Quarterly performance: Compliance remains strong as SIRS notifications rise

The first quarterly sector performance report for the 2023-24 financial year has been released by the Aged Care Quality and Safety Commission. There’s positive news right off the bat: there is a significant improvement in the number of fully compliant aged care providers. 

Performance gaps are a persistent issue, however, as one in five residential aged care providers failed to meet all of their Quality Standards and monthly Serious Incident Response Scheme (SIRS) notifications increased.

Key points

• Residential care providers’ compliance with the Aged Care Quality Standards highly stable Quarter 1 2023-24 with 81% of audited providers meeting all 42 requirements
• Complaints about clinical issues are the most common concern, totalling three out of the five most complained about issues, while Serious Incident Response Scheme (SIRS) notifications are increasing
• There has been a decrease in compliance from home care service providers, with only 63% of audited providers fully compliant compared to 71% in the previous quarter

Compliance rates rise, compliance actions fall

Residential aged care compliance rates have hit a period of positive stability with the rate of compliance increasing to 81% of audited services – compared to 67% 12 months prior. This comes after the Commission conducted 219 audits in Q1 2023-24, compared to 447 in Q4 2022-23. 

While they have not offered a decisive reason for the strong increase in full compliance, the Commission acknowledges they focused on higher-risk services earlier in the auditing cycle, resulting in more notable non-compliance actions. 

The introduction of the Star Ratings system may have also resulted in more incentive to comply. As a result, there has been a consistent decrease in the Commission’s compliance actions. 

Over half of the non-compliance instances found by auditors are dealt with through early remediation with no need to issue a formal notice. This suggests many examples of provider non-compliance are in no way directly impacting the quality of care residents receive.

“We have been working to build incentives for providers to fix lower risk non-compliance sooner through early remediation. This has been well received by the sector and has meant that fewer services have faced formal regulatory action,” the Report said.

The Commission has identified quality Standard 8 (Organisational governance) as an area of concern. 

In total, home care compliance rates have decreased after peaking at 71% in Q4. A sample size of 65 audits does mean the 63% full compliance rate only reflects a small portion of the sector and the Commission plans to ramp up the number this financial year.

“These compliance [..] show that nearly two out of five home services are failing to meet the minimum requirements of the Quality Standards. There needs to be significant improvement for home services providers to deliver consistent, high-quality care for older Australians. In response to the higher rates of non-compliance found in home services, we are increasing the number of quality audits we are undertaking in 2023-24,” the Report stated.

Rise in neglect reports mars SIRS stability

• Although SIRS incident notifications have remained relatively steady in residential care, neglect notifications have risen each quarter, totalling 13,797
• Unreasonable use of force remains the number one complaint topic, accounting for over 60% of notifications, with core issues such as medication management, communication and falls also prevalent 
• Many issues are between residents rather than staff and residents, including over 90% of notifications for unreasonable use of force
• Neglect is the largest volume of incident reports in home care settings, closely followed by stealing and financial coercion

SIRS, which ultimately contributes to compliance with Standard 8 as providers must have effective incident management systems, is a recurring focal point for aged care providers. The increase in reportable incidents, particularly neglect, may be a sign of increased awareness or more shortcomings, added Commissioner Janet Anderson.

“While some of this increase may well be related to a heightened awareness of this incident type, it could also point to shortcomings in personal and clinical care in some services. Clearly, there is more work to do in this important area at the levels of sector, provider and individual services,” Commissioner Anderson said.

“What this example underscores is the importance of providers continuously monitoring and analysing a range of indicators which can show when there is a risk of harm to the people for whom they are providing care.

Overall, the Commission expects serious incidents to decline over time, particularly Priority 1 incidents that are of greatest risk to older people. But providers need to remain on top of their incident management systems and ensure they respond quickly to ongoing issues.

“Many reported incidents are preventable. We expect providers to be able to show how they use continuous improvement to reduce the likelihood of incidents occurring. This includes studying what happens when things go wrong and introducing changes to avoid it happening again,” the Report said.