Inside the Commission’s vision for aged care excellence

With the new Aged Care Act commencing in less than two months, the Aged Care Quality and Safety Commission’s Compliance Management leader, Peter Edwards, said the Commission is focused on building a sector that’s invested in self-assurance and understands its own risk.

Speaking at last week’s Ageing Australia SA State Conference, he explored some of the key changes the Commission is involved with ahead of a transformative era for the sector. 

“As the national regulator, our core purpose is to protect the rights and interests of older people by working with aged care providers and workers to make excellence the standard,” Mr Edwards said. 

“The success of our regulatory model is when you, as providers, are identifying your risks and managing those risks before they become issues.”

Meanwhile, it’s not only providers who are evolving under the new Act’s spotlight. The Commission has been ‘looking internally’ at its operating model and staff capabilities so it can manage the reform. 

Mr Edwards said it’s feeling ‘the pain that you feel’ in a sign of understanding to providers. 

Changes galore 

During his presentation, Mr Edwards ran through some of the key changes that are going to fall under the Commission’s responsibility. This includes the new registration model, where providers will need to be registered by the Commission, rather than approved and then registered in their relevant categories. 

“When we make a registration decision, we’ll test the provider’s suitability, capacity and capability. Registration will be set usually for three years and the Commission can change the registration of a provider because of risks to older people,” he explained.

“Registered providers can also request to vary, revoke and suspend their registration. When registration is set to expire, we will invite providers to renew their registration and this will restart the cycle of registration. All current providers will be deemed as registered providers from the start of the new act on 1 July and the Department of Health and Aged Care is coordinating the transition process.”

The other significant change he spoke of is the Strengthened Quality Standards, which is not new news. However, he reaffirmed that complying with the Strengthened Standards is a condition of registration for providers in categories 4,5 and 6. 

“The Strengthened Standards are more simplified, comprehensive and measurable and strengthen expectations for providers in five areas: dementia care, governance, food and nutrition, diversity and clinical care,” Mr Edwards said.

“They are an integral part of the rights-based approach to the new Act with the rights of older people embedded throughout the Standards, and importantly, give providers a way of reviewing and understanding their own performance.”

The Standards that apply will not be the same for all providers as they will depend on the registration category. 

Conformance supports compliance

Countless debates over the ramifications of provider non-compliance have taken place, particularly as non-compliance often seems to have no impact on visible metrics such as provider Star Ratings.

Mr Edwards shed some light on how the Commission will view compliance moving forward, admitting that conformance can often be prioritised over non-compliance. 

“Conformance with Standards is assessed through an audit, and the results of the audit help us make a registration decision. An audit, in some senses with service accreditation, was a part of a determinative process. Now, an audit is a piece of information that’s considered alongside all the other information we hold to understand how the provider is doing,” he stated.

“It’s about conformance rather than compliance, and conformance speaks to the likelihood of being able to comply. For example, if you have a residential service and we find a minor non-conformance, it gives the provider an opportunity to say ‘This is what we’re going to do about it’ and if we accept that what you’re going to do is sufficient and timely, then we can form a view that you conform.

“We’re going to give you lots of opportunities when it comes to audits because audits are part of the system. If you allow the non-conformance to persist, opportunities are squandered.”

He said the Commission wants providers to achieve continuous improvement as the Commission’s focus is to ensure ‘the right thing is happening’. He pointed out that the use of formal powers has decreased significantly in recent years because the Commission prefers to support providers into doing the right thing rather than penalising them to force compliance. 

Promoting financial viability

Another talking point was the changes to the Financial and Prudential Standards. There are three revamped Standards — liquidity, financial and prudential management, and investment — with records and disclosure essentially covered by other existing and new obligations. 

The requirements should be familiar to providers, according to Mr Edwards, with the addition of an enforceable minimum liquidity amount arguably the greatest change. Under the new Aged Care Act, the financial and prudential management standard will apply to all non-government providers registered in categories 4,5 and 6. The investment and liquidity standards will apply to all non-government residential providers. 

“We are committed to making this work in a manner that ensures all providers across the sector hold sufficient liquidity,” he said. 

“We do want the Standard to help us to manage that 5% to 7% of the sector that has genuine viability issues. Viability is a lead indicator of bad care. We have engaged with providers who don’t even realise that their financial situation is going south. It’s a very important measure.”

For providers that are in a precarious position, Commission decisions will take into account whether a provider can or cannot afford to implement necessary measures. Mr Edwards said the Commission is happy to work with providers and the Department of Health and Aged Care to find solutions that result in sustained compliance. 

With Aged Care Act Rules and relevant information unfinalised, he said the Commission is doing its best to put forward relevant details — even in draft — to ensure providers have ‘something to work with’. 

Despite the uncertainty, he said there is no excuse for non-compliance and making no attempt at improvement. 

“We can’t walk past non-compliance, we don’t have discretion to do that. Where we do have discretion is how we manage non-compliance. How we work with you will depend on your posture. If you want to work with us, we’ll work with you, but if you’ve repeatedly made promises in the past and never kept them, our trust will be lower,” he finished.