It is often said that the Living Longer, Living Better reforms reflect an evolution not a revolution, and for many in the sector the new Australian Aged Care Quality Agency which came into effect on January 1 is a case in point.
While the Quality Agency’s expansion to include home care has been widely welcomed, changes to the agency fall short of what was recommended by the Productivity Commission and supported by the industry and consumer peaks during the Caring for Older Australians inquiry.
Sue Macri, former associate commissioner at the Productivity Commission inquiry, says the former government cherrypicked the PC’s recommendations and ultimately was not “brave enough” to establish an independent regulatory agency, the proposed Australian Aged Care Commission (AACC).
Such a move would have stripped the department of its regulatory functions and created a clear separation between policy setting on regulation and compliance and enforcement responsibilities.
Under the PC’s proposed model, the Aged Care Standards and Accreditation Agency would have been established as a statutory office within the independent AACC instead of being inside government, and would have been overseen by a Commissioner for Care Quality.
By rejecting the PC’s recommendation Macri says the government “still leaves a conflict between policy setting by the department and regulation and compliance.”
She says ensuring the Quality Agency maintains its independence from the Department of Social Services will be a critical issue moving forward.
Political context
Chief Executive of COTA Australia Ian Yates says the consumer peak strongly supported the PC’s recommendation for an independent aged care regulator and complaints system and is disappointed but unsurprised by the lack of political support.
Yates says both Coalition and Labor governments have been committed in recent years to centralising control of statutory authorities within government, in line with the 2004 Uhrig Review recommendations.
In its policy response to the PC inquiry, the former Labor government cited the Uhrig Review as a key rationale for transitioning the Accreditation Agency from a government company limited by guarantee to an agency under the Financial Management and Accountability Act 1997.
The Accreditation Agency was believed to be one of the few remaining statutory authorities still operating under the Commonwealth Authorities and Companies Act 1997.
In its formal response to the PC recommendations, the Labor government also cited the high start-up and ongoing operational costs of establishing an independent regulator as a reason for not supporting the proposal, an assertion both Macri and Yates reject as unconvincing.
New government
From the Coalition, very little has been said on the subject of the Accreditation Agency barring a line in its Healthy Life, Better Ageing policy document that acknowledged support for “independent accreditation, complaints and quality care assessment processes.”
Yates said he has flagged this as a topic of conversation with Minister Fifield as the agency rolls out.
More broadly, however, the Coalition Government has signalled early support for extending the accreditation period for providers with a long history of successful accreditation.
Governance structure
In his final months as CEO of the Accreditation Agency, Mark Brandon expressed some reservations about new Quality Agency as a public service agency and cited its changed governance structure as a reason why he did not apply to head up the new body.
Brandon said he believed that the model put in place by the Howard government in 1997 was the correct structure for the agency and that he felt unable to work under the “strictures” of the public service.
While acknowledging the restrictions on the public service, both Macri and Yates say they do not hold significant concerns about a lessening of the agency’s independence under the new arrangements.
While the new Quality Agency no longer has a company board (it has an advisory council and a CEO appointed by the minister), Yates says as a government-owned company, the former Accreditation Agency was also open to government control.
As the sole shareholder of the Accreditation Agency, the minister appointed the board directors and the chair and therefore a change of government could result in a change in the make-up of the board, as has occurred during the company’s history.
“Effectively there was government control but instead of it being at the level of appointing the CEO, it was at the shareholder role,” says Yates.
Macri also says the former Accreditation Agency could not be thought of as truly independent from government. “I sat on the board of the Accreditation Agency for three years and the department itself sat around the board meetings anyway. The person delegated by the minister attended the board meeting so whilst it sat out there talking about independence, there was still departmental involvement.”
Yates says with the loss of a company board under the move to the FMA Act, the status and capacity of the Quality Agency’s advisory council will be critical to the success of the new agency.
Responsibility for home care
Governance issues aside, the sector has welcomed the transfer of responsibility for quality review of home care from the department to the new Quality Agency from July 1.
The change means that for the first time in the sector’s history, aged care will have a single quality agency responsible for the accreditation and quality review of both residential aged care and home care including Home Care Packages, the Commonwealth HACC program and the National Respite for Carers Program.
Dr Mike Rungie, CEO of the ACH Group, says running the two quality processes separately has been a missed opportunity for the sector. “The single agency dramatically increases the possibility of having learning transfer from residential to community and from community to residential in a quality sense and that’s really important.”
In addition to efficiencies and streamlined processes, the other opportunityDr Rungie identifies is the potential to shift the agency’s focus from accreditation and continuous improvement to looking more broadly at driving innovation.
“My sense is we had to open the door on accreditation and quality thinking to allow for bigger new innovation,” he says.
“What the Accreditation Agency did very well was to drive quality improvement but it didn’t necessarily drive innovation, and so if you wanted to run a different kind of hybrid service using housing or transition care or short-term care that didn’t fit in terribly well into that accreditation model. Whereas broadening the agency out will make it easier to encourage bigger innovation, and it is absolutely critical that we go down that path.”
While Illana Halliday, CEO of Aged and Community Services NSW & ACT, says providers are generally supportive of the single agency, she says there is also some concern about how the agency will operate in practice.
In particular, she says providers are keen to ensure that the quality improvement approach to quality reporting in home care “is not lost or watered down” in the transition.
Halliday says the training of quality reviewers will also be important to ensure they are experienced in all aspects of community and in-home care including the application of CDC. The peak body says it would be inappropriate to use residential care assessors in home care reviews without substantial re-training.
Similarly, Rob Hankins, chief executive officer of ECH, says he would be very concerned if the new agency simply overlaid the compliance-focused approach to accreditation in residential aged care onto home care.
He says the focus on continuous improvement, education and broadening the measures of quality in aged care should be maintained and strengthened under the new agency. In particular, Hankins supports introducing quality of life measures into the accreditation process to better monitor resident outcomes.
The new CEO of the Quality Agency and its advisory council are yet to be announced. Chris Falvey had been appointed as the acting CEO of the Quality Agency until 1 April.
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OLD Vs NEW: how the agencies compare:
Australian Aged Care Quality Agency
- Statutory agency under the Public Service Act 1999 and a prescribed agency under the Financial Management and Accountability Act 1997 (FMA Act)
- Sole agency responsible for both residential and community aged care
- Aged Care Quality Advisory Council of up to 11 members appointed by the minister
- CEO appointed by the minister
Aged Care Standards and Accreditation Agency
- A company limited by guarantee, wholly owned by the Australian Government, established under the Corporations Act 2001 and subject to the Commonwealth Authorities and Companies Act 1997
- Responsible only for residential aged care
- Independent board of directors appointed by the minister
- CEO appointed by the board of directors
Correction: This table originally stated that the Aged Care Standards and Accreditation Agency was a statutory agency. This is incorrect. The Accreditation Agency was a public company limited by guarantee, wholly owned by the Australian government.
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