In its sector performance report released in early February, the aged care regulator flagged poor governance compliance as an area of ongoing worry.
“Provider governance remains an issue of concern for the commission,” wrote Aged Care Quality and Safety Commissioner Janet Anderson in her introductory message.
“This is worrying because we know that poor governance leads to poor clinical care, more complaints and more serious incidents,” she added.
However, Cynthia Payne – founder and managing director of aged care consultancy firm Anchor Excellence – said the commission’s critique was unfair.
“It is harsh to claim that sector governance is poor,” she told Australian Ageing Agenda. “It is also important to recall that David Tunes’ review also had much to say about the commission – so let’s stop throwing stones and work together encouraging all leaders to rise up.”
Ms Anderson’s comments relate to the commission’s findings that, during 1 July to 30 September 2023, quality standard eight – organisational governance – had the lowest rate of compliance across both the residential and home care sectors.
“The commission expects to see an improvement in governance arrangements, and we are supporting providers to achieve this through educational programs such as Governing for Reform,” she said.
Established in March 2022, the Governing for Reform in Aged Care Program aims to support the sector to strengthen corporate and clinical governance capabilities and enact critical reform. The program includes online learning modules, practical tools, podcasts and webinars.
“The program helps to strengthen your understanding of good governance and leadership practices while helping to practically apply your learnings in the workplace. Whilst the program concepts are primarily aimed at governing bodies and executives, all leaders, emerging leaders and all aged care sector employees who are interested in strengthening their governance and leadership capabilities will find the program beneficial,” according to the commission’s website.
Providers would be prudent to participate in the program as compliance in general is under ongoing regulatory scrutiny – with home care operators increasingly on the commission’s radar.
According to a report released in January by aged care consultancy firm Pride Living, there has been a noticeable rise in the number of quality audits conducted by the commission regarding home care compliance issues.
“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 AAA. “This is unsurprising given the rapid increase in the share of aged care funding that has been directed towards the home care sector.”
As Pride Living’s report shows, during the 2022-23 financial year, the commission exceeded its target of 700 home care spot checks, conducting 720 in all.
“And we can expect compliance expectations to increase into the future,” said Mr Howie, co-author of Home Care Non-Compliance Trends.
The commission can conduct a spot check – or an assessment contact – with a residential aged care or home care provider at any time, including outside of business hours and on weekends. Assessment contacts can be made with or without notice given to the provider. They can be conducted by a regulatory official onsite or remotely, or a combination of both.
As well as spot checks, providers are required to notify the commission of any infractions through the Serious Incident Response Scheme. Requirements for governing body membership and provider advisory bodies have also come into effect.
“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 breakdown in the care management systems as being a core responsibility of the board.”
Great governance and leadership are the leading determining factors for high-quality care
Cynthia Payne
Indeed, should a residential or home care 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.
Regulatory changes afoot this year include the introduction of the new Aged Care Act and a revision of the industry’s quality standards. Both are due to come into play from 1 July.
The new quality program includes seven standards – down from the current eight – with the one concerning provider governance moved up the line to Standard 2: The Organisation.
The intent of Standard 2 “is to set out the expectations of the governing body to meet the requirements of the quality standards and for the provider to deliver quality care and services.”
The commission regards a provider’s governing body as “critical to the delivery of safe, quality, effective and person-centred care for every older person.”
Ms Payne agrees: “Great governance and leadership are the leading determining factors for high-quality care,” she said.
In light of the forthcoming regulatory changes, Mr Howie and Ms Ong strongly suggest providers act now to strengthen their governance systems and processes.
Providers would be wise to “prioritise an effective board with the right skill mix, especially for medium and small providers, as it may impact compliance outcomes,” they said in the report.
Ms Payne told AAA the sector was doing its best to address its governance responsibilities. “In fairness, it’s an area that has been in focus for all providers, and the mandated majority independent non-executive directors and nominated clinical director, and the set-up of the two advisory bodies, have only been in place since December.”
It’s very easy for people to say “we need to do more,” added Ms Payne. “That is stating the obvious,” she said.
“Every stakeholder – which includes the Quality and Safety Commission and Department of Health and Aged Care – is embarking on a significant reform agenda. Managing fast, agile change is a more recent phenomena for aged care providers, and I can only but admire the resilience and tenacity we have seen as leaders continue to dig deep and improve care and services for their organisations.”
We hope you enjoyed this article – please add your comments below
Visit our features portal for more in-depth stories
