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.
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.
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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