Home care governance under scrutiny

Industry analysis crunches the data on more than 700 quality spot checks on home care providers during 2022-23.

Non-compliance trends highlight the increased focus on holding home care boards to account, according to an industry report.

Analysis from aged care consultancy firm Pride Living shows there has been a noticeable increase in the number of quality audits conducted by the Aged Care Quality and Safety Commission regarding home care compliance issues.

Jason Howie

“It is clear that the days of home care being the poor cousin to the residential sector when considering compliance are over,” Jason Howie – Pride Living partner – told Australian Ageing Agenda. “This is unsurprising given the rapid increase in the share of aged care funding that has been directed towards the home care sector.”

As the report shows, during the 2022-23 financial year the regulator exceeded its target of 700 home care assessment contacts, conducting 720 checks in all. “And we expect compliance expectations to increase into the future,” said Mr Howie, co-author of Home Care Non-Compliance Trends.

The commission can conduct an assessment contact at any time, including outside of business hours and on weekends. Assessment contacts can be made with or without notice given to the home care provider. They can be conducted by a regulatory official onsite or remotely, or a combination of both.

As well as spot checks, home care providers are required to notify the commission of any infractions through the Serious Incident Reporting Scheme. And from 1 December 2023, requirements for governing body membership and provider advisory bodies also took effect.

Katrina Ong

“The data we reviewed provided insights into the additional activity being undertaken by the commission, and an increased focus on holding governance bodies to account for the care results that organisations are achieving,” Katrina Ong – Pride Living partner and report co-author – told AAA.

“We noted in our review of the data that there is a correlation between care management requirements and governance requirements, indicating that the ACQSC regards a break down in the care management systems as being a core responsibility of the board.”

Indeed, should a provider fail to meet certain criteria within the new proposed Aged Care Act, board members could face civil and criminal penalties for serious breaches of care.

“In light of the proposed penalty regime for responsible persons regarding poor performance in service outcomes, it is important that controlling committees invest time in understanding their clinical governance performance and responsibilities,” said Ms Ong.

Source: Pride Living Home Care Non-Compliance Trends

When analysing the number of non-compliant providers, Pride Living found that not-for-profit operators were most at fault with 64.1 per cent shown to be non-compliant, compared to for-profit (25.8 per cent) and government-run (10.1 per cent).

But as Mr Howie and Ms Ong note in the report, this could be “indicative of the composition of providers in the sector (52 per cent NFP, 37 per cent for-profit, 11 per cent government-run).”

They add: “It’s crucial to note that the number of provider representations does not directly correlate with the number of care recipient representations as 61 per cent of care recipients are serviced by not-for-profit providers.”

Source: Pride Living Home Care Non-Compliance Trends

The report also shows that – while representing 35 per cent of the home care market share – very large providers only accounted for 9 per cent of compliance issues reported during the period.

Small and medium-sized operators, however, are significantly overrepresented in compliance issues when compared to the volume of services they deliver.

As the report’s authors highlight, small operators represent a market share of 4.4 per cent but have recorded 31 per cent of total compliance issues. Representing a market share of 24 per cent, medium providers have recorded 42 per cent of total compliance issues.

“We noted in our review of the data that, when measured against share of market, larger organisations represent far fewer reported compliance issues per consumer than the smaller and medium-sized providers,” Mr Howie told AAA.

“Further analysis would need to be conducted to understand whether this is due to better performance generally, or the nature of reporting, whereby a systemic problem across a larger organisation is still only raised as a single compliance item,” he added.

Source: Pride Living Home Care Non-Compliance Trends

Crunching the non-compliance data, the report’s authors were able to rate which quality standards were most commonly infringed.

  1. Standard 8 – organisational governance
  2. Standard 2 – ongoing assessment and planning with consumers
  3. Standard 7 – human resources
  4. Standard 6 – feedback and complaints
  5. Standard 1 – consumer dignity and choice
  6. Standard 3 – personal care and clinical care
  7. Standard 4 – services and support for daily living
  8. Standard 5 – organisation’s service environment.

“Governance themes related to systems and processes dominate the majority of the identified non-compliances, underscoring the critical importance of effective systems and overall governance,” say the report’s authors.

Source: Pride Living Home Care Non-Compliance Trends

During 2022-23, Victoria was found to be the state with the highest non-compliance rate at 25.3 per cent, followed by Queensland (23.7 per cent). At 1 per cent, the Northern Territory recorded the lowest non-compliance rate.

Although receiving the highest number of assessment contacts and audits (30.7 per cent), New South Wales received a relatively high non-compliance score (16.7 per cent). “This may indicate that despite the high number of audits, there are still a significant number of non-compliance issues,” say the report’s authors.

Conversely, the report shows Western Australia and the Australian Capital Territory had a low number of assessment contacts (7.6 per cent and 2.8 per cent) and also low non-compliance rates (7.1 per cent and 6.1 per cent). “This suggests,” say the authors, “that these states have a lower non-compliance risk based on the available data.”

In the report’s conclusion, and in light of the forthcoming regulatory changes, Mr Howie and Ms Ong suggest home care providers focus on strengthening their governance systems. Providers would be wise, they say, to “prioritise an effective board with the right skill mix, especially for medium and small providers, as it may impact compliance outcomes.”

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Tags: home care, jason howie, Katrina Ong, non-compliance, pride-living,

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