New Quality Measures For Australian Aged Care

Tough new measures come into effect on January 1 as part of the Rudd Labor Government’s push to improve the quality of care for the frail and aged in Australia’s 2,830 aged care facilities.

They include new laws:

* Allowing – in some cases – the verbal lodgment of complaints by residents, family or staff members to the independent Aged Care Commissioner – previously all complaints had to be lodged in writing;
* Requiring police checks for all aged care staff; and
* Requiring aged care facilities to report the absence of residents who go missing without explanation;

The expanded investigative changes, police checks and reporting protocols were implemented as part of the new laws – the Aged Care Amendment (2008 Measures No. 2) 2008 – passed by Federal Parliament on December 4.

“This is about protecting the most vulnerable members of our society – the frail and aged,” the Minister for Ageing, Mrs Justine Elliot said.

“The Australian Government is committed to ensuring older Australians in aged care facilities receive quality care in a safe and secure environment.

“I am confident that the aged care industry and the many older Australians it serves will see the longer term benefits of a more transparent and accountable aged care industry.

“I will continue to work in partnership with older Australians, aged care providers, unions and consumer groups to improve the quality in residential aged care and ensure the long-term viability of the sector.

“Staff working in our nation’s nursing homes are dedicated, hard working and the backbone of the sector. They are on the front-line providing quality care; these measures support their important work.

“For the past 12 years, the previous government neglected aged care and neglected our older Australians; we plan to change that,” Mrs Elliot said.

Australians now have among the longest life expectancies in the world. Currently, there are some 2.8 million Australians – about 13 per cent of the total population aged 65 and over. This number is expected to triple in 40 years.

Lodgment of complaints

The Aged Care Commissioner would have the ability to take oral requests to review decisions of the Department of Health and Ageing. This recognises that there are circumstances where a nursing home resident or family member is unable to apply officially in writing because they are frail or have a disability.

There was a recent case of an elderly man who has suffered a stroke and had difficulty in writing. Despite an offer of assistance by the Commissioner and staff, the man abandoned his complaint due to the previous legislative requirement.

The change brings the Commissioner into line with a similar provision in the Ombudsman Act 1973 (Subsection 7 (2)) and the Department of Health and Ageing’s Complaints Investigation Scheme.

Police Checks

Currently, police checks are required for only aged care home staff with unsupervised access to residents. It will soon apply to all workers.

The police checks would also apply to staff delivering community care packages such as Extended Aged Care at Home (EACH) and EACH Dementia.

In total, there are 174,866 people working in the residential and community aged care. (Source: National Aged Care Workforce Census and Survey. December 2008)

A police check can be obtained from State/Territory Police, the Australian Federal Police or through direct application to CrimTrac – the agency which is used by all police jurisdictions to obtain information on an individual’s criminal history.

There has been extensive consultation on the police checks measure, starting back in February 2008. The Aged Care Consultative Committee, aged care associations and providers, peak bodies, unions and government departments, including the Australian Federal Police have all been consulted.

Staff and volunteers must renew their police check every three years to confirm their suitability to provide aged care.

Police checks are monitored by the Aged Care Standards and Accreditation Agency. The Department of Health and Ageing’s Complaints Investigation Scheme also investigates issues relating to police checks.

During 2007 to 2008 the Australian Government took compliance action on three homes in New South Wales, two homes in Victoria and one home in Queensland in relation to police checks.

Persons who currently do not require police checks include medical practitioners, pharmacists, aged care assessment team assessors and persons invited by residents.

Current requirements in relation to volunteers will not change. Volunteers have had to have police checks since the measure was introduced in March 2007.

The cost of police checks varies across states/territories, and currently ranges from $36 to $52 and some jurisdictions offer concession rates. They are also tax deductible.

Reporting the absence of residents

Under the laws, residential aged care services such as nursing homes and hostels will be required to report missing residents. Reporting protocols will also be implemented in respite, transitional care and flexible services following further consultation with the aged care sector.

Under the “Notification of unexplained absences of care recipients to be given to the Secretary”, approved providers will be required to contact the Department of Health and Ageing, if:

* A care recipient is absent from a residential care service;
* The Absence is unexplained; and
* The Absence has been reported to the police.

The Department of Health and Ageing must be told about the absence as soon as reasonably practicable and in any case within 24 hours after the provider reports the absence to the police. This is in line with timeframes for reporting of reportable assaults under the Aged Care Act.

Earlier this year, there have been a number of missing persons from aged care services, including:

* A North Queensland resident died after wandering; and
* A NSW Central Coast man disappeared for four days but was found dehydrated and suffering hypothermia and eventually died.

The issues were examined by the Senate’s Standing Committee on Community Affairs before the passage of the legislation.

Mrs Elliot said aged care services have a responsibility and a duty of care to ensure that residents are safe at all times.

“I believe that the issue is not primarily about whether someone has dementia or not, but whether appropriate action is taken by the aged care provider when any resident is identified as missing without explanation.

“This is a complex matter; it is about ensuring providers are fulfilling their duty of care to residents, while supporting residents’ rights to come and go – which is part of maintaining their quality of life.”

United Kingdom research found that one in six people wander unintentionally as a result of Alzheimer‘s Disease, dementia, other mental health problems, accident or miscommunication. (Biehal, Mitchell & Wade 2003).

Last year, in NSW, more than 6,500 people over the age of 65 were reported missing – accounting for 40 per cent of all missing persons and a major proportion had dementia.

The Queensland Police say that about 30 per cent of all land searches are for people with Alzheimer’s or dementia.

It is estimated that more than 200,000 Australians are affected by dementia. It is more prevalent in older Australians, with almost one in four people aged 85 years and over having the condition. In the next 20 years, the number of people with dementia is expected to more than double.

An increase in missing residents – even temporarily – may give the Department of Health and Ageing an indication about the standard and staffing of the service. To reduce the incidences, the Department of Health and Ageing recommends aged care providers have adequate management practices in place to ensure the safety of residents.

The Department of Health and Ageing says management strategies and harm minimisation plans can include, but are not limited to:

* Ensuring adequate staff on every shift;
* Good design that ensures residents who wander are encouraged towards doors that lead to internal rather than external areas;
* Alerts on external doors to notify if doors have remained open for extended periods; and
* Sensor mats to monitor particular residents, who may have a tendency to wander and cause harm or discomfort to other residents. This enables staff to monitor the resident with minimal intrusion for both the resident and other residents who may be affected.

January 1 measures build on

The January 1 measures – police checks and the reporting the absence of residents – build on the Rudd Labor Government’s numerous measures to improve the quality and care in Australia’s aged care facilities – which includes record funding of more than $41.6 billion into aged and community care over the next four years.

They complement the Australian Government’s record 7,000 visits – including 3,000 unannounced visits — by the independent Aged Care Standards and Accreditation Agency.

So far, the Accreditation Agency has conducted a record 1,796 unannounced visits for the period – July 1, 2008 to December 15, 2008. In addition, the Department of Health and Ageing has conducted 742 unannounced visits for the same period.

Last financial year, the Accreditation Agency found 199 aged care facilities which did not comply with at least one of the 44 standards quality outcomes.

There are currently 14 aged care facilities – out of a total of 2,830 around Australia under sanction. Nine were identified through direct or indirect result of unannounced visits.

Anyone with concerns about the care or welfare of residents should immediately contact the Department of Health and Ageing’s Complaints Investigation Scheme – 1 800-550- 552.

Record Funding

Over the next four years, funding for aged and community care will reach record levels of more than $41.6 billion — with $29.5 billion of that on residential aged care alone.

This means that over the next four years, the Government will be providing an average of $43,000 for every aged care home resident in Australia.

This year the Government will spend $5.6 billion on residential aged care. This represents an increase of 10.8 per cent over the final outcome for the 2007-08 financial year.

Media Statement – 29th December 2008
Justine Elliot – Minister for Ageing