Governance compliance still an issue, says report

Governance compliance continues to be an area of concern for the sector’s regulatory body, according to the latest anaylsis.

Released last week by the Aged Care Quality and Safety Commission, the January to March 2024 sector performance report shows that three of the 10 quality standard requirements with lowest compliance relate to standard 8 – organisational governance: effective organisation-wide governance systems, risk management systems, and clinical governance framework.

“Governance is still an area of concern in both residential care and home services,” says Aged Care Quality and Safety Commissioner Janet Anderson.

Since 1 December 2023, all providers are required to comply with strengthened governance responsibilities. As the report’s authors note, not complying with the governance requirements “is linked with a decrease in the quality of a person’s care and their safety.”

Quality standard 2 – assessment and planning – is also on the commission’s radar. It is, says Ms Anderson, “a rising area of concern”, particularly across home care services where the standard now has more non-compliance than any other.

“Over a quarter of audited providers failed at least one requirement of this standard,” she says. “This included failing to manage risk when there had been a change in circumstance, and poor communication and documentation.”

Overall, compliance rates in home care services remain lower than in residential care, with only 64 per cent of providers recording full compliance with the eight quality standards. “This is a major focus for the commission, and we are addressing some of these risks in the way we manage home services quality audits,” says Ms Anderson. “In a recent change, we now assess all services of a single provider in one quality audit.”

This change has meant the commission conducts more home care audits. In Q3, 391 audits were conducted compared with 118 the previous quarter.

In comparison, residential care providers maintained relatively high rates of compliance, with 84 per cent of services audited during the period recording full compliance with all eight quality standards.

Compliance with the quality standards is just one area scrutinised by the commission during its quarterly audits. The regulatory body also considers complaints and serious incident reports.

When assessing residential care, clinical issues are the most common complaints made to the commission. In home care, it’s communication and financial matters. “These issues are clearly important to people who receive aged care, their supporters and staff,” says Ms Anderson.

In response to the “persistence of complaints” about financial issues, the commission audited a sample of home care providers to make sure they are charging people appropriately.

While it found a “high level” of compliance, the commission discovered outdated home care agreements, incorrect pricing schedules, and issues with monthly statements.

Although providers are largely complying with quality standard 4 – which assesses meal services – the quality and variety of food is the fourth most complained about issue and food appears in 26 per cent of complaints the commission receives about residential aged care.

As Ms Anderson notes: “It is not just about good food. When you get the food right many clinical risks are reduced, and a person’s quality of life is improved.”

Results for compliance with workforce responsibilities were “mixed”, say the report’s authors. In March 2024, more than 91 per cent of residential care services met the responsibility to have at least one registered nurse on-site 24/7.

However, recruitment, training and support is “an area of concern” across the sector and complaints about the number and sufficiency of staff are the third most complained about issue in residential care.

Analysing reports issued through the Serious Incident Response Scheme, the commission found the overall numbers and rates of SIRS notifications in residential care increased slightly since Q1, with priority 2 incidents accounting for just over two-thirds – 68 per cent – of notifications.

The top eight incidents reported during Q3 are:

The authors note that: “Notifications of neglect have been increasing over time and increased again this quarter by approximately 5 per cent.” Notifications of psychological or emotional abuse increased by 14 per cent.

Reports of unreasonable use of force in residential care still account for more notifications than the other incident categories combined.

“Providers should be reviewing their incident management systems to look for ways they can improve how they stop incidents from happening and how they respond to incidents when they do happen,” say the report’s authors.

When reviewing SIRS notifications, the commission has also found that providers underassess the impact of serious incidents on people receiving care. “Providers may not be considering less obvious impacts that can be harder to identify,” say the authors. To help remedy the issue, the commission has developed an impact assessment tool.

Explaining the purpose of the sector performance reports, Ms Anderson says: “We join the dots between this information to decide where we should focus our attention both at a sector-wide level and by individual provider.”

She adds: “We encourage providers to also draw together the many pieces of information available to them when considering their own data. This helps them to address their own risks before it becomes an issue that requires commission intervention.”

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