The new standards in home care have resulted in ‘unchartered waters’ for stakeholders including the Aged Care Quality and Safety Commission, consumers and providers, writes Lorraine Poulos.

Lorraine Poulos

As we all know, a new set of standards was introduced into the aged care sector in July 2019. The sector was told that home care services would be given appropriate consideration during quality reviews, and in the main that has happened.

However, three things have happened which are beginning to alarm and concern key stakeholders, including the community, the government and home care providers.

  1. The community is being spooked about residential aged care and wants to have their loved ones remain at home, or older people themselves are wanting to remain at home. This may not always be appropriate or best for a person’s health and wellbeing, and places additional stress on loved ones.
  2. Due to COVID 19 and increased scrutiny of the Aged Care Quality and Safety Commission, we are now starting to see a more pronounced compliance model from regulators when assessing home care providers against the standards.  Notorious media cases like Ann Marie Smith have put providers on notice. The Royal Commission has also highlighted significant deficits/issues in the areas of care provision and behaviour of some providers and consumers.
  3. Consumer directed care has resulted in lots of grey areas. For example, what does self-direction mean? What are ‘excluded’ and ‘included’ items in home care package services and purchases? I believe we have now reached a point where these areas need to be black and white. Stakeholders tell me they want guidance and clearer explanations.

Facing change

Change is happening very quickly. We knew it was coming, but were we prepared?

An example is the recent initiative by government to allow CHSP services to provide care to residents who may wish to leave residential care in Victoria. This puts a huge amount of risk and responsibility onto providers who may not have the infrastructure in place to provide safe care to this client cohort.

In terms of clinical governance, it’s very important that providers have a suitable framework in place, as it provides them with reassurance that they are managing or mitigating risks around consumer health outcomes.

In terms of clinical governance, it’s very important that providers have a suitable framework in place, as it provides them with reassurance that they are managing or mitigating risks around consumer health outcomes.

It is not good enough to have a ‘framework’ in place if it is not meaningful and practical. There need to be strategies in place such as regular meetings, clinical registers, policies and procedures, competency testing of staff and evidence of genuine consumer engagement.

The new standards are proving to be a challenge for some home care providers, and although many already have effective systems in place that were required by the previous home care standards, robust training is still required.

Embracing a new order

My experience in assisting providers with clinical governance systems and chairing their committees is that they want to embrace the new model – they are willing to learn, and tell me the changes are giving them a sense of confidence and reassurance about how they are assisting consumers to stay at home and be healthy.

Can smaller providers survive given these new changes?  Yes they can.

Can smaller providers survive given these new changes?  Yes they can. Not only can they  survive, they can make a difference locally – it is often much easier to have clinical oversight measures in place due to relationships in local areas.

 Prior to COVID-19 aged care was heading in the direction of health promotion and preventative models. We have had to rethink job roles, reshape our service models, upskill non-clinicians to understand their role in early detection of health changes and educate consumers about their rights and roles in care provision.

There’s no doubt it is an exciting time, but it will require a dedicated commitment from providers and additional resources from government if the community is to be given the opportunity to stay at home as long as possible at the end of their lives.

*Lorraine Poulos is a trainer and consultant with experience working with government and aged care providers

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