Aged Care Quality Bulletin #69 - September 2024
In this issue
Commissioner’s message
On 12 September, a Bill for a new Aged Care Act was introduced in Parliament by the Minister for Aged Care, the Hon Anika Wells MP. The Aged Care Bill 2024 is very different from the existing legislation. It focuses on older people and their rights, needs and personal choices. It will also impact the way that the Aged Care Quality and Safety Commission regulates providers and holds them accountable for complying with their responsibilities.
To become law, the Bill has to be debated and passed by both Houses of Parliament. Depending on these parliamentary debates and voting processes, the new Act is expected to commence from 1 July 2025. It will replace existing legislation, including the current Aged Care Act 1997 and the Aged Care Quality and Safety Commission Act 2018.
Commencement of the new Act will introduce strengthened Aged Care Quality Standards and a new regulatory framework. Older people will also be placed front and centre of their aged care through a Statement of Rights.
In other news, we have just released our new Service Charter which provides an overview of our commitment to you and what to do if you’re not satisfied with our service. We undertake to deliver a service to people receiving aged care, providers and the sector that meets the Australian Public Service Values and Code of Conduct. This includes being impartial, committed to service, accountable, respectful, ethical and ensuring stewardship.
If you feel we haven’t followed the Charter, or you disagree with a decision we have made, there are steps you can take. We encourage people to contact us with any concerns or complaints about our work.
An exciting note on which to end my message this month – please save the dates of Monday 28 to Wednesday 30 July for our National Aged Care Providers Conference 2025. In the coming month, we will be updating our website with further information which will also be provided in coming Quality Bulletin issues.
Our reports
Sector performance – latest insights
Our latest aged care quarterly Sector Performance Report is now available. The report includes data from 1 April to 30 June 2024 (Quarter 4 2023–24).
We use the findings from the report to inform how we focus our regulatory activities. Working together with providers, our goal is to keep improving the quality of care and protect the wellbeing and rights of older Australians receiving aged care services.
Year in review
The Q4 report includes a Year in review section. This shows trends in compliance, complaints and serious incident notifications over the last 2 financial years.
There has been a significant uplift in compliance with the Aged Care Quality Standards for both residential and home services, starting at the beginning of 2022–23. However, while the lift has been maintained over 2023–24, there has been no further improvement in compliance in either residential care or home services and this is concerning. The Commission will focus on the areas of underperformance by providers.
Compliance with the Quality Standards dropped to 81% in audited residential care services in Quarter 4.
In home services non-compliance is more pronounced with only 65% of providers undergoing audit now fully compliant with the Quality Standards.
The Commission is increasing its attention and reach into home services through its expanded audit program. We now review all the services of a provider in a single quality review. We’re paying close attention to home services provider systems and processes and how they’re applied to reduce risk in their services.
Compliance with the Aged Care Quality Standards
As well as the risks identified in home services, we have identified key areas for providers to focus on to lift the overall standard of care in the sector. These are:
Quality Standard 3 (Personal care and clinical care). Compliance with this standard dropped in both residential care and home services this quarter. We are creating evidence-based resources to support providers to deliver safe and high-quality clinical care.
Quality Standard 8 (Organisational governance). This standard continues to have the lowest rate of compliance in both residential care and home services. Under our provider supervision model, we are working with governing bodies and executives to ensure that they understand their responsibilities for managing and controlling risks and non-compliance in their services.
Complaints
The most common complaints we receive are consistent quarter to quarter. These are:
clinical issues in residential care
communication and financial issues in home services.
Serious incidents
The number and rates of incidents under the SIRS for residential care have increased slightly since Quarter 1, 2023-24. The number of serious incident notifications from home services has increased steadily as providers better understand their reporting obligations.
In residential care, notifications of neglect are still the second most common notification type after unreasonable use of force. We are looking for providers to do more to prevent these incidents.
In focus: Provider supervision
Provider supervision is part of our strategy to drive the delivery of high-quality care - and it is under the spotlight in our “In focus” section this quarter. As well as an overview of the provider supervision model, the In focus includes 5 case studies. The case studies are based on real examples of providers that we have tested our model with over the past year.
Read the full report.
Aged care reform update
Aged Care Bill 2024 introduced to Parliament
The Australian Government introduced the Aged Care Bill 2024 to Parliament on 12 September 2024.
The Bill is for a new Aged Care Act – the main law that sets out how the aged care system operates. It will put the rights of older people first.
The Bill aims to:
improve the lives of older people accessing aged care services in their home, the community or residential aged care
encourage providers to deliver high-quality care.
The proposed rights-based law:
addresses around 60 recommendations from the Royal Commission into Aged Care Quality and Safety
includes feedback from several public consultations run by the Department of Health and Aged Care
responds to the Aged Care Taskforce on sustainably funding aged care into the future.
The Bill has been referred to the Senate Community Affairs Legislation Committee. During this time, the department will release some of the rules under the new law for feedback. Anyone interested in aged care will be able to provide input.
Subject to parliamentary processes, the new Act and the new Support at Home program are expected to commence from 1 July 2025.
You can read the Minister for Aged Care’s media release, the Bill or a plain language fact sheet on the department’s website.
Helping you prepare for the strengthened Quality Standards
The strengthened Aged Care Quality Standards will be introduced with the new Aged Care Act.
If you’re unsure what the new strengthened Standards will mean for you, our draft guidance resources can help providers, workers and older people understand what will change and why.
Resources include:
an interactive guidance tool with information tailored to you as a person receiving care, a provider or worker
high-level fact sheets with an overview of each of the strengthened Standards
detailed information on each strengthened Standard to help providers meet their new obligations
information explaining how we will assess provider performance against the strengthened Standards
how the strengthened Standards compare with the current Standards
a summary of what the strengthened Standards will mean for aged care workers.
We’re currently updating our draft guidance resources in response to feedback we received from our public consultation. We will publish our updated guidance towards the end of 2024.
We will keep creating materials to help you understand the strengthened Standards in the lead up to the anticipated new Aged Care Act. Recently, we published 2 new posters to help workers and older people understand the aim of the strengthened Standards.
In the coming months, we will be publishing more information for older people, their families and carers on what the strengthened Standards will mean for them.
If you have any questions or comments about the strengthened Quality Standards or our resources, please email agedcarereform@agedcarequality.gov.au.
Our Regulatory Strategy 2024-2025
The Commission’s Regulatory Strategy for 2024-2025 is central to how we regulate the aged care sector, making sure that people receive safe and quality care as we move to the new Aged Care Act.
Safeguarding and protecting older people is at the centre of everything we do. The Regulatory Strategy provides information on how we regulate the sector, including how:
we meet our regulatory responsibilities under the current legislation
our policies and strategies work to identify and respond to risk and enhance older people’s experience of aged care
we inform and engage with our stakeholders
we regulate providers and aged care workers to make sure that they provide safe and high-quality care.
If you missed it, you can watch on demand our July webinar A new regulatory strategy for aged care, where we introduced the strategy in detail.
Helping providers prepare for the new Aged Care Regulatory Model
The Department of Health and Aged Care is working to prepare Australian Government-funded aged care providers for the new registration and renewal system ahead of the new Aged Care Act coming into effect.
Under the new aged care regulatory model, 6 provider registration categories will be introduced. The categories group services together based on similar care complexity and risk.
The registration categories will make it possible for every aged care provider to have a single registration covering all the aged care services they offer.
Providers can be registered into one or more of the 6 categories relevant to the type of services they provide. Each category has clearly defined obligations that providers must meet to provide care in that category.
In preparation for the new Act, and to enable providers to continue to deliver care and services to older people, the department will move existing providers to registration categories based on the current services you deliver. This is known as ‘deeming’.
The department will contact providers to validate the information it has for their organisation to make sure they are placed in the correct category.
There will be opportunities for providers to update the information the department holds or adjust the proposed registration categories if there may be an error.
This validation process is expected to start in the coming weeks.
For now, providers don’t need to do anything.
For more information, visit health.gov.au/regulatory-model.
Increase to care minutes in residential services from 1 October
All providers of residential aged care services across Australia must meet their workforce-related responsibilities, including mandatory care minutes.
From 1 October 2024, the care minutes responsibility will increase to a sector-wide average of 215 care minutes for each resident each day. This includes 44 minutes of direct registered nurse (RN) care. Also from this date, providers will be able to meet up to 10% of their RN target with care provided by an enrolled nurse (EN).
This change recognises the important role of ENs in aged care and aims to improve recruiting and retention of these skilled workers. It follows feedback from providers, workers (particularly ENs), worker representatives, older people and the TAFE sector. It will also help providers to deliver their care requirements if they face workforce shortages.
You can find more about the increase to care minutes on the Department of Health and Aged Care’s website.
Consumers and Families Panel survey
This month we sent out a survey to members of our Consumers and Families Panel to help us better understand their experience as a panel member, and ways we can improve how we engage with the panel. We’ll also use the survey results to find out how older people get information about aged care and learn what our panel members know about the different government agencies working across aged care. Panel members can fill in the survey online, over the phone or on a hard copy. The survey closes on 7 October 2024.
We set up our Consumers and Families Panel in July 2022 to help us hear the voices of people who receive aged care services. Since establishing the panel, over 350 people have joined. This includes:
people living in residential aged care
people receiving home care
family, friends and supporters of people receiving care
people planning to access aged care services in the next 12 months.
Over the past 12 months, we’ve offered opportunities to all panel members to be involved through things like webinars and online surveys. Recently we’ve asked smaller groups of panel members for feedback about our:
complaints satisfaction survey
older person guidance on strengthened Quality Standard 1
draft Complaints report about home services
review of What is the Commission fact sheet.
We’ve also shared invitations to join our culturally and linguistically diverse (CALD) and First Nations projects. We value the feedback that panel members have given us, and we’ve used this to improve the Commission’s resources and to learn what really matters to people receiving aged care.
If you, or people you care for, would like to join our Consumers and Families Panel, you can read more on our website.
New Government Provider Management System features
The Department of Health and Aged Care has updated the Government Provider Management System (GPMS) to improve the way that approved providers manage information.
The update on 30 September 2024 will:
reduce the amount of administration that providers need to do
improve data quality and processing times
support more efficient communication between providers, the department and the Commission.
Manage Your Organisation tile
The new Manage Your Organisation tile allows providers to view and manage information that the department has. This includes:
provider details
services
key personnel and contacts
third-party arrangements.
Digital forms
Providers can now complete and submit Approved Provider Notification or Governing Body Determination forms through GPMS (the form titles have changed slightly with the update). You can also track the progress of your submissions.
At this stage, the digital forms can’t be used to update information about service key personnel. To make changes about your service key personnel, complete a notification form and submit it to APnotifications@agedcare.gov.au. (Changes to provider key personnel can be made using the digital form on GPMS.)
How notifications and determinations are assessed hasn’t changed, just the way you submit the forms.
If you submitted a form via email before 30 September 2024, it will be processed in the usual way. There is no need to resubmit it. If you urgently need to action a change within 10 business days, please email APnotifications@agedcarequality.gov.au.
You can find more information on the update, including user guides and how-to videos, on the department’s website.
GPMS is being improved to support aged care reforms and make the exchange of information between providers and government systems more efficient.
For technical support with GPMS, contact the My Aged Care Help Desk on 1800 200 422.
Upcoming changes to the Australian National Aged Care Classification
From 1 October 2024, the Australian Government will increase the Australian National Aged Care Classification (AN-ACC) price to $280.01. This means an increase of 13% in average daily funding to providers, which will help them to meet the increase to 215 care minutes from 1 October.
Changes will also be made to AN-ACC fixed and variable funding to follow the Independent Health and Aged Care Pricing Authority's advice, except for services in remote and very remote areas.
From 20 September 2024, the hotelling supplement will also increase from $11.24 to $12.55 for each resident each day. This will make sure that providers are fully funded to deliver the cost of everyday living services.
You can find more information in the media release from the Minister for Aged Care, the Hon Anika Wells MP.
Be aware of aged care scams
We have been made aware of scammers targeting aged care residents and their families and carers. Some scammers have impersonated aged care providers and collected refundable accommodation deposit payments.
Providers need to ask their residents and their families and carers to be cautious of unfamiliar emails, phone calls or texts.
Providers can also share the below tips with residents and families to help them to protect themselves:
Always stop and check suspicious links, or before sharing personal details and transferring money.
If they are unsure, they should call the provider using contact details from their official website.
Before they transfer money to their provider, they should contact the provider, using details from their official website, to confirm the correct bank account details.
If something feels wrong, act quickly – they should contact local police and their bank, then report the scam to ScamWatch and ReportCyber.
You can learn more about avoiding and reporting scams on My Aged Care website.
Food, nutrition and dining
Food for thought – Be proactive with protein
Protein supports health, immunity and physical ability. It’s a nutrient found in food, and we often hear the myth that older people need less than younger adults. But research shows that they may actually need more to maintain their muscle mass, strength and health. Maintaining muscle mass and strength is important as people age, and protein plays a vital role in this process.
The benefits of maintaining muscle include:
less frailty
more independence
lower risk of falls and fractures
better immunity
higher life expectancy
help to control diabetes.
High-protein foods include:
fish, meat and chicken
eggs
dairy (milk, yoghurt, cheese, skim milk powder, cottage cheese)
soy milk
beans and other legumes
nuts and seeds
tofu and tempeh.
Each person’s protein needs vary. A dietitian can help with individual assessments and recommendations. Making sure that older people get enough protein in their everyday diet is especially important in residential aged care. Older people living in residential care mostly rely on the food and drinks provided by the service for all their nutritional needs.
As our bodies can’t store protein to use later, it’s important to spread protein intake across the day. This means including enough protein in breakfast, lunch, dinner and snacks to help fuel muscles and prevent loss of strength.
Some tips for providers to get you started
Focus on protein first. For example, offer the protein part of a meal or snack first.
Provide a milkshake station where you make milkshakes to order with added protein.
Offer protein-focused breakfasts with eggs and high protein yoghurts.
Arrange a menu and mealtime review with an accredited practising dietitian.
You can read more details, examples and tips and find links to resources in our full article.
Managing nutritional issues and malnourishment
In the August issue of our Compliance Management Insights we heard from Lisa Peterson, Deputy Commissioner, Sector Capability and Regulatory Strategy, about managing the risk of malnourishment and why aged care providers must be vigilant in their management of nutritional issues. The first prerequisite for providers is to have suitable systems in place to detect when a person is malnourished or is vulnerable to developing the condition.
Although weight loss can be an indicator of malnutrition, the Commission’s Chief Clinical Advisor and Geriatrician Dr Mandy Callary advises that a person can be malnourished or at risk of malnutrition without weight loss. This means it can go undetected, so providers need to make sure they are regularly using evidence-based screening tools to identify people who need more nutritional support. That’s because if left untreated, malnourishment will harm a person’s health, wellbeing and quality of life.
A contributing factor to poor nutrition is food quality and the overall dining experience. This is why the Commission invests heavily in making sure that providers are taking seriously their responsibilities to provide high-quality food. For example, in the 2023–24 financial year we conducted unannounced site visits at 608 services across the country, with a focus on food, nutrition and dining. A number of these site visits included a dietitian or speech pathologist from our Food, Nutrition and Dining Advisory Support Unit.
You can read the full article and subscribe to the monthly Compliance Management Insights on our website.
G-MEDSS: a tool to support deprescribing in aged care
People living in residential aged care homes are regularly taking multiple medicines. This is called ‘polypharmacy’. Polypharmacy becomes more likely with increasing age and the progression of chronic health conditions.
The Residential Aged Care Quality Indicators (January to March 2024) show that over a third of residents are taking at least 9 medications.
Polypharmacy increases the risk of:
harmful drug incidents
falls
cognitive decline
hospitalisation
in some cases, death.
To reduce polypharmacy, approved providers are expected to work with prescribers (typically general practitioners) to monitor medications being taken by individuals. There is also a requirement to report on a polypharmacy measure, which is one of the mandatory Quality Indicators.
Deprescribing is one way of reducing polypharmacy and improving the health and wellbeing of people receiving aged care. Deprescribing is the process of reducing the dose or stopping medication that a person no longer needs.
The G-MEDSS tool
Providers and health professionals who are looking for assistance with making decisions about, and implementing, deprescribing for aged care recipients might want to consider the Goal-directed Medication review Electronic Decision Support System (G-MEDSS©) tool. This tool can help identify polypharmacy in older people that may be an issue. It can then help coordinate deprescribing medicines where side effects and risk of harm are higher than their benefits.
The G-MEDSS tool includes the Drug Burden Index (DBI) calculator. This measures a person’s level of anticholinergic and sedative medications. These can affect cognitive function in older people. Many medications commonly used by older people have ‘anticholinergic’ properties. This means that they reduce the level of acetylcholine, an important chemical in the brain and nervous system. Low levels of this chemical are typical in people with Alzheimer’s Disease and Lewy Body Dementia.
The DBI calculator allows health professionals to:
assess the anticholinergic and sedative effects of each medicine
understand why a person might be having adverse side effects
score medications to help decide which can be deprescribed.
This information can help health professionals, people receiving care and their families to make decisions about deprescribing.
Webinars
New infection prevention and control guide
Thursday 3 October, 2:00pm – 3:00pm AEST
The Department of Health and Aged Care is holding a webinar on the new Aged Care Infection Prevention and Control (IPC) Guide for aged care providers.
The new IPC Guide outlines the basic principles of infection prevention and control and explains how to apply these principles using a risk-based approach in an aged care setting.
The webinar will cover how aged care homes can:
apply basic principles of infection prevention and control in aged care
minimise the risk of infection for older people and the workforce, by taking a risk-based approach
meet the requirements of the strengthened Aged Care Quality Standards
develop policies and procedures to support IPC in your organisation.
Registrations are now open.
For more information and to download the guide, visit Infection prevention and control in aged care.
Trust is built in drops and lost in buckets – Why open disclosure matters
Tuesday 15 October 2024, 2:00pm – 3:00pm AEDT
Join us to learn about the role of open disclosure in aged care:
What is it?
Why is it important?
What is the Commission doing to support service providers to meet their open disclosure obligations?
Open disclosure is an important way for providers and workers to work with older people to resolve issues when things go wrong. More than that, it can help to restore trust and confidence in the service and can stop issues from happening again.
We are preparing for a greater focus on rights under the anticipated new Aged Care Act and the strengthened Quality Standards. Service providers and workers can join us to hear about ways to have open conversations with older people about dignified care.
Panellists will also highlight some of the common challenges in using open disclosure in aged care and ways to overcome them. The panellists include:
Janet Anderson PSM, Aged Care Quality and Safety Commissioner
Louise Macleod, Complaints Commissioner, Aged Care Quality and Safety Commission
Bill Lyon, Chief Executive Officer, Churches of Christ
Donna Hart, Executive Director - Seniors Living, Churches of Christ.
This webinar is for approved aged care providers, workers and older people receiving care, their family and other supporters.
Registrations are now open.
Recording available – Sector Performance Reporting: Joining the dots to detect risk and prevent harm
The recording is now available from our 17 September webinar, Sector Performance Reporting: Joining the dots to detect risk and prevent harm. This webinar looked at the results from our latest Sector Performance Report and included trends over the past 2 years.
We discussed some of the issues we have seen, including common and persistent compliance and complaints issues in both residential care and home services. We also looked at how the Commission is responding to these issues and how providers can look at their own data and performance in the context of overall sector performance.
Governing for reform
Governing for Reform in Aged Care Program
Effective governing bodies lead and shape the culture of an organisation. The Governing for Reform in Aged Care Program supports governing body members, executives and leaders to strengthen their corporate and clinical governance skills. These skills will help you lead change and improve your service’s delivery of safe, high-quality aged care. Thousands of leaders have already taken part in this program.
Program learning activities and resources include practical governance tools and templates, podcasts and webinars, including:
Governance within home care: this online learning module covers the obligations and responsibilities of home care providers, exploring different governance approaches and practices
Delegations register audit: this tool along with the Policy and delegation topic guide helps you set up and maintain a register of all financial and nonfinancial authorities delegated from the governing body
Business impact tool: use this tool along with the Crisis management topic guide to develop a business impact analysis for your organisation that identifies the first activities to restore after a disruptive event.
Learn more about the program and upskill today.
Training and resources
Online workshops for approved providers
Places are available for our upcoming workshops in October. Each month, we deliver workshops for people working in the aged care sector. These workshops offer practical tips to support learners to understand how to meet their obligations within their service setting.
Our workshop topics for October are:
Strengthened Quality Standards in practice – learn about the strengthened quality standards and how you can start preparing for their implementation.
The Serious Incident Response Scheme – understand your obligations under the SIRS and know how to identify a reportable incident and notify the Commission.
These workshops are delivered by experienced Commission facilitators, with Subject Matter Experts from our regulatory teams on hand to answer your questions.
Places are limited, so head to Workshops | Aged Care Quality and Safety Commission to learn more or register today.