The International Risk Management Standard ISO 31000:2018 defines risk as the “effect of uncertainty on objectives.”

By that definition, residential aged care is a particularly risky business at present. The industry is plagued by uncertainties: will there be a COVID-19 outbreak? Will our staff burn out? Will the assessors turn up on our doorstep tomorrow? All these uncertainties affect providers’ capacity to deliver quality care. That’s why we call them risks.

Drawing on survey data from the Aged Care Impact Report and feedback from aged care providers, ACE has set out 5 of the Top Risks for residential aged care homes, along with links to helpful resources to help you better understand what these risks involve.

1. COVID-19 Outbreak

Outbreaks of COVID-19 in aged care homes have cost the lives of almost 700 residents across Australia. Even the mere threat of an outbreak has had a significant impact. The Aged Care Impact Report revealed that over 80% of homes have had to change their systems and processes as a result of the pandemic.

The COVID-19 pandemic functions as a kind of “meta risk” for aged care homes, hovering over everything they do. The strain that the pandemic has put on staff, finances, consumers and visitors has exacerbated all of the risks mentioned below.

As if this weren’t challenging enough, aged care providers also have to keep up to date with infection control legislation and regulations, which can change almost on a weekly basis. To take the stress out of this task, see CompliSpace’s "COVID-19 Regulatory Changes" Page, a free online resource that sets out all the latest COVID-19 legal changes in one place.

For guidance on how to prepare for an infection control spot check, see our article from last week: Infection Control Spot Checks in Residential Aged Care: What Providers Need to Know.

2. Lack of Staff

The Aged Care Impact Report revealed that increased workloads and stress-levels are causing some aged care staff to leave the industry at a time of increasing demand. These findings have recently been confirmed by the National Ageing Research Institute Report. Not only is staff retention at risk, aged care providers report increasing difficulty in finding appropriate staff, particularly in regional areas, and this risk may be exacerbated by COVID-related travel restrictions.

The risk here is not only lack of staff, but lack of appropriate skills among the staff you have. The Organisational Statement for Standard 7 of the Aged Care Quality Standards requires the organisation to have “a workforce that is sufficient, and is skilled and qualified to provide safe, respectful and quality care and services.” The particular risk during the COVID-19 pandemic is that an aged care home fails to provide staff with the time and the tools to deliver quality care to consumers every day and/or fails to assess, monitor and review to ensure effective human resource management.

For more information see the section on Standard 7 in the Guidance and Resources for Providers to support the Aged Care Quality Standards.

3. Failing an Assessment

As we reported in last week’s article, the Aged Care Quality and Safety Commission (ACQSC) has stepped up its program of infection control spot checks of residential aged care homes. This comes in the wake of the ACQSC copping criticism from the Aged Care Royal Commission for not conducting enough quality reviews of aged care homes. The regulator is caught in the glare of the media and government spotlight and may well respond by increasing the frequency and tenacity of their assessments.

See the ACE guide, How to Comply with the Aged Care Quality Standards, for practical tips on how to manage assessment contacts.

Also, CompliSpace's Head of Aged Care, Ruth Greene, recently ran a training session for CompliCare clients about "Tips and Tricks for Completing the Self-Assessment Tool to Guide Your Continuous Improvement and Facilitate Assessor Visit Requests". An excerpt of that training video will be shared with Aged Care Essentials subscribers in November. If you'd like to receive an earlier copy of that video, please click here to submit your request. 

4. Lack of Funding

Lack of funding has long been a major risk for residential aged care homes in Australia and will almost certainly continue to be so for years to come. While they were happy to see some increases in funding, many peak aged care bodies criticised the recent Federal Budget as a band aid measure that failed to implement substantive financial reform. The situation may end up being even tougher for residential aged care as the Federal Government shifts its focus and resources to Home Care.

For more information, see the Aged Care Royal Commission’s Research Paper 9: The Cost of Residential Aged Care.

5. Damage to Reputation

Only one in five Australians have a high degree of trust in the aged care industry, according to the Inside Aged Care Report 2020. This may come as little surprise to aged care providers, who are all too aware of the hammering they’ve received in the media this year. As one respondent to our Aged Care Impact Report survey put it, “We feel bullied and found guilty by the Media - bad people do bad things, but not as an industry overall - lost a lot of great staff that feels this did impact the enjoyment working in aged care. Media reports often one sided and we can't defend ourselves.”

Whether or not they deserve it, all residential aged care homes are suffering damage to their reputations. This risk, like COVID-19, can exacerbate other risks: increasing the chances of being assessed while also making it harder to attract and retain consumers and staff.

How to Manage Risks in Residential Aged Care

The key to managing risks is to tackle them strategically and proactively. For an individual this boils down to simple common sense and “thinking ahead” – you manage the risk of getting wet, for instance, by bringing an umbrella. But for organisations like aged care homes, who face multiple, complex risks every day, common sense alone won’t cut it. You need a system and a process.

The name of this process is Enterprise Risk Management (ERM). Enterprise Risk management is a structured process which assists aged care providers to predict future events that may impact on their activities, and allows them to take appropriate actions to address the likelihood of the event happening, and/or the impact of the event should it occur.

In practice, ERM is a dynamic process that continuously involves:

• Risk Assessment – identify the risks and their possible consequences
• Risk Treatment – make a plan to deal with the risk and then implement your plan
• Monitoring and Review – check how your risk management process is going
• Recording and Reporting – document the results of your monitoring and review, share those results with the right people then revise your risk accordingly.

This is a very broad overview of what ERM involves. In future articles we’ll take a closer look at each stage of the process and include some practical, aged-care-related examples.

In the meantime, the key takeaway is this: in the long term, risks can’t be managed ad hoc. You need a system. This is not only a better way to protect consumers and the sustainability of your business, it’s also a compliance requirement. As it says under Standard 8 of the Aged Care Quality Standards, aged care providers are “expected to have systems and processes that help them identify and assess risks to the health, safety and well-being of consumers.”

For more information on ERM, see our article: Aged Care Homes and the Risk in Not Practising Enterprise Risk Management.