Compliance v Care: Providers hope to avoid a culture of form-filling

Compliance burden is one of the top fears for many providers awaiting the implementation of the new Aged Care Act, with home care and residential care operators set to inherit daunting amounts of regulatory work.

Aged care providers and stakeholders at the Perth Community Affairs Legislation Committee meeting last week explained that over 1,200 pieces of information will be required to satisfy the Aged Care Quality and Safety Commission’s accreditation process.  

Mark Sheldon-Stemm, CEO of Riverview Residence Collie, said it runs the risk of becoming a box-ticking exercise where providers will have to show how they’re complying with almost 300 subsections under the new Aged Care Act. 

“I know that in terms of even a small provider, as far as Valleyview is concerned, we’ve had to put an extra staff member on to simply tick boxes and make sure that we can provide that evidence. Whether that is going to improve the quality of care, I’d have to question, in terms of the use of resources,” he said.

“It’s really about the interpersonal skills on the floor, basically, in terms of when people are dealing with people’s daily living needs – food, nutrition and so on. What’s the interaction like and how are people treated with respect? No box-ticking exercise is ever going to give you that information.”

Mr Sheldon-Stemm added that he has no major issues with the Aged Care Bill itself, but is worried overall about the rules and regulations that have resulted in the sector carrying the heaviest compliance burden.

Similar opinions were shared by Roule Jones, CEO, The Bethanie Group, who said the risk of compliance burden is that it evolves into a culture of form-filling rather than a culture of caring for individuals. 

“Instead, staff are thinking about what they are being held to account for and making sure that they have ticked all the boxes,” she said.

Stephanie Buckland, CEO, Amana Living added: “The risk from a cultural standpoint, within an organisation, is that you lose sight of the wood for the trees and focus too much on meeting all the compliance requirements and not on actually providing the care and the support that each individual person needs, taking the time to get to know each individual person, to know not just what their physical requirements are but also what their emotional, spiritual and social requirements are.”

Recognising enrolled nurses

Western Australia is by no means immune to the same workforce challenges the entire Nation faces. It’s why Brightwater Care Group CEO, Dr Catherine Stoddart, said there needs to be greater recognition of enrolled nurses in care minute targets.

“We have quite a strong reporting regime that demonstrates whether or not we are meeting our quality indicators. The flexibility to utilise those care minutes for the right type of workforce would be really useful in terms of residential aged care,” she explained.

“At Brightwater we are seeking to utilise enrolled nurses to the full 10% of the possibility, because they offer a very stable regulated workforce that can add value. It would be really useful to have some contemporary research around the impact of enrolled nurses in the aged-care sector.”

Dr Stoddart also said it’s common for the sector to underestimate the value of therapy assistants across the broad spectrum of residential care service delivery. 

Carolyn Smith, State Secretary National Director, Aged Care at the United Workers Union, reinforced the need for increased enrolled nurse recognition, labelling them the “absolute backbone of aged care” and calling for better acknowledgement of their direct impact.

“They have held the aged-care system together. There is an issue about the calculation of care time and nursing minutes where ENs have not been counted in those nursing minutes,” Ms Smith said.

“I think there is a real issue for ENs feeling like they’re being squeezed out of the sector at the moment after having held it together. Many, many times, you can be in a facility where there might be one RN and the rest of the nursing staff are enrolled nurses.”

She continued by expressing her support for mandatory care time, stating that the key to good quality care is having enough staff on the floor. However, many providers are unlikely to provide this if there’s no mandatory requirement.

“I think there are some unintended consequences in terms of mandatory care time, but that’s not a problem because of care time; that’s a problem with providers then trying to rort the system, to be really blunt,” she said.

“We need a system that requires a certain number of staff in facilities. It’s what our members tell us again and again is absolutely key to quality care. I don’t think we need to make mandatory care time more flexible. We need to make sure we’re fulfilling it.”