Residential Aged Care Assessments: What to Expect in 2021

The Aged Care Quality and Safety Commission (ACQSC) recently released its Sector Performance Report for the period July to September 2020.

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New Mandatory Quality Indicators Coming 2021: Is Your Aged Care Home at Risk of a Bad Report Card?

The Department of Health has announced that it will introduce two new Quality Indicators to the National Aged Care Mandatory Quality Indicator Program in July 2021. At the same time, new research by the Royal Commission into Aged Care Quality and Safety has found that particular types of homes are performing worse than others when measured against the Quality Indicators.

What do the new Mandatory Quality Indicators involve? And is your aged care home might at risk of receiving a bad report card when measured against them?

 

Key Points


Currently, all residential aged care homes must report on three mandatory Quality Indicators (QIs):

  • pressure injuries
  • use of physical restraint
  • unplanned weight loss.

From July 2021, all residential aged care homes must also report on:
  • falls and major injury
  • medication management.

New research shows that:
  • homes in small rural towns tend to perform better on the QIs than homes in larger towns
  • smaller homes tend to perform better on the QIs than larger homes
  • government-run homes tend to perform better on the QIs than non-government homes.

 

What is the Mandatory Quality Indicator Program?

The National Aged Care Mandatory Quality Indicator Program started on 1 July 2019. The program requires every residential aged care home to collect data on three particular issues and report that data to the Department of Health every three months.

The three issues that residential aged care homes must report on are:

  • pressure injuries
  • use of physical restraint
  • unplanned weight loss.

For more information see the Department of Health’s website.

 

What is Changing?

Two new QIs

From July 2021, there will be two new quality indicators. The existing three will remain in place. So, from July 2021, every residential aged care home to collect data on these five issues and report that data to the Department of Health every three months:

  • pressure injuries
  • use of physical restraint
  • unplanned weight loss
  • falls and major injury
  • medication management.

 

Falls and major injury

Residential aged care providers will be required to report:

  • the percentage of care recipients who experienced one or more falls
  • the percentage of care recipients who experienced one or more falls resulting in major injury.

 

Medication management

Residential aged care providers will be required to report:

  • the percentage of care recipients who were prescribed nine or more medications
  • the percentage of care recipients who received antipsychotic medications.

 

No changes to the process

At this stage, there are no proposed changes to the process for submitting QI data. Providers will continue to submit via the My aged care provider portal as per usual. For more information on how this works, see the Department of Health’s reference guides on:

 

Is Your Home at Risk of a Bad Report Card?

On 16 November 2020, the Royal Commission into Aged Care Quality and Safety released its Research Paper 15 – Residential Care Quality Indicator Profile. The paper reported on the aged care industry’s performance across a number of different quality indicators, including the three mandatory QIs.

The research found that certain types of homes achieved the “best results” when measured against the three mandatory QIs.

 

What are “Best results”?

Pressure injuries: the best result is the least number of pressure injuries per 100 residents.

Physical restraint: the best result is the least number of “intent to restrain” incidents per 100 residents. An “intent to restrain” is “the intentional restriction of a care recipient’s voluntary movement or behaviour by the use of a device, removal of mobility aids, or use of physical force for behavioural purposes.” The research also counted the number of physical restraint devices in the home at the time of assessment, per 100 beds (whether being used for physical restraint or not). Such devices include “bedrails, chairs with locked tables, seatbelts (other than those used during active transport), safety vests, shackles and manacles.” Here, “Best results” means the least number of devices.

 Unplanned weight loss: the best result is the least number of residents with unplanned weight loss over three consecutive months. “Unplanned weight loss” means any unplanned loss. The research also recorded “significant unplanned weight loss” which means any loss of three kilograms or more over a three-month period.


 

Which types of homes achieved best results?

The research found that across all three QIs:

  • homes in small rural towns achieved the best results compared with homes in larger towns, regional centres and metropolitan areas (except in regard to the number of physical restraint devices, which was much the same regardless of location)
  • homes with 1-30 places achieved the best results compared with homes with more than 30 places
  • government-run homes achieved the best results compared with non-government homes.

 

Is your home at risk?

What this research gives us is a set of “risk factors”. It suggests that you face an increased risk of underperforming on your management of pressure injuries, unplanned weight loss and physical restraint if one or more of these factors applies to your home:

  • your aged care home is located in a medium-sized town, regional centre or metropolitan area
  • your aged care home has more than 30 places
  • your aged care home is not government-run.

It’s not clear whether these factors will increase your risk of underperforming in regard to the two new QIs (falls and major injury, and medication management) but it would be diligent to assume that they might.

 

What Now?

The Royal Commission’s research gives us no clues as to why small, government-run homes in small rural towns tend to perform better than other homes. That is a hugely complex question that will likely have academics tearing out their hair for years to come.

But it need not to be so frustrating or complex for aged care providers. This is because, for those providers whose homes are at risk, why is not the critical question. The critical question is: what do we do about it?

Fortunately, the process of answering that question is not a rarefied academic exercise – it is a standard part of the risk assessment process. And it can be applied to risks arising from the existing Mandatory QIs and the two new QIs. In fact, if you’ve read through the “risk factors” above, then you’ve already completed one of the first steps in the risk assessment process: “identifying the risk”.

We’ve been writing and talking about the risk assessment process for the past month and you can find more details about it here:

Meanwhile, you can start to make reporting on the mandatory QIs work for you and your organisation. Actions you can take include:

  • Improve your understanding of the QIs and your related responsibilities under the Aged Care Quality Standards – Standard 8 and Standard 3 are a good place to start.
  • Share the outcomes of the collected QI data with relevant Stakeholders, reporting overall outcomes, comparisons with previous quarter outcome YTD results and the home’s set targets.
  • Review individual consumer outcomes and care plans and implement appropriate treatment. This should include ongoing monitoring and evaluation.
  • Identify any action areas and planning of continuous quality improvements, including policy and procedure updates.
Mark Bryan
ABOUT THE AUTHOR | Mark Bryan
Mark is a Legal Research Consultant at CompliSpace and the editor for ACE. Mark has worked as a Legal Policy Officer for the Commonwealth Attorney-General’s Department and the NSW Department of Justice. He also spent three years as lead editor for the private sessions narratives team at the Royal Commission into Institutional Responses to Child Sexual Abuse. Mark holds a bachelor’s degree in Arts/Law from the Australian National University with First Class Honours in Law, a Graduate Diploma in Writing from UTS and a Graduate Certificate in Film Directing from the Australian Film Television and Radio School.

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