Aged Care Quality Bulletin #71 - November 2024

Commissioner’s message

This week heralded the passage of the Aged Care Act 2024 in Parliament, paving the way for a new era in aged care in Australia that firmly places person-centred and rights-based care at the forefront. You can read the statement issued by the Minister for Aged Care, the Hon Anika Wells MP.

The new Aged Care Act will 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.

The new Act introduces a rights-based framework for the delivery of aged care which focuses on the people accessing funded aged care services, and their rights in relation to that care.

For the Commission, the new Act means a new regulatory framework which includes a clear, comprehensive set of obligations for providers and a more flexible and streamlined suite of powers for the Commission. This will enable us to more effectively incentivise providers to improve their performance while also holding them to account through provider supervision, as supported by our Regulatory Strategy 2024–25.

Further information on the new Act is available on the Department of Health and Aged Care’s website.

To support the sector and the broader community, we have published a new section on our website called Changing aged care for the better. In this section you will find information for older people, providers and workers.

We will continue to expand this section as new information, resources and guidance becomes available. I encourage all providers to familiarise themselves with the information here as it will help to prepare you and your services for the incoming changes. Also, keep an eye out for advice on the sector webinars that the Commission will be offering in the first half of next year to help providers get ready for the new regulatory requirements under the new Act.

A particular regulatory focus for the Commission this month has been on provider performance in delivering care minutes targets in residential aged care. This included a webinar on Workforce responsibilities – the key to delivering a great aged care experience and our November Compliance Management Insights.

Mandatory care minutes ensure that older people in aged care homes receive the dedicated care time they need. These targets complement existing provider obligations (under the Aged Care Quality Standards) to maintain an adequate number of appropriately skilled staff to ensure that residents receive safe, respectful, quality care and services. The care minutes targets also complement the 24/7 registered nurse (RN) responsibility introduced on 1 July 2023.

If you missed it, I encourage you to watch the recording of our November webinar on workforce responsibilities and read our latest Compliance Management Insights. All residential aged care providers are also encouraged to read our updated regulatory bulletin on workforce-related responsibilities, which explains our regulatory approach to the 24/7 RN and new care minutes responsibilities.

As temperatures start to heat up around the country, now is the time to check your plans for heatwaves and other extreme events. Being prepared is vital to make sure that older people receive continuity of care and services.

Advice from the Bureau of Meteorology is that there is a high risk of heatwaves, bushfires, flooding and tropical cyclones during this summer. Planning and preparing for emergency events can reduce the impact on older people receiving care, and on staff. Aged care providers must have effective plans ready and must also have ‘rehearsed’ them. This is especially important for providers of residential aged care services. Older people receiving home services and living alone may also be vulnerable.

As part of your preparation, I encourage you to look up your state or territory and local government emergency management arrangements. The department has also published resources to help services provide continuity of care and providers to prepare for emergencies.

This is also a timely reminder for providers and staff to be alert to the greater risks of heat-related illness among older people in their care. Read our latest clinical alert about preparing for summer and preventing heat-related illness. Clinical signs of heat-related illness include confusion and clinical deterioration. This can quickly lead to serious illness and even death if not recognised early and responded to as a priority.

Staff need to be able to recognise the clinical signs of heat-related illness, be aware of additional risk factors for each resident, and understand the environmental factors that may contribute.

The coming holiday season is also an important time to check the vaccination rates at your service. It is important for providers to make sure that residents are up to date with their COVID-19 vaccinations. With increased travel and visits during the holiday season, there is often a spike in COVID-19 cases among residents and staff. Controlling this risk by arranging timely vaccinations for consenting residents should be a priority for residential providers.

And a reminder for 2025 diaries – please save the dates of Monday 28 to Wednesday 30 July for our National Aged Care Providers Conference 2025! The conference will be held at the Melbourne Convention and Exhibition Centre. We’ll have more to share in the coming months on the exciting Conference program.

Aged care reform update

Public consultation – New Aged Care Act

Parliament passed the Aged Care Bill on 25 November which means the new Aged Care Act can now start from 1 July 2025. This is a big step for everyone connected to aged care. It paves the way for a better system that puts the rights and needs of older people first.

Public consultation continues on the new Aged Care Rules which will provide further detail on how the Act will operate and what the sector will need to do and when. The Department of Health and Aged Care is inviting feedback in stages between now and early 2025. The feedback will help make clear how the Rules will affect older people and the care they receive, ensure the Rules capture feedback from previous consultations and are refined based on new feedback, and allow providers to tell us what they need to help prepare for the new Act. More information about the public consultations is on the Department of Health and Aged Care website.

A new Act was the number one recommendation of the Royal Commission into Aged Care Quality and Safety. It will bring a range of improvements for older people. This includes:

• a new regulatory model
• strengthened Aged Care Quality Standards
• easier entry and access to services.

The new Act also gives older people and their supporters a more independent voice. This will allow them to make their own informed decisions about the care and services they receive and deserve. This includes protections to speak up when you’re not satisfied and better preparing providers to handle complaints effectively.

The Aged Care Quality and Safety Commission will play an important role in preparing the sector for the new Aged Care Act. Under the new legislation, the needs and interests of older people will be at the forefront of our considerations as we undertake our monitoring and compliance activities. This focus will be required and enabled through implementation of the new regulatory model and the new powers established under the Aged Care Complaints Commissioner.

The new Act also marks the launch of the new Support at Home program from 1 July 2025. This will help more older people to live in their own home for longer. It will also get them home modifications and assistive technology so they can do so safely.

Those who need to access aged care services earlier in life will also be better serviced under the new laws. This includes Aboriginal and Torres Strait Islander people and those aged 50 to 64 years who are at risk of, or already experiencing, homelessness.

Under the new Act, the Government will remain the main funder of aged care. For every $1 an aged care resident contributes, the Government on average will contribute $3. There won’t be any new levies or taxes, and nor will there be any changes to means testing of the family home. No one will pay more than $130,000 in non-clinical care costs over their lifetime.

Find out what the new law means for you. 

Read the Minister for Aged Care’s media release. 

Transitioning providers to new registration categories: how will it work?

To support the new Aged Care Act, the Australian Government is introducing a new regulatory model. The new model will include a new provider registration and renewal system.

The Department of Health and Aged Care (department) is working to prepare Australian government-funded aged care providers for the new registration and renewal system ahead of the new Aged Care Act.

The department is moving all current government-funded aged care providers to new registration categories. This process is called deeming. These categories are based on the services that providers deliver or the services they are funded to provide.

To prepare for this, the department has started contacting current providers to confirm their details. Not all providers will be contacted at once.

During this process, current providers will be asked to complete a contact nomination request to confirm their contact details. This will be followed by a deeming validation survey, where providers will be asked to review their proposed registration category or categories.

The department will contact providers to request their contact nomination through a third-party email address, noreply@qemailserver.com. Providers may receive further correspondence about deeming from AgedCareRegModel@health.gov.au. Please keep an eye out for emails from these addresses.

Visit the department’s website for more details on the deeming process.

Changing aged care for the better – new website section

We have a new section on our website dedicated to the changes that will take place with the introduction of the new Aged Care Act in July 2025. In this section we have provided tailored information for older people, providers and workers.

For older people, the information explains what the changes under the Aged Care Act mean in ensuring improved choice and quality of aged care services.

For providers, you can learn more about your obligations and conditions. It is important to understand what these changes are and how they will impact your delivery of aged care services.

For workers, the information has been developed to help them understand how the changes will impact the way they deliver care and services to older people.

We will be updating the information in this new section regularly, including adding guidance materials and other resources as they become available to support sector readiness.

Care minutes – how we’re dealing with continued non-compliance

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 increased 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 are able to meet up to 10% of their RN target with care provided by an enrolled nurse.

In our November Compliance Management Insights, Peter Edwards, Executive Director, Compliance Management Group, talks about residential aged care providers and their obligation to meet care minutes targets. We’re closely monitoring and supervising providers that are demonstrating continued non-compliance with this obligation.

Care minutes is the minimum target all providers must meet for how much care each resident receives each day. Without the right number and mix of staff, the care that’s delivered can be rushed. Residents’ needs can end up not being fully met. This causes quality and safety issues for residents. We know from speaking to workers that this is also stressful for them. They feel that they’re not able to give the people they care for the time and attention they deserve.

Through daily contact with providers across the country, we know that many providers are actively working to meet their care minutes targets. They’re showing us evidence of the work they’re doing on this, and many who have a shortfall are making progress on addressing it. 

However, there are providers with residential services that are still a long way from meeting their minimum care minutes targets. These providers aren’t able to show that issues with workforce availability or financial viability are major contributing factors to their continued non-compliance. These are the providers that need increased monitoring and supervision by the Commission.

Where residential aged care providers are actively working towards complying with their care requirements and can demonstrate that they are taking all steps to ensure the provision of safe and quality care, the Commission will continue to take a fair and sensible approach to actively monitor risks and confirm that the provider is making appropriate progress towards compliance.

However, where a provider is not making genuine efforts to meet their care minutes requirements or where we encounter resistance, we will take enforceable regulatory action to compel compliant behaviour. A provider that fails to meet their commitments under an enforceable plan can expect to be subject to a sanction or civil penalty.

Read more in our full post.

Protecting people in your care from COVID-19

As the festive season approaches, the Department of Health and Aged Care has written an open letter to all aged care providers about the ongoing risks of COVID-19 to older people receiving care.

Worryingly, overall vaccination rates are low. Yet it is well known that older age is still the biggest risk factor for severe illness from COVID-19, and vaccination is the most important way to protect against severe disease from COVID-19. The way forward is both clear and urgent.

Providers must make sure that residents are up to date with their COVID-19 vaccinations. With increased travel and visits during the holiday season there is often a spike in COVID-19 cases among residents and staff. It’s also important to start planning early for 2025 COVID-19 and influenza vaccination clinics ahead of winter.

General practitioners and pharmacists primarily administer COVID-19 vaccines in residential aged care homes, with funding available for these services. If you don’t have an existing relationship with a GP or pharmacist, we encourage you to engage with your Primary Health Network (PHN) for assistance.

If you need further information or help with booking a clinic, email RACFVaccineClinics@health.gov.au.

COVID-19 vaccinations are free and recommended every 12 months for people aged 65 and over, and every 6 months for those aged 75 and over or with severe immunocompromise. Importantly, this schedule applies irrespective of when an older person last had COVID-19.

Aged care homes are responsible for supporting residents to access vaccinations and oral antivirals, and for maintaining effective infection prevention and control.

Providers are encouraged to read our Regulatory Bulletin on COVID-19 vaccination in residential aged care homes. It explains providers’ responsibilities and details how we are regulating these responsibilities and responding to providers found to be non-compliant.

Accommodation options for younger people

The Australian Government is working to avoid the need for people under 65 years old to go into residential aged care. The Government wants to help them find suitable, age-appropriate accommodation and support.

The number of younger people living in residential aged care has reduced from more than 6,000 in 2017–18 to 1,381 in March 2024 (excluding Aboriginal and Torres Strait Islander people aged 50 to 64 years).

If you work with younger people who need complex care, there are several ways you can help them find suitable accommodation and supports, including:

1. the Am I eligible checklist or ask for access to the National Disability Insurance Scheme (NDIS)
2. talking to an Ability First Australia (AFA) Younger People in Residential Aged Care (YPIRAC) System Coordinator
3. discussing goals and options with an NDIS support coordinator, NDIS planner or AFA YPIRAC System Coordinator.

Whether a younger person is living in, or considering an aged care home, they have options to find the right home for their needs.

Help for younger people

A younger person should only be in a residential aged care in exceptional circumstances.

An AFA YPIRAC System Coordinator can help a younger person to:

• navigate the disability, housing, health and aged care systems
• find alternative accommodation and support services to meet their needs
• test their NDIS eligibility
• move from an aged care home.

The AFA YPIRAC System Coordinator Program helps younger people to get the support they need to access and live in suitable accommodation. Call 1800 771 663 or email enquiries@abilityfirstypirac.org.au for more information.

Food, nutrition and dining

Menu and Mealtime Review Program EOI – round 2

To support improvements to food, nutrition and dining in residential aged care, the Commission and the Department of Health and Aged Care have partnered to deliver a free national Menu and Mealtime Review Program for residential aged care services. Up to 500 aged care services in 2024–2025 will be supported with expert assessment and recommendations from independent, accredited practising dietitians.

Expressions of interest are currently open for the second round, closing 4 December 2024.

The program:

• is completely free and confidential
• is run onsite by an accredited practising dietitian
• provides tailored feedback and recommendations.

Only residential aged care services are eligible for this program. We will prioritise providers that:

• are in small rural towns, remote communities and very remote communities
• are under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program
• are small (with 1–2 services) and medium (with 3–10 services)
• operate smaller services (with 60 or fewer residents)
• have services with a score lower than 3 on the Residents’ Experience Survey question - ‘Do you like the food here?’

We invite residential aged care services wanting to take part in this tailored educational program to submit an expression of interest (EOI). EOI’s close on 4 December 2024.

For more information and to express your interest, please visit our website.

More than a meal: thoughtful menus transforming residential mealtimes

In residential aged care, food is more than nourishment. It’s a source of comfort, connection and pleasure for residents. Menus must be well-designed and focus on nutrition, taste, variety and choice. Food is vital for improving residents’ health, wellbeing and quality of life.

Many aged care homes work with dietitians to conduct regular menu assessments. These dietitians provide expert feedback and recommendations to improve dining experiences. They ensure menus are nutritious, offer variety and provide adequate opportunities to consume fluids across the day.

Dietitians use relevant, evidence-based and best practice guidelines to assess the menu. To evaluate and support choice, they talk to residents and kitchen staff to understand preferences and needs. Management can then expect to receive a report from the dietitian. It will outline actions to support choice and achieve adequate quality, quantity and variety of meals.

Involving various professionals such as allied health staff, hospitality staff, chefs and cooks, as well as food service experts to support training, can provide the skills and knowledge needed by staff to provide an enjoyable dining experience for all residents.

All staff play a critical role in creating a positive dining experience. Many services offer nutrition and hospitality training that covers:

• food safety basics when preparing food and drinks
• table setting techniques that create a welcoming environment
• serving techniques, such as when to deliver each course
• meal fortification techniques to boost the nutrition of food and drinks
• skill building to support residents with eating difficulties or special diets.

You can read more in our full article.

Clinical update

Summer alert 2024/2025

Summer is around the corner – and aged care providers and staff need to be alert to the greater risks of heat-related illness among older people in their care.

Heat-related illness can be very serious and progress quickly in older people – to confusion, clinical deterioration and even death – if not recognised early and responded to as a priority.

Older people are at increased risk of heat-related illness

Older people tend to be at increased risk of heat-related illness for several reasons. These include ageing-related physiological changes, the greater likelihood of having multiple chronic illnesses, and their use of certain medications.

Additional risk factors

Certain groups of older people are at additional risk, including:

• those who are frail or have a low body mass – who may heat up more easily
• those with dementia – who may not plan well or remember to drink regularly or recognise that they are heating up
• those who struggle to maintain good hydration – such as those eating modified diets (including thickened fluids), on a fluid restriction and/or taking diuretic medications to reduce fluid retention
• those with mobility and other functional problems – such as those who can't independently move into the shade or a cooler space or who can't remove their outer clothing or bedding when they're feeling hot.

Environmental awareness and temperature changes

Providers should also be aware of environmental risks such as:

• buildings or internal areas which can't be airconditioned or easily cooled
• indoor areas where the sun’s radiant heat shines through glass
• outdoor areas which change from shade to full sun as the sun moves across the day and are not able to benefit from cooling breezes
• outdoor areas which are hidden from view.

Staff working in residential aged care homes should be mindful of the temperatures in their surroundings at different times and locations within the home and its grounds, the locations of residents at all times, and of the suitability of clothing that the older person is wearing.

During the warmer summer months, staff should be reminded to:

• monitor and ensure the adequacy of the fluid intake of vulnerable residents
• encourage more frequent drinking of fluids
• be aware of the signs of dehydration – including a dry mouth and tongue, heat rash, and less frequent toileting/less heavy incontinence pads
• respond as a priority to residents who say they are, or appear to be hot or thirsty
• offer lukewarm (not cold) sponging or showering to assist in cooling residents
• remind and assist residents with sunscreen, hats and protective clothing if sun exposure is possible
• avoid sun exposure on very hot days – particularly for older people who may be reluctant to return indoors when encouraged to do so.  

The Department of Health and Aged Care has checklists about caring for older people in warm weather – specifically for residential aged care and for home services providers.

Further information on our website 

Keep your fluids up! 

Thickened fluids: Supporting choice, nutrition, hydration and safety 

Caring for older people in hot weather 

World AMR Awareness Week 2024: Educate. Advocate. Act now.

World Antimicrobial Resistance Awareness Week (WAAW) (18–24 November) is held each year to highlight the threat posed by antimicrobial resistance (AMR), and to promote best practices to reduce the spread of drug-resistant bugs.

Rates of AMR for organisms including Staphylococcus aureus (golden staph), and Escherichia coli (E. coli) are higher in aged care services.

AMR happens when bacteria, viruses, fungi, and parasites no longer respond to antimicrobials. As a result, antibiotics and other antimicrobial medicines no longer work. This increases the risk of the spread of disease, severe illness and death.

The Commission is a champion of WAAW in Australia. Efforts in educating, advocating, and acting to reduce inappropriate use of antimicrobials and prevent AMR are ongoing. We create resources and programs to support providers, clinicians, and carers in using antimicrobials effectively in aged care.

We recently published an article sharing the findings of a new report by the Australian Commission on Safety and Quality in Health Care. The report showed that there was an overall increase in these medicines being prescribed to people over 65. This level is even higher for people living in aged care homes.

AMR in aged care needs strong, reliable infection prevention and control measures and a planned AMS response. This is reflected in the new draft strengthened standard 5: clinical care.

More information from the Australian Commission on Safety and Quality in Health Care

Antimicrobial use in the community: 2023 | Australian Commission on Safety and Quality in Health Care

Sustainable glove use for healthcare workers - fact sheet

Clostridioides difficile infection (CDI) - Information for primary health providers

AMR Quiz

Put your AMR knowledge to the test! There are 2 interactive AMR quizzes – one for clinicians and one for carers and general staff. Bring your team together at your next team meeting to complete the quiz:

• Carer Quiz
• Clinician Quiz.

Webinars

Recording available – Workforce responsibilities – the key to delivering a great aged care experience

The recording is now available from our 19 November 2024 webinar. Hosted by Commissioner Janet Anderson PSM, this webinar explored providers’ workforce responsibilities with a focus on care minutes responsibilities. Our panel discussed the regulatory approach to provider non-compliance, and guidance for providers to embed effective workforce governance and management processes.

All older people receiving aged care should have confidence that they will receive safe, high-quality care and services that meet their changing needs. It’s vital that providers understand their workforce responsibilities to make sure that they can deliver on this reasonable expectation.

Training and resources

Online workshops for approved providers

Places are available for our upcoming workshop in December. 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.

Our workshop topic for December is:

• Strengthened Quality Standards in practice – learn about the new strengthened quality standards and how you can start preparing for their implementation.

Our 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. Workshop dates for 2025 will also be added and updated on this page.

Strengthened Quality Standards online learning modules

We’ve created a series of online learning modules to help aged care workers understand what is expected of them under the strengthened Aged Care Quality Standards.

The strengthened Quality Standards will be introduced with the new Aged Care Act from 1 July 2025. It’s important that everyone involved in delivering aged care understands the changes and what they need to do to provide care that meets the new requirements. These short, introductory modules will support workers to understand and comply with the strengthened Quality Standards.

The 8 learning modules provide an overview of the strengthened Quality Standards, including an introduction module and a module for each of the 7 standards.

Each module explores the outcomes and key topics in a different standard and provides examples of how to apply the key topics in practice.

The strengthened Quality Standards modules are available on our online learning platform, Alis. To register for Alis or to find out more, go to our website.

New resources

• Updated Regulatory Bulletin – Workforce-related responsibilities
• Compliance Management Insights – November 2024
• Letter from the Commissioner – Preparing for the high-risk weather season 2024-25
• Summer clinical alert 2024 / 2025