Current residential aged care regulatory mechanisms do not consistently provide the assurance the community expects in terms of quality of care, according to the review into regulatory processes, which has made 10 recommendations aimed at boosting consumer protection, compliance monitoring and transparency.
The Review of National Aged Care Quality Regulatory Processes, led by Kate Carnell and Professor Ron Paterson, was triggered by failures at the Makk and McLeay aged care wards at the Oakden Older Persons Mental Health Service in South Australia (read our story here).
Minister for Aged Care Ken Wyatt, who announced the review in May, released the final report on Wednesday after receiving it on 4 October.
The reviewers found that the current system is fragmented, absent of reliable and comparable information and doesn’t do enough to ensure consumers know their rights.
On accreditation and compliance monitoring, the reviewers said the accreditation processes that permitted the Makk and McLeay wards at Oakden to pass all 44 outcomes in February was clearly inadequate and “a deeply concerning failure”.
To strengthen ongoing accreditation processes the review has recommended replacing planned accreditation visits with comprehensive unannounced audits influenced by risk profiles, which the Coalition Government has already committed to implementing (read our story here).
Overall, the review has identified five key elements of an effective regulator and made 10 recommendations to reform the system.
To address the currently fragmented system, the review looked to the original Productivity Commission proposal and has recommended establishing an independent Aged Care Quality Commission governed by a board and comprising a quality commissioner, complaints commissioner, and consumer commissioner in addition to a chief clinical advisor.
To improve the availability of reliable, comparable and sharable information, the review has recommended the new commission develop and manage a centralised database for real-time sharing and a star-rated system for public reporting of provider performance and that all residential aged care services participate in the National Quality Indicators program.
“We envisage the publication of clear, readily intelligible information that includes some form of star rating against core standards,” they wrote.
It said the simple and readily understandable rating information published by England’s care regulator provided a useful star-rating example.
Consumer support and protection
The review found that awareness of the charter of consumers’ rights was low and has made recommendations to give the rights of consumers and their representatives more prominence in residential aged care including through education for consumers and staff.
It also determined through evidence from this review and previous inquiries that residents were not adequately protected from abuse and neglect under the current system.
The review has endorsed the ALRC recommendation for a new independent serious incident response scheme (SIRS) and has proposed that the Aged Care Commissioner oversee the new scheme, which would replace the current reportable assaults process in the Aged Care Act.
The review has also made recommendations to limit the use of restrictive practices, whether physical or chemical, saying that alternative means for behaviour management should become the norm in facilities.
Accreditation and compliance
To address a “tick-the-box” exercise focused on processes rather than outcomes, the review has recommended a more effective risk-based approach to accreditation using information from a single integrated database combined with that of the unannounced visits mentioned above.
In response to concerns over medication errors and as part of the recommendation to ensure assessment against standards is consistent, objective and reflective of care expectations, the reviewers have recommended that medication reviews be conducted on admission to the facility, after hospitalisation and upon deterioration or changing medication regimes.
To enhance the handling of complaints the review has recommended increasing the powers of the complaints commissioner to enable the commissioner to share information and publicly name non-compliant providers.
It has also recommended that the commissioner modify the Australian Open Disclosure Framework for the residential aged care setting and that it be adopted by all residential services, and create an online register with information on the nature of complaints and how they have been resolved.
As it moved to immediately implement the changes around accreditation, the Minister Wyatt said the government was now considering the entire review in detail.
Access the full report here.
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