Aged Care Transformation

There’s a fundamental shift unfolding within Australian healthcare, specifically within aged care, that holds the promise of profoundly improving the health and lives of older people. This isn’t about the advent of a groundbreaking drug or research breakthrough; it's about the implementation of a new, robust set of national Quality Standards for Australian Aged Care providers. Given that most healthcare organisations, outside specialised fields like midwifery or paediatrics, will engage with older people, the significance of these changes touches us all. They resonate not just professionally but personally, as we all hold a vested interest in the well-being of older Australians whom we know, love, and care for.

The Impact of Regulation

Lately, I’ve been reflecting on just how significant of an impact regulation actually has on an organisation. Firstly, organisations cannot operate unless they’re compliant, therefore, a budget is allocated to making sure they are. Secondly, regulation is one of the biggest drivers or inputs into a training schedule for any healthcare organisation, regardless of the sector. Regulation commonly generates a need that education can fill. Whilst other non-educational initiatives are also necessary, education is a powerful vehicle. Planning and carefully using education to drive a new regulatory framework into tangible practice offers a genuine opportunity to improve care.

Implementing Standards

When we reflect on the ability of education to translate regulation into practice, it becomes apparent that the desired result of education on the new Standards is not mere conformance. Completing a checklist and box-ticking that training has been assigned is not the goal; improving care is. Now is the time to use education (wisely) if we wish to translate the new Aged Care Quality Standards into tangible improvements in care.

Background to the New Standards

Let’s rewind. What’s the background to the implementation of a new set of Aged Care Quality Standards? To understand genuinely why we need to use education to translate regulation into better care, it’s critical to reflect on why the regulation has changed. Whilst all sets of quality standards undergo regular review, often every five years, the catalyst for significant aged care reform is traced back to the Final Report into Aged Care. The Royal Commission identified several areas of focus for the urgent review, including governance, diversity, dementia, food and nutrition and clinical care.

Unprecedented Changes

Since the Final Report was released and the Government confirmed its responses to each recommendation, a considerable number of changes have been made to the aged care sector. This rate of change is far greater than anything I’ve ever seen in the acute care sector. Changes have been made across so many areas, ranging from governance, clinical care, the sector’s regulatory model, staffing requirements and financial stewardship to quality reporting. For anyone working in the aged care sector, it’s probably felt like a fast-moving train, regularly stopping but never for long—lots of changes to continually embrace, swiftly followed by another round of changes.

A New Aged Care Act

Each change to be embraced is described as a reform. A reform means an amendment to an existing regulation or the introduction of a new regulation. The main piece of legislation that houses this regulation and all subsequent reforms is the Aged Care Act 1997 (Cth). The current Act has had minor amendments to accommodate these recent reforms. A new Aged Care Act is one of the final pieces of the puzzle in response to the Final Report, tabled in the Australian Parliament on 1 March 2021. The Revision of the Aged Care Act 1997 was Recommendation #1 of the Royal Commission Final Report. The first line of the Government’s response to the Final Report was that ‘The Aged Care Act 1997 (Cth) should be replaced with a new Act to come into force by no later than 1 July 2023’. The Strengthened Aged Care Quality Standards are slated for release on July 1 2024, with the passing of the new Aged Care Act through the parliamentary passage. It now appears that there may be a delay in the passing of this crucial legislation. Much commentary is occurring around the pros and cons of this.

Preparing for Change

Regardless of the go-live date, as is the case with any set of national quality standards, as is the case with any set of national quality standards, all aged care providers will be impacted by the new Aged Care Act and Strengthened Aged Care Quality Standards. The changes inherent in the new Standards will affect all aspects of a provider's operations and business. This means that all Australian Aged Care Providers must prepare their organisations, service environments and workforce for the rollout of the Strengthened Aged Care Quality Standards.

Operationalising New Standards

Rollout is typically is overseen and coordinated by one overarching committee, supported by up to five discrete work streams or working groups. For example, the Clinical stream, usually overseen by someone like a Director of Clinical Services, closely collaborates with another team focused on Education or Training, where an L&D manager or Head of Education takes charge. There are also other teams handling things like environment, risk, and compliance. And specifically for the Strengthened Aged Care Standards, there's a brand new standard (Standard 6) solely focused on food and nutrition. To make sure this standard is implemented correctly and followed, it's suggested to create a new team dedicated exclusively to coordinating its rollout and ensuring compliance.

Alignment with NSQHS Standards

For anyone with an acute care background, the structure of each standard may seem familiar, and there are many commonalities with the NSQHS Standards (second edition). Interestingly, the background to this also stems from the final report, in which there were a number of recommendations relating to an urgent review of the Aged Care Quality Standards and the Australian Commission for Safety and Quality in Healthcare (ACSQHC) taking responsibility for standard-setting. Not all recommendations were accepted, but embedding high-quality aged care was a clear focus and has brightly shone through. A recommendation for the Aged Care Quality Standards to be replaced by a new set of standards developed by the Australian Commission on Safety and Quality in Health and Aged Care (note, change in title) was rejected. However, Standard 5: Clinical Care was developed by the Australian Commission on Quality and Safety in Healthcare.

Focus on Clinical Care

The transfer of responsibility to the ACSQHC to develop standard 5 on clinical care came with a direct focus on protecting older people from harm and improving their clinical care. Standard 5 is the largest of any of the strengthened standards. There are seven outcomes for Standard 5 - Clinical Care.

Outcomes for Standard 5 - Clinical Care

5.1 Clinical governance

5.2 Preventing and controlling infection in clinical care

5.3 Safe and quality use of medicines

5.4 Comprehensive care

5.5 Clinical safety

5.6 Cognitive impairment

5.7 Palliative and end-of-life care

Attached to the seven outcomes are 35 extensively written actions. This translates to over eight pages of requirements relating to clinical care that Aged Care providers must implement to conform with the new Standards. As part of Ausmed’s internal gap analysis, we identified 75 specific training requirements relating to Standard 5. Clinical care education has never been more relevant to the aged care sector.

The Role of Education in Implementing Standard 5

The new Aged Care Quality Standards are more than just a document. Particularly when it comes to Standard 5 Clinical Care, they aim to establish a common framework of expectations within aged care. This new regulation is setting a clear signal and expectation to genuinely improve the clinical care of older people. Ausmed is proudly supporting providers with this important task. Education is our vehicle for translating this change into everyday practice. Our metric for doing a good job is the improvement in the health and lives of older Australians.

References and Resources

1. The Strengthened Aged Care Quality Standards – Final draft
2. Aged Care Quality Standards: Standard 5 – Clinical Care
3. Draft audit methodology
4. Draft evidence framework
5. Draft pre-audit preparation tool
6. Glossary
7. Royal Commission into Aged Care Quality and Safety Final Report: Care, Dignity and Respect
8. Australian Government Response to the Final Report of the Royal Commission into Aged Care Quality and Safety
9. Aged Care Bill 2023 Exposure draft
10. New Aged Care Act: Defining high-quality care
11. Supporting Sector Readiness for the New Strengthened Aged Care Quality Standards (Webinar)

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