Home care sector gets to know quality watchdog

Six months after the Quality Agency assumed responsibility for standards and quality in community care and some in the sector are still seeking proof it won’t simply impose a residential-based framework, while the agency says it acknowledges community care is different. Megan Stoyles reports.

The quality of all community aged care services – including the Commonwealth Home Support Program when it commences from 1 July 2015 – is being overseen by the Australian Aged Care Quality Agency.

The standards and quality of community home care services were previously monitored by the department, but the Quality Agency’s role has been expanded to include quality review of home care, in addition to residential aged care.

However, despite having assumed oversight of home care quality since 1 July 2014, home care services tell Community Care Review that they are still keen to get more information from the agency about the processes involved. And, they are seeking proof that residential-based approaches won’t simply be imposed on the home care experience.

Some services feel that the formulaic nature of the written reports provides less feedback than was previously the case. While this makes them more defensible in a legal context, it also means, according to one observer, that the services lose “the colour and movement you used to get in reports. It also makes them less useful to check on quality.”

Different philosophies, says chief

Quality Agency CEO Nick Ryan stresses that the objective is improving quality in both residential and home care. He concedes that there are different philosophies in assessment for both, so recruitment of assessment staff with either residential or community skills is still occurring.

“Our medium to long-term aim is to have a flexible workforce that is able to apply and review the standards whether they are in residential aged care or in home care,” Ryan tells CCR.

“The change in our operating philosophy is not the shift into home care but to CDC, which is central to the government’s reforms for aged care as a whole.”

The Quality Agency continues to monitor the three Home Care Common Standards and 18 expected outcomes, checking care, effective management, continuous improvement and consumer rights.

To strengthen consumer participation in the quality review process, the Quality Agency now provides a template that requires service providers to contact all clients in advance of the quality review process and invites them to either call the review team, or participate in face-to-face discussions to discuss their experiences, satisfaction and knowledge of the care provided.

Review staff do not visit a service provider’s clients, but usually interview them at the service provider’s nominated service outlet.

“There is a difference in that in a residential care environment we look at matters on site. However, in home care it is about checking that the service provider has policies and systems in place,” says Ryan.

“We ask about training and supervision; we speak to home care workers when they go into homes, we check the policies are right, that continuous improvement is occurring.

“The Quality Agency has a significant educational function and we’ve had very positive feedback from surveys and meetings about our education in residential care. One of our most exciting moves is working up a new educational program for home care, which is well underway.”

The agency says it has communicated with services directly via letters, circulars, updates in magazines and online, and plans a community emphasis in its 2015 Better Practice conference round.

“We will be focussing on regional, rural and remote and indigenous home care provision, and will also talk to disability services providers as they can add value to our aged care models of care,” says Ryan.

“In the residential space, we do 55,000 interviews each year. Similarly, within home care, we want to do thousands of interviews as part of a consistent approach. Fundamentally the best judge of service quality is the person receiving it.”

Sector concerns

While the Quality Agency might point to its work to date, there are different views from industry.

Illana Halliday, CEO of Aged and Community Services NSW&ACT, says that the Quality Agency’s communication with the sector started late, although she acknowledges it has since improved.

“In NSW, Quality Agency meetings with industry did not incorporate community on the agenda until November – five months after they took over responsibility for it,” Halliday tells CCR.

“The key thing for providers is that whoever does assessments understands the community sector. We want the agency to show us that they know it is different from residential care.”

Paul Sadler, CEO of Presbyterian Care NSW&ACT, which provides both residential and home care, says that when it was under departmental responsibility, oversight of community care systems was slack. “They rarely met timeframes for giving reports back, and were disorganised in planning for visits, although they weren’t too bad when on site,” he recalls.

“Early evidence is that the Quality Agency is improving these aspects, with good systems, clear agendas and good communications, although I’ve heard that this can vary from state to state.”

In South Australia, ECH, which has exited residential care to focus on home care service provision, has been assessed by both the former Accreditation Agency and now the Quality Agency.

“We were concerned that community care might move towards a residential care compliance type focus, because the legislation seemed to just tack on community care,” CEO Rob Hankins tells CCR.

“But talking with the agency at national and state level, it is working hard to make sure the community care culture in assessment is not affected by residential care or vice versa.

“In South Australia, the agency is keeping assessors for community care separate from residential care other than those assessors – mainly contractors – who are experienced in working in both.”

Hankins’s major concern is the 1 July deadline for the many scheduled changes to home care programs.

“The Regional Assessment Services tender closed on 19 December but successful tenders won’t be announced until April 2015, with a requirement to be fully operational two months later.

“It’s a challenge, added to the huge workload around CDC on service provision, never mind the quality side of things. There is also massive uncertainty for staff and some may have to be let go unless current HACC contracts are rolled over instead of being re-tendered.”

For national private sector operator KinCare, which provides care in over 10,000 homes, communication was essential when preparing for its Quality Agency reviews.

Wendy Hill, portfolios manager of ageing at KinCare, says the organisation selected a key person to communicate with the lead auditor during the run-up to site visits, so as to help the provider understand what was required, to prepare evidence and examples, and advise staff and clients how the review would be structured.

“We’re used to quality audits; we have quality systems and have been meeting the same three standards and 18 outcomes, so for us it’s part of continuous improvement. We already have CDC packages so the changes we have to make are just part of a logical change management process,” Hill tells CCR.

She says that KinCare sees one of the main challenges to the new Quality Agency process as the lead-in time to provide letters to every client, and it believes there are other ways of obtaining quality feedback.

“We support client and consumer feedback, but it could be easier if sampling was used from a range of different consumers with different experiences,” she says.

The Quality Agency says it is responding to these and other service provider concerns, and is currently analysing a recent industry needs analysis to determine the education and information needs of both the residential and home care sectors.

This article first appeared in the January 2015 Community Care Review.