Aged care quality standards

The Department has published a range of materials on the Updated Standards, to facilitate consultation. The materials are extensive (particularly the Detailed Draft of the Updated Standards and the Consultation Paper) and will not be covered comprehensively in this update. Rather, we offer a brief overview of each of the Updated Standards, and the Government's plans for consultation over the next six weeks.

We encourage all of our clients to become involved in the public consultation around the Updated Standards, as the in-depth involvement of experienced approved providers is the greatest opportunity to ensure that the Updated Standards are fit for purpose and achieve the desired outcome.

The Government has stated that although the current version of the Aged Care Quality Standards (Current Standards) has set 'expectations' to support the delivery of quality care, further improvement is required to:

Provide more detail to consumers about what to expected from aged care services and what providers need to do to provide quality care;

Make the requirements that provides are subject to 'less subjective and more measurable';

Strengthen requirements

• relating to provider governance and human resources;
• to better recognise diversity in people receiving aged care;
• to better reflect the needs of people living with dementia;
• relating to food and nutrition, through both making sure the food is desirable to eat and that it meets the individual's needs, and
• relating to clinical care, including addressing clinical risks and ensuring the care is safe and meets the individual's needs.

The Governments goal in implementing the Updated Standards is:

To have a stronger focus on the individual and to ensure that care and services are designed for the individual's 'needs and preferences';

Address a range of issues considered by the Royal Commission into Aged Care Quality and Safety, including the strengthening of requirements relating to:

• provider governance;
• diversity;
• dementia;
• food; and
• clinical care;

Clearly communicate expectations to providers;

Enable some standards to be tailored to the type of service being provided; and

Increase harmonisation with the NDIS Practice Standards (where possible).

The Updated Standards consist of the following seven key pillars, which we have provided along with a brief summary of the scope of each below:

1. The Person:

I have the right to be treated with dignity and respect and to live free from any form of discrimination. I make decisions about my care and services, with support when I want it. My identity, culture and diversity are valued and supported, and I have the right to live the life I choose. My provider understands who I am and what is important to me, and this determines the way my care and services are delivered.

Standard 1 is intended to be an overarching standard which places the individual care recipient at the centre of care provision. It is intended to reflect the importance of key concepts such as person-centred care, dignity of risk, independence, quality of life, culturally safe care, transparency and choice and control.

2. The Organisation:

The organisation is well run. I can contribute to improvements to care and services. My provider and workers listen and respond to my feedback and concerns. I get care and services from workers who are knowledgeable, competent, capable and caring;

Standard 2 is focused on the approved provider and in particular, accountability for the governing body of the approved provider. This means that although Standard 2 focuses on matters such as risk management, and ensuring that appropriate mechanisms and systems are in place to ensure quality and safe services are delivered, there is also a focus on ensuring that the governing body of an approved provider is accountable for the delivery of quality and safe care at its services, as well as maintaining oversight over 'all aspects' of an approved provider's service delivery.

Further, Standard 2 appears intended to extend to all matters required to keep the organisation running and delivering high quality and safe care, such as adequate workforce planning to maintain service delivery into the future, and appropriate information management to ensure the records held about care recipients and accurate, identifiable and easily access and understood by those who need the information.

3. The Care and Services:

The care and services I receive:

• are safe and effective
• optimise my well-being and quality of life;
• meet my current needs, goals and preferences; and
• are well planned and coordinated.

Standard 3 describes the way providers are to deliver care and services. Standard 3 is not intended to stand alone, and providers will need to draw on all of the Updated Standards in order to deliver high quality care and services. Standard 3 focuses on the involvement of care recipients in their care planning, the delivery of care and services that meets the needs, goals and preferences of the care recipient, effective communication and co-ordination of care and services amongst multiple care providers.

4. The Environment:

I feel safe when receiving care and services. Where I receive care and services through a service environment, the environment is clean, safe and comfortable and enables me to move around freely. Precautions are taken to prevent the spread of infections;

Standard 4 focuses on the service environment where aged care services are delivered, and ensuring that environment is clean, supportive, safe and meets the needs of care recipients.

Standard 4 includes split sub-standards, so that there are different standards relating to the delivery of care and services in a home environment as opposed to a residential aged care facility.

5. Clinical Care:

I receive safe, effective, person-centred clinical care which meets my needs;

As you would know, the Australian Commission on Safety and Quality in Health Care has assumed responsibility for clinical care standards in aged care, and accordingly Standard 5 falls within its ambit. Standard 5 is still however included in the general review of the Updated Standards, and is part of the consultation process.

Standard 5 considers clinical care and covers such factors as clinical governance, infection management, medication safety and end of life care. It is primarily focused on ensuring that any clinical care delivered in an aged care setting is high quality and safe.

This includes the implementation of strong clinical governance practices, to ensure that the care delivered in an aged care facility is sustainably of a high quality over the long-term.

6. Food and Nutrition:

I receive plenty of food and drinks that I enjoy. Food and drinks are appetising, nutritious and safe, and meet my needs and preferences. The dining experience is enjoyable, includes variety and supports a sense of belonging; and

Standard 6 focuses on food and nutrition, which was a key plank of the Government's aged care reform promises at the election earlier this year. Standard 6 focuses on the need for appropriate assessments to understand the nutritional needs of care recipients, and what is required to meet these needs, however there is also a strong focus on intangible factors such as enjoyment and experience, and ensuring that the care recipient is partnered with to deliver food that the care recipient enjoys and finds appealing.

7. The Residential Community

I am supported to do the things I want and to maintain my relationships and connections with my community. I am confident in the continuity of my care and security of my accommodation.

Standard 7 focuses on two separate matters to contribute to the wellbeing of care recipients. Firstly, the delivery of daily living services, to support care recipients in ways which contribute to their overall health and wellbeing and enable them to do things they want to do. It also focuses on security of tenure matters, including the appropriate planning and coordination of any transition between approved providers.

At a surface level, there are some obvious similarities between the Updated Standards, and the Quality Standards which are currently in place. There is however significant detail on the Updated Standards in the materials published by the Department, and we expect that the major differences between the Updated Standards and those currently in place will be in the detail and nuance of each standard.

Updated quality performance indicators

In addition to the Updated Standards, the reform of the National Aged Care Mandatory Quality Indicator Program (QI Program) is ongoing, with a goal of gathering data which can be used to improve the quality of care services provided to recipients as well as empowering care recipients to exercise informed choice.

A pilot program has been held to develop new quality indicators, and it was completed in June 2022. Through the pilot program, additional quality indicators were identified and approved providers will need to commence collecting these additional quality indicators from 1 April 2023. The additional quality indicators are:

• Activities of daily living: Percentage of care recipients who experienced a decline in activities of daily living;
• Incontinence care: Percentage of care recipients who experienced incontinence associated dermatitis;
• Hospitalisation: Percentage of care recipients who had one or more emergency department presentations;
• Workforce: Percentage of staff turnover;
• Consumer experience: Percentage of care recipients who report ‘good’ or ‘excellent’ experience of the service; and
• Quality of life: Percentage of care recipients who report ‘good’ or ‘excellent’ quality of life.

Key dates to be aware of are:

• start collecting new quality indicators (listed above) in the April – June 2023 quarter; and
• submit quality indicator data in the 1 – 21 July 2023 reporting period. 

If you would like to discuss this update, please do not hesitate to get in touch.