Home care services under greater scrutiny
The government is conducting significantly more quality audits within and across organisations.
The aged care sector’s regulatory body is now assessing all services of home care providers in a single audit.
The recent change comes in response to low compliance rates recorded by the Aged Care Quality and Safety Commission.
Its latest sector performance report shows that during January to March 2024 only 64 per cent of home care providers fully complied with the eight quality standards.
“This is a major focus for the commission, and we are addressing some of these risks in the way we manage home services quality audits,” says Aged Care Quality and Safety Commissioner Janet Anderson. “In a recent change, we now assess all services of a single provider in one quality audit.”
This change has meant the commission conducts more quality audits in the home care sector. In Q3, 391 audits were conducted compared with 118 the previous quarter.
Governance compliance also continues to be an area of concern for the commission. The report shows that among the quality standard requirements with lowest compliance, three of them relate to standard 8 – organisational governance: effective organisation-wide governance systems, risk management systems, and clinical governance framework.
“Governance is still an area of concern in both residential care and home services,” says Ms Anderson.
Since 1 December 2023, all aged care providers are required to comply with strengthened governance responsibilities. As the report’s authors note, not complying with the governance requirements “is linked with a decrease in the quality of a person’s care and their safety.”
Quality standard 2 – assessment and planning – is also on the commission’s radar. It is, says Ms Anderson, “a rising area of concern” – particularly across home care services where the standard now has more non-compliance than any other.
“Over a quarter of audited providers failed at least one requirement of this standard,” she says. “This included failing to manage risk when there had been a change in circumstance, and poor communication and documentation.”
Compliance with the quality standards is just one area scrutinised by the commission during its quarterly audits. The regulatory body also considers complaints and serious incident reports.
The most common home care complaints made to the commission concern communication such as not answering or returning calls or emails and not responding to requests for goods and services.
Complaints regarding financial matters also rate highly. In response to the “persistence of complaints” about financial issues, the commission audited a sample of home care providers to make sure they are charging people appropriately.
While it found a “high level” of compliance, the commission discovered outdated home care agreements, incorrect pricing schedules, and issues with monthly statements.
Analysing reports issued through the Serious Incidence Response Scheme, the commission found neglect topped the list of notifications (732), followed by stealing from or financial coercion of a client by a staff member (311), psychological or emotional abuse (96), unreasonable use of force (48), and missing consumers (42).
When reviewing SIRS notifications, the commission has found that providers regularly underassess the impact of serious incidents on people receiving care. “Providers may not be considering less obvious impacts that can be harder to identify,” say the authors. To help remedy the issue, the commission has developed an impact assessment tool.
“Providers should be reviewing their incident management systems to look for ways they can improve how they stop incidents from happening and how they respond to incidents when they do happen,” say the report’s authors.
Explaining the purpose of the sector performance reports, Ms Anderson says: “We join the dots between this information to decide where we should focus our attention both at a sector-wide level and by individual provider.”
She adds: “We encourage providers to also draw together the many pieces of information available to them when considering their own data. This helps them to address their own risks before it becomes an issue that requires commission intervention.”
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