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The year in review

This section provides an overview of the key legislative changes and events that directed and shaped our work in 2019–20. It also highlights some of the initiatives and projects we undertook to improve the effectiveness of our regulatory functions and respond to risks and events.

Aged Care Quality Standards introduced

The Aged Care Quality Standards (the Quality Standards) were introduced on 1 July 2019. The Quality Standards replace the former:

  • Accreditation Standards
  • Home Care Standards
  • National Aboriginal and Torres Strait Islander Flexible Aged Care Program Quality Standards
  • Flexible Care Standards for short-term restorative care.

The Quality Standards apply to all aged care services including residential care, home care, short-term restorative care, as well as services under the Commonwealth Home Support Programme (CHSP) and National Aboriginal and Torres Strait Islander Flexible Aged Care Program.

The Quality Standards focus on outcomes for consumers and shift the regulatory focus for providers from process to outcomes. They represent transformational change for Australians receiving aged care services, putting consumers at the heart of aged care, requiring evidence of their experience and outcomes, and increasing transparency and accountability.

We continued the work (which commenced in 2018–19) to support the sector and consumers in preparation for the new Quality Standards through production of a range of guidance and resources including videos and online learning modules.

New Charter of Aged Care Rights introduced

On 1 July 2019, a single Charter of Aged Care Rights came into effect. It replaced previous charters of care recipients’ rights and responsibilities, and underpins the Quality Standards.

The comprehensive and concise new charter sets out the same rights for all consumers, regardless of the type of subsidised care and services they receive.

The charter focuses on 14 high-level consumer rights, making it easier for consumers, their families, carers and representatives to understand what they can expect from an aged care service. Providers have responsibilities to support consumers to understand the new charter.

The charter is available in a range of languages. We supported its introduction through resources for providers and consumers including posters and booklets. A charter template for providers and consumers to co-sign was developed as one way to demonstrate that the provider has assisted the consumer to understand their rights under the charter.

A new assessment methodology introduced

The Commission developed and introduced an updated assessment methodology, which guides the Commission’s overall approach to assessing aged care provider performance against the Quality Standards.

The assessment methodology supports quality assessors to use a consistent approach to assessing a provider’s performance against the Quality Standards within the broader assessment program and the Regulatory Strategy. It aims to support quality assessors to reach similar conclusions about performance against the Quality Standards in similar circumstances and provides clarity for stakeholders about the conduct of performance assessments.

The Commission’s assessment methodology is supported by training and resources for quality assessors.

Regulations to minimise chemical and physical restrictions

Legislative requirements regarding the use of physical and chemical restraints are contained in the Quality of Care Principles 2014 (Principles). The restraint requirements were first introduced to the Principles from 1 July 2019, with amendments strengthening the legislation applicable from 29 November 2019. These amendments place explicit obligations on providers to minimise chemical and physical restraints in residential care settings.

The Commission published a Regulatory Bulletin, ‘Regulation of physical and chemical restraint’ outlining the requirements that must be met before and during any use of restraint. The Bulletin outlined how the Commission will assess the use of restraint in the context of the Quality Standards and the Principles.

The Commission’s program of work on minimising the use of restraints has been included in broader work to minimise inappropriate use of medications in residential aged care more generally, initially focusing on psychotropic medication. The goal is to increase knowledge and awareness of how to ensure that any medication use is appropriate and minimised where it constitutes a restrictive practice, and to create sustainable cultural change. Aged care consumers and their representatives were involved in developing a range of print, electronic and other resources which are published on the Commission’s website, including:

  • Clinical advice and guidance materials for providers and consumers about informed consent and restraint.
  • Scenarios illustrating physical and chemical restraint, showing the complexity of the issue and the need for providers to be mindful of the requirements of the Principles.
  • Tools and fact sheets to help providers make decisions, manage, record and monitor the use of psychotropic medications.
  • Commissioning a suite of works with the Older Persons Advocacy Network (OPAN) for consumers and their representatives and decision-makers.

The resources for consumers, providers, care workers and Commission staff reflect our shared responsibility to address this issue and the multiple individuals, influences and processes involved in medication management and use of restraint.

The Pharmacy Project reducing inappropriate use of medication

The Commission was allocated funding in the 2019–20 budget to run a project aimed at reducing the inappropriate use of medication in residential aged care, with a particular focus on psychotropic and antimicrobial medicines.

The project introduced a pharmacy outreach program focusing on medication management and chemical restraint, the latter of which has the potential to do great harm to the health and quality of life of elderly people.

Pharmacists gather information on the challenges and barriers to safe prescribing and medication management and provide tailored information, education and ongoing support on any aspect of medication management in residential aged care facilities.

The project targets residential services in areas designated ‘remote’ and ‘very remote’. The Commission contracted 10 experienced and accredited clinical pharmacists who undertook the RedUSe train-the-trainer program that promotes quality and appropriate use of sedatives. A key program strength was the promotion of communication between consumers and their families, nurses, care staff, GPs and pharmacists.

Services in the regional target areas were offered a pharmacist visit, which included training for nominated staff on deprescribing medications, who would then have responsibility for sustaining the program in their services.

Prior to the COVID-19 pandemic, it was intended that the pharmacists would continue to deliver the training to services in more than 60 remote and very remote locations. However, the pandemic resulted in this program of visits being put on hold and consideration is being given to alternative means of continuing to engage with the sector on reducing the inappropriate use of medication, such as trialling a pharmacy advice telephone line. A pilot of the Aged Care Pharmacy Advice Line (Aged Care PAL) commenced operation on 11 May 2020. Pharmacists are rostered to answer pharmacy related queries from aged care providers, services and consumers in remote and very remote locations. The works mentioned above, commissioned with OPAN, are part of this project.

Transfer of regulatory functions

On 1 January 2020, the aged care regulatory functions of the Secretary of the Department of Health were transferred to the Aged Care Quality and Safety Commissioner, establishing a new regulatory framework for the Commission. The Commission is now responsible for approval of providers, where appropriate to do so, aged care compliance (including with Prudential Standards) and compulsory reporting.

Consolidating these regulatory functions and powers within a single regulator provides greater clarity of the regulatory model for providers and consumers of care and ensures that the Commissioner has the full suite of regulatory functions from entry, quality monitoring and compliance to exit (if required) for providers of aged care services. It supports more effective triage of poor performance into voluntary and enforceable compliance pathways, allowing the Commission to shift to enforceable regulatory responses when risks are unresolved or escalate.

Commission Rules amendments

Amendments to the Rules were implemented from 1 January 2020 to support the transfer of regulatory functions. The amendments focused on:

  • integration and removal of duplication in the management of non-compliance with the Quality Standards
  • establishment of a regulatory framework with graduated and escalating responses to non-compliance
  • streamlining existing performance assessment processes, providing greater clarity to consumers and transparency of decision-making for providers.

A summary of the key changes for providers from 1 January 2020 is available on the Commission’s website. Our Regulatory Strategy, initially published in June 2019, was also updated to reflect the new regulatory powers.

Regulatory Integration Project commenced

In 2019–20 the Commission commenced a Regulatory Integration Project to streamline our functions, achieve consistent regulatory practice, and support the transfer of regulatory functions from the Department of Health on 1 January 2020. The more streamlined end-to-end regulation and consistency of approaches are expected to reduce duplication and complexity, and benefit consumers and providers. The whole-of-Commission integration process includes new operating models to support four pillars of work:

  • Risk Assessment and Escalation
  • Case Coordination
  • Intelligence and Analysis
  • Managing Non-Compliance.

This includes development of a Regulatory Risk Management Framework, which supports implementation of a standardised approach to the trend analysis, escalation and treatment of risk, and improved capabilities through changes to organisational design and training.

The project will continue throughout 2020–21 to enable a fully integrated Commission.

New IT infrastructure to support regulatory functions

The Commission is progressing a single IT platform for Commission staff, including development of a single cloud platform called the ‘Aged Care Case Management Information System’. Single IT infrastructure will support integration of regulatory functions, work on risk profiling, and analysis of home services including at market entry.

Home services regulation strengthened

The Home Services Regulation Project aims to facilitate the effective and efficient regulation of home services across the range of Commission functions through the utilisation of revised regulatory practices, risk methodologies and operational processes in a coherent model.

The project complements the Commission’s regulatory strategy and current regulatory integration and compliance framework development. It also builds on the Commission’s strong focus on home services in complaints handling and home care investigation and compliance, and will continue to be progressed in 2020–21.

Royal Commission into Aged Care Quality and Safety

Engagement with the Royal Commission into Aged Care Quality and Safety has been a significant priority for the Commission during 2019–20. In response to specific requests and to offer proactive support, we provided numerous documents, witnesses and submissions, and closely followed hearings and other activities to learn from the initial findings. Supporting the important work of the Royal Commission will continue to be our priority.

Following the release of the Royal Commission’s Interim Report on 31 October 2019 and addressing some of the key themes in the report, the Commission has:

  • established a project (described above) specifically focusing on strengthening the regulation of home services
  • continued its focus on working with providers, consumers and key stakeholders on minimising the use of restraints, as outlined earlier
  • worked to raise provider awareness and encourage the use of best practice models including, during unannounced visits, looking for evidence that services are applying best practice
  • conducted a project to research and develop best practice models for engagement between providers, consumers and their representatives (as outlined in consumer engagement activities below)
  • reviewed information published on the Commission’s website to improve transparency and depth of information about provider performance, including naming providers who are issued directions 2, the actions to be met and the timeframes for meeting them
  • improved the sharing of information with other key agencies including the Australian Health Practitioner Regulation Agency (AHPRA). A memorandum of understanding signed with AHPRA will support the Commission to raise concerns with AHPRA about the health, performance or conduct of registered health practitioners working in aged care. The agreement will also enable AHPRA to disclose information to the Commission if it has concerns about the care and safety of someone receiving Commonwealth-funded aged care services.

2. If the Commission is not satisfied that a service provider is meeting its responsibilities, a direction may be given to address the issues raised through a complaint. A direction will require the service provider to demonstrate how they have met or will meet their responsibilities under the Aged Care Act 1997 or their funding agreement with the Australian Government.

Aged Care Quality and Safety Council

The Aged Care Quality and Safety Advisory Council (Advisory Council) is established under section 37 of the ACQSC Act.

The legislated functions of the Advisory Council are:

  • On its own initiative or at the request of the Commissioner, to provide advice to the Commissioner in relation to the Commissioner’s functions.
  • At the request of the Minister, to provide advice to the Minister about matters arising in relation to the performance of the Commissioner’s functions.

In 2019–20 the Advisory Council was requested to provide advice to the Minister for Aged Care and Senior Australians, Senator the Hon Richard Colbeck, on additional powers that the Aged Care Quality and Safety Commission should have to achieve its objectives.

As requested by the Minister, the development of the options paper considered the Interim Report of the Royal Commission into Aged Care Quality and Safety and recommendations of the Carnell Inquiry into events at Earle Haven in identifying and developing priorities for change.

The Minister subsequently notified the Advisory Council that he had shared the options paper with the Royal Commission to assist with its consideration of quality and safety regulation and in April 2020, senior staff from the Royal Commission met with the Advisory Council to discuss the contents of the options paper.

The Advisory Council continues to consider the options outlined for reform and provide advice to the Commissioner and the Minister on a range of strategic issues. The options paper is published on the Commission’s website.

Response to the bushfire crisis

The 2019–20 summer season was characterised by devastating bushfires in many parts of the country, affecting a number of aged care services.

The Commission closely monitored the situation through information provided to us by the Department of Health and established operations to monitor evacuations of consumers affected by bushfires.

Based on geospatial mapping of fire movement, we made decisions about any adjustments required to our schedule of performance assessment and monitoring activities for affected services.

Our messages to the sector emphasised the critical importance of effective emergency risk management and planning, and of good communication with aged care consumers and their representatives during the bushfire season. Services operating in fire-affected areas and those impacted were encouraged to contact the Commission to discuss their circumstances if needed, and to access the information and resources about bushfire preparedness on our website.

Greater transparency in performance reporting

The Commission is integrating and enhancing the information it makes publicly available about the performance of providers and regulatory actions and outcomes. This includes publishing a range of sector performance measures including regulatory activities and findings, the volume of complaints received, and the issues most frequently raised in complaints.

Sector performance data is shared on the Commission’s website to help providers understand sector-wide performance and the areas of high prevalence or high impact risk to the safety, health or well-being of consumers. It supports providers to identify and examine their own management of these risks. The Sector Performance Report for the January to March 2020 quarter integrated a range of compliance decisions that transferred to the Commission on 1 January 2020.

The Commission and the Department of Health worked closely with consumer and industry stakeholders on the development of residential service compliance ratings which are now available on the My Aged Care website. The facility and service rating information was released on 1 July 2020.

The rating will allow consumers to access and compare easy-to-understand information on the quality of residential aged care services, supporting more informed decision-making.

The service compliance rating signifies a service’s current compliance status. It is based on the outcomes of compliance activity, such as performance assessments, by the Commission and whether a service is meeting its obligations to provide safe, quality care and services to aged care consumers.

Aged Care Learning Information Solution launched

The Commission’s Aged Care Learning Information Solution (Alis) was launched on 20 February 2020 and provides access to the Commission’s education programs anywhere and anytime via interactive online learning.

The initial program included in the launch focused on implementation of the Quality Standards and supporting providers in the delivery of quality aged care services and their continued improvement. The program includes nine modules. In addition to an introductory module called ‘Getting to know the Standards’, there is a separate module for each of the individual Quality Standards.

At 30 June 2020, 3,544 users were registered within Alis and user numbers were continuing to grow weekly.

Administrators have access to a dashboard and reporting functions, which provide a real time picture of their staff engagement with and completion of the modules.

Engaging with consumers

An important function of the Commission is consumer engagement. It enables us to develop, in consultation with aged care consumers and their representatives, best practice models for the engagement of providers with their aged care consumers and to promote those models to providers.

In 2019–20 we conducted a consumer engagement project overseen by a steering group of key stakeholders. A number of resources produced by the project were published on the Commission’s website in January 2020. The resources are designed to support aged care providers in improving the way they engage with their consumers and includes the ‘Care that is right for me’ resource. This resource highlights that placing consumers at the centre of their care is fundamental to quality care outcomes. It focuses on assisting providers to deepen their engagement and develop a partnership with consumers in all aspects of planning, delivery and evaluation of care and services.

The Commission also conducts consumer experience interviews. From December 2019 we changed the collection of consumer experiences from a randomised sample during site audits of residential aged care services to a risk-based approach across all visits.

There has been continued interest in consumer experience in the home services sector and consumer experience interviews for home services are continuing to be trialled. From 1 July 2019, consumers were provided the opportunity to participate in a face-to-face consumer experience interview or the same interview by telephone with plans to add an online option in 2020–21.

Effective complaints resolution

We continued to promote our complaints resolution processes and to support people to resolve concerns with their service providers. Our focus is on resolving concerns in the best interest of the person receiving care. Complaints can be made about Commonwealth-subsidised aged care services received at home or in an aged care facility.

We have reviewed and improved our complaints resolution processes in relation to intake, initial and ongoing engagement with complainants, risk assessment and escalation. These improvements have been supported through additional guidance and training provided to complaints officers.

Each complaint we receive is risk- assessed and dealt with accordingly. We use flexible approaches depending on the circumstances of each case. For instance, we may support people to resolve their concerns directly with their service provider, we may raise concerns with the service provider ourselves, we may bring the parties together to seek a resolution, or we may undertake an investigation process.

Overall contacts increased from 17,579 in 2018–19 to 19,782 in 2019–20 (13 per cent increase). From these contacts, the number of complaints lodged with the Commission increased from 7,828 in 2018–19 to 8,539 in 2019–20 (nine per cent increase). Public awareness of the Commission’s establishment and a broader community focus on the aged care sector are likely to have contributed to this increase, in addition to the COVID-19 pandemic as outlined below.

Complaints related to COVID-19

The impact of COVID-19 was clearly demonstrated by a dramatic increase in complaints about providers made to the Commission as public awareness of the pandemic and its effect on people living and working in aged care settings grew.

We received 2,613 contacts related to COVID-19 this year. Of these, 1,269 were complaints. The main themes raised in contacts were:

  • visitor restrictions
  • concerns about preparedness for and prevention of outbreaks
  • impact of a COVID-19 outbreak or of visitor restrictions on the quality of care.

Rapid response to the COVID-19 pandemic

As the COVID-19 pandemic began to impact Australia and specifically the aged care sector, the Commission moved quickly to adjust its regulatory approach and prioritise the safety, health and well-being of consumers in services affected by, or at risk of being affected by, COVID-19.

We adjusted our regulatory approach in line with latest public health and clinical advice about preventative measures to minimise infection risks to aged care consumers, staff and our own employees. We established a COVID-19 Executive Steering Committee and Taskforce to provide oversight and coordination of the Commission’s response to the pandemic. We adopted a risk-based proportionate approach that is sensitive to the challenges faced by providers during this time.

Our approach has included:

  • Undertaking site visits based on assessment of risk including short notice site visits and unannounced infection control monitoring visits. Up to 30 June 2020, 157 infection control monitoring visits were undertaken; 36 were unannounced and 121 were short notice.
  • Undertaking 2,503 assessment contacts with services by telephone to monitor and support the quality of care to consumers. The focus of assessment contacts has been on supporting providers’ infection control program and outbreak preparedness, and providing advice on tools and resources available to providers to assess their readiness for COVID-19. These contacts were made to approved providers of residential services and providers of home services.
  • Provision of online self-assessment survey to support providers to evaluate their infection control preparedness. Residential services completed 2,638 responses, and 1,416 responses were completed by home service providers.
  • Partnering with public health responders to support the management of suspected and confirmed outbreaks of COVID-19 at aged care services and sharing information on the performance of providers to support the Commonwealth and state responses to the pandemic.
  • Working closely with the Department of Health and other stakeholders to develop practical tools to assist providers as information became available.

We provided information, guidance and education to support providers and consumers during the pandemic, including:

  • Posting regular updates from the Commissioner on our website about latest information on the pandemic and the Commission’s regulatory responses.
  • Providing education, support and advice from the Commission’s Chief Clinical Advisor.
  • Maintaining a frequently updated section of the Commission’s website to ensure provider access to the latest information and tools to protect and enhance the safety and well-being of consumers, and to ensure that consumers could access information about COVID-19 and what to expect from their services.
  • Providing webinars to providers in Victorian residential services to support their preparation and preparedness for a COVID-19 outbreak.
  • Supporting compassionate application of visitor restrictions, by:
    • coordinating a problem-solving roundtable with representatives from a number of providers to understand issues around implementation of visitor restrictions imposed during COVID-19 and to share ideas for managing the issues
    • coordinating a roundtable with consumer peak bodies to share and problem-solve issues in relation to visitor restrictions
    • developing resources that support good decision-making in relation to visitor restrictions
    • issuing advice to the sector on actions providers could take while applying visitor restrictions in line with state/ territory orders, and issuing guidance on how to implement entry screening procedures for staff and visitors to services.
  • Resolving complaints about the impact of visitor restrictions on the care and well-being of residents.
  • Introducing a consumer engagement survey for home care consumers to better understand the quality of care being provided and how services could be improved. The survey included a number of questions related to COVID-19 including whether services have been changed or cancelled and whether precautions were being taken to prevent the spread of COVID-19. The survey will continue into the next financial year, with the aim to contact more than 5,000 consumers.
  • Providing good practice examples of how services across the country are exploring new ways of promoting consumer well-being and helping them to stay connected to family, friends and carers during the pandemic.

We have adjusted our work practices to keep our staff safe, with our staff quickly adapting to working remotely using new technologies, and practices and innovative solutions to support our regulatory responsibilities. We are continuing to strengthen our IT infrastructure as a critical component of our intelligence- led, risk-based regulatory strategy and to support our communication and inclusion as we maintain elements of our work in virtual environments and home-based offices. The pandemic has sharpened our focus on business continuity planning so we are well-positioned for potential future business disruptions.

Learning from experience

We continue to study and reflect on experiences of outbreaks in aged care and to apply learnings in our regulatory approach. We have engaged with regulators in other countries to share experiences and lessons.

Our close working relationship with the Department of Health is ongoing, and we are also engaging with health authorities and clinical experts in all jurisdictions.

The following sections outline our regulatory functions and key activities in 2019–20 in more detail.