“Unprecedented” Times for 2020 and Focus for 2021

Here at Critical Success Solutions (CSS), as we watched the new year fireworks on TV (see our photo above) and in summarising 2020 for our AGM – we have demonstrated that often-quoted word in the news – “unprecedented” being applied to our aged care industry over the past 12 months. We have faced “unprecedented” challenges with the COVID-19 (virus) pandemic. We thank our dedicated workforce – because it is through their determination and compassion, that they have cared for the most vulnerable Australians – our residents and home care consumers. The majority of us have never faced a pandemic in our lifetime, however just like the community rallied against the “unprecedented” bushfires that ravaged the eastern part of Australia early in 2020, our team rallied and worked together to deliver on our commitment to quality care.

Aged care facilities are particularly vulnerable to COVID-19 outbreaks. The following chart shows the number of confirmed active COVID-19 cases, deaths and recovered cases in Australia and states/territories (to 3 January 2021), for people living in Australian Government-subsidised residential aged care facilities.

Our hearts go out to those families and friends who lost a loved one to COVID.

It has also been “unprecedented” for the number of changes that our workforce has had to implement and embed…sometimes we were receiving daily updates on policy and health order changes from the Department of Health and other advisory bodies.

It was also “unprecedented” for our families, friends and representatives, who also have been adapting to these changes with us, especially in relation to visitation requirements recommended by health authorities. We have been communicating, where possible in a timely manner these changes that impact you as providers with sometimes a newsletter a week and listening to what you want to know about and providing this in the newsletters and the services we provide at CSS. We have appreciated the patience and sacrifice that you, your families, friends and representatives have made to ensure that we worked together to protect our vulnerable residents and consumers.

Throughout these “unprecedented” times, we also focused on the everyday feedback and insights from our clients, their residents, home care consumers, families and representatives to ensure continued consulting services to assist providers in delivering quality care and safety. Combining this with the experience and knowledge of our team, we are already delivering consulting services for 2021.

Focus for 2021

Quality Aged Care Standards and Accreditation – “EVIDENCE”
We work with our clients to regularly review through comprehensive review audits (styled on the depth and breath that the Aged Care Quality and Safety Commission (ACQSC) conduct on care quality and safety against the eight quality aged care standards. These standards focus on outcomes for consumers and reflect the level of care and services the community expect from organisations that provide Commonwealth subsidised aged care services. We advise our clients on how they can consistently ensure that their workforce, systems, policies and processes are operating in alignment with these Standards.

Please review our quarterly reviews on what we are seeing from the ACQSC ‘not mets’ from our network, in these newsletters for 2020 – we are expecting similar themes in 2021:
August 2020: https://mailchi.mp/cssconsulting/not-met-findings-standards-4-8-year-in-review
July 2020: https://mailchi.mp/cssconsulting/not-met-findings-standards-1-3-year-in-review
February 2020: http://mailchi.mp/a16648d58c37/not-mets-and-unannounced-visit-handbook

If there was one word to sum up what we expect the Commission to continue to focus on, it is “EVIDENCE”. Whilst your residents and home care consumers may give great feedback and love your carers and all that they do, you need to prove through “evidence”. Some examples that were highlighted by the Commission in a recent report were:

  • Consult more regularly with consumers about their wants, needs, and preferences to better understand the best possible way to support consumer’s independence.
  • A substantial amount of work is being undertaken relating to ongoing assessment and planning with consumers (Standard 2). However, documentation needs to be completed to represent this; it is suggested that care plans be updated and staff make it easier for consumers to access these (Requirement 2(3)(e)).    

Therefore we test this “evidence” when we conduct a review audit where if your workforce cannot produce it during our audit visit then it is noted and forms part of the detailed report (normally around 80 pages PDF report) and in the action plan (excel spreadsheet that you can action with your staff).

We also conduct Customer Experience Review (CER) surveys, comprehensive Residential and Home Care Satisfaction Surveys (that into much more depth that the CER), Workforce Satisfaction Surveys and Lifestyle Satisfaction Surveys to ensure that you are collecting this evidence during the year.

We work with our clients to review, implement and embed through training and systems, policies and procedures that are aligned to the standards and that support our clinical care and service operations.

Organisational Governance
Key to success is strengthening your Governance Framework to ensure systems are strong and robust. Operations and feedback mechanisms need to continually be checked to ensure that residents/home care consumers are at the centre of decision making on delivery, with organisational governance (such as our Leadership Team and systems) and corporate services supporting care and services delivery. You need to prove this with evidence such as specifics in minutes of this input, surveys/forums from residents/consumers.

The organisational Governance Framework has five focus areas – which are illustrated in the following diagram.

These Governance Framework areas are aligned to the five main requirements of providers under Quality Standard 8 – Organisational Governance:

  1. Consumers are engaged in all aspects of care.
  2. There is a culture of safe, inclusive and quality care.
  3. The provider has organisation wide governance systems which govern: (i) information management (ii) continuous improvement (iii) financial governance (iv) workforce governance (including the assignment of clear responsibilities and accountabilities) (v) regulatory compliance (vi) feedback and complaints.
  4. The provider has effective risk management systems that address risks associated with the care of consumers, including potential abuse or neglect, and that support consumers to live the best life they can.
  5. The provider has a clinical governance framework which includes, at minimum: (i) antimicrobial stewardship (ii) minimising the use of restraint (iii) open disclosure.

Royal Commission Recommendations

Part of the Governance Framework is considering the issues and action areas from the Royal Commission into Aged Care Quality and Safety (RC). In the Final Hearing to the RC, Senior Counsel Assisting, Peter Gray QC and Peter Rozen QC, presented submissions on behalf of the Counsel Assisting team. These submissions included 124 proposed recommendations available for Commissioners to make based on Senior Counsel Assisting’s analysis and examination of the evidence and information. The recommendations in the final report (due by 26 February 2021) will form the basis of authoritative advice to government and to the aged care sector on how to ensure the aged care system of the future aligns with the expectations of the Australian people.[1]We sent to our clients a checklist based around these 124 proposed recommendations because we believe that the themes are useful for aged care providers to consider in their risk and governance management. 

The Aged Care and COVID-19 Special Report was the result of the hearing of the RC into the impact of COVID-19 on aged care, which was held in Sydney in August 2020. As noted by the Commissioners, they released the brief report in advance of their Final Report “because we do not know how long the pandemic will last. Its end is impossible to predict. However, aged care residents continue to suffer and, tragically, some more may die as a result of COVID-19.” [2]

The Commissioners concluded that “The COVID-19 pandemic has been the greatest challenge Australia’s aged care sector has faced. Those who have suffered the most have been the residents, their families and aged care staff. The suffering has not been confined to those homes which have experienced outbreaks. Thousands of residents in homes that have not suffered outbreaks have endured months of isolation which has had and continues to have a terrible effect on their physical, mental and emotional well-being.”[3]

The Commissioners noted in the Interim Report that “care workers develop close relationships with residents. Many are grieving for residents who have died after contracting COVID-19. Others are anxious about bringing the virus into their work place or home to their loved ones. We pay tribute to aged care workers and to the vital work they do.”[4] Our organisation also pays tribute to our dedicated workforce.

Aged Care now part of the Federal Government Cabinet

The Prime Minister (PM) announced a reshuffle of the Ministry just before Christmas on 18 December 2020. The PM’s press release states “The Aged Care portfolio will be brought into Cabinet with the Hon Greg Hunt MP as Minister for Health and Aged Care responsible for the Government’s response to the Aged Care Royal Commission. Senator the Hon Richard Colbeck will retain responsibility for aged care services, including delivery of residential and home care packages, aged care sector regulation and Senior Australians. He will also continue as Minister for Sport.” In response to a journalist question about the Hon Richard Colbeck and taking primary responsibility for his portfolio away from him, the PM in his response (from transcript) stated he “is putting more grunt, more resource, more capacity into dealing with the challenges in aged care…ensure we frame our response to the Royal Commission that we have more effort, more application, and more senior-level engagement…more focus on aged care not less.”

Therefore CSS expects an even greater spotlight on aged care in 2021 as Minister Hunt will probably want to bring more mechanisms that he has applied to health to aged care and better synergies between the sectors.

One of the themes in Minister Hunt’s October 2020 Garran Oration to the Institute of Public Administration Australia, was on innovation in the response to the COVID-19 pandemic. “The rapid migration to whole of population universal telehealth — something that prior to the pandemic had been scoped as a ten-year plan. In ten heady days, we took a ten-year plan at the end of March and we were able to bring whole of population universal telehealth into being…over 35 million telehealth services (as at last week of October 2020) have been delivered in Australia. It’s arguably the largest revolution in healthcare delivery and Medicare since Medicare was introduced. What begun as a temporary measure will be a permanent measure.” 

CSS agrees with LASA where ““we understand that Minister Hunt will lead the response to the Aged Care Royal Commission’s final report in February (2021). At present, we are standing on the edge of the biggest transformation of the Australian aged care system ever. What we do as a sector and what the Government does in the coming months will have far-reaching impacts for older Australians, and the people and organisations who care for and support them, today and into the future.”

What others are saying in the Industry
The Weekly Source – 2021 promises to be even bigger than 2020 for Aged Care Providers 

  • “If bushfires and a global pandemic weren’t enough to have providers gripping their seats, next year will. Thanks to COVID, aged care is now top of mind for the politicians.”
  • “Aged care sector has done well to care for its residents compared to other countries. But the real story for this year has been the Royal Commission – and the financial viability and future sustainability of the sector.”
  • “The Royal Commission’s findings – set to be delivered to the Governor-General by 26 February 2021 – will deliver major reforms including a new Aged Care Act, new financial models and a new digital world. The quality, pay and development of the aged care workforce will also be high on the agenda. How many providers will be equipped for this new world?”
  • “Widespread consolidation across residential care and home care is expected, from 800-plus operators to just 100. We also estimate that even without consolidation, 65% of middle and senior executives will retire or leave the sector within three years. The question is: who will lead this transformation?”

Inside Aging – 2021 Predictions for the Aged Care and Disability Sectors by Civica Care MD Craig Porte
https://insideageing.com.au/2021-predictions-for-the-aged-care-and-disability-sectors/ (10 December 2020)

  • Funding from the government for care packages is important step.
  • Complex and manual processes often meant elderly applicants wait six+ months.
  • Need investment in business to government cloud-based technologies to drive efficiencies in processing times.
  • This will enable aged care sector to have access to accurate and up-to-date information and better engagement.
  • Protraction of digital developments poses greatest risk.
  • Need access to accurate and timely information from National Disability Insurance Agency.
  • Should be a greater focus on shifting awareness and funds to home care support and packages. Significant portion of funding is still allocated towards institutional care; however, we can expect a greater number of aged-care recipients to select care from their homes. Better and quicker allocation of funds will be required to support those vulnerable people in our community.

[1] Royal Commission into Aged Care Quality and Safety, 2020, Counsel assisting’s final submissions, pp.7-8. [2] Royal Commission into Aged Care Quality and Safety, 2020, Aged care and COVID-19: a special report, p. 2. [3] Ibid., p. 25. [4] Ibid., p. 1.

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