Aged Care Quality Bulletin #57 - September 2023
Commissioner’s message
Reforms that are likely to be front of mind for residential aged care providers at the moment include the new workforce-related responsibilities. The provisions regarding 24/7 registered nurse cover that were introduced from 1 July will be added to from 1 October when providers must meet minimum care minutes targets.
Both of these reforms were key recommendations from the Royal Commission into Aged Care Quality and Safety’s Final Report. They are aimed at giving residents (and their families) greater confidence that their care needs, including their clinical needs, will be met. You can read more about these responsibilities in our Regulatory Bulletin on Workforce-related responsibilities.
This month we released our Sector Performance Report for the final quarter of 2022–23, which we also used as an opportunity to review the full year. The report provides an overview of how the sector is performing through the lens of our regulatory and complaints resolution activities. It includes insights on the most common types of complaints we receive about residential and home services respectively, as well as the most frequently identified areas of non-compliance. This report also provides early data on Serious Incident Response Scheme notifications received from home services.
Like all organisations, the Commission has been busy finalising our planning for this financial year, and we have now published our Corporate Plan 2023–24 which captures the priorities and objectives that we expect to deliver this year. The document also looks forward (at a high level) over the next 3 years, seeking to connect our strategic direction, priorities, key activities and performance so that we can continue to meet government, sector and community expectations. The second half of the document (from page 49 onwards) presents our Annual Operational Plan 2023–24, setting out 26 actions and 96 deliverables for this year.
Together these 2 documents outline the significant changes being pursued by the Commission alongside providers as we work on strengthening our capabilities as an effective, accountable regulator and preparing ourselves, and the sector, for the proposed new Aged Care Act.
We are now approaching the national referendum to decide whether to alter the Constitution to recognise the First Peoples of Australia by establishing an Aboriginal and Torres Strait Islander Voice. I was pleased to work with the Australian Electoral Commission (AEC) to co-author a joint letter to residential aged care providers outlining the importance of supporting residents and AEC staff, who will be providing mobile polling in aged care services, to make sure everyone can vote and follow processes to keep people safe.
The referendum and access to residential services
On 14 October, Australians will have their say in a referendum about whether to change the Constitution to recognise the First Peoples of Australia through an Aboriginal and Torres Strait Islander Voice.
A joint letter from the Australian Electoral Commission (AEC) and the Aged Care Quality and Safety Commission is being provided to residential aged care homes that are receiving the AEC’s mobile polling service.
The letter, which outlines the COVID-19 and influenza safety requirements for AEC staff conducting mobile polling, aims to streamline requirements to assist AEC staff to access residential aged care services.
The AEC worked with the Department of Health and Aged Care to determine the appropriate COVID-19 safety measures for AEC staff prior to entering residential aged care homes to provide in-person voting services.
The AEC will ensure that mobile polling staff are:
up to date with their COVID-19 vaccinations
have a current influenza vaccination
have a negative rapid antigen test (RAT) result each day prior to entering an aged care home
wear face masks while onsite
not attending a facility if they have cold and flu symptoms or are unwell.
The mobile polling teams will provide a copy of the letter to the staff upon their arrival on mobile polling day.
For further information on the AEC processes and requirements, call the AEC on 13 23 26.
Our reports
Sector performance – latest insights
The Commission’s latest aged care Sector Performance Report is now available. The report includes data from the April to June 2023 quarter and the financial year as a whole.
The report uses our regulatory and complaints data to provide information and insights on aged care performance. This helps providers to assess their own performance and identify areas where they can improve.
Key information in this quarter’s report includes:
Serious Incident Response Scheme (SIRS)
The report includes home services data on SIRS notifications for the first time. The SIRS was extended to home services in December 2022.
The early volume of notifications received has been relatively low and we expect the monthly numbers to grow over time as home services providers and workers become more familiar with their notification responsibilities.
Service accreditation
There has been an encouraging reduction in findings of non-compliance in residential services and an increase in the proportion of services receiving 3 years’ accreditation.
Reasons for this include prioritising higher risk services for reaccreditation audits in 2021–22, which meant that a higher proportion of services audited in 2022–23 were lower-risk. We have also been working with providers to encourage them to fix lower risk non-compliance earlier. This has been well received and has meant that fewer services have faced formal regulatory action.
Governance
There has been an increase in findings of non-compliance in relation to Quality Standard 8 –organisational governance. We are closely monitoring providers’ governance arrangements, and are also supporting sector leaders to strengthen their capability in this area through our Governing for Reform program. Additional provider governance and reporting responsibilities will start in December 2023.
Complaints
Complaints about workforce have increased. The number and quality of staff is now the second most complained about issue in residential care. Complaints about staff behaviour and conduct also made it into the top 10 issues.
Consistent with past quarters, the most common complaints in home services were about consultation and communication; fees and charges; and other financial issues.
Enriching life through care: our response
Understanding how providers operate in a challenging environment is important to us. This information helps us support services to provide safe and quality care.
To get the views and experiences of providers, we held the Enriching Life Through Care roundtable program in 2022. The roundtables gave us an opportunity to hear firsthand how providers are responding to older Australians who want different and better aged care. They also gave us insight into providers’ experiences of working with us.
In this video, Assistant Commissioner Lisa Peterson PSM shares some of the key things we learned through the roundtables, and what we’re doing in response, under 4 themes:
Connecting with the Commission and sharing good practice
Building capability through communication and education
Reaccreditation audits for residential aged care and quality audits for home services
Reflecting on how we understand sector performance.
Want to know more?
The Enriching life through care – case studies report shares the creative and practical ways that providers are transforming aged care for older Australians.
You can also find key learnings from the roundtables, shared by more than 320 people from across the aged care sector, in our Enriching life through care national roundtable program final report.
Aged care reforms update
Care minutes responsibilities from 1 October 2023
The second stage of the mandatory clinical care responsibilities for residential aged care providers starts next month.
From 1 October, residential aged care providers must meet care minutes targets. These targets are for the care time residents receive from:
registered nurses (RNs)
enrolled nurses
personal care workers.
The care minutes targets follow the introduction of the 24/7 RN responsibility, which started on 1 July this year. Both the 24/7 RN and care minutes responsibilities were key recommendations made by the Royal Commission into Aged Care Quality and Safety.
The care minute targets are based on a resident’s Australian National Aged Care Classification (AN-ACC). Average care minutes targets for a residential service will reflect the care needs of residents in that service. They will be calculated on the amount of direct care time a resident would be expected to need over 24 hours.
Care minutes are expected to average about 200 minutes a day per resident, with 40 of these minutes being delivered by a registered nurse. The average care minutes targets will increase from 200 to 215 minutes from 1 October 2024.
View your service’s care minutes targets
Residential aged care providers can now view the care minutes targets for their service for the October–December 2023 quarter in the My Aged Care service and support portal.
A list of service level care minutes targets is also available on the Department of Health and Aged Care’s website. This list will be updated each quarter.
See the Department’s website for more information on care minutes. You can also view the department’s Mandatory care minutes webinar that was held on 5 September 2023. The Commission’s Peter Edwards, Executive Director Compliance Management also spoke at this webinar about our regulatory approach.
Our regulatory approach
The Commission’s role is to monitor, identify and respond to areas of risk to people receiving aged care and where we find providers are not complying with their responsibilities.
Our focus is on making sure that an older person’s care is safe and high quality. The onsite availability of RNs and the delivery of minimum care time are important to providing safe and quality care.
You can read more about these responsibilities and the Commission’s regulatory approach in our Workforce-related responsibilities Regulatory Bulletin.
Update on 24/7 RN coverage
Every residential aged care home across Australia must now have a registered nurse (RN) available 24 hours a day, every day of the week, unless they have an exemption. This helps ensure that people living in aged care homes have access to the care they need, when they need it.
The Department of Health and Aged Care has published a list that shows how each aged care home in Australia is meeting their 24/7 RN cover responsibility. You can view this by visiting the Registered nurse coverage in residential aged care by facility page.
Other helpful resources include:
Registered nurse coverage in residential aged care dashboard which shows 24/7 RN coverage by state and territory (updated monthly)
Approved providers with an exemption from the 24/7 registered nurse responsibility (updated monthly)
24/7 registered nurse responsibility the department’s overview
24/7 registered nurses in aged care homes fact sheet for older people
24/7 registered nurse cover and care minutes which lists and links to all our 24/7 RN resources.
Provider governance
The provider governance reforms introduced in December 2022 strengthen and complement the responsibilities providers already have for delivery of safe and quality care and services, as set out in Standard 8 of the Quality Standards.
From 1 December 2022, all approved providers must be meeting the reporting obligations for material changes, for example a change in key personnel or the subcontracting out of care services.
If you are a corporation, this includes the obligation of your key personnel to notify you of changes to their suitability to remain in that role:
the provider must also assess the suitability of your key personnel at least once a year, and
report on your operations through an annual statement.
From 1 December 2023, these obligations will expand and all approved providers must also:
ensure your governing body has a majority of independent non-executive members and at least one member with experience providing clinical care
establish and continue operating a quality care advisory body
offer consumers and their representatives annually the opportunity to establish one or more consumer advisory bodies
ensure your staff are skilled and build your service capability
prioritise older Australians (not the holding company) if the organisation is a wholly-owned subsidiary owned by another body corporate.
The Commission held a webinar on 19 September focused on provider governance responsibilities. You can watch the recording and view the presentation on our website.
The webinar included a discussion on different scenarios to assist providers to understand their obligations. Below is one example.
Provider A is an organisation providing care to more than 50 older people. It has only 3 people on its Board. Does it need to comply with the governing body requirements or is it exempt?
The Aged Care Act 1997 provides that the governing body responsibilities do not apply to an approved provider where the governing body has fewer than 5 members, and provides aged care services to fewer than 40 care recipients (see section 63-1D(3) of the Aged Care Act).
The Act requires a provider to satisfy both these conditions at the same time for this provision to apply. For clarity, if both conditions are satisfied, the provider is not obliged to have a majority of independent non-executive members or at least one member with experience providing clinical care.
Given that Provider A has over 50 care recipients, it does not satisfy one of the 2 conditions and therefore is expected to comply with the governing body requirements.
However, there is another provision in the Act that is also relevant here. If the provider believes that other circumstances are present that may impede its ability to meet the governing body responsibilities, it could choose to apply to the Commission for a determination (under section 63-1E of the Act) that either one or both membership responsibilities do not apply in respect of its governing body.
To request a determination, approved providers must complete the application form, which is now available on our website.
For more information, visit our provider governance webpage.
Procedural fairness regulatory bulletin
The Commission must provide procedural fairness to a person or provider whose rights or interests may be negatively affected by one of our decisions. This is required under administrative law.
To help everyone to understand what this involves, we have published a Procedural fairness regulatory bulletin. It explains:
what procedural fairness is
the circumstances where we must give procedural fairness
how we provide procedural fairness when making decisions.
The Commission is committed to ensuring that we make decisions and take actions in line with legislative requirements. This includes us giving a person or provider who is affected by our decisions an opportunity to respond to negative information about them that we use in our decision-making process. However, if there is immediate and severe risk to people receiving aged care, we may take action against a person or provider without giving them notice or a chance to respond.
We approach our obligations for ensuring procedural fairness in the context of our primary priority to protect and enhance the safety, health, wellbeing and quality of life of people receiving aged care. Also, our procedural fairness responsibilities increase in proportion to the seriousness of a decision and the impact it will have on a person or provider.
You can read more about procedural fairness in our Applying procedural fairness to regulatory decisions - fact sheet. A fact sheet for aged care workers on procedural fairness and the Code of Conduct will be available shortly.
Financial reports due in October and November
Approved providers have 2 financial reports that are due soon.
For most providers, the Aged Care Financial Report (ACFR) for 2022–23 is due by 31 October 2023. Providers who hold refundable accommodation deposits must also lodge their Annual Prudential Compliance Statement (APCS) as part of the ACFR. The Forms Administration Portal is open now for ACFR submissions.
For all providers, the Quarterly Financial Report (QFR) for quarter 1 of the 2023–24 financial year is due on 4 November 2023.
To meet your financial reporting responsibilities, you should:
audit your accounts early
log into the Forms Administration portal early to check you have access
complete all parts of the financial report relevant to your business
check all documents are complete and uploaded
make sure authorised personnel sign a new declaration form for each financial report submission
submit your completed financial report by the due date.
If you don’t submit a financial report by the due date, you are non-compliant with your approved provider responsibilities. This may mean that the Commission will take regulatory action.
All non-government residential aged care providers must publish their General Purpose Financial Report (GPFR) within 5 months of the end of their financial year. For most providers this will be 30 November 2023.
For more information and help on financial reporting, please visit the Forms Administration webpage.
Share your aged care reform experience
The Department of Health and Aged Care wants to better understand how they can support the aged care sector to implement the changes to aged care. Your input lets them know what they need to do to help you and make sure the changes to aged care are put in place.
From 10 October, you will be able to access the Sector Pulse Survey on the Aged Care Engagement Hub in the Get involved section. In the meantime, you can read a summary of the last survey’s results in the What we’ve heard page of the Hub.
Food, nutrition and dining
Accessing the Food, Nutrition and Dining Hotline
You can call the Commission’s Food, Nutrition and Dining Hotline on 1800 844 044 between 9 am and 5 pm AEST/AEDT, Monday to Friday. People receiving aged care, their representatives, approved providers and aged care staff can call the Hotline with questions and concerns about food, nutrition and dining.
We have created a short video overview about the Hotline for you to share with your executive, staff and residents.
We have also developed 2 fact sheets to help people receiving aged care and providers to understand what the Hotline does, the types of questions or issues we can help with, and what to expect when you call:
‘Do you have questions, concerns or complaints about your food, nutrition and dining in aged care?’ – consumer fact sheet
‘About the Food, Nutrition and Dining Hotline' – provider fact sheet.
Food for thought – Dementia, eating and nutrition
Making sure that people living with dementia get enough daily nutrition can be a challenge for those who care for them. It may be that the individual doesn’t want to sit down to eat at mealtimes, forgets to eat or doesn’t recognise food. Sometimes people can’t remember when or how to eat or what utensils are for. Dementia can also affect the part of the brain that controls taste and smell, and people can lose or misinterpret these senses or develop a taste for strong or unusually flavoured foods and drinks.
In this month’s Food for Thought, we share some ideas to help carers make sure that residents living with dementia get the nutrition and hydration they need, with as much enjoyment as possible.
Tips that can help with common eating issues:
provide easy to chew, finger-sized food for those who don’t like to sit down to eat, may be agitated or distracted, or don’t want help
make sure the food options are from the 5 food groups so there is a range of nutrients, available during, and outside mealtimes
provide a range of menu items for those who find it hard to make choices in advance
allow plenty of time for meals and offer food often instead of waiting for a person to ask for food
when a person is holding a spoon or finger food, gently guide their hand to their own mouth (while also reassuring them if necessary) rather than trying to feed them.
Understanding the needs of each person:
individualise your approach and try different things
document what works and doesn’t work, as well as what has been tried for each person
notice non-verbal signs of likes and dislikes.
Some great ideas in action:
red crockery and contrasting placemats to help identify what table items to use
menu cards with pictures to help identify food items
protein and calorie rich snacks, available day and night using a snack fridge and fruit bowl for residents who struggle to eat at mealtimes
allowing residents to eat while walking or wandering
a bar arrangement so people can eat and drink while standing
adding some herbs and spices to make meals and snacks tastier.
This year’s Dementia Action Week (18–24 September) included World Alzheimer’s Day on Thursday 21 September. The theme for the week was Act Now for a Dementia-Friendly Future. What it underscores is that communities, including residential aged care communities, that take action to become dementia-friendly have less fear and promote a greater understanding of dementia.
If you have a food, nutrition or dining story or idea to share, or creative ideas about caring for people living with dementia, we’d love to hear from you! Please send them through to info@agedcarequality.gov.au.
Webinars
Complaints and continuous improvement in practice
Tuesday 17 October, 1:00 – 2:00 pm AEDT
This webinar will put a spotlight on the Aged Care Quality Standard 6 – Feedback and complaints and discuss what each of the requirements mean in practice for everyone. This includes what consumers, family, and carers should know and look out for, and what best practice looks like for providers and aged care workers.
Recording available – Provider governance
The recording and presentation slides are now available from our 19 September webinar on provider governance. This webinar covered existing provider responsibilities and the provider governance reforms that start on 1 December 2023.
Governing for reform
A shared approach to leadership in aged care – Webinar
As our ageing population becomes more diverse, it becomes even more important for the leaders in aged care to represent the communities they serve. Diversity within governing bodies and among executives can reduce the risk of blind spots in problem-solving and decision making, and open up opportunities for finding new and better ways of meeting the needs of those receiving aged care.
We invite you to attend the webinar Diversity of thought: A shared approach to leadership in aged care, on Wednesday 11 October 2023 at 12 pm AEDT.
In this webinar, leaders and subject matter experts will look at the benefits of promoting diversity in leadership, and will share strategies to partner with people receiving aged care and staff to make the most of diverse perspectives and expertise.
To attend, enrol in the Governing for Reform in Aged Care Program and register for the webinar.
Training and resources
OPAN Planning for Diversity workshops
Supporting people receiving care to have a good experience of aged care isn’t possible if a provider doesn’t know what matters to those people as individuals, including their cultural identity.
The Older Persons Advocacy Network (OPAN) is offering free workshops to providers on planning for diversity. These workshops 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:
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 actions you can take and include diversity in your continuous improvement processes.
Workshops are 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 October include:
The Serious Incident Response Scheme (SIRS) within home services
Monitor and assess the performance of your service for home services
Effective Incident Management Systems.
Visit our Workshops webpage for further information and registration details.