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Aged Care Quality Bulletin #61 - Janurary 2024

Sarah Burrell-Davis
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Commissioner’s message

Welcome to our first Quality Bulletin for 2024 in what promises to be another busy year of important reform for the aged care sector.

As I’m sure you are all aware, the Department of Health and Aged Care published an exposure draft of the Bill for the new Aged Care Act late last year. The consultation on this draft closes on 16 February and I encourage you to take the opportunity to have your say. Your feedback will help shape this important Bill before it is introduced to Parliament. You can find out more about the department’s consultation in this issue.

To support sector readiness for the new strengthened Aged Care Quality Standards, next month (February) the Commission will release a suite of draft resources and tools for public consultation. We will also be holding a webinar on Tuesday 6 February, Supporting sector readiness for the new strengthened Standards, and I encourage you to register to attend. We will be discussing the draft guidance resources and how you can provide your feedback.

The Commission’s webinars will be an increasingly important source of information for providers, aged care workers, and people receiving aged care this year. You can access our webinar program for the first quarter of the year on our website. In addition to our webinar on the strengthened Standards, topics will include dementia and the importance of food, nutrition and dining, restrictive practices and behaviour support plans, and particular aspects of the proposed new Aged Care Act.

Stay up to date with our webinar program on the dedicated webinar page on our website, where you’ll also find recordings of previous webinars. The Quality Bulletin and our social media channels will also flag what’s coming up.

Final preparations are being made for our upcoming National Aged Care Provider Conference, Getting in on the Act – working together for better aged care, in Adelaide 22–23 April 2024. We are close to reaching the cap on attendees so I do encourage you to register to attend the conference if you have not done so already. Our pre-conference workshops being held on 21 April have reached capacity.

Finally, I want to draw your attention to the Regulatory Bulletin on workforce responsibilities including 24/7 registered nurse cover and care minutes. This month providers are reporting on the delivery of mandatory care minutes, introduced from 1 October 2023, for the October–December quarter. In this issue, you can read about the regulatory approach that the Commission will take to support providers to meet and exceed their mandatory targets.

Our reports

Sector performance – latest insights

Our latest aged care Sector Performance Report will be available on our website from 5 February. The report includes data from 1 July to 30 September 2023 (Quarter 1 2023–24).

We have redesigned the structure of our sector performance report to make it easier for providers to compare their performance data with the sector as a whole and with similar providers and services.

We hope you use this along with your own data to identify areas where you can benefit older Australians in your care. The report also includes a link to a survey. We want to hear from you about the data you would like to see in future reports and what other information would make the report more useful for you.

Key information in this quarter’s report includes:

Compliance

Residential providers’ compliance with the Aged Care Quality Standards has increased considerably over the past 12 months. We found that 81% of residential providers we audited in Quarter 1 2023–24 met all 42 requirements of the 8 Quality Standards.

While this is an improved result, it nonetheless indicates that 1 in 5 residential aged care services failed to meet all the requirements of the Quality Standards in the care they provided.

There has been a welcome increase in compliance with Quality Standard 3 (Personal care and clinical care). However, providers need to consider all the data available to them in order to identify risks and areas for continuous improvement. For example, complaints about clinical issues still account for 3 out of the 5 most complained about issues for residential services. Further, Serious Incident Response Scheme (SIRS) notifications of neglect, which includes many clinical and health care incidents, have been increasing.

Quality Standard 8 (organisational governance) now has the lowest compliance for both residential and home services. This is of concern as we know that poor governance leads to poor clinical care, more complaints and more serious incidents.

Overall compliance rates for home services are lower than for residential care. Only 63% of audited providers were fully compliant with the Quality Standards in Quarter 1 2023–24 compared with 71% compliance in Quarter 4 2022–23. This will be a key focus for the Commission this year.

Complaints

Complaints about home care packages increased from Quarter 2 in 2022‒23 to Quarter 3 in 2022‒23 but have now steadied. Complaints about fees, charges and communication account for 1 in 5 complaints about home services.

In residential care, medication management is the number one topic people complained about. Complaints about this issue have increased since Quarter 4 in 2022–23. Complaints about communication and falls have also increased.

In focus: Infection prevention and control

We included a new ‘In Focus’ section in this report. The first topic in this new regular series is Infection Prevention and Control (IPC). This includes results from our 2023 online IPC self-assessment survey for residential services. Of the 80% of services that responded to the survey, 70% rated their IPC capability as best practice – up nearly 10 percentage points on the 2020 survey.

Aged care reform update

Upcoming: strengthened Standards guidance consultation

We are committed to making sure that the aged care sector is prepared for the anticipated introduction of the strengthened Aged Care Quality Standards on 1 July 2024, with the new Aged Care Act.

We have developed the first set of draft guidance materials to support providers to conform with the strengthened Standards. These include:

  • Guidance for providers – information to understand provider obligations and how to achieve outcomes under the Standards

  • Evidence mapping framework – evidence the Commission will look for when assessing provider performance against the Standards

  • Audit methodology – the processes the Commission will use to assess provider performance

  • Audit preparation tool – information to enable providers to assess their performance and achieve continuous improvement

  • Requests for information – information the Commission will request from providers to inform audit activities

  • Framework analysis – comparison of the current Standards and the new strengthened Standards.

We will be releasing these for public consultation on 6 February 2024 and encourage you to provide feedback. Your insights will help us make sure that these materials support the delivery of quality aged care.

We encourage all providers to register for our first webinar of 2024, Supporting sector readiness for the new strengthened Standards, at 2.00 pm – 3.00 pm AEDT on Tuesday 6 February. We will discuss the consultation process, the draft products being released and how providers can provide feedback.

Registrations for our 6 February webinar are now open.

Meeting mandatory care minutes in residential aged care

The Commission has released an updated Regulatory Bulletin on Workforce-related responsibilities – including 24/7 registered nurse and care minutes, outlining the workforce-related responsibilities of approved providers. It explains how the Commission will regulate these responsibilities and respond to non-compliance and associated risks to residents.

Since 1 October 2023, residential aged care homes must meet or exceed their mandatory care minute targets. There is a sector-wide average of at least 200 care minutes per resident per day, including 40 minutes with a registered nurse.

Providers are required to comply with their obligations and where they fall short, we expect them to actively mitigate any risks and demonstrate how they're making progress towards compliance. Our regulatory approach is focused on detecting, assessing and responding to areas of risk to residents.

Residential aged care homes submitted their first report on their delivery of mandatory care minutes (for July–September 2023) in their quarterly financial report (QFR) due on 4 November 2023. The Commission will draw on that data and the October–December 2023 QFR data (due 14 February 2024) to identify and engage with services that aren't meeting their care minutes targets.

The Commission’s regulatory responses will be aligned with the most effective treatment(s) of the underlying causes of a provider’s non-compliance and the associated risks to the people in their care.

Where a provider isn't meeting their mandatory care minute targets, the Commission will take compliance or enforcement action to require them to comply and manage risks to people in their care if:

  • the non-compliance is principally due to deficiencies in their workforce strategy or other related business decisions; and/or

  • they're not delivering quality and safe care to residents; and

  • they have not taken reasonable steps to mitigate risks to residents and achieve compliance.

Our initial focus will be on those non-compliant services that are identified as performing poorly relative to other similar services in their locality. We will seek further information to understand any actions taken by such providers to achieve compliance and advise on support available to assist them to meet the care minutes requirements.

To access the Commission’s regulatory bulletin and other guidance materials, please visit our website. 

Further information is available on the Department of Health and Aged Care’s website: 

Interim First Nations Aged Care Commissioner

In welcome news, Ms Andrea Kelly has recently commenced in the new role of interim First Nations Aged Care Commissioner. Ms Kelly is a proud Warumungu and Larrakia woman, and a respected First Nations leader who brings 32 years’ experience engaging with First Nations communities and developing public policy.

The interim Commissioner will be engaging with First Nations communities and stakeholders about the purpose and tasks of the permanent Commissioner role. These consultations will form the basis for a proposal to government on the permanent Commissioner.  

The role will also advocate for First Nations peoples and providers to make sure that ongoing changes to aged care meet the needs of older First Nations people.

To find out more, visit the Interim First Nations Aged Care Commissioner webpage.

Have your say on the draft new Aged Care Act

The Australian Government is introducing a new Aged Care Act. It will change the way services are delivered to older people in their homes, in community settings and in residential care homes.

Public consultation is now open on the draft new Aged Care Act, and the Department of Health and Aged Care wants to hear your views.

Anyone can contribute, including:

  • aged care providers and staff

  • older people, their families and carers

  • sector peaks, associations and unions

  • researchers and experts

  • people interested in Australia’s aged care system.

To get involved, read the full consultation paper, plain English consultation paper summary or the draft law.

You can also watch the department’s recent webinars on the draft Act held on 14 December 2023 and 18 January 2024.

You can provide your feedback in several ways. You can:

Consultation closes at 7:00 pm AEDT on Friday 16 February 2024. All consultation details are available on the department’s consultation webpage.

Community feedback informs aged care regulatory model

Commencement of the new Aged Care Act will also see the introduction of a new regulatory model. 

Over the past 18 months, the Department of Health and Aged Care has been consulting on the core components of this model, seeking input from a broad range of aged care stakeholders including older people and their representatives, providers, unions, aged care advocates and advisory groups.

Feedback received during these consultations is presented in the document A new model for regulating aged care: Consultation Summary Report recently published by the department.

The new model will put into practice the rights-based and person-centred foundations of the new Act. It has been designed to focus the sector on embracing continuous quality improvement to make sure that older people can feel confident that the care they access is safe and high quality.

Read more about the consultation feedback the department received in the What we’ve heard article on the Aged Care Engagement Hub.

Compliance Management Insights

Over the last 18 months, the Commission has successfully expanded its social media presence and is now routinely using digital channels to amplify key messages to a broader range of stakeholders.

From the beginning of this year, a monthly post on Financial and Prudential Insights published by Peter Edwards (Executive Director, Compliance Management) has been rebadged as Compliance Management Insights to reflect our commitment to provide a broader analysis of all compliance matters affecting the sector. 

Each month we will now share insights aimed at building a clearer understanding of the relationship between different aged care provider obligations (financial and non-financial), and how compliance with them supports better outcomes for people receiving aged care.

In the January issue, Peter provides an overview of how we manage non-compliance and how our regulatory decisions affect the star rating that a service receives. We welcome topic suggestions for future editions from the sector. Please send your ideas to prudential@agedcarequality.gov.au and subscribe via our website.

Targeted review program – Annual Prudential Compliance Statement submissions

The Commission has begun a targeted review on late submissions of Annual Prudential Compliance Statements (APCS). We will do reviews with selected providers between February and March 2024.

Providers must submit their Aged Care Financial Report (ACFR) and APCS within 4 months of the end of the financial year. For most providers these are due by 31 October.

We have selected providers that have submitted their APCS late at least twice in the past 3 financial years. If you have been selected, the review will check if you meet the Prudential Disclosure Standard and Governance Standard.

The targeted review will also assess whether you have met your responsibilities under ‘management of refundable deposits’ in the Aged Care Act 1997.

The main aim of the targeted review is to:

  • lift providers’ awareness of their legal obligations

  • help to ensure that providers meet their prudential reporting responsibilities and prudential obligations

  • identify and address sector concerns and educational needs.

We will: 

  • improve the sector’s understanding of prudential reporting responsibilities and prudential obligations 

  • improve provider financial management transparency

  • protect residents’ money 

  • increase trust in the sector. 

For more information on financial and prudential reporting responsibilities, download our Financial and Prudential Reporting Responsibilities fact sheet.

Safety and security reminder

In the wake of several recent reported break-ins where older Australians have been confronted by intruders, it's timely to provide a reminder of residential providers’ obligations regarding the safety and security of people in their care.

Personal safety is a basic human right and everyone should feel safe and secure in their home. As providers, you have a responsibility to make sure older people in your care are safe and to provide a secure environment.

Several crime prevention security tips you can consider include:

  • encouraging residents to lock all doors and windows

  • making it harder for intruders to get in without being seen – this can include cutting overgrown bushes and trees and installing CCTV

  • reporting suspicious behaviour to the police immediately

  • not allowing entry to (or escorting off the premises) anyone who is unwilling to identify themselves or can't provide a plausible reason for being at the service.

You can report suspicious activity or raise concerns with the police by calling 131 444. If there is an emergency call 000.

For more information on seniors’ safety, see these local police resources:

Food, nutrition and dining

Thickened fluids: Supporting choice, nutrition, hydration and safety

Older people can develop eating, drinking and swallowing difficulties (dysphagia) that increase the risk of something going wrong when they eat or drink (such as choking or inhaling food particles or liquid).

Following individual assessment of an older person, a speech pathologist may recommend giving them thickened fluids to help deal with these problems.

Thickening fluids slows down the flow and improves control in the person’s mouth and throat. This can reduce the risk of aspiration (where fluid enters the airway and passes into the lungs instead of down the throat and into the stomach).

It's important that when an older person begins thickened fluids, their choices are not limited. You should take their individual preferences into consideration and review this regularly to make sure they drink enough fluids to stay hydrated. Water should also be part of the fluids on offer. 

Symptoms and severity of dysphagia affect people differently and can change over time. Providers should:

  • closely monitor each person’s eating and drinking of recommended texture modified foods and thickened fluids

  • refer people for reassessment by a speech pathologist in line with their needs. 

A person has the right to choose how they eat and drink. It’s important that they understand their options, benefits and any risks so they can choose what is right for them.

A speech pathologist can guide you on the management strategies and options available to the older person. This should be supported by kitchen staff and dietitians to make sure that fluids are delicious and nutritious.

Thickened fluids: top tips

  • Make sure staff are trained to prepare thickened fluids effectively and safely to the level recommended by the speech pathologist and following a standardised framework such as the International Dysphagia Diet Standardisation Initiative (IDDSI).

  • Any beverage can be thickened. Make sure people who need thickened fluids are included in happy hour and social outings and can enjoy their beverage of choice. Common happy hour drinks including wine, beer, milk, juice and carbonated beverages, all can be thickened in line with the IDDSI framework.

  • Make sure people drinking thickened fluids are staying hydrated, particularly in hot weather or if taking diuretics. Some people may find it hard to drink enough, especially if they’re not enjoying what they’re being given. This might include documenting how much fluid they’re having. 

  • Make sure a person’s nutritional needs are still being met by looking at the nutritional content of both food and fluids. Careful choice of thickened fluids can support nutrition as well as hydration. 

  • Make sure people who have swallowing difficulties but who prefer to have drinks that are not thickened are supported to make an informed decision. This decision, known as eating and drinking with acknowledged risk (EDAR), should be made in consultation with the person, the speech pathologist and any other supporting multidisciplinary team members. The decision should be regularly reviewed.

Find out more:

Swallowing resources:

New module on texture modified food and thickened fluids

A safe food and dining experience is key to the health and wellbeing of older Australians with swallowing difficulties living in aged care.   

A new training module produced by the Commission is available for providers and staff to learn about texture modified food and thickened fluids and to help promote change. The Using Modified Food and Fluids on the Aged Care Learning Information System (Alis):

  • defines and describes texture modified food and thickened fluids 

  • separates the myths from facts when it comes to modifying food and fluids 

  • describes things to consider when planning and preparing modified food and fluids 

  • explains what best practice looks like.

Webinars

Supporting sector readiness for the new strengthened Standards

Tuesday 6 February 2024, 1.00 pm – 2.00 pm AEDT

This webinar will inform the aged care sector about the strengthened Aged Care Quality Standards and will discuss the new draft guidance resources that will be released to the sector for consultation. Details will be given on how you can provide feedback. 

Panel members:

  • Janet Anderson PSM, Aged Care Quality and Safety Commissioner

  • Ingrid Leonard, First Assistant Secretary, Department of Health 

  • Emily McGrath, Australian Commission on Safety and Quality in Health Care

  • Lisa Peterson PSM, Assistant Commissioner, Sector Capability and Regulatory Strategy 

  • Tara Pamula, Executive Director, Education, Engagement and Communications Group, Aged Care Quality and Safety Commission.

The live webinar will include a Q&A session and we encourage you to register and submit questions in advance through the registration link.

Supporting people with dementia to eat and drink well

Thursday 22 February, 2:30 pm – 3:30 pm AEDT

This fifth webinar in our Food, Nutrition and Dining series will focus on how aged care providers and staff can support those with dementia to eat and drink well. Key discussion areas will include:

  • how dementia impacts the ability to eat and drink well

  • the importance of nutrition for those living with dementia

  • ways to improve food, nutrition and dining for people living with dementia

  • identifying changes in eating and drinking and strategies for managing these

  • supporting culture, choice and independence with meals

  • the importance of food and mealtimes – creating dementia friendly dining environments and making mealtime enjoyable with personalised approaches.

Registrations will open on 8 February and you will be able to register via our webinar page.

Governing for reform

The Commission’s highly successful Governing for Reform in Aged Care Program is now available to all leaders, managers, providers and services interested in strengthening their governance and leadership skills in the aged care sector.

Free learning activities and resources are now available on the Governing for Reform section of our website that cover:

  • organisational and clinical governance

  • enhanced knowledge sharing within your organisations and across the sector

  • online modules, podcasts, webinars, flip guides, topic guides, tools and a For the Board Kit.

The Governing for Reform website section also includes news of upcoming events.

You can find the program’s online learning modules on our learning platform Alis (Aged Care Learning Information Solution). After completing a learning module or workshop, you get a completion certificate as a record of achievement.

New webinars, podcasts, workshops and coaching sessions will be available in February.

For questions or feedback please email: governingforreform@agedcarequality.gov.au

Training and resources

Online workshops for approved providers

The Commission regularly hosts online workshops for approved providers of residential aged care and home services.

Upcoming workshops in February include:

  • The Serious Incident Response Scheme (SIRS) in residential services

  • Monitor and assess the performance of your service for residential services

  • 5 Key Areas of Risk for home services.

Visit our Workshops webpage for further information and registration details.

New resources