Quality Standards evolution: Is this the end of unannounced visits?

Australia’s aged care sector is on the brink of a significant transformation with the introduction of a strengthened regulatory framework under the new Aged Care Act.

The enhanced Quality Standards will set a new benchmark for care delivery, with a more transparent audit process and a grading system that recognises excellence. Could it also bring an end to unannounced visits?

As providers prepare for these changes, understanding the new requirements will be key to ensuring compliance and continuous improvement in aged care services.

Ready for approval: Registration changes

The new ‘universal’ provider registration system will result in a single registration for each provider across all aged care programs. If you currently deliver multiple programs (such as home care and residential aged care), you will only need to register once under the new regulatory model. This includes if you are registered in multiple registration categories. 

For existing providers, you will be automatically set up or deemed as registered providers in the new regulatory system for aged care from July 1, 2025. There is no need to apply for registration if you’re already in the system. 

All existing registered providers will have early access to a registration preview in April that summarises their deemed states based on current information held by the Commission. It will offer insights into registration statuses once the new Act is implemented.  

“For providers operating in these categories it will also be a condition of registration that you comply with the strengthened Quality Standards in the delivery of services,” Robert Day, Assistant Secretary, Harmonisation and Regulatory Strategy Branch, Department of Health and Aged Care, explained. 

“In addition to the Quality Standards, there are a number of overarching obligations that will apply to all aged care providers regardless of the type of aged care you’re offering or the registration categories that you are in. Core conditions include having an understanding of the Statement of Rights and having systems in place to make sure the care you deliver is consistent with those rights.”

The 6 proposed registration categories are: 

• Category 1: Home and community services
• Category 2: Assistive technology and home modifications
• Category 3: Advisory and support services
• Category 4: Personal care and support in the home or community
• Category 5: Nursing and transition care
• Category 6: Residential care 

Providers applying for registration to deliver services in categories 4, 5 and 6 must have an audit against the strengthened Quality Standards as part of the application to be a registered provider. Audits will also occur for registration renewals or when an eligible category is added to an existing registration.

Service providers seeking to enter the sector can apply for registration from July 1, 2025. They will have to tell the Commission which provider registration categories they want to be registered in. The Commission will then test their suitability, capacity and capability through an audit which is part of the registration and renewal process. 

“Organisations and people applying for registration need to show that they meet the registration requirements. This includes general requirements as well as registration requirements specific to each category that they’re applying to be registered in,” Sarah Kelly, Acting Executive Director Registrar, explained. 

“We’ll provide procedural fairness where we’re considering refusing an application, we’re not registering a provider in a category that they’ve applied for or not intending to approve a residential care home.”

Ms Kelly added that the Commission can add conditions to registrations, such as asking a provider to regularly report on their operational plan for a new residential care home. 

Audit evolution: No more unannounced visits

The audit process will continue to be a key feature in the Commission’s powers, however, there will no longer be unannounced visits as part of its regular auditing process. There will be some exceptions if risk or non-compliance is identified. 

Instead, the Commission is establishing a far more transparent process where providers are always informed about visits in advance. All providers will have a single point of contact, an audit manager. Each audit will be based on a provider’s re-registration date and it will be coordinated appropriately. 

Christian Hesse, Acting Executive Director of the Quality Assessment and Monitoring group, outlined the following audit process:

• Stage one is about initiating the audit and obtaining information to understand the provider’s operating context. This occurs through an information request and audit initiation meeting.
• Stage two of the audit delivery is to collect and assess evidence. The audit team meets with the provider’s governing body to gain an understanding of the governance arrangements systems and processes. They gather evidence by meeting with senior management before looking at how care and services are being delivered to older people. For home care providers in categories 4 and 5 this will involve a sampling approach that covers all care and services being delivered.
• Stage three is audit reporting where the Commission gives the provider a preliminary audit report that details the performance ratings for each outcome and quality standard. The provider has a chance to review and respond to the report and then a final report is prepared. This approach should drive efficiency and transparency for providers while allowing the Commission to assure itself that providers are meeting the Quality Standards as a condition of their registration.

Systems and processes will be a recurring theme throughout this process. Where non-compliance with new conformance standards is found, providers are less likely to be penalised in any way if they demonstrate that systems and processes are in place to enable continuous improvement. 

Exceeding expectations: A new benchmark

The Commission is also introducing a new graded assessment model that goes beyond the current ‘met’ and ‘not met’ model. It will feature four grades: conformance, minor non-conformance, major non-conformance and exceeding. 

Gradings are applied to all relevant outcomes with an overall rating for each audited Quality Standard. Mr Hesse said the assessments provide more transparency that supports future improvements.

“Conformance is when we’re satisfied with the provider’s performance against the standards. Minor non-conformance is where we can see there’s an opportunity for improvement, such as a gap in provider systems and processes but it’s not systemic and it doesn’t represent high risk to older people,” he explained.

“Major non-conformance is where we do find high risks to older people. We expect providers to have systems in place at all times to support the safe delivery of quality care. Providers will need to show how those systems are implemented and how they monitor and improve those systems. If they cannot demonstrate that they provide safe and quality care, that’s likely to lead to a finding of major non-conformance. 

“An exceeding rating allows us to recognise when a provider is fabulous. We’re still working on what the framework for this looks like right now.”

The transition to the new audit methodology and grading assessment model will begin from July 1, 2025. Providers with a registration expiry date in early 2026 can expect to receive renewal invitations around then. 

“If you’re compliant now you’re likely to be in a really good place. You don’t need to completely change what you’re doing but there will be resources to assist you to prepare for the uplift in expectations,” Mr Hesse said. 

“Minor non-conformances are an expected audit outcome during this transitional period, similar to the rollout of the current quality standards in 2019 which saw a significant increase in non-compliance rates, which have reduced over time. We’ll be considering evidence of the provider’s commitment to continuous improvement when determining audit ratings.”

The Aged Care Quality and Safety Commission webinar is now available for public viewing. All additional information and resource links can be found here.