Governance compliance a concern, says regulator

Aged care providers need to lift their game when it comes to governance, according to the latest sector performance report.

Released Tuesday by the Aged Care Quality and Safety Commission, the first quarter sector performance report shows that, during 1 July to 30 September 2023, quality standard eight – organisational governance – had the lowest rate of compliance across both the residential aged care and home care sectors.

“Provider governance remains an issue of concern for the commission,” writes Aged Care Quality and Safety Commissioner Janet Anderson in the report’s introduction. “This is worrying because we know that poor governance leads to poor clinical care, more complaints and more serious incidents.”

In better news, residential aged care providers’ rates of compliance with the industry’s quality standards have increased significantly over the past 12 months. The report shows 81 per cent of audited homes were compliant with the 42 requirements of the eight quality standards.   

“This is a notable improvement over the same quarter last year,” says Ms Anderson. There are, she adds, a couple of explanations for the upturn. “One reason for the improvement is that we are now auditing lower-risk services, having prioritised high-risk services for onsite audits during the height of the Covid pandemic. Another contributing factor may be the star ratings program, introduced in December 2022, which provides additional incentives for residential providers to achieve and maintain compliance across multiple quarters.”

The improvement in compliance has led to a drop in regulatory action by the commission with over half of the non-compliance found now dealt with through early remediation. This is where the provider takes prompt and effective action to address the problem the regulator has identified without it having to issue a formal notice.

However, while the commission’s data shows “an improving trend”, it also means that nearly one in five residential aged care services were less than fully compliant.

“These concerning trends warrant specific attention and action.”

Home care providers recorded much lower compliance rates than residential aged care providers with only 63 per cent of services found fully compliant with all quality standards – a drop from a high of 71 per cent in quarter four of 2022-23.

As well, while compliance with quality standard three – personal care and clinical care – has increased across the residential sector, it has fallen among home care services. “These concerning trends warrant specific attention and action by home services providers,” say the report’s authors.

Neglect high on reportable incidents

Analysing Serious Incident Response Scheme data, the report’s authors find that incidents in residential aged care “are mostly stable”. There is, however, one exception: neglect – where notifications are increasing each quarter.

Neglect notifications are also over-represented in home care settings where they account for the largest volume of incident reports. “While some of this increase may well be related to a heightened awareness of this incident type, it could also point to shortcomings in personal and clinical care in some services,” says Ms Anderson. “Clearly, there is more work to do in this important area at the levels of sector, provider and individual services.”

The second largest number of home care notifications relate to stealing and financial coercion.

When it comes to complaints, medication management is the top topic in residential aged care with complaints about the issue increasing since the fourth quarter of 2022-23. Complaints about communication and falls have also increased in residential care.

Fees, charges and communication complaints account for one in five complaints about home care services. And while complaints about Home Care Packages had increased from the second to third quarter of 2022–23, they have now stabilised.

Ms Anderson concludes her introductory message by saying: “While data is the core of this report, it is only useful if providers consider it carefully and act on it.”

Providers are encouraged to provide feedback on the latest sector performance report by completing a five-minute survey.

Meanwhile, the regulator is hosting workshops to develop a first draft of guidance materials to support providers to implement the revised quality standards when they come into effect alongside the Aged Care Act from 1 July 2024.

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