Consultation leads to further Aged Care Quality Standards changes

The Department of Health and Aged Care has released its summary report of the public consultation regarding the strengthened Aged Care Quality Standards, which will be introduced on July 1, 2024. 

A six-week public consultation was held in late 2022 involving key stakeholders, which resulted in the Review of the Aged Care Quality Standards Consultation Summary Report, released in late May. The feedback will influence further changes and refinements to the Standards. 

The Aged Care Quality Standards

• First launched in 2019 as the new compliance benchmark for organisations providing Government-subsidises aged care services
• Features eight overarching standards, including Consumer dignity and choice and Personal care and clinical care
• The Quality Standards influence the Compliance component of the Aged Care Star Ratings system which is 30% of the total Star Rating weighting
• 33% of responses in the public consultation period were from aged care providers, while there was strong representation from peak bodies, aged care service users, workers and health professionals

The consultation period received over 1,000 survey responses and submissions, while more than 900 focus group attendees provided valuable insight across the aged care spectrum. There was a positive response from stakeholders regarding the strengthened Quality Standards as the general consensus believed it better addresses diversity and cultural safety, person-centred care and specialised care.

Hello Leaders has summarised the key points to give you a snapshot of the feedback, and what will happen next regarding the Aged Care Quality Standards.

Standard 1: The Person

Although the inclusion of person-centred, culturally safe care, dignity of risk and communication regarding decision-making were broadly supported, stakeholders were keen to see definitions strengthened, explained and supported to ensure there was follow-through. 

In particular, they highlighted the need to not just offer lip service regarding person-centred and culturally safe care as those terms are not always understood by people delivering care. Concerns were also raised about supporting dignity of risk as there are providers who remain cautious when protecting older people. 

The next steps

• Additional support will be implemented, including detailed resources on how providers can introduce and maintain key concepts like person-centred care and dignity of risk
• There will be stronger requirements for providers to understand care recipient communication needs and increase the resources available for supported decision making
• Adjustments to various Standards to improve dignity of risk, including understanding personal goals and preferences and supporting positive risk-taking measures

Standard 2: The Organisation

Accountability was a top concern for stakeholders. Some queried the requirement to introduce a governing body and how they might be held accountable for non-compliance, while others recognised the importance of better complaints management systems and processes. 

Workforce challenges were also identified as the Standards provided stricter expectations in some scenarios, with requirements to ‘engage suitably qualified and competent workers’ potentially limiting the ability of providers to take on workers who they can train on the job. Likewise, they queried the need to ‘engage workers as employees whenever possible and minimise the use of independent contractors’ as it could impact the use of allied health professionals who are employed as independent contractors. Despite concerns, the Department said requirements will not be changed.

The next steps

• Workforce issues will be addressed through separate regulatory reform activities and initiatives, such as the 15% pay rise
• Strengthened expectations regarding cultural change for governing bodies will be introduced
• Enhanced worker training requirements will be implemented
• Providers will have more concrete expectations regarding incident feedback, complaints, and management 

Standard 3: The Care and Services

Assessment and planning featured heavily as stakeholders are keen to see more flexibility when creating plans and also sharing them with care recipients. For example, stakeholders said ad-hoc services like home maintenance don’t need a detailed care and services plan, while requirements to provide a copy of a care and services plan to the individual should be dependent on the information requested by the client. Not every client might want a copy of their care plan, or they might only want a brief summary.

The separation of dementia care was quite divisive. Some stakeholders felt it should be a discrete standard or outcome with its own requirements, while others said dementia care is a core business of aged care and there’s no need to separate it when delivering care and services.

The next steps

• There will be provisions to support strengthened partnerships with family, carers and health professionals involved in care planning and delivery, including strengthened requirements for multidisciplinary teams
• Work will begin to support the alignment of assessments by separate service providers, thus reducing the chance of duplicate assessments and wasted time

Standard 4: The Environment

Regarding the environment where care is delivered, stakeholders said the biggest challenge was taking responsibility for the safety of an older person in their home environment where there is limited ability to address risks. They said there are obstacles to screening risks such as cost and client compliance, and the purpose of screening needed clarification. However, there was an acknowledgement of positive change as it would allow service providers to give feedback to clients that could enable them to live at home for longer.

Accessibility and infection prevention and control (IPC) measures were also addressed as stakeholders felt there needed to be more clarity around expectations. For example, the reference to an environment being ‘safe, welcoming and comfortable’ is subjective and not descriptive enough.

The next steps

• Revised expectations for screening environmental risks will be created
• Strengthened requirements will be introduced or service environments being accessible, including for people with disabilities
• More information and references will be provided to clarify other points of contention regarding IPC, and what constitutes a fit-for-purpose or dementia-enabling environment

Standard 5: Clinical Care

The addition of a standard for clinical care was strongly supported as it addresses key safety and quality issues identified by the Royal Commission into Aged Care Quality and Safety. However, stakeholders said there needed to be more distinction between the delivery of care in the home and in an aged care setting.

In addition, the focus on acute care and nursing left some stakeholders worried about the lack of guidance on preventative care, reablement and the use of allied health care. Stakeholders also wanted stronger definitions around the provision of palliative care as the current standard indicates it occurs closer to the end of life only.

The next steps

• Standard 5 will undergo considerable change as it becomes more person-centred and holistic
• The importance of optimised function and reablement will be emphasised
• A distinct outcome for cognitive impairment will be introduced to enhance requirements for addressing clinical risks and changed behaviour
• There will be more detailed concepts for the use of allied health and medical professionals, plus the safe and quality use of medicines 

Standard 6: Food and Nutrition

A new food and nutrition standard was welcomed by all stakeholders as they recognised its importance in supporting quality of life, health and well-being. Many stakeholders felt the standard needed to include home care services, not just residential care, although they acknowledged the challenges in governance as the requirements can be varied.

The dignity of risk was seen as one area for emphasis as food and drink can provide enjoyment for many older people. Stakeholders said competing safety needs and personal preferences could be successfully managed, particularly when delivering texture-modified meals. 

The next steps

• Strengthened expectations on meal presentation will be introduced, including for texture-modified meals, to ensure they are appealing and meet individual needs
• Annual menu reviews by accredited practising dietitians will be necessary
• There will be enhanced clarity of expectations for the provision of nutritious food and improved dining experiences 

Standard 7: The Residential Community

A focus on improving the quality of life in residential aged care received support from stakeholders, including the promotion of community engagement and active participation in hobbies. Terminology regarding requirements to minimise boredom and loneliness was divisive as some applauded the simplicity while others queried the subjective nature.

Stakeholders also felt there should be explicit requirements to support maintaining relationships within aged care, while there has to be a greater focus on diversity and inclusion. There was mixed feedback on the role aged care providers could play in managing transitions. Many felt this was a key point of risk for residents but poor communication from external parties and the sudden nature of emergency transitions meant planning and coordination can be impacted.

The next steps

• Expectations for diversity and inclusion will be enhanced
• Additional work is already underway to provide more support for those involved in the transition between health care systems and aged care

Implementing the strengthened Standards

A pilot project featuring 40 aged care providers will determine if the proposed changes can be practically implemented. This will occur over the next few months with further updates to be provided.