Aged Care Quality Bulletin #58 - October 2023

October 31, 2023 Sarah Burrell-Davis

Commissioner’s message

The high-risk weather season we are now entering warrants attention by all aged care providers. As I said in my letter to approved providers sent earlier in October, without adequate provider preparation, the heightened risk of bushfires and other extreme weather events across the summer period can negatively impact on standards of care and jeopardise the safety, health and wellbeing of those receiving care.

Preparing and planning for emergency events can lessen the impact on people receiving care, and all approved providers must have effective plans in place to manage these events.

If your service does not have an emergency management plan, you must prepare one. An example of a good template you could use (as a residential and/or home care provider) is available on the Safe Work Australia website.

Advice on caring for older people in hot weather will shortly be issued as a clinical alert by the Commission’s Chief Clinical Advisor, Dr Melanie Wroth, and should be read alongside my letter to help you prepare for the coming months.

On 10 October, I issued a statement noting the promising early reports from providers in relation to achieving around-the-clock registered nurse (RN) cover in residential services. The Commission’s regulatory posture with respect to providers’ fulfilment of new workforce-related responsibilities has been communicated in a recent regulatory bulletin. In summary, if a provider is not meeting their 24/7 RN requirement or care minute targets, we will not look at this in isolation. The Commission acknowledges that a number of providers, and especially those located away from urban population centres, are experiencing challenges with workforce supply and retention.

Where a provider is not meeting their targets, we base our response on the risk to their aged care residents. If a provider is providing quality and safe care that is meeting their residents’ needs, we will work with them while they improve their compliance with their targets. However, if residents are at heightened risk of harm because a provider is not meeting their targets, then we will take the regulatory action necessary to protect those residents. In other words, our action will be in proportion to the level of risk faced by residents.

I encourage you to register for our upcoming webinar on 21 November where we will discuss in greater detail our regulatory approach to 24/7 RN cover and care minutes, and alternative clinical arrangements. You can find out more about this topic on our 24/7 registered nurse cover and care minutes page.

I recently signed a new Memorandum of Understanding (MOU) between the Commission and the Australian Health Practitioner Regulation Agency (Ahpra). A significant number of the health practitioners registered and regulated by Ahpra work across aged care services regulated by the Commission. The new MOU supports the sharing of information between our 2 organisations to help ensure that people receiving aged care are kept safe. Information is most likely to be shared (subject to privacy and confidentiality provisions) where either agency holds a justifiable concern that a regulated person’s health, performance and/or conduct may place an aged care or health service consumer (or the wider community) at significant risk of harm.

In November, we expect to be ready to go live with our new website. Much work has gone into building a new site to deliver a better user experience through better navigation, increased accessibility and simpler language. The beta version of the site is now available to give you an opportunity to explore the new site before we switch over to it.

The Commission’s website receives around 6.2 million page views a year, averaging over 500,000 page views a month. With such a high access rate, this is a very important project to make sure that our information and resources are accessible and easily available.

Finally, I am pleased to advise that the Commission’s National Aged Care Provider Conference 2024 for residential and home services providers will be held at the Adelaide Convention Centre on Tuesday 23 and Wednesday 24 April. As with our conference held earlier this year, registration will be free and participants will have the option to pay to attend the conference dinner. Look out for more details in next month’s issue of the Quality Bulletin. For now, please save the date in your calendars!

Aged care reforms update

New audit program to support home care providers

The Commission has launched a Home Care Pricing Audit Program. We will conduct audits with selected home care providers from November 2023 to June 2024.

Our main objective is to support providers to meet the new legislative requirements that started on 1 January 2023. Home care providers must now make sure (among other obligations) that:

care management prices are capped at 20% of the package level
package management prices are capped at 15% of the package level
there are no charges for package management in a calendar month where no services (other than care management) are delivered, except for the first month of care
third party services are not charged separately
exit fees are not charged.

Providers that we audit can expect support to help them understand and meet their pricing responsibilities. We aim to:

improve the sector’s overall performance
protect people receiving home care packages
increase trust in the home care sector.

The audits will help us identify and address sector concerns and educational needs.

You can find further information on the home care pricing in the Home Services Pricing and Agreements – Navigating changes the right way guidance document and the Changes to Administration and Management Charges in the Home Care Packages Program Regulatory Bulletin.

Code of Conduct banning orders and pre-employment screening

An essential step for all providers before they make a job offer to a successful applicant is to check the banning orders register on our website to see if someone they’re looking to employ or engage (including as a volunteer) has been banned from providing aged care.

From 1 December 2023, the Code of Conduct for Aged Care will have been in place for 12 months.

We’re responsible for making sure that aged care providers and their workers and governing persons comply with the Code. This includes taking action when someone’s behaviour is in breach of the Code.

We use a range of compliance and enforcement tools and powers to do this. In the most serious cases we can ban a current or former worker or governing person from working in aged care. We can also ban someone who has never worked in aged care based on their lack of suitability for this work. An example of this might be where a person has had an NDIS banning order made against them. When taking these actions, we pay close attention to meeting the requirements for procedural fairness.

A banning order stops a person from being able to provide or be involved in providing, aged care. We may make a ban if:

we find that a person isn’t complying with the Code or isn’t suitable to provide aged care
we find that a person poses an immediate or severe risk to the safety, health or wellbeing of people receiving aged care
a person has been convicted of an offence involving fraud or dishonesty.

To date, banning orders have been issued to 81 people. These people can’t provide any type of aged care for a specified period.

More information is available in our Regulatory Bulletin: Banning orders (RB 2023-17), including the consequences if a person or provider breaks a banning order.

Procedural fairness for workers

The Commission must provide procedural fairness to a worker or governing person of an aged care provider whose rights or interests may be negatively affected by one of our decisions. This is required under administrative law. This means that any decision we make must be done in a way that is fair and appropriate.

We have published a Procedural fairness and worker regulation fact sheet to help workers and governing persons understand:

what procedural fairness is
how it applies to decisions we make about them
what to do if they don’t think they’ve been provided with appropriate procedural fairness.

The Code of Conduct for Aged Care (the Code) describes the behaviours expected of people who provide aged care. If a person working in aged care behaves in a way that is not consistent with the Code, we can take action against them. This includes, in severe cases that breach the Code, banning people from working in aged care. We can also make decisions about whether a person is suitable to provide aged care.

In making a decision that may negatively affect a person working in aged care, we must give them procedural fairness. This includes an opportunity to respond to any negative information about them that we use to make our decision. However, if there is immediate and severe risk to people receiving aged care, we may take action against a person without giving them notice or a chance to respond.

You can also read more about procedural fairness in our Procedural fairness regulatory bulletin and Applying procedural fairness to regulatory decisions - fact sheet.

New care minutes responsibilities

On 1 October 2023, mandatory care minutes targets were introduced for residential aged care. Aged care providers must now deliver a sector average of 200 minutes of care to each resident each day, including at least 40 minutes from a registered nurse. The specific target set for each aged care home relates to their residents’ needs.

Mandatory care minutes targets work alongside the requirement for aged care homes to have a registered nurse onsite, around the clock.

These new requirements mean that people living in aged care will have better access to personalised care to meet their care needs. Family members of aged care residents can have greater trust and confidence that their loved one is receiving the right level of care.

The majority of aged care homes are already meeting these new workforce responsibilities.

The Commission will continue to take a fair and sensible approach to regulating aged care providers’ compliance with their workforce responsibilities.

We will be working with providers to make sure that:

they’re taking reasonable steps to recruit and retain staff
they have arrangements in place to make sure that their residents receive safe and quality care that meets their needs around the clock.

Only when an aged care provider isn’t working towards meeting the care minutes or registered nurse care targets, or there are concerns about the quality and safety of the care they’re delivering, will we consider taking regulatory action. Whatever action we decide to take will be in proportion to the level of risk. Actions will also be aimed at encouraging the provider to address the risk to make sure residents are safe and well.

You can find information on the 24/7 registered nurse coverage and care minutes requirements on the Department of Health and Aged Care’s website.

Information on how we regulate the 24/7 registered nurse coverage and care minutes requirements is available on the Commission’s website.

Are you ready? Meeting consumer advisory body requirements

Providers of residential services and home care packages that were approved before 1 December 2022 have until 1 December 2023 to implement a number of Strengthening provider governance reforms. New providers need to meet this responsibility from the date they are approved.

This includes the requirement from 1 December 2023 for all approved aged care providers to write to the people for whom they provide care with an offer to establish a consumer advisory body. They must then repeat this exercise at least every 12 months.

Governing bodies must consider comments and suggestions made by consumer advisory bodies about the quality of care and services. They must also explain, in writing, how they evaluated feedback from a consumer advisory body.

Consumer advisory bodies provide valuable information that helps aged care providers to tailor their care and services to people’s needs and preferences. They also promote a respectful, person-centred culture and a fulfilling experience for the people in your care.

For a more personal perspective, watch this video where Maggie, Jo and Jan from Queen Victoria Care in Tasmania talk about what matters most to them, and how they partner with management in the design of their care.

Further information for providers and consumers about consumer advisory bodies is on our website.

Younger People in Residential Aged Care Program

The Younger People in Residential Aged Care System Coordinator Program is a national initiative funded by the Australian Government. It is run by Ability First Australia.

The program supports people under 65 who are:

currently living in permanent residential aged care, or
at risk of having to move to a residential aged care service.

The program helps people to navigate the system and to look for age-appropriate options relevant to their needs and circumstances. Since the program started in July 2021, they have helped over 2,500 people.

There are experienced staff available in each state and territory. Involvement in the program is voluntary and access is free. The team’s focus is to work with people who are not eligible for the NDIS.

To speak directly with someone from the program, you can call Ability First Australia on 1800 771 663 between 8:00 am to 6:00 pm AEDT.

Food, nutrition and dining

Introducing the new Food, Nutrition and Dining Advisory Support Unit

The Commission is excited to announce its establishment of a group of experts dedicated to supporting our efforts to make sure that people accessing aged care are given the opportunity to exercise choice and influence over their food, nutrition and dining experience.

The Food, Nutrition and Dining Advisory Support Unit is a small team of:

accredited practising dietitians – who provide professional nutrition and dietary advice
certified practising speech pathologists – who support people with communication and swallowing needs.

Team members have diverse and extensive experience across the aged care, acute care and private sectors. This includes experience providing clinical, food service and project management services.

One of the new team’s responsibilities is to provide advice to callers to the Commission’s Food, Nutrition and Dining Hotline. People receiving care, family members, aged care workers and managers, can call the Hotline with questions, concerns and issues related to food, nutrition and dining. The Hotline is available on 1800 844 044, Monday to Friday, 9 am to 5 pm AEDT.

Help spread the word about the Food, Nutrition and Dining Hotline?

We are keen to promote the Food, Nutrition and Dining Hotline and have created a promotional kit for you to spread the word! In the kit you will find newsletter and social media content including images.

There are also links to key fact sheets and the Commission’s wider food, nutrition and dining suite of resources. These include fact sheets and posters, videos and learning modules on dining, choice, swallowing and oral health.

We hope you will share this information with your leadership group and staff, the people you care for, their families and carers.

Clinical update

Celebrating the fundamentals of infection prevention

Infection Prevention and Control Week (15–21 October) promoted better infection prevention and control practices around the world. The theme for Infection Prevention and Control Week 2023 was Celebrating the Fundamentals of Infection Prevention.

Infection prevention and control (or IPC as we all came to know it courtesy of COVID-19) works to protect us from surges in infections, measles outbreaks, flu season, and many other infectious diseases. Effective IPC education and practices reduce the risk of transmission of infectious illnesses by increasing knowledge and changing behaviours.

In aged care, IPC is everybody’s responsibility – from leaders in charge of organisational and clinical governance through to onsite IPC leads, clinical and care staff and staff in non-clinical roles.

During COVID-19, aged care service providers made many lasting improvements in IPC supported by embedding the role of IPC leads.

A provider’s infection prevention policies should cover:

surveillance and auditing
hand hygiene
vaccinations
staff training and education in IPC
environmental cleaning
personal protective equipment.

The Commission regulates and supports best practice infection control processes. The importance of infection prevention and control in reducing the risk of illness for older people is highlighted in Standard 3 (Personal care and clinical care) of the Aged Care Quality Standards.

The Commission has also produced guidance and resources around IPC including:

our IPC online toolkit
the Governing for Reform program, which includes IPC learning materials and resources for aged care governing body members and executives
IPC fact sheets, including Are you alert and ready? Safeguarding against infectious illnesses in aged care settings (this document also has links to information for the public that providers can give to visitors)
the Partnerships in Care program.

Webinars

Staffing obligations and mandatory care minutes

Tuesday 21 November, 1:00 – 2:00 pm AEDT

This webinar will put a spotlight on recent changes to providers’ obligations regarding staffing. This includes the requirement that all residential aged care services:

have a registered nurse (RN) onsite and on duty 24 hours a day, 7 days a week (from 1 July 2023)
meet care minute targets for RNs, enrolled nurses, assistants in nursing and personal care workers (from 1 October 2023).

Recording available – Complaints and continuous improvement in practice

The recording is now available from our 17 October webinar on complaints and continuous improvement. This webinar put a spotlight on Aged Care Quality Standard 6 – Feedback and Complaints and discussed what each of the requirements means in practice. This included what consumers, family, and carers should know and look out for, and what best practice looks like for providers and aged care workers.

Quality improvement in residential aged care

Thursday 2 November, 2pm – 3pm AEDT

The Department of Health and Aged Care is running a webinar on quality improvement in residential aged care on Thursday 2 November 2023. The webinar is an opportunity to share advice and practical information with providers to help them apply quality improvement in their aged care homes.

Presenters from both the Department and the Commission will deliver a practical session covering:

understanding quality improvement and why it matters
how Star Ratings and the QI Program can be used as tools for quality improvement
making our quality improvement resources work for you
what’s working well across the sector: practical examples from residential aged care homes
hot topics: addressing some common feedback
live question and answer session.

Before the webinar, providers should read the Department’s quality improvement resources including the:

Governing for reform

Conversations to Transform Aged Care – Season 3

The Governing for Reform in Aged Care program’s podcast series, Conversations to Transform Aged Care, has just returned with a third season.

In this season, join podcast host Susan Staples and guest speakers as they discuss:

delivering home care services through a period of sector change
transitioning from a governing body member role into an executive role.

You’ll also hear from people receiving aged care and advocates about what they want to see changed in the aged care sector.

You can listen to all seasons of the Conversations to Transform Aged Care podcast on major streaming platforms (Spotify, Apple Podcasts, Google Podcasts) or through the Governing for Reform in Aged Care program’s online learning platform.

Training and resources

Swallowing, food, nutrition and dining

Swallowing is something most of us take for granted, but it actually involves a sequence of steps and co-ordinated movements (involving, for example our lips, teeth, tongue and throat) that some older people in particular can find increasingly difficult to manage. Swallowing difficulties can affect a person’s health, wellbeing and their ability to enjoy their meals.

We have created new resources to help people receiving aged care and their families, as well as providers and staff to understand and spot the signs of swallowing difficulties and take action.

These resources include 2 new videos:

Aged care providers and staff can also access free learning modules on the Aged Care Learning Information System (Alis) including:

Supporting residents with swallowing difficulties
Supporting residents’ oral health
Getting the dining experience right.

Online workshops for approved providers

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

Upcoming workshops in November include:

The Serious Incident Response Scheme (SIRS) in home services
Monitor and assess the performance of your service for residential services
Effective Incident Management Systems (IMS).

Visit our Workshops webpage for further information and registration details.

SSD Connect