On 18 February 2020 we issued a survey to our subscribers asking about their recent experiences with Assessment visits from the Aged Care Quality and Safety Commission (the Commission). We will keep this survey open a while longer in case you haven’t had a chance to respond (you can access the survey here). Meanwhile, here are the preliminary results.

Key Results

• Vast majority of visits from Commission Assessors were unannounced (81%).
• Vast majority of visits from Commission Assessors were during business hours (99%).
• Around half of the total respondents received 0 findings of “Not Met” (52%).
• 48% of total respondents had more than one “Not Met” with over 5% having 10+.
• 51% of the total respondents felt they were adequately prepared.
• Over 45% of the total respondents felt only somewhat prepared.
• 48% of total respondents said the level of scrutiny by Assessors was about what they had expected it to be.
• 42% of total respondents said the level of scrutiny by Assessors was MORE than they had expected it to be.
• Compared with their counterparts in Queensland and Victoria, respondents in New South Wales reported greater levels of Assessor scrutiny, felt less prepared and ended up with more findings of “Not Met”.

Who Responded to the Survey?

The survey was anonymous, and we have so far had nearly 100 responses from subscribers in NSW, Victoria and Queensland. The vast majority of respondents described themselves as managers working in residential aged care. Most respondents work in facilities with fewer than 100 beds, although there were a substantial number of respondents who work in larger homes.

Was the Commission visit announced or unannounced?

The vast majority of respondents reported that the visit they’d had from the Commission’s Assessors was unannounced.

Was the Commission visit within business hours or outside of business hours?

Almost every respondent reported that the Commission’s Assessors visited within business hours. Only one respondent (from NSW) reported a visit outside of business hours.

Was the level of scrutiny during the Commission visit what you expected it to be?

Overall the most common response was that the level of scrutiny was “about what I expected it to be.”

There was some variation across the states. Twenty-six per cent of Victorian respondents said the visit was “not as intense as I expected it to be.” They were the only group to report such a positive experience. NSW respondents felt the most scrutinised, with almost 55 per cent of NSW respondents saying they felt more scrutinised than expected.

How prepared did you feel for the Commission visit?

In Queensland and Victoria, the most common response was “I felt adequately prepared”, but the picture was a bit grimmer in NSW where about half of respondents felt only “somewhat prepared.”

Very few respondents “didn’t feel prepared at all” (6 per cent in NSW, about 4 per cent in Victoria and none in Queensland).

How many findings of “Not Met” did you have?

Overall, the most common response was zero findings of Not Met. However, there was significant variation across the states on this question.

Victoria seemed to be having the best time, with about 70 per cent of respondents reporting that they received zero Not Mets following a Commission visit, and nobody reporting that they received more than nine Not Mets.

Queensland’s experience was also positive, with about half of respondents reporting zero findings of Not Met and the other half reporting 1-3 Not Mets. Nobody in Queensland reported receiving more than three Not Mets.

NSW respondents were having a tougher time. The most common response was still zero Not Mets (about 40 per cent of NSW respondents) but there were also significant cohorts who reported receiving several Not Mets, including the 12 per cent of NSW respondents who reported receiving more than 10 Not Mets.

What were your “Not Mets” for?

We asked for comments here rather than simple “tick-a-box” responses. Most respondents said that their Not Mets related to Standard 3: Personal and Clinical Care. Several respondents said that their Not Mets were for issues relating to Standard 8: Organisational Governance such as “governance” and “risk management.”

What was the focus of the assessment? (i.e. which Standards and requirements were covered? If the focus wasn’t clear, please include that in your answer).

Again, we asked for comments here. One clear theme was the Assessor’s focus on Standard 3: Personal and Clinical Care. Many respondents said that the assessment focused solely on Standard 3, and many said that the assessment focused on Standard 3 plus several other Standards (often Standards 1, 2, 7 and 8). There were also many respondents who said that the focus of the Assessment was “all the Standards.”

What would help you meet all the Standards in future Commission assessments?

Responses to this question fell into two groups:

• internally-focused responses that described changes aged care providers needed to make to their own systems and processes
• externally-focused responses that criticised the Commission’s processes and made suggestions for how they could improve.

Percentagewise, the split was right down the middle: about 50 percent of responses were internally-focused and 50 per cent were externally-focused.

Most of the internally-focused responses related to staffing. One respondent said, “the more our staff understand the expectation on us as providers, the more we can improve in the service we provide to our consumers.” Other respondents suggested the way to improve was to “reintroduce the midday meeting”, appoint a Case Manager or simply hire “more registered staff.”

Key criticisms that respondents made via their externally-focused responses were:

• poor communication from the Commission generally and from its Assessors, including lack of transparency
• assessments were inconsistent and too subjective
• assessors were not competent
• assessors were antagonistic.

As one respondent put it:

“Assessors arrived with no knowledge of a previous unannounced [assessment] and our response … Assessors not coming with an agenda (one unannounced [assessment] focusing on 2 areas turned into a full audit within hours and both assessors had sufficient clothes packed and accommodation booked for a 4 day visit). Assessors made staff feel uncomfortable with questioning. One asked a staff member if she was lying. In one visit a resident was having her nails trimmed by a staff member. Resident was in a wheelchair and when the staff member (momentarily) stood in front of the resident to focus on one hand, the Assessor called the action a restraint.”

Other comments, questions and concerns

Most respondents used this section to express dissatisfaction with the Commission, its Assessors and the assessment process. Our preliminary results include 30 separate comments in this section. Twenty of these comments describe negative experiences with Commission Assessments. Six comments are positive (though one of these is a mix of negative and positive) and the rest are neutral.

Most of the positive responses came from Victorian respondents. Only one NSW respondent gave a positive comment.

The positive comments tended to focus on the behaviour of the Assessors, describing them as “calm, professional and helpful”, “supportive and positive”, “approachable” and “fair, professional, systematic in their approach.”

The negative comments tended to focus on two areas: the behaviour of the Assessors and the impact of Assessment on providers. The Assessors were described as unprofessional, inexperienced, uncommunicative and keen to find fault. As one respondent put it:

“I have never in my advanced years of nursing felt so professionally compromised. On the whole, the auditors are looking/digging for fault, and very happy when they find it. I work in an aged care home that has a very good reputation, the residents are happy and feel well cared for and the families are happy, and still, we are found at fault. The aged care standards are wonderful, but are unachievable on the government funding that we receive. Therefore, all aged care homes are struggling to meet the standards. Last audit, we had issues that were recorded on the report, that I as manager, had no idea was an issue with the auditors. The first I knew was when I read the report. This to me is not good auditing.”

In terms of the impact on providers, this same respondent added that, “Auditing from the ACQSC has now become a misery rather than a positive experience, which is sad at best.” Another respondent said, “I have worked myself into the ground and like so many am thinking of leaving the sector.”

Have Your Say and the Full Report

Thank you to everyone who has responded so far – your input will inform future ACE articles, helping to keep them relevant and grounded in the real experiences of aged care providers.

To those who haven’t yet had a chance to complete the survey, we are keen to hear from you. The survey is completely anonymous, and you can access it here:

The full report will be released at the Quality in Aged Care Conference March 18-19 in Sydney and made available to ACE subscribers the following week.