Compliance rates take a dip after performance peak

The Aged Care Quality and Safety Commission’s latest Sector Performance Report (April – June 2024) reveals long-term compliance improvement has continued its rollercoaster ride with performance dropping in some areas after reaching its peak.

Key points

• Home care service providers continue to lag behind residential care providers where Quality Standards compliance is concerned, while compliance with Quality Standard 8 (Organisational governance) is an area of concern for the Commission
• Quality Standard 7 (Human resources) now has the third lowest rate of compliance in residential care and the highest number of requirements that are ‘not met’
• Fees and charges, and management of finances still account for three of the top five most complained about issues in home care services
• Serious incident rates in residential care have increased since the start of the last financial year, however, the Commission noted the rate has stabilised in the last two quarters

Compliance results remain a mixed bag

Residential care continues to outperform home care services in overall compliance rates, with the sector achieving 81% compliance compared to home care’s 65%. 

That 81% mark is a three percentage point decrease from the previous quarter and 12 months prior. For home care, 65% compliance is one percentage point higher than the previous quarter but six percentage points lower than 12 months prior.

Long-term comparisons from Quarter 1 2022-23 to Quarter 4 2023-24 show that residential care has improved in seven out of eight Quality Standards, the exception being Quality Standard 3 (Personal care and clinical care). 

However, comparisons with Quarter 3 2023-24 show the exact opposite with compliance rates dropping in seven Quality Standards. Quality Standard 2 (Ongoing assessment and planning with consumers) was the only one to see improvement.

As for home care, five out of seven Quality Standards have recorded long-term improvement, while the same amount saw short-term negative results. This includes compliance with Personal care and clinical care plus Feedback and complaints both dropping by nine percentage points.

Overall, it is Organisational governance that remains the greatest challenge for all providers, with Quality Standard 7 (Human Resources) another that has moved backwards. Positively, while Feedback and complaints are a pressing issue for home care, residential care compliance sits at 95%, a strong return.

SIRS notifications finally plateau 

After the number and rate of serious incidents in residential aged care reported to the Commission grew significantly since the start of the 2022-23 financial year, a plateau appears to have been reached.

In total, 14,408 SIRS incident notifications in residential care were recorded in Quarter 4, 11 fewer than the previous quarter. That makes it three quarters in a row where SIRS incident notifications have been between 14,331 and 14,419.

After SIRS was introduced to home care in December 2022 the number of quarterly notifications has increased from 809 to 1,466. The Commission said they are “working with home services providers to ensure they understand their responsibilities to report all serious incidents that occur as well as to have in place an effective incident management system”.

The complaint rate has also remained steady in residential care, although the 1,489 complaints received by the Commission is the highest in the past two years. Just over 1,100 home care complaints were received after experiencing a surprise drop in the previous two quarters. 

“While there is no definitive answer as to why there was a drop in Q2 2023–24, there can be many reasons why the number of complaints varies between quarters, such as seasonal variation. A higher rate of complaints can also show that a provider is helping people receiving care to give feedback and raise concerns,” the Commission said.

Provider supervision in the spotlight

Each Sector Performance Report also includes an ‘In Focus’ section with the latest featuring an insight into the Commission’s new provider supervision model. 

The Commission uses a range of regulatory approaches and tools to monitor if providers are doing the right thing and will take compliance and enforcement actions to protect older people if it identifies serious failures to provide safe care.

Under the new supervision model, the Commission has given all providers a supervision status. Providers assessed to be high risk will be under a greater level of supervision and engagement.  

Aged Care Quality and Safety Commissioner Janet Anderson said the sector performance reports are an overview of the types of data used by the Commission to inform the provider supervision model. 

“As well as using information in the report to identify sector risk, we join the dots to decide where we should focus our attention at a provider level. Under our provider supervision model, the intensity of our engagement with a provider is proportional to the assessed level of risk, with higher-risk providers being subject to active or heightened supervision,” she said. 

The statuses include:

• Targeted supervision – Where the Commission requires a provider to take corrective action to manage specific events or issues and has confidence in their ability to do this in a timely and appropriate manner, a targeted supervision status will be applied.
• Active supervision – If a high level of risk or harm to older people is identified, or the Commission is not confident the provider is willing to do what is required, the Commission will regularly engage with the provider to ensure they do take action.
• Heightened supervision – If severe levels of risk to the safety of older people or ongoing continuity of care are present, plus high levels of public interest, heightened supervision is required. Stakeholders such as the Department of Health and Aged Care will also be involved. 

Currently, 83 providers are under active supervision while five are under heightened supervision.

“Providers can be moved between supervision levels at any time based on the level of risk and their demonstrated capacity and willingness to manage that risk. This can include moving straight from the lowest level of supervision to the highest, if necessary.  If there are no specific risks or compliance concerns, providers will have a ‘risk surveillance’ status,” the Commissioner added.

More information about provider supervision, including case studies, can be found in the Sector Performance Report on the Commission’s website.