Compliance snapshot: Providers still on notice despite home care gains

Home care providers remain on notice despite improvements in compliance rates, while organisational governance remains the top problem aged care problem, according to the latest sector performance report from the Aged Care Quality and Safety Commission.

Commissioner Janet Anderson PSM expressed her pleasure regarding the positive trend for residential care providers while warning that home care providers can expect extra attention during audits.

“I am pleased to report that we have seen a significant increase in home services providers complying with the Quality Standards this quarter. We want to see this improvement continue. 

“In Q1, 73% of home services providers we audited were fully compliant with all their Quality Standards – up from 65% compliance in Q4.

“At the same time, it is worth noting that more than a quarter of the home services providers we audited in Q1 are still falling short in at least one requirement of the Quality Standards.”

Key points

• The Sector Performance Report for Quarter 1 (July-September 2024) revealed that more than 80% of residential care providers audited complied with all 42 requirements of the Quality Standards
• Quality Standard 8 (Organisational governance) remains a focal point as compliance remains the lowest at 87%
• The 10 percentage point increase in compliance for home care service providers is a positive change
• The top 5 complaint issues for home care services are still related to communication, coordination of care and financial issues
• Risk-based assessments are returning positive outcomes, including an increase in vaccination rates and improvements in infection prevention and control, food nutrition and dining and workforce responsibilities 

Data shows that compliance with the quality standards in Q1 was stable, improving by one percentage point. However, it still means that one in five residential care services were below the minimum standard in at least one area. 

There was notable improvement across the board as Quality Standard 3 (Personal care and clinical care) and Quality Standard 7 (Human resources) compliance increased by three percentage points to 92% and 93%, respectively. 

Quality Standard 1 (Consumer dignity and choice) and Quality Standard 4 (Services and supports for daily living) improved by two percentage points, with Quality Standard 1 at a near-perfect 99% compliance rate.

Three standards saw a drop in compliance rates from the previous quarter, however: Quality Standard 5 (Organisation’s service environment), Quality Standard 6 (Feedback and complaints) and Quality Standard 8 (Organisational governance). Quality Standard 8 was the only standard to be lower than 92% with an 87% compliance rate.

While most quality standards have compliance rates in the mid-to-high 90s, the Commission said it is worried about quality standards where one or more requirements are not being met. This is the biggest concern for Quality Standard 8 as clinical governance framework, effective risk management systems and practices and effective governance systems continue to be a problem for a minority of aged care providers.

The Commission will continue to work with providers to address these issues. Ms Anderson said penalties will only be handed out for those failing to implement change. 

“There is no tolerance for providers that are persistently not complying with their obligations without an explanation, or not committed to fixing the issues in the required timeframes,” she said.

“Where a provider or worker has breached their obligations, causing or posing serious harm to older people, we may also impose a consequence including a penalty such as a fine, or sanction a provider, preventing them from receiving additional government funds.

“Holding providers to account for the quality of care they deliver and for their compliance with financial and prudential obligations is not about ticking a box. It is about ensuring that providers review and reduce their risk, are committed to continuous improvement, pursue transparency and remain accountable.”

Home care improvements welcomed 

Lower compliance rates in the home care cohort have resulted in a sharp increase in the number of quality audits completed by the Commission. This has arguably led to notable improvements.

As per the Commission’s data, 222 quality audits were conducted across the first half of the 2023-24 Financial Year. The Commission then conducted 391 in Q3, 406 in Q4 and 323 in Q1 2024-25.

The long-term outcome here is that compliance rates with all 42 requirements jumped from between 63%-66% during 2023-24 to 73% in 2024-25.

Quality Standard 6 (Feedback and complaints) saw the greatest improvement from Q4 to Q1, rising from just 80% to 93%. Quality Standard 3 (Personal care and clinical care) improved by eight percentage points to 89%, Quality Standard 7 (Human resources) rose to 88% and Quality Standard 4 (Services and supports for daily living) remained the best at 94%.

Meanwhile, although they both remain lower than would be liked, Quality Standard 2 (Ongoing assessment and planning with consumers) and Quality Standard 8 (Organisational Governance) also improved to 83% and 75% compliance rates, respectively. 

Negatively in Q1, one in four providers did not meet one or more requirements of Quality Standard 8, compared with one in three in Q4 2023–24. Only Quality Standard 1 (Consumer dignity and choice) decreased, dropping to 91%. 

SIRS and concerning trends

Interestingly, while quality audits have increased in home care, risk-based monitoring decreased in Q1 as the Commission focused on residential care. It conducted 644 risk-based monitoring assessment contacts in Q4 compared to 124 in home care settings. 

The Majority of targeted assessment contact activities in residential care were related to food, nutrition and dining, while the Commission also looked at COVID-19 vaccination rates.  

Elsewhere, the Commission received 15,107 reportable incident notifications with the unreasonable use of course accounting for just over half of reportable incidents in the Serious Incident Response Scheme (SIRS).

Neglect and psychological or emotional abuse also saw a high number of reports as the overall number of notifications increased by roughly 1,200 compared to Q1 2023-24.

The Commission said it saw a significant increase in the number of neglect incident reports, with medication errors, falls, personal care needs not being met and pressure injuries all common. 

“In Q1 2024–25, there have been 3,950 notifications of neglect, which is an almost 11% increase from Q4 2023–24, and a 26% increase compared with Q1 2023–24. It is the second-most common incident type after unreasonable use of force,” it revealed. 

“Many providers’ internal incident management systems (IMS) are not in line with the SIRS reporting framework. Providers should use their IMS to identify, address and track incidents to stop them from happening again. Our review shows that providers are not often using their IMS to identify trends or system-wide issues.”

The Commission added that there is not enough detail in provider responses to incidents.

“It is important that providers are detecting incidents and acting immediately to safeguard people in their care. However, the responses do not often address underlying issues or root causes that could help prevent incidents of neglect happening again.”

The full Sector Performance Report – Quarter 1 (July – September 2024) can be viewed here.