Unpacking the quality expectations
Even with the delay, it’s time for all levels of aged care operations to get their heads around the new quality standards, writes Judi Coombe.
Once again, the aged care sector braces for change as we prepare for the implementation of the Strengthened Aged Care Quality Standards, now set to occur in July 2025 with the commencement of the new Aged Care Act.
Once introduced, these standards mark a significant step forward, as they build upon the previous regulations to both enhance existing requirements and add new elements, ultimately aimed at strengthening a person-centred approach to aged care.
This is the first in a planned series of articles, where my colleagues and I aim to provide an overview of the key aspects we recommend providers focus on in relation to each standard. We’ll illustrate how these resonate across the various levels of operations – the boardroom, the executive level and point of service.
We want to empower aged care providers with some key ideas and understanding of where to direct their focus to successfully navigate these changes. As we delve into each standard, we will shed light on both the new and strengthened elements we believe are the critical areas for providers to consider. Below is a summary of key elements to be considered across all standards.
Below we look at the key elements of the first standard and what they mean for each of the three levels of operation.
Standard: 1 The Person
Consumer expectation: I am valued and have choice over the life I lead
The foundation of this standard – and all standards – is person-centred care.
But currently – and despite having well-constructed person-centred care models – truly understanding the people we’re caring for is often a crucial component missing when it comes to effectively putting the models into action.
The concept of “know your consumer” is pivotal here. It requires delving into their life histories, preferences, medical backgrounds and current health risks. Collecting this information is not just about ticking off boxes; it is about building real connections with the people we are helping.
We recognise many organisations collect information on their residents, however, it is important to seek the right information that offers real insights into who the resident is and what is important to them.
Often, workflow structures are focused on getting tasks completed, rather than on building meaningful relationships.
A task-oriented approach does not result in care that is responsive to the individual, or truly centred around them as a person. We need to shift away from this sort of paint-by-numbers approach and start prioritising and fostering genuine human connections.
Until we do, person-centred care is just going to be about ticking off tasks, instead of understanding the person and caring for them in a way that enhances their sense of self and respects their preferences, needs and rights.
Having a person-centred care model is just the beginning
The key elements of person-centred care include:
- understanding the consumer’s lived experiences, relationships, interests, history, values and beliefs
- identifying factors that have shaped and influenced the consumer to become the person you now care for
- using these two above to inform the construct of care
- the art of knowing your consumer at an individual level and partnering with them on all levels.
Board: Having a person-centred care model is just the beginning. Does the model support effective practice at both the partnership and individual consumer elements of person-centred care?
Unless there is effective delivery at an individual level model, the organisation level model will just be words on a page with little perceptible improvement in consumer’s wellbeing being realised.
Executive: Ensure organisational strategy and concepts are effectively translated into practice on the ground.
This is about driving and supporting the process of understanding who the consumer is and what lived experiences, relationships, achievements and/or traumas have shaped them and continue to cause them joy and a sense of self-worth or grief and a sense of hopelessness.
Point of service: Take a humancentric approach to understand the person’s past, present and future.
You need to enable consumers to be an active partner in their care whether this is through on-going interaction or a deep understanding of who they are, what has shaped them as a person and how this should inform their care.
Trauma aware and healing informed care
The notion of trauma aware and healing informed care and services is a relatively new concept. It is a key element of the first standard and also referenced in standard 3 and 5.
This element of the strengthened standards intends to ensure that governance and management practices are informed by healing principles.
This is premised on the notion that the most effective support for trauma-exposed consumers is when the organisation itself is functioning in a healthy and effective way, enabling consumers to enjoy a trauma aware, healing informed experience without bias or judgement.
Board: As an organisation, providers need to recognise how an individual’s history of trauma may influence his or her health, relationships, and ability to build trust that the care experience will be supportive and will not add to or trigger further trauma.
Supporting a culture of awareness of the principles of trauma aware and healing informed care is fundamental to the establishment of a culturally safe, trauma aware and healing informed care environment. It is underpinned by the organisation’s understanding and commitment to recognising and promoting social, sexual and cultural identity and self-esteem, with consideration for cultural knowledge, skills, beliefs and connectedness.
From a board’s perspective, it is essential to ensure your organisation partners with individuals and organisations with the capability to support the establishment and ongoing effectiveness of a culturally safe environment. This environment would enable the exploration of trauma and identity where the health professional’s lived trauma, beliefs or values do not contribute to or otherwise adversely affect the trauma experienced by the consumer.
Executive: Understanding the different types of traumas that consumers could experience and how these can impact on them is fundamental to creating a trauma healing culture.
Trauma generally manifests from the person’s lived experience, their personal and social culture, sexual identity, religious beliefs or sense of gender and identity. It could be the result of experiences such as the Stolen Generation, war, homosexual persecution, sexual abuse, domestic violence or as a victim of other crimes.
To address this, the executive needs to develop a good understanding of the ways in which staffing structures, staff knowledge, values and beliefs support, or hinder, the application of a person-centred culture to create a trauma aware, healing informed model.
Care and service delivery, staffing structures, staff knowledge and beliefs should not be a cause of re-traumatisation or blame of victims for the way in which they manage their traumatic reactions.
Point of Service: The impact of trauma can be lifelong and affects the person, their emotions, mental state and relationships with others. The circumstances of the trauma can affect their sense of self, their ability to trust others, cause them shame, anger or fear and/or a suspicion regarding the motives of others, even caring health professionals.
Being aware that trauma can exist, even if it is not spoken about is fundamental in delivering healing informed care and services.
Trauma-informed healing acknowledges and supports trauma survivors as unique individuals who have experienced extremely abnormal situations and have tried to manage the impacts of this as best they can.
As care workers, you need to be aware of, and anticipate, how your actions, words and care support activities can negatively impact consumers and trigger past traumas.
Choice and decision-making
Choice and decision-making extend beyond the basic issues of lifestyle preferences and who will be recognised as the consumer’s representative.
Dignity of risk decisions need to be underpinned by the risk appetite of the organisation with clear information to guide staff to deliver considered and safe practice that addresses the regulatory requirements and liabilities of the organisation and responsible officers.
The notion that having the consumer sign a consent form absolves the service from their duty of care is not correct and it is unlikely this would provide adequate defence should an adverse outcome occur.
Board: The strengthened standards bring the need for effective governance to address the organisational and personal liability aspects into sharp focus.
It is essential for boards to address the disconnect between the board’s risk appetite to support highly risky dignity of risk issues and how this is applied on the ground.
A strong framework to guide how clinician’s manage dignity of risk within the board’s appetite and parameters is fundamental to exercising the obligations of responsible persons.
Give particular consideration to the risks of choking and smoking. For example, is the organisation comfortable to support a resident by providing him/her with a normal diet knowing that there is a high risk of choking, which could result in their death.
Executive: Bridging the gap between organisational risk appetite and choice and decision-making requires a framework and sound informed decision-making processes.
The executive serves as the link between the board and the point of care and service delivery. Members need to have a solid understanding of the dignity of risk issues being addressed with consumers, how duty of care is being exercised and evidenced, and how they can provide assurance to the board that each responsible person’s responsibilities and liabilities are protected in a safe manner.
Be specific regarding the type of risky decisions a representative can make on behalf of a consumer and what can only be decided by the consumer themselves when in receipt of all the relevant information.
It is doubtful that stating that the action was at the request of the family will be an appropriate defence should an adverse outcome occur, even if there is evidence to support this.
Documenting that the “risks have been discussed” with the consumer is not adequate evidence
Point of Service: Having a “waiver” does not absolve the clinician from their duty of care to do no harm and to ensure that the consumer has the capacity and information to make an informed decision.
Whether it is a risky decision or a request for a restrictive practice, once the clinician signs a consent form, they are making a clinical judgment and giving their agreement for the action or issue to be implemented.
The role of the clinician in any decision-making by the consumer, is to ensure that the consumer understands the reason for the “treatment”, the alternative options, implications, and risks.
Documenting that the “risks have been discussed” with the consumer is not adequate evidence. The documentation must clearly state all the issues that were discussed, what was said by the clinician and what was said by the consumer and demonstrate that the clinician was satisfied that the consumer had capacity to make an informed decision.
Judi Coombe – a registered nurse with 30-plus years of clinical, quality and executive experience in aged care services – is principal operations consultant at Ansell Strategic
We hope you enjoyed this article – please add your comments below
Visit our features portal for more in-depth stories
