, panic and fall alarms or pendants
personal devices such as tablets or mobile phones
devices loaned or given to residents that need a network connection to work
modems
smart watches or smart appliances.
Some 4G devices may also be affected. You can find more information about these on the Department of Infrastructure’s website.
Providers who source, provide, or maintain these devices for their aged care and services, need to identify anyone who may be affected by these changes as quickly as possible. There may be a high risk to people receiving care if these devices don’t work, especially in emergency situations.
Providers should also think about how they can support people receiving care who use an affected device that the provider doesn’t provide or maintain. This is particularly important if the people using these devices are vulnerable or isolated, or have limited community or family support.
You can find more information on the Department of Health and Aged Care website, under the heading 3G Network shutdown and impact on client devices and on the Department of Infrastructure’s website.
Draft new Aged Care Act consultation – feedback report
Feedback and submissions from the recent consultation on the draft new Aged Care Act are now available. The Department of Health and Aged Care:
received over 320 submissions and over 800 surveys
heard from more than 10,000 people at 3 webinars, 42 workshops and 5 roundtables.
Some of the most common issues people raised were:
the time available to implement the new Act
how people’s rights will be upheld
how supported decision-making, whistleblower protections and the new definition of high-quality care will work in practice
the suggested new duty for board members and people in positions of responsibility to make sure that aged care providers don’t negatively affect the health and safety of older people in their care
the level of independence of the Complaints Commissioner.
This feedback will be drawn on by the Government to shape the final version of the Bill to be introduced to Parliament.
Depending on parliamentary processes, the new Act will start on 1 July 2025 alongside the launch of the new Support at Home program. Just a reminder also, that the strengthened Aged Care Quality Standards will apply from the commencement of the new Act.
The consultation feedback report and submissions are now available on the department’s website.
Voluntary assisted dying – the role of aged care providers
The Commission has published a fact sheet for providers about their responsibilities when an older person in their care seeks to access a formal voluntary assisted dying (VAD) arrangement underpinned by legislation in their state or territory.
We have listened to providers and other stakeholders tell us that they’re unsure about how to handle a situation where an older person asks for access to, or information about VAD. Some providers who object on moral or religious grounds to engaging with VAD also raised concerns about how to respond to and support residents who make VAD requests.
We want to assure you as a provider that you can follow the laws in your state about VAD services in a way that’s consistent with your existing aged care obligations under aged care law.
The VAD rights of people in your care
It’s important for you as a provider to understand that people in your care have the right to seek access to and use VAD while they are living in your service.
This right exists even where the provider has made the decision not to participate in the VAD process. It also applies to states (such as Victoria) where there is no obligation for a provider to provide access to VAD services. This is because providers mustn’t act in a way that’s inconsistent with an older person’s legal rights to access VAD. You have the responsibility to support an older person to make independent choices.
The Charter of Aged Care Rights also sets out the right of people receiving care to:
be treated with dignity and respect
be independent
make choices without this negatively affecting the way they are treated.
The laws on a person’s access to VAD are different in each state and the Australian Capital Territory (they have not been passed in the Northern Territory). This means that the policies and procedures you establish to guide your staff in this matter will need to be consistent with the relevant legislation.
This fact sheet includes links to support services to help you, your staff, their supporters and families if an older person in your care is considering VAD.
Aged Care Volunteer Visitors Scheme toolkit
The Department of Health and Aged Care has developed a communication toolkit to help you spread the word about the Aged Care Volunteer Visitors Scheme.
The scheme supports regular in-person volunteer visits to give friendship and companionship to older people and help them feel less isolated.
The toolkit includes content that you can share on your website, social media and newsletters to:
recruit new volunteers
encourage older people who would benefit from volunteer visits to be referred into the program.
You can access the communication toolkit and find out more about the Aged Care Volunteer Visitors Scheme on:
2024 Australian Elder Abuse Conference
Elder Abuse Action Australia and Aged Rights Advocacy Service invite you to the 2024 Australian Elder Abuse Conference, Turn Up the Volume. The conference is in Adelaide from 22–24 July 2024. It is an opportunity for professionals, advocates and community members to address the issues of elder abuse, ageism and neglect.
This year's keynote speakers include experts who will share their insights on ageism and personal experiences in caring for older loved ones. There will be a variety of sessions covering topics such as financial abuse, dementia and the unique challenges faced by Aboriginal and Torres Strait Islander and LGBTIQA+ communities.
One of the days is dedicated to exploring cultural safety, featuring an interactive workshop to improve your cultural competence.
For more information and to register, visit the Conference website.
Food, nutrition and dining
Enhancing food, nutrition and dining in aged care: Presenting on our approach
The Commission is committed to improving food, nutrition and dining in aged care. Working with stakeholders and the wider community is key to our efforts to drive positive change in this area.
The Commission recently spoke about our work in this area at 3 industry events:
the Lantern Alliance's webinar
the Institute of Hospitality in HealthCare's national webinar
the Aged Care Catering Summit in Sydney.
We shared our strategy to support providers on how to make improvements and we shared insights from our monitoring activities and the Food, Nutrition and Dining Hotline (1800 844 044). Our content focused on provider responsibilities to offer person-centred care and the goal to achieve something more than meeting basic requirements.
Our presentations
The presentations showed the Commission's greater focus on food, nutrition and dining. This included information about our support through a Food, Nutrition and Dining Advisory Support Unit, which includes qualified speech pathologists and dietitians, and the Hotline. The Hotline offers support to providers and people receiving care, including information and guidance on food, such as meal quality and staff training. We also plan to do 1,440 unannounced targeted assessment contact visits to aged care services over 2 years focused on food, nutrition and dining.
Other work being undertaken by the Commission includes preparing providers for the strengthened Aged Care Quality Standards, specifically the food and nutrition elements. We’re highlighting the importance of working with older people to provide enjoyable food, drink and dining experiences. Our focus is on the areas of choice, dining, swallowing and oral health. We are developing resources that support people living with dementia and from culturally and linguistically diverse cultures.
You can find more on our food and nutrition initiatives and resources on our Food, nutrition and dining: resources for providers webpage or call the Hotline on 1800 844 044.
Nourishing connections: The role of social dining in aged care
Moving into an aged care home can bring a mix of emotions for older people. For some individuals, this can include a sense of loss, isolation and loneliness. Some may miss the activities and social interactions they once loved. During this change, the dining room can be an important space. Engaging mealtimes can improve a person’s quality of life, which then contributes to people eating more and getting better nutrition which supports their health and wellbeing.
The importance of social dining experiences
The dining room is more than just a place to eat. It’s a place for connection, social interaction and engaging with community. Sharing meals with companions can increase enjoyment.
Having meals together in a group setting provides an opportunity for residents and staff to socialise together, and it can create opportunities for staff to offer support if needed. Taking part in social activities has also been shown to boost mental and physical health.
Supporting inclusive social dining
There are many ways that providers can support and promote inclusive social dining. For example, designing layouts that leave space for wheelchairs and seating positions, lighting, assistive eating utensils and staff assistance can improve the dining experience for people with vision or hearing impairments. Accessible menus with larger fonts and photos of food are also useful for many residents.
You can read more about the benefits of social dining and success stories we’ve seen in our full article.
Clinical update
Updated antimicrobial stewardship resources
The To Dip or Not to Dip (TDONTD) program focuses on avoiding unnecessary testing of urine samples to improve the appropriate prescribing of antimicrobials through educating and training aged care staff, auditing and feedback.
Antimicrobial stewardship is the ongoing work by a provider (and clinical caregivers) to optimise and minimise the use of antimicrobial medicines, like antibiotics. Not using antimicrobials appropriately adds to antimicrobial resistance, which has become a global problem.
TDONTD is a program for residential aged care services that helps them improve how they manage urinary tract infections (UTI) and reduce antibiotic prescribing for UTIs. After it was launched in 2021, the Commission evaluated the program resources by interviewing:
nurses and pharmacists who had used TDONTD in their services
nurses and personal carers who had received TDONTD training and used the clinical pathway in their everyday work.
Based on the feedback we received, we produced updated TDONTD education, training and auditing resources. Key changes include:
New: TDONTD implementation guide to support nurse and pharmacist champions introducing TDONTD in services
New: Survey ‘Take the dipstick test’ for staff to identify where dipstick testing practice doesn’t follow best practice
New: GP resources
New: Huddle tool to provide staff with reminders on TDONTD
Updated: User guide to the clinical pathway with new sections on practical ways to assess and manage residents with cognitive impairment and chronic urinary incontinence.
World Continence Week 2024
This year’s World Continence Week (17 to 23 June) theme was ‘Let’s Talk’. The Commission acknowledges the work of the Continence Foundation of Australia in encouraging aged care providers and clinicians to discuss continence issues with the people in their care. Incontinence is a common condition and, although it can affect people at any age, it’s more common among older people. But it’s not an inevitable part of ageing.
Residents in aged care can experience periods of incontinence for many reasons but with the right professional advice and person-centred care, it can be managed, improved and sometimes resolved.
Last year the Continence Foundation of Australia ran a consumer survey to get insight into the community’s perceptions and experience of incontinence. Three quarters of the people surveyed believe that there isn’t enough community awareness around bladder and bowel health.
Almost half said they haven’t talked about their continence issues with friends or family because they’re embarrassed. Many said they could be encouraged to talk about the issue if their health professional raised it or if information was displayed.
Help is just a phone call away. Call the National Continence Helpline on 1800 33 00 66 to speak with a nurse continence specialist for free and confidential advice for your service.
Webinars
A new regulatory strategy for aged care
Tuesday 16 July 2024, 2.00pm – 3.00pm AEST
In preparation for the introduction of the new Aged Care Act and strengthened Quality Standards, this webinar will introduce the Commission’s new draft Regulatory Strategy that describes how we will deliver on our commitment to safeguard and protect older people, and how we hold providers and workers to account. It will advise providers and workers what we expect from them, and how we will engage with them. Importantly, it also tells older people and their families, as well as providers and workers what they can expect from us.
Registrations will open on Tuesday 2 July
Recording available – Provider regulation – accountability driving performance
The recording is now available from our 18 June webinar on Provider regulation – accountability driving performance. In this webinar, our panel discussed the importance of an integrated approach to risk management and continuous improvement at the provider level. Panel members also discussed how this is changing the way we work with providers to support sustainable improvement in the quality and safety of care.
Governing for reform
The Governing for Reform Program supports governing body members and leaders to improve their corporate and clinical governance capabilities and lead change. The program provides valuable governance resources for leaders in aged care. Learning resources include online modules, workshops, printable resources, podcasts and webinars.
The program’s topic guides include information and examples of best practice governance, with case studies, tools and templates that governing body members and executives can use. Popular topic guides include: Risk Management, Building an Effective Governing Body and Strategic Planning.
Recording available – Changing values and culture – a person-centred approach to quality care
The Governing for Reform webinar series includes discussions with experts in governance and leadership.
The recording is now available from our 19 June webinar, Changing values and culture – a person-centred approach to quality care. This webinar focused on how adopting a person-centred approach acknowledges the needs, preferences and aspirations of each person receiving care. Understanding the needs of older people not only supports them to make decisions; it supports a positive aged care experience by promoting dignity, autonomy and respect.
Visit the Governing for Reform website for more information and to access program resources.
Training and resources
Online workshops for approved providers
The Commission hosts online workshops for approved providers of residential aged care and home services. Our workshop program is managed in our online learning platform – the Aged Care Learning Information Solution, or Alis.
To register or access, please go to the Alis website.
Our next available workshop sessions are in July:
The Serious Incident Response Scheme in residential and home services
Effective incident management systems
new workshop – The strengthened Quality Standards in practice.
Visit our workshop webpage for more information.