Aged Care Quality Bulletin #55 - July 2023

Commissioner’s message

On 21 July 2023, the Minister for Aged Care, the Hon Anika Wells MP, released the final report of the capability review of the Aged Care Quality and Safety Commission, conducted by independent reviewer Mr David Tune AO PSM.

We welcome this report which will ensure that the Commission continues to strengthen its capability, efficiency and effectiveness in upholding best practice care for older people. You can read my full statement on our website.

The independent capability review provided an important and timely opportunity for the Commission to reflect on its own performance. We appreciate the thoroughness of Mr Tune’s review and his acknowledgement of the work undertaken by the Commission since its inception in 2019 to set us on an aspirational path towards becoming a world class regulator.

The final report is available on the Department of Health and Aged Care’s website.

I am pleased to advise that we are launching our Food, Nutrition and Dining Hotline this month. The Hotline will be available to anyone involved in the aged care sector who has questions or complaints about food, nutrition and/or dining experiences that can have such a significant impact on consumers’ wellbeing. We’re hoping the hotline will operate to sharpen providers’ focus (where necessary) on this key area and over time, support improvements in consumers’ experience of aged care. Keep up to date with the launch of the Hotline via our website.

There have also been important additions to our role in relation to financial and prudential regulation. As of 1 July, financial monitoring functions transferred from the Department of Health and Aged Care to the Commission. This change follows a recommendation of the Royal Commission into Aged Care Quality and Safety, and will give us a more integrated view of risk by enabling us to consider financial viability alongside the quality of care. As part of our financial monitoring responsibilities, we will be reviewing and assessing the Aged Care Financial Report and the financial components of the Quarterly Financial Reports submitted by aged care providers.

You can stay informed about this area of the Commission’s work by registering for our August sector webinar, ‘Financial and prudential regulation’ and by subscribing to the Financial and Prudential Regulatory Insights which gives you monthly updates from Peter Edwards, Executive Director, Compliance Management Group within the Commission. A short outline of the Commission’s new functions is also available on video on our YouTube channel.

This month also marks the start of the 24/7 registered nurse cover responsibilities. From 1 July, residential aged care homes across Australia are required to have a registered nurse on-site and on duty 24 hours a day, 7 days a week. As I have previously stated, we will be taking a fair and sensible approach to the regulation of these new responsibilities. We understand the challenges being experienced by many providers, and especially those located outside urban population centres, in attracting and retaining a suitably qualified workforce. Provider reporting on this new requirement will commence in early August and I’m sure there will be significant interest in seeing the profile of coverage across residential services.   

We value the opportunity to consult and engage with providers to better understand their perspective and information needs, and to obtain feedback that will assist with our continuous improvement journey. If you would like to get involved by reviewing and providing feedback as we develop and adapt communications and education products for providers and workers, please register your interest to join our Provider Engagement Panel.

Aged care reforms update

Approved provider application fees updated for 2023–24

In November 2021, the Government authorised the introduction of fees for processing applications for approved provider status. Every year, the Commission is required to review the charging model and fees ahead of the new financial year.

We recently released our 2023–24 Cost Recovery Implementation Statement (CRIS) following our annual review. This statement outlines the fees, charges and waivers that apply to:

• organisations that are seeking ‘approved provider’ status
• existing approved providers who are seeking approval to provide additional services or to change their services.

There is a small increase in fees this financial year based on indexation. The new fees started from 3 July 2023.

You can find more information on our Approved provider application fee webpage.

Code of Conduct banning orders update

The Code of Conduct for Aged Care has now been in place for almost 8 months.

The Commission is responsible for overseeing the sector’s compliance with the Code. This includes taking action when workers’ or governing persons’ 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, and following detailed examination of available evidence, the Commission can ban a current or former worker or governing person from working in the aged care sector. We can also ban someone who has never worked in aged care on the basis of their lack of suitability (for example, if an NDIS banning order has been made against them). In taking these actions, the Commission strictly observes requirements for procedural fairness.

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

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

To date, banning orders have been issued to 48 individuals who are prevented from providing any type of aged care for varying periods. 

We remind all providers to check the banning orders register on our website to see if someone they are looking to employ or engage (including as a volunteer) has been banned from providing aged care.

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

Strengthening provider governance in aged care

Changes are being made to enable greater transparency by aged care providers and services. Specifically, residential care, home care and transition care providers are now required to report information on their operations annually to the Department of Health and Aged Care.

The reporting period begins on 1 July and ends on 30 June every year. To meet the deadline for submissions, providers need to lodge their information by 31 October.

The first reporting period for this new requirement is 1 July 2022 to 30 June 2023, with reporting due on 31 October 2023.

Residential and home care

Residential care and home care providers will report through the Provider Operations Collection Form now available through Government Provider Management System. They will need to report on:

• a statement signed by the governing body
• diversity information
• the most common kinds of feedback and complaints they received by each service
• key improvements made to service quality
• information on the members of their governing body
• any individual who holds an executive position in the organisation (such as the CEO) for publication on My Aged Care.

Transition care

Transition care providers will report through the Transition Care Annual Accountability Report. They will need to report on:

• the most common kinds of feedback and complaints they received by each service
• key improvements they’ve made to service quality.

You can find more information on the changes to provider governance on the Department’s Stronger provider governance in aged care webpage.

A short primer on star ratings

Star Ratings were introduced in December 2022 for all residential aged care services.

The ratings make it easier for someone who is looking for, or already accessing, aged care services to compare the quality and safety of aged care homes.

What do the Star Ratings mean?

All homes now receive an overall Star Rating on a scale of 1 to 5 stars:

• 1 star means ‘significant improvement needed’
• 2 stars mean ‘improvement needed’
• 3 stars mean an ‘acceptable’ quality of care
• 4 stars mean a ‘good’ quality of care
• 5 stars mean an ‘excellent’ quality of care.

How are the ratings calculated?

The overall Star Rating is calculated from an aged care home’s ratings across 4 performance sub-categories. These are nationally consistent quality measures used to monitor, compare and improve residential aged care.

1. Residents’ Experience (33% of overall Star Rating) – this rating is based on a survey of 10% of residents about their experiences of the aged care home.
2. Compliance (30%) – this rating is based on non-compliance decisions the Commission makes.
3. Staffing (22%) – this rating is based on the average amount of care time each resident receives from nursing or personal care staff, compared with the average care targets that the Australian Government sets.
4. Quality Measures (15%) – this rating is based on information (quality indicator data reported by providers) about 5 crucial areas of care – falls and major injury, unplanned weight loss, pressure injuries, medication management and the use of physical restraint.

The overall Star Rating is recalculated automatically when new data is available. The Compliance sub-category rating is updated daily, Staffing and Quality Measures 4 times a year and Residents’ Experience once a year.

More information

Star Ratings are available through the ‘Find a provider’ tool on the My Aged Care website.

For further information about the Compliance sub-category rating which we oversee, visit our Star Ratings webpage.

The Department of Health and Aged Care manages the other 3 sub-categories and the Star Ratings system. If you want more information, you can find resources about the Star Ratings on the Department’s website.

Updated Sector Code for Visiting in Aged Care Homes

Having endured the very significant challenges posed by the pandemic, residential aged care providers are now very aware of the physical, psychosocial and nutritional impacts on older people if they go through extended periods of social isolation. These impacts can be profound, and must be heavily weighted in all decisions made by providers about how they respond to an infectious disease outbreak. 

To provide clear guidance where directions from local state or territory public health authorities are not available, 12 aged care consumer and provider organisations have developed an updated version of the Sector Code for Visiting in Aged Care Homes version 7.2 (the Code). The Code outlines a nationally consistent approach that enables residents to receive visitors while minimising the risk of COVID-19 and other respiratory diseases.

The Code provides guidance for aged care homes, including providers of the Transition Care Programme, Multi-Purpose Services and National Aboriginal and Torres Strait Islander Flexible Aged Care Program.

People who have tested positive for COVID-19 must not visit high-risk settings such as residential aged care homes for at least 7 days and until they have no symptoms.

Visit OPAN’s website for further information about the Code.

Food, nutrition and dining

Food, Nutrition and Dining Hotline

The Food, Nutrition and Dining (FND) Hotline went live on Friday 28 July 2023.

The FND Hotline can be accessed on 1800 844 044 and will operate from 9am to 5pm AEST, Monday to Friday.

Dietitians and speech pathologists from the Commission’s Food, Nutrition and Dining Unit will support our Customer Contact Team in triaging and responding to enquiries received via the Hotline.

Aged care consumers and their representatives, approved providers and aged care staff can call the Hotline with enquiries, questions, concerns and complaints relating to food, nutrition and dining.  While the Hotline staff won’t provide individual dietary advice or recommend allied health professionals, they will be happy to respond to questions about, for example, nutrition, particular foods, menus, and how consumers and providers can work together to improve the consumers’ overall dining experience.

Those calling about a complaints matter will continue to be assisted by our Complaints team who will now be supported by the Commission’s newly established FND Unit to assess clinical risk, quality of life and seek information on contemporary best practice guidelines.

We look forward to working with the sector to improve the food and dining experience of older Australians receiving aged care. As all of us know, good food, nutrition and dining in aged care is a key contributor to individual wellbeing and quality of life.

We encourage you to check our website and social media channels regularly for information, resources and updates on both the work of the Food, Dining and Nutrition Unit and hotline.

Oral and dental health and its impact on eating and nutrition – Webinar

Friday 11 August, 2.30pm – 3.30pm AEST

This webinar is the fourth in our series on Food, Nutrition and Dining.

Join us to learn more about:

• common oral health problems and the impact on the dining experience
• signs of oral and dental issues
• the role of oral health in nutrition
• best practices for good routine oral and dental care including in a dementia setting.

Panellists will include Dr Melanie Wroth, Chief Clinical Advisor, Aged Care Quality and Safety Commission; Honorary Professor Janet Wallace, College of Health, Medicine and Wellbeing, University of Newcastle; Nick Greer, Director, Australian Dental Prosthetists Association, and Dr Janani Ravichandran, Oral Health Promoter, Australian Dental Association.

Registrations are now open.

We want to hear from you!

Listening carefully to the voices of people receiving aged care is vitally important when it comes to improving their care experiences and outcomes. Promoting feedback from consumers and supporting their involvement in co-designing a service’s meal arrangements are additional areas that the Commission is keen to work on with residential service providers.

For example, we are interested to learn how residential aged care services have brought about change by implementing food focus groups (or designated food committees), where residents are provided with an opportunity to inform, guide and evaluate quality improvement initiatives.

There are many different models and ways this can be done, and we want to hear about them!

Our survey will take around 5 minutes to fill in and all responses will be confidential unless you choose to provide your contact details. One of the benefits for us if you do include your details is that we can get in touch to hear more about initiatives that you are especially proud of. The survey closes on Friday 4 August 2023.

Thank you in advance for your valuable insights. We will use your input to guide the development of our education resources and guidance materials.

If you have any questions about this survey, please contact us at info@agedcarequality.gov.au.

Clinical update

The power of words and insight: caring for people living with dementia

When a person living with dementia loses the ability to communicate effectively with verbal language, attend to their own needs or solve their own problems, they may show they are distressed in different ways. Others may see these behaviours as irrational or problematic and try to contain them. But such behaviours may be the person’s only way of communicating their pain, frustration, loneliness or fear.

The words we use to describe both the condition of dementia itself and a person’s behaviours are as important as the actions and responses we choose. Our responses as carers should be compassionate, person-centred and based on knowledge of the individual.

You can read more about the language we use around dementia and find links to resources on our website.

National Pain Week –‘painchanger’ 

National Pain Week (24–30 July 2023) is Australia’s annual awareness event for chronic pain.  

The Commission and Chronic Pain Australia took this opportunity to focus attention on the experiences of people living with chronic pain, particularly older Australians. There are many useful resources and tools available to support those living with chronic pain. People often describe trying a new pain management tool as a ‘gamechanger’. Chronic Pain Australia came up with ‘painchanger’ as a play on words for this year’s theme. 

According to PainAustralia ‘older people and those living with a disability have the highest rates of chronic pain in our community. One in 3 people aged over 65 are living with chronic pain. In residential aged care, 92% of people are taking at least one analgesic medication daily and 80% of people report pain as a problem.’ 

We encourage clinical staff and providers to consider the range of options often available for assisting someone in managing their pain that can include non-pharmacological alternatives. If analgesic medication is required or prescribed, combining the medication with non-medication based approaches to pain management may allow you to use lower doses. This in turn can reduce side effects. 

More information 

The Australian Pain Society’s Pain in Residential Aged Care Facilities: Management Strategies, 2nd Edition – Resources can be used alongside the PMG Kit for Aged Care.

The Australian Pain Society’s Key principles for managing pain in older people  is also a useful resource.

Webinars

Financial and prudential regulation

Tuesday 15 August, 1.00pm – 2.00pm AEST

Join us on 15 August for this informative webinar on financial and prudential regulation in aged care. You will hear about our Financial and Prudential Regulation team, the activities we undertake, and how and when you may be engaged as a provider. Also covered will be our approach to compliance and risk assessment, with case studies provided.

Register now

Recording available – Compliance in practice

The recording and presentation slides from our Compliance in practice webinar held on 18 July are now available.

Through our contact with providers, the Commission is aware that providers have different levels of understanding about why, when, and how the Commission exercises its enforcement powers. In this webinar we explain the process we follow before we decide to take formal regulatory action, and what a provider can expect when we do that. The webinar included a Q&A session with panellists.

Recording available – Stronger Standards Better Aged Care program

The recording and presentation slides from the Stronger Standards Better Aged Care program webinar held on 20 June 2023 are now available.

Governing for Reform

The Governing for Reform in Aged Care program is currently seeking expressions of interest for its free coaching program for small, medium, regional and remote aged care providers. The coaching program provides the opportunity for your governing body and executive team to come together and:

• discuss sector-based governance requirements as they apply to the needs of your specific provider
• focus on continuous improvement as a board
• stay up to date with contemporary best practice.

The coaching program consists of a series of dedicated sessions specifically tailored to the issues relevant to your organisation and is facilitated by a governance and aged care specialist.

There are limited places available so please don’t dawdle if you would like to register your organisation’s interest.

Training and resources

Introduction to the SIRS Module

The Commission has a new online module available now on Aged Care Learning Information Solution (Alis). The module introduces the Serious Incident Response Scheme (SIRS), effective incident management and reportable incidents. It also includes a suite of learning modules that include key concepts about provider requirements for: a best practice effective incident management system which supports prevention, response to and management of incidents and near misses; and reporting incidents to the Commission.  

Keep your eye out for more modules in the series which will be released over the coming months. All modules are available on Alis which aged care providers and workers can access for free, anywhere and at any time. 

OPAN Planning for Diversity workshops

Supporting care recipients to have a good experience of aged care is not possible if a provider doesn’t know what matters to those people as individuals, including their cultural identity. 

Free workshops are being offered to individual providers by the Older Persons Advocacy Network (OPAN) on Planning for Diversity. These workshops are designed to offer strategies, local diversity data insights, and tools to support providers to deliver safe and inclusive services for older people.

The workshop series is aimed at the person in your organisation who is responsible for quality improvement, service planning or compliance.

The workshops will help you to:

• differentiate your service to better engage older people and families from diverse groups
• identify and address barriers for older people who are missing out
• show you’re working towards Aged Care Quality Standards and your commitment to the Charter of Aged Care Rights
• find specific actions and embed diversity within continuous improvement processes.

Workshops are rolling out Australia-wide and OPAN is currently enrolling for NSW, ACT and NT. You can check upcoming dates or make an enquiry for other states on the OPAN website.

Online workshops for approved providers

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

Upcoming workshops in August include:

• The Serious Incident Response Scheme (SIRS) within residential and home services
• Residential Services – Monitor and assess the performance of your service
• Effective Incident Management Systems
• Understanding the Quality Standards.

Visit our Workshops webpage for further information and registration details.

New resources

• Volunteers in Aged Care
• Self assessment checklists
• Language and responding to behaviours while caring for people living with dementia