Aug 21, 2017

The Role of Accreditation: Whose Responsibility is it Anyway?

Whose responsibility is it to check that aged care facilities are maintaining adequate standard of care? In Australia, it belongs to the regulatory bodies in charge of aged care accreditation.

Government accreditation is meant to ensure that the aged care facilities that older Australians are living in are up to scratch and providing a minimum standard of care to their residents.

In essence the role of the Accreditation Agency, as the accreditation body, is to assess performance against predetermined standards and report those assessments to the Department of Health and Ageing, who act as the regulator.

What happens is that approximately every three years aged care facilities are audited, along with at least one annual “unannounced spot check”, to ensure that they have met the accreditation standards.

The accreditation system for residential aged care in Australia consists of many of the characteristics, which include:

  • a framework that provides incentives and disincentives
  • mandatory participation
  • evaluation conducted by an external accreditation body
  • open and transparent accreditation standards and processes
  • public reporting of accreditation reports
  • unannounced visits to monitor continuing compliance with accreditation standards

And it’s not just about meeting the minimum standard, the organisation is expected to maintain a level of performance that complies with the accreditation standards, while also expecting to undertake continuous improvement.

Aged care accreditation is primarily a relationship between the Accreditation Agency and the aged care providers. The accreditation scheme exists for the benefit of the residents and their families.

The system, which has a number of stakeholders with an interest in the assessment and its outcomes, is expected to be transparent and accountable in its processes and open to public scrutiny. These stakeholders include: relatives of residents, prospective residents, staff, management and owners of aged care facilities, government and the taxpayer generally who seek reassurance that public money allocated to providers, directly or as subsidies is achieving the required level of care.

How does aged care accreditation compare around the world?

The International Society for Quality in Health Care (ISQua) describes accreditation as ‘a public recognition of the achievement of accreditation standards by a healthcare organisation, demonstrated through an independent external peer assessment of that organisation’s level of performance in relation to the standards’

Today, many countries have their own accreditation systems in place to for health care organisations to encourage improvement of performance and to promote safety and quality of care.

United States of America

Accreditation began in the US, and was soon adopted in Canada and Australia in the 1950s and 1960s.

The Joint Commission on Accreditation of Healthcare Organisations (JCAHO) began accrediting hospitals in 1951 and now accredits over 17, 000 health care organisations and programs.

Their system has on-site audits that are conducted once every three years. Typically, on-site surveys are conducted by one surveyor for two days and involve:

  • ‘Tracing’ the patient’s or resident’s experience – looking at services provided by various care providers and departments within the organisation as well as ‘hand-offs’ between them
  • On-site observations and interviews with surveyors
  • Review of documents provided by the organization
  • Assessment of the physical facility


A recent survey of European countries revealed hospital accreditation programs in 15 countries and the development of programs in two others.  

In England, health and adult social care services, including residential care for the elderly, are assessed and continuously monitored against essential standards by the Care Quality Commission (CQC).

The CQC carry out regular checks on health and social care services called “comprehensive inspections”. Some things – such as how frequently they inspect, the size of the inspection team and whether or not visits are announced or unnannounced – depend on what type of service they are inspecting.

There are also “focused inspections”, which are smaller in scale than comprehensive inspections, but they follow a similar process.

New Zealand

Closer to home, in New Zealand, residential aged facilities are evaluated and monitored against predetermined standards by an a third party auditing agency designated by the Ministry of Health.

Certification audits happen every 1–4 years. After the audit, aged care homes are certified for a set period of time – the exact length depends on how well the rest home performed at the certification audit. Once this time is up, the facility must be re-audited and its certification renewed.

An unannounced spot audit (also called a surveillance audit) happens around the middle of a rest home’s certification period.

In addition to audits, the facility also have to report how they are addressing issues found at audit. These improvements are then verified at the next audit event.

Even though accreditation systems around the worlds may use different terms to describe their roles and processes, they all assess the performance of long term care facilities against predetermined standards and guidelines.

And most importantly, they all involve assessment by a third party where their processes are all mandatory and all involve continuous monitoring of performance.

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