This article is part of a series looking into the Final Report from the Royal Commission into Aged Care Quality and Safety. Click here to see the series as it's published.

The Royal Commission into Aged Care Quality and Safety has released its Final Report. In this article we explain the Report’s recommended changes to the way residential aged care homes are assessed, and give you some tips on what you can do now to get your home fit and ready to pass an assessment.

Quick Summary

The Royal Commission found two underlying problems with the way residential aged care is currently assessed:

• Failure to gather sufficient data and expose hidden problems.
• Ineffective enforcement.

The Royal Commission recommended these problems be addressed by:

• imposing a more rigorous reporting regime on aged care providers
• expanding the regulator’s data-capturing powers
• increasing public reporting of data about aged care homes’ performance
• expanding the regulator’s powers to conduct assessments and impose sanctions
• increasing the frequency of assessments.

What’s wrong with the current assessment process?

The Royal Commission found two underlying problems with the way residential aged care is currently assessed:

Failure to gather sufficient data and expose hidden problems: according to the Royal Commission, the assessment process has failed to bring to light serious and systemic problems within the aged care homes: “It is disturbing that the numbers of young people in residential aged care, the prevalence of the use of physical and chemical restraints, the frequency of assaults in aged care and other instances of abuse and substandard care that we have uncovered in the course of our inquiry have remained hidden for so long in this opaque system.” [52]

Ineffective enforcement: the Royal Commission’s Final Report found that the regulator was inefficient and lax, and conducted assessments with a limited set of tools that were not fit for purpose. The Commissioners called for the creation of a fundamentally redesigned system that is:

• much more rigorous in only letting into the system those providers that can demonstrate their suitability and capacity to deliver high quality care
• more vigilant and energetic in assessing the performance of providers, and
• more determined to remove from the system providers that are either unable or unwilling to deliver consistently high quality and safe care. [55]

Gathering data and exposing hidden problems: some key recommendations

• Review of the Aged Care Quality Standards: urgently review the Aged Care Quality Standards and establish a process for regular ongoing review. (Recommendations 19-21).
• Expansion of the Quality Indicators: develop a “more comprehensive suite of quality indicators” and adopt the quality indicators as a tool for benchmarking the performance of providers against similar providers for continuous improvement. (Recommendations 22, 23).
• New “Star Rating”: introduce a Star Rating for a provider’s performance published on My Aged Care. The Royal Commission’s Final Report criticised the existing Service Compliance Ratings system because it gives the highest rating to those who achieve the minimum standard, i.e. it does not differentiate between “providers who just meet the standards and those who are outstanding.” (Recommendation 24).
• Serious incident reporting (SIRS): expand the Quality Regulator’s powers to investigate serious incidents and to require providers to take specific remedial actions within specific timeframes. (Recommendation 100).
• Greater weight to be attached to the experience of people receiving aged care: the regulator to regularly interview residents to get their views and then periodically publish a report on the experience of people receiving care from an aged care service. (Recommendation 94)
• New Complaints Commissioner: establish a new Complaints Commissioner within the Quality Regulator with expanded powers to gather and respond to information on complaints about aged care homes. The Complaints Commissioner would have a duty to publish information about these complaints at least every six months (Recommendation 98).
• Regulation of restraints: use of restrictive practices in aged care must be based on an independent expert assessment and subject to ongoing reporting and monitoring. The Quality Regulator should be able to sue providers who breach the rules. (Recommendation 17).

Improving enforcement – some key recommendations

Several of the recommendations mention above in regard to improved data-gathering also involve improvements to enforcement. In particular, recommendations about the SIRS, Complaints Commissioner, Regulation of Restraints and Quality Indicators also involve expanding the regulator’s enforcement powers. Other key enforcement recommendations include:

• A new regulator with more power: the two Commissioners disagreed about some aspects of different agencies that might oversee aged care, but both wanted to see the Aged Care Quality and Safety Commission overhauled or abolished and replaced by a new agency with expanded powers. (Recommendations 5-12, 97, 101-103). Changes would include expanded powers to inspect documents and goods in an aged care home, and power to enter and inspect premises without warrant or consent if the regulator “reasonably believes” there is “immediate and severe risk” to the health and safety of residents.
• Civil penalties for failure to provide proper care: impose on providers an explicit legal duty to provide quality care and services. If providers or their personnel fail in the duty, they could be sued by the Quality Regulator. (Recommendations 1-3, 13, 14, 101, 102).

What can aged care providers do?

Daunting changes are coming to the residential aged care sector, but the challenges can be met if you start acting now. In previous articles we’ve outlined practical steps you can take to get your home fit and ready to pass an assessment. Here is a quick summary of these tips along with links to the full articles:

Residential Aged Care Assessments: What to Expect in 2021: use the Quality Regulator’s Sector Performance Report to your advantage by using it to:

• focus an audit to identify if your organisation is at risk of non-compliance
• inform your preparations for your next unannounced ACQSC visit and to ensure you have the appropriate evidence available to demonstrate compliance
• test and improve your self-assessment.

Is Your Risk Management System Effective Enough to Pass an Aged Care Quality Assessment?: When it comes to passing assessments, it’s not enough merely to have an effective Risk Management System. You also have to demonstrate that your system is effective. The first step in achieving this is to maintain thorough and accurate records. The next step is to present your records to an assessor in a way that demonstrates a narrative of change, showing how you identified a risk, responded and improved.

How to Use the ACQSC Self-Assessment Process to Your Advantage: the self-assessment can seem like burdensome paperwork, but if it is incorporated into strategic operations it can become a useful management tool that helps you maintain continuous improvement while measuring and reporting on the care and services you provide. Use the tips in this article to turn your self-assessment into an active and collaborative document that works for you.

Further Resources

Enterprise Risk Management Training

Presented by Ruth Green, CompliSpace's Principal Consultant, Aged Care, this training helps Aged Care providers better understand Enterprise Risk Management (ERM, including practical tips on establishing an 8-step Enterprise Risk Management Process.

Click here to request your copy.

WEBINAR: “Understanding the Gaps in Infection Control Plans that can put Residential Aged Care Facilities at Risk”

This webinar includes:

• How your COVID-19 infection prevention control systems – and outbreak management plan – relate to other key areas of operational risk and compliance.
• Which of these interrelated areas are most often missed by residential aged care facilities, and what are the potential risks and consequences.
• The role of active surveillance and risk management in identifying gaps and areas to improve.
• How to stay on top of change and adapt quickly to best practice updates and new legislative requirements.
• How to efficiently and cost-effectively keep up with continual change so that your systems and processes produce the outcomes needed now, and in the future.

Click here to request your copy of the recording.

CompliCare

CompliCare has been developed by CompliSpace’s team of Aged Care specialists to deliver Residential Aged Care Providers with complete transparency and oversight across ERM, policy, staff compliance training, compliance actions, data capture and reporting.

Learn more here.