Once unannounced visits are introduced, reaccreditation may no longer be necessary, suggests Kate Carnell, lead author of the Review of National Aged Care Quality Regulatory Processes report.

Speaking at the Criterion Aged Care Reform After the 2018 Federal Budget Conference, Ms Carnell said, “I can’t for the life of me see what the point is [of reaccreditation] if we’ve gone to a proper risk based system and we have unannounced visits.”

Accreditation has been the very cornerstone of the industry for decades, but sweeping changes to the industry coming in over the next few years could mean that after initial accreditation is given, reaccreditation will not be necessary, unless there is a significant change within a facility, Ms Carnell suggests.

The Carnell Paterson Review

Ms Carnell said the review looked how aged care regulations can ensure that the industry meets community expectations that residents are kept safety, well cared for, and that they have a good quality of life. In addition, in the wake of Oakden, problems must be promptly detected and followed by “swift remediation”.

Of the government’s response so far, she said it was a “good start. The devil is in the detail. Now we need a really good plan.”

The review team consulted throughout the industry widely, finding that:

  • 41.7% had complained to aged care staff
  • 72% had complained to management
  • 37% had complained to the aged care complaints commission
  • 60% were dissatisfied by the time taken to resolve the complaint
  • 54% were dissatisfied with the clarity of the process
  • 52% were unhappy with the communication
  • 38% had difficulty finding information about who to direct complaints to

She said the key elements of an effective regulatory system were:

  • Integration
  • Good information for consumers and providers
  • Support for consumers
  • Improve effectiveness of accreditation
  • To have a complaints monitoring process

Ms Carnell went through the report’s 10 recommendations and explained which recommendation the government had taken up – and which they hadn’t.

Recommendation 1 – Create a single entity for compliance and complaints handling

An aged care quality and safety commission will commence from 1 January 2018, with a commissioner and a chief clinical advisor – but though the government said that another commissioner will be appointed, it had not provided clarity that it will be dedicated to consumers – which Ms Carnell said was their firm recommendation.

Recommendation 2 – Real time information sharing

The system will move accreditation from a tick the box system with 44 guidelines to a risk based system, as recommended.

“This is a really big move and a really challenging move,” said Ms Carnell, and said it was still uncertain how the government would determine that risk.

“Words are lovely but how do we do that,” she said.

Ms Carnell said the review recommended that 20% of care recipients have their views sought at accreditation, but the government has gone with 10%.

Recommendation 3 – All residential aged care services must participate in a national quality indicator program

This recommendation hasn’t been picked up, although a single set of standards has been, and the government will bring in a user-friendly provider comparison tool.

Recommendation 4 – A performance rating system to help compare residential aged care services

This has been taken up with improvements to the My Aged Care site and the introduction of star ratings and plain English accreditation reports.

Recommendation 5 – A single charter of rights

The charter of right will help consumers understand their rights and have clear expectations. The current charter is not widely known about, and Ms Carnell said it was important that consumers know the new charter exists.

Recommendation 6 – A serious incident response scheme

The government will bring in a serious incident response scheme. Ms Carnell said this would be “essential to protecting aged care recipients from abuse and mistreatment.”

Recommendation 7 – Aged care providers will limit the use of restrictive practices

Restrictive practices should only be used as a last resort, Ms Carnell stated.

She said that more work also need to be done around medication to prevent mistakes from occurring.

This is “something we need to address, and I don’t believe we’ve done that yet,” she said.

Recommendation 8 – Ongoing accreditation with unannounced visits to ensure the safety of residents

The first thing the minister announce after the report was handed down was that planned visits would stop and unannounced visits would take their place, and from 1 July unannounced audits have applied.

This approach wasn’t in line with the recommendations, which questioned the role of accreditation once a risk based unannounced visit approach is implemented.

Recommendation 9 – Ensure assessments are in line with expectations of care

This recommendation will be particularly important when the single set of standards is introduced, Ms Carnell said.

Recommendation 10 – Give the complaints commissioner more powers

A more transparent and open system is being brought in, and there’s a capacity to share between residential aged care facilities. “The way you get better is to learn from failure,” Ms Carnell said.

Ms Carnell concluded by saying that the government must now deliver a clear plan to deliver the changes.

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