Sector compliance a mixed bag as residential and home care results vary

Governance continues to be an area of concern for the Aged Care Quality and Safety Commission with the latest Sector Performance Report revealing that 84% of audited residential care providers fully complied with all eight standards.

However, over a quarter failed at least one requirement of Quality Standard 2 (Assessment and planning) while home care services continue to lag behind with just 64% achieving full compliance. That’s a decrease of seven percentage points since Quarter 4, 2022-23.

Key points

• Quality Standard 2 and Quality Standard 8 (Organisational governance) now have the lowest rates of compliance in both residential care and home services
• Compliance with Quality Standard 3 (Personal care and clinical care) has improved, however, clinical issues remain the most common complaint
• Complaints about fees and charges, and management of finances account for three out of the top five most complained about issues in home care services

Compliance with Quality Standards

A quick glance at the last four quarters reveals relatively consistent performance. After a slight dip where compliance with all 42 requirements dropped to 81%, residential care providers have otherwise hovered between 84-85%.

Nearly one in seven providers are below the minimum standard in at least one area of the care they provide. 

Impressively, full compliance was achieved with Standard 4 (Services and supports for daily living), while Consumer dignity and choice and Organisation’s service environment scored 99% compliance.

All others achieved 91% or higher with Ongoing assessment and planning with consumers and Organisational Governance being the lowest. Home care providers also recorded the most non-compliance in those two Standards. 

The Commission said the drop in Ongoing assessment and planning with consumers is a concern, and so too is the non-compliance with individual requirements. Failure to achieve compliance with a specific requirement means a provider is found to be non-compliant with the whole Quality Standard.

Over in home care, a new approach to audits has seen a rise in quality audits for Quarter 3, 23-24. Almost 400 quality audits were conducted, more than triple the previous quarter’s total. With this came a drop in full compliance as 36% of home services providers were below the minimum requirements of the Standards.

Where residential care providers are over 91% compliance with all Standards, home care services only scored 90% or above in three: Consumer dignity and choice, Services and supports for daily living and Personal care and clinical care. 

Incoming: provider supervision

For those unaware, the Commission has announced something called ‘provider supervision’. 

“We ‘watch’ all providers all the time to identify where there might be risks or failures of care. We do this by constantly scanning all the information we collect […]. We also review information we receive from the aged care system like the Quality Indicator Program (QI Program), Quarterly Financial Reports and the Annual Statement of Provider Operations. We call this risk surveillance,” they stated. 

“When the risk posed to older people receiving care is high or rising, we intervene. We will appoint a Commission case manager who will decide the best way to make sure that the provider is managing the risks quickly and properly to protect older people. 

“Through this process we can focus our efforts on specific providers and make sure we intervene in the right way at the right time. This means we can protect people receiving care while also supporting providers to get it right.”

Food, nutrition and dining and infection prevention control are two of the top sector-wide risks being focused on during onsite assessment visits in residential care. With an increased focus on common risks, the Commission has ramped up its early remediation efforts: Over 60% of non-compliance was resolved through early remediation.

This has seen directing and compelling actions decrease, meaning the Commission has found providers to be more willing when fixing issues than in the past. As a result, only two non-compliance notices were handed out between January and March, compared to 16 from October to December. 

Workforce highs and lows

Over 91% of residential care services met the requirement to have a Registered Nurse on duty 24/7, up from 86% last July. The Commission is looking for evidence that providers who have not achieved their target have clear plans in place to meet their obligations in the future. 

While providers continue to strive for complete RN coverage, worker regulation continues to be a minor concern for some organisations. 

For example, 27 banning orders were handed out between January and March, contributing to one-fifth of the 126 issued since December 2022. Elsewhere, 11 caution letters and nine reminder of obligation letters were sent to individuals deemed to be a risk to people receiving care. 

These letters encourage compliance through education and awareness while reminding individuals of potential consequences or risky behaviour. These letters and banning orders are in the minority but they serve as a reminder that even the best aged care providers have to be diligent over workers who are potentially not suitable for the role.