Jun 20, 2019

Aged care quality assessors more aggressive, experts say

Aged care assessors have become more “aggressive” and “combative” during audits, and it’s more difficult to know how to prepare for them, say two highly experienced advisors to the sector.

Peter Vincent, principal consultant at Aged Care Management Australia, told HelloCare assessors are coming into homes with preconceived ideas of the outcome of their visit.

“What we’re experiencing and what is being conveyed to me by other very experienced advisors and administrators from around the country… is that there seems to be an attitude among some assessors, not all, that facilities are guilty of non-compliance before the assessment has been done,” he said.

He said some assessors are “on a mission” when they come into facilities, and, where six months ago it was almost unheard of not to recover a non-compliance outcome within an agree timeline, it’s now happening more often.

Assessors “abrupt”, “combative”

“We’re getting feedback from some quarters that the attitude of the assessors when they get into the facility is quite abrupt. It’s not congenial to a pleasant 2.5-3 days on site,” he said.

Historically, Mr Vincent said assessors would start an audit with a meeting to explain what was going to happen over the next few days. Often those involved knew each other because many had worked in the industry for years. But that friendly approach doesn’t always happen these days, Mr Vincent said.

“What we’re hearing is they (the assessors) are very combative from their first statement. They’re saying, ‘We want this information, and we want it now.’” he said.

Huge differences between assessors

Dr Rodney Jilek, principal advisor with Aged Care Consulting and Advisory Services, told HelloCare he agrees.

“There’s certainly been a change,” he said.

“There’s huge variances in the people coming out (to assess aged care facilities). Some of the assessors are still very much running the old system, coming out, plodding along, being very cooperative. Doing what they used to do.

“And then you’ve got this other extreme of either being really picky, or almost to the point of aggression, and in some cases it’s about their personal views,” he said.

Assessments made based on personal views

“I’ve done a number of submissions following visits where there’s been an unmet (standard), and I’ve been surprised by the number of things in reports that are not in the legislation at all. They’re personal views of the individual who’s doing the assessment,” Dr Jilek said.

Dr Jilek said it’s difficult for operators to know what to expect when audits are taking place, and therefore almost impossible for them to properly prepare.

“It’s a bit of a dog’s breakfast, and you just don’t know what’s going to happen until they’re there,” Dr Jilek said.

“It really comes down to, who is the person (assessor) who walks through your door,” he said.

Dr Jilek said he thinks the changes have occurred because of uncertainty within the Aged Care Quality and Safety Commission.

“I think there’s a very quickly shifting political agenda going on, and I think it’s really hard sometimes for people that are working in government agencies to keep up,” he said.

“Irrelevant” and “pedantic” issues are creating frustration

Mr Vincent said assessors can get bogged down in detail that is not helpful to the issues they are trying to solve.

“We’ve never lost or failed to recover an outcome, and we’ve done over 60 review audits now as a team. But even for us, it’s becoming increasingly difficult when you’re being challenged about things that are not relevant or are so pedantic that it becomes a source of frustration because you’re wasting time doing stuff you shouldn’t’ need to be explaining,” he said.

Inconsistencies have been let go for too long

Dr Jilek said there have always “inconsistencies” with the Commission, and the Aged Care Quality Agency before it.

“You’ve got some people that understand the rules and police the rules, and you’ve got others that are a lot more flexible,” he said.

“I think that’s caused a huge problem for the sector… but things have been let go for so long.”

Dr Jilek said facilities are passing an audit one month, and failing the next. One manager said she had an unmet standard recently for something she had been doing 19 years.

“I had to say to her, ‘yes, and you’ve been non-compliant for 19 years but no one’s ever exposed it,” Dr Jilek said.

“There are some managers and staff out there who are very confused, because they’ve been doing this stuff for years, and there’s never been an issue and now all of a sudden it’s an issue and they’re having unmet outcomes.”

Inexperienced assessors audit more qualified seniors

Mr Vincent said he believes the changes among assessors could be the result of the commission employing new staff who lack direct experience of the aged care sector.

“While there are still some very competent, very experienced assessors working for the Commission who’ve obviously transferred from the Quality Agency, there seem to be a lot of new, very young and very inexperienced assessors in their workforce who haven’t experienced aged care before,” he said.

“There is a growing number of non-clinical assessors, and we’re even hearing that non-clinical assessors are assessing standard 2 (Clinical Care), which is completely contrary to convention.

“We’re hearing incidents where assessors are enrolled nurses who are being sent to assess the outcomes of very experienced registered nurses. Again it’s not a common-sense approach,” he said.

“Aged care providers welcome and value input from the Quality Agency where that input is constructive and balanced,” he said, but added that recently, this isn’t always happening recently.

Staff morale has taken a hit

Both Mr Vincent and Dr Jilek believe the changes to audits have eroded staff morale.

“Staff are leaving (the industry) in droves,” Mr Vincent said.

Only last night Mr Vincent said he received a call from a senior manager who had handed in his resignation and was leaving the industry.

“Aged care can’t afford to lose good quality, experienced people,” Mr Vincent observed.

Dr Jilek said staff are being “hammered”, and he’s spoken to a number of people in the last couple of months who have said, ‘we’re out (of the industry)’.

“I think it’s going to be really hard to attract new people. People can deal with strict rules, but there has to be consistency,” he said.

Some providers may be forced out of the industry

“I personally think it’s going to become a combative environment which is just wrong,” Mr Vincent said.

“The Quality and Safety Commission should be there to support good providers, but also providers that have failed outcomes,” he said.

Mr Vincent said it’s likely the more an operator fails, the less support it will get from the Commission.

“If you are a provider with a bad track record, do not expect any warmth or love or support form the Quality Agency because you’re not going to get it,” he said.

Providers that can’t turn their operations around may have to leave the industry, Mr Vincent said, and their facilities taken up by the more reputable, proven operators.

“That’s not necessarily a bad thing,” Mr Vincent said.

“But becoming non compliant now is a random thing. Providers who you never thought would suffer at the hands of non compliance are now equally likely to be non compliant as anyone else,” he said, giving examples such as Southern Cross and AngliCare.

A less “punitive” system is needed

“We need to move away from the quality safety process altogether,” Mr Vincent said.

“We need to move to a different form of non punitive regulation, where good providers are encouraged.”

“I think the Commission, as it stands now, is going to have a huge gap between them and the providers and the sector, and I think it’s going to become fairly ugly,” he cautioned.

The new standards will make the situation even more difficult for providers to maintain compliance, Mr Vincent said.

Dr Jilek was of the same view. “The new standards “are going to make it worse”, he said.

Mr Vincent said he suspects very few providers will be ready for 1 July, when the new standards come in, and even the Commission itself isn’t ready.

“We’ve known about these changes for nearly two years. For the quality agency itself not to be ready is a real worry,” he said.

Click here to read the response of Janet Anderson, commissioner, Aged Care Quality and Safety Commission, to this article.

The views and opinions expressed in this article are those of the people interviewed and do not necessarily reflect the official position of HelloCare.

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  1. There are many issues involved with compliance or non compliance and the one over riding issue is that there are so many variations on residential care documentation options. I have been bashing on about the need for the government to issue exactly the documents that they want operations to follow rather than each and every operation trying to piece together a compliant system from enormously varied options. Assessors see a particular form at this home and then try to insert same in the next despite already being compliant.
    If we are going to talk about Standards then there needs to be a clear set of guidelines for facilities and assessors alike to follow.
    Right now it’s not uncommon to read that a facility passes the 44 and a couple of months later they ludicrously fail heaps!
    This is purely a differing in interpretation of assessors and this reflects more on the agency rather than facilities, the public is even wising up to this nonsense and they are confused about how the standards are judged.. as they should.

    As to the comments about operators leaving the industry I disagree that they would leave because they can’t “turn around” their operations and rather they are tired of the inconsistency, aggression, trying to deliver care with unrealistic expectations, systems not being adhered to and lets not forget the hopelessly unviable situation the liberals have put upon us.
    We have delivered care, excellent care for 35 years but now it seems it’s more about excessive documentation rather than actual care.
    Let’s get the document steam organised, if the small providers leave the industry then God help us in our old age because they are the back bone of care, not the multinational organisations already dominating the scene.

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