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Facilities to face surprise compliance checks for re-accreditation


Comprehensive unannounced audits will replace planned accreditation visits in residential aged care facilities, Minister for Aged Care Ken Wyatt has announced.

The decision coincided with the release of the Review of National Aged Care Quality Regulatory Processes report, which proposes moving exclusively to unannounced visits for ongoing accreditation among its 10 recommendations (read our story on the report here).

The review led by Kate Carnell and Professor Ron Paterson was launched in May following the failures at the Makk and McLeay aged care wards at the Oakden Older Persons Mental Health Service in South Australia (read our background story here).

Following an initial announced accreditation check, the report recommends eliminating planned re-accreditation visits and replacing them exclusively with unannounced audits, which assess service performance against all standards over at least two days and use a risk-based process to determine the frequency and rigour of visits.

Facilities are currently subject to one annual unannounced visit as part of their ongoing accreditation,which the reviewers found was usually limited to one day and not all outcome measures assessed.

Minister Wyatt, who released the report during an address at the National Press Club on Wednesday, said the Turnbull Government would move as soon as possible to implement the recommendation for exclusive unannounced audits.

“Aged care safety and quality are non-negotiable and must be delivered to residents 365 days of the year, without exception,” Minister Wyatt said.

“While I ordered this review after Oakden, there have been other high-profile aged care failures which have highlighted where parts of our systems have sadly let us down.”

He said the overwhelming majority of facilities provided excellent care but the focus must be on those not delivering because no senior Australian should be subjected to some of the events that have happened.

“Maggots in the mouth when you are admitted to a Canberra hospital is not appropriate,” Minister Wyatt told the press club event.

“Wounds that should have been dealt with when they were small ulcers should not be allowed to develop to a large pressure wound.”

He said the Australian Aged Care Quality Agency would continue to conduct initial accreditation audits in consultation with the provider to allow them to understand the standards and meet licensing requirements.

Proposed model

Under a strengthened risk-based approach, high-performing facilities with a low risk profile would receive fewer unannounced visits while the frequency, duration and staffing of unannounced visits would be greater for providers in higher-risk circumstances, the review proposed.

While risk can be based on compliance history, it also relates to the complexity of care a service provides along with the vulnerability of the residents at the facility, the review found, citing severe dementia, mental illness, disability, guardianship and homelessness as contributing factors.

It is proposing that existing provider payments for re-accreditation visits and the annual contribution for an unannounced visit be rolled into one annual contribution with no net increase to providers and that provider contributions for visits be based on the number of beds in a facility rather than the number of visits conducted.

Labor said it supported the proposal to expand unannounced accreditation visits.

Stakeholder reaction

From left: Ian Yates, Pat Sparrow, Sean Rooney, Cameron O’Reilly

The Minister’s announcement about changes to the ongoing accreditation process has been welcomed by consumer peak COTA Australia.

Chief executive Ian Yates said COTA supported the recommendations to increase the number and scope of unannounced visits to aged care facilities as well as risk-based targeting of audits.

The CEOs of the provider peak bodies Aged & Community Services Australia, Leading Age Services Australia and the Aged Care Guild issued a joint statement following Mr Wyatt’s address pledging their commitment to work with government on reforms to quality regulatory processes.

ACSA CEO Pat Sparrow said unannounced visits under the current system already held providers to account 365 days a year.

“With any extra regulations that flow from the report, including the replacement of announced visits with unannounced audits, we urge them to be targeted and effective, maintaining a laser-like focus on quality outcomes, including any unintended consequences around cost and implementation,” Ms Sparrow told AAA.

“The system must differentiate between those providers who are delivering quality of care and those who do not meet the standards the community expect.”

Similarly LASA chief Sean Rooney agreed on these points and added that no aged care provider should be alarmed by unannounced quality audit visits, which were part of existing accreditation.

“The cost of moving to unannounced visits will need to be determined and negotiated with industry to work through who pays and how much. Similarly, any cost impost associated with unannounced visits will need to be measured against the added benefits to quality and confidence,” Mr Rooney told AAA.

Moving to unannounced visits also required a revision of the accreditation method, he said.

“Current practices for announced visits provide for an efficient process that ensures key staff are available, documentation is collated and provided in appropriate formats, residents and families are invited to participate. For unannounced visits this will not be the case.”

The Aged Care Guild supports in principle the move to unannounced audits but the process of introducing them needs to be carefully considered and assessed, said CEO Cameron O’Reilly.

“Maintaining a good reputation and the trust of the public is crucial to providers’ ability to attract consumers and this driver is just as important as regulation in delivering the highest quality standards,” Mr O’Reilly told AAA.

He said the Guild supported rolling current provider payments for accreditation and compliance visits into the new model, providing there were no net increases to overall provider contribution and that the system was genuinely risk based where providers with a strong track record of quality benefitted from lower regulatory costs.

“However, the Guild is strongly opposed to cost recovery for unannounced site visits through a levy, which amounts to taxation of the sector and effectively reduces government subsidies to the sector, diverting funding otherwise directed to the core business of delivering care to residents,” he said.

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8 Responses to Facilities to face surprise compliance checks for re-accreditation

  1. stevie October 27, 2017 at 2:01 pm #

    And what will he do about it. He needs to up the nurse and carer compulsory ratios . Better education for all the new ones that come in doing crash courses . Look at the profit making on the profit nursing homes . Cut back on work visa due to many coming over and cheaper to employ , often with poor knowledge and poor english skills .
    Funding has been cut back by the liberal Government which neeeds to be restored .
    It will be more likely that they will sweep it all under the carpet
    All the good staff are burning out !!!!

  2. Cannot give my name October 30, 2017 at 5:58 pm #

    In many places prior to announced visits the facility ups the staffing to make a great show and then drops it back, often quite drastically, immediately after.

    You are right that understaffing leads to stress for both carers and residents and the specification of a ratio of 1:6 minimum in low care and 1:4 minimum in high care especially dementia care would make life better for all – except the profit makers and quite frankly I don’t care about them. When did services become brands anyway. It is soul destroying.

  3. Trish October 30, 2017 at 9:04 pm #

    This is more appropriate as a monitoring process.
    The unannoounced visits will put more pressure on the Director of Care to ensure that staff are maintaining the standards & delivery of quality
    care / personal support.

  4. Nurse October 31, 2017 at 11:17 am #

    I hope this system will force the hand of facilities to ensure that adequate staffing is maintained at all times.
    Particularly the RN ratios, which in my experience should be no more than 1 to 60 in low care with a qualified EEN at 1 to 30 maximum and in High Care Dementia absolutely no more than 1 to 30 for the RN.with the same for the EEN.
    Care staff in general 1 to 6 in high care and 1 to 4 in Dementia care. Even on mixed wards/units. And we must ensure these levels are maintained during the busy periods of rising, settling and meals.
    Activities officers must be available from Breakfast till settling.
    I believe this will effectively reduce falls, behaviours and provide excellent care for our resident’s.
    My current situation is that after failing various Standards admin freely admit as soon as the next visit is over staffing will be reduced again.
    Staff morale is terrible. Admin support is non existent.
    It is not the Care staff failing. The failure is in an administration that fails to listen, educate or support staff.
    Simple recommendations made 3 years ago have not been implemented yet surprisingly were not followed up by the accreditation team and not part of the reasons for failure.
    Providing excellent care requires adequate staffing of appropriately trained staff.
    No Aged Care provider should be making profits above and beyond what is required for future planning. If Providers are profiting at such obscene levels. Where are the cuts being made to facilitate this. This is where accreditation fails. It is not about paperwork it is about care. Look to the big provider’s no care but great paperwork.

  5. Christine October 31, 2017 at 3:19 pm #

    Canada has been doing unannounced visits in Long Term Care for years now. I actually think the accreditation here is a little lenient compared to the strict rules and regulations in Canada.  It should not matter when  assessors pop in for their visit the documentation of care, policies and procedures, resident files organized and should be ready at a moments notice.

  6. Jenny November 3, 2017 at 11:26 pm #

    In addition to unannounced visits, how about a bit more money into the system to support the employment of RNs and ENs? Not all residential aged care facilities can afford to have an RN on duty 24 hours a day. A tad unsatisfactory in my opinion.
    When you think a hospital bed costs $1600 a day, before anything else like money depending on the illness the individuals may be in there with, and the most a very high level of care an older person can get is around $230, it tells us the value put on our frail elderly people needing care!
    Fund more and stop making us jump through the validation hoops we have to, and care will improve. And accreditation assessors will not help but be impressed…
    In addition, hospitals will not be so clogged with older persons awaiting placement, because RACFs will be able to employ RNs to supervise more acutely-unwell people in their RACF, which has become their home, and where they want to be, after all.
    A big shake-up of the system is desperately needed.

  7. Nancy November 4, 2017 at 3:31 pm #

    I agree whole heartedly that the change is overdue, and should all visits should be unannounced. From past experience in the workforce and now from the experience of my husband using residential facilities for respite, I have been appalled at the deterioration in aged care standards. There always were issues, but now that profit is the only aim, and more profit is involved, the standards have fallen.

  8. Marcus Aston December 24, 2017 at 5:20 pm #

    What about the quality and qualifications of the quality assessors
    Don’t here much about their 2 week training for such a vital job. What a joke
    And they get paid $70-90 per hour 3-4 times what a care worker gets while they wonder around facilities totally out of their depth accrediting Oakden and many others while outragers we’re going on under their noses
    This neo liberal system is designed and run for and by the providers not for the benefit of residents but for their benefit meaning of course their bottom line.
    It doesn’t matter that residents and staff suffer as long as the free marketing of the aged makes our executive and of course our shareholders a descent buck.

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