Jun 22, 2019

Quality commissioner responds to claims that quality assessors have become more “aggressive”.

Janet Anderson, commissioner with the Aged Care Quality and Safety Commission, has responded to claims recently published in HelloCare, that aged care quality assessors have become more aggressive. We have published her response below.

The role of the Aged Care Quality and Safety Commission is to protect and enhance the safety, health, well-being and quality of life of aged care consumers. We perform this role through our statutory functions relating to consumer engagement, education, complaints resolution, and quality assessment and compliance monitoring against legislated standards.

Our quality assessors are bound by a code of conduct which ensures the highest standard of performance and integrity. Under this code, they are required to act professionally at all times and accurately report findings in a consistent and unbiased manner.

To meet registration requirements, all our quality assessors must complete the Commission-approved training program and participate in a mandatory continuing professional development program. This is to support consistency across the Commission, not only in in our approach to assessment but also with our policies and procedures.

Providers are invited to give feedback to the Commission following a site audit or monitoring visit. We welcome this feedback which is used to improve how we work. I encourage any provider who considers that our quality assessors may not have acted professionally to make a complaint to the Commission. They can call 1800 951 822 or download and fill in our Complaints About Us form.

Approved providers are expected to be compliant with the applicable legislated standards at all times. In order to properly assess this, the Government decided that audits and monitoring visits should be unannounced rather than booked with the provider in advance (which afforded the provider an opportunity for intensive preparation). It is now the case that all re-accreditation audits are unannounced, and all providers are subject to at least one unannounced monitoring visit each year. All visits commence with an entry meeting where our quality assessors outline how the assessment will be conducted.

The Commission and its predecessor, the Australian Aged Care Quality Agency (Quality Agency), have supported providers throughout the transition year leading up to implementation of the Aged Care Quality Standards from 1 July 2019.

Guidance and resources to help providers ensure that they are ready to be assessed against the new Standards was made available to the sector by the Quality Agency from August 2018. Other supporting information and resources have progressively been published online since the Commission commenced in January 2019.

In April 2019 I wrote to all approved providers to ensure they are aware of the important changes that come into effect from July. A provider education pack with material that is available on the Commission’s website has been distributed to over 5,000 aged care services across Australia. 

The Commission has also provided face-to-face education programs for over 5,000 participants representing providers across multiple locations including in rural and regional areas. A recently published video on the Commission’s website explaining the assessment process under the new Standards has been viewed by over 20,000 people. 

The stronger focus on consumer outcomes under the new Aged Care Quality Standards will inform the Commission’s approach to assessing and monitoring compliance from 1 July. Providers will be expected to demonstrate how consumers are treated with dignity and respect and how they involve consumers in decisions about their care. 

Where non-compliance against the new Standards is identified, the Commission will (as is the case now) set a timetable for improvement to support the provider’s return to compliance. The Commission’s response to non-compliance is and will remain proportional to the level of assessed risk and the potential consequences of that risk for consumers. In implementing all its statutory functions, the Commission is committed to promoting continuous quality improvement by individual aged care providers and across the aged care sector. 

I acknowledge the enormous effort each of us – providers and regulator – in our respective roles, has given to ensuring successful implementation of the new Standards. I am confident the new Standards will not only deliver better experiences and outcomes for aged care consumers but also boost the trust and confidence that older Australians are entitled to have in the quality and safety of their aged care services. 

By Janet Anderson, commissioner, Australian Aged Care Quality and Safety Commission.

Image: Janet Anderson. Source: The Australian.

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  1. The idea that some providers are finding assessors a bit aggressive will be wonderful news for many consumers, and families of aged care consumers. For far too long audits and assessments have been ineffective in protecting consumers from the age care providers who are incompetent or careless.

    There are many good age care service providers and many wonderful staff.

    However, the incompetent and careless have stayed in business because regulators have been too willing to find excuses for them. Even now unannounced inspections can be turned away if the aged care provider decides they do not want them on the premises. That’s right, the provider can refuse access.

    It is time to be serious, if the inspection is unannounced then we should remove the right of the aged care provider to refuse access.

  2. Accreditation has never been an effective regulator. It has failed in the USA and Australia. Accreditation was not designed to be a regulator, was not intended to be a regulator and between 1997 and 2014 the agency insisted it was not a regulator – although everyone else knew it was a central part of the regulation that government and industry boasted of. As the criticisms show accreditation and regulation are incompatible.

    In 2003 industry and regulator promised parliament that they would collect objective data about the outcomes of care. They have never done so and we can only guess why! They clearly cannot be trusted to do so. We need to insist on that and ensure that the data is verified.

    We can compare Australia with the USA where on average they provide twice as much care from trained nursing staff and a third more nursing care overall. In 2016 in Australia 97.8% passed all accreditation standards. In the USA they collect data and verify yearly. Only 7% pass every test. Of the 93% who fail at least one assessment, 20% have a serious failing. We do not advocate this intensity but what we do is unacceptably inadequate.

    In 2014 the agency’s independence was removed and it became part of a government department. An industry heavyweight was put in charge of it. Under the guise of ‘red tape reduction’, the Abbott/Turnbull government introduced a $6 billion reduction in regulation in Australia.

    As a consequence between 2012 and 2017 the number of visits to nursing homes by the agency fell by 1725 (30%) from 6435 to 3864. The number of visits by the complaints system started falling after the Walton Review in 2010 from 3197 to in the region of 100 in 2017 (98%). Overall the number of regulatory visits fell by over 50%. With an unregulated and uncontrolled market things rapidly got worse and we now have a Royal Commission.

    With fewer visits and less regulation the number of facilities not meeting all standards each year fell from 7.6% in 2012-13 to 2.5% in 2015-16. The percentage of facilities being sanctioned fell from 0.94% in 2012-13 (one in a hundred) to 0.19 (I in 500). (from over 20/year to 5/year).

    Recently released data shows that in the 5 years 2013 to 2017 seven facilities had their accreditation revoked and 5 were closed (2 were appealing). The minister recently indicated 1 per month has been closed in the last year (ie. 12).

    So those unhappy managers and their advisers are right, the regulatory role has been brought back and yes accreditation is not a regulatory process and does not work when it tries to be.

    Both Anderson and the minister have made statements elsewhere which make it clear that this same market model and same regulatory system are to continue. This model spelt out on the aged care roadmap has not worked. As communities we should not allow that to continue.

    We need a new model based on care. This model asserts that each one of us and each of our communities is ultimately responsible for our fellows when they are in need. Anyone who provides care does it on our behalf. They are our agents. Our capacity to hold our agents to account has been taken away by the flawed aged care roadmap.

    Aged Care Crisis argue that it is time for the management and oversight of aged care to be brought back into local communities where they can work cooperatively with their agents and make sure they are doing what is needed. It is government’s role to support and build community and train its members so that they have the knowledge to work with their agents in providing services to their communities. Communities need to have a role in deciding who will care for their frail elderly and be able to reject those who fall short. They can make this market work for them and their members. They can change the culture and make nursing homes the sort of places where trained staff want to work because they are appreciated.

    It is government’s role to create a proper regulator, a policeman that citizens can call on when any of their members are harmed. If accreditation has a role it is to work with providers and help them to meet each community’s expectations. Its utility should be assessed by its performance in transparently securing outcomes.

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