With the focus on the Southern Cross Care (Tas) and Bupa South Hobart case studies for the whole week, there was little in the way of ‘new thinking’ put forward by witnesses – instead, it was the Counsel Assisting and the Commissioners (pictured above) putting forward solutions to the issues being raised, namely:
- Board members to be required to attest to the quality of care at their organisation
- Boards to be obligated to consider care of residents in their decision-making processes
- Boards to be required to inform themselves on quality of care issues
- Boards to include a director with a clinical care background
- The regulator to have a role in checking the qualifications of board members
- The regulator to review staffing rosters
- A ‘care home health check’ to review facilities and their clinical risks
- A publicly available complaints register in facilities
- ‘Attitude’ testing for facility managers
See the full list and my analysis below:
Tammy Marshall, the Clinical Care Coordinator at Southern Cross Care (Tas)’s Yaraandoo Hostel:
- More funding and additional staffing
Jo-Anne Cressey Hardy, the former Nurse Adviser/Administrator at Yaraandoo Hostel:
- More funding to support and train facility managers
Direct experience witness Ann McDevitt:
- More training for staff to identify medical issues
- High staff-to-resident ratios
- Counselling or supports to help new aged care residents adapt
Peter Williams, the former Facility Manager at SCC (Tas)’s Glenara Lakes:
- A template of clinical risk information that facilities should monitor on a weekly, daily, and monthly basis
- Greater scrutiny of recruitment processes and aptitude testing for facility managers
Andrew George-Gamlyn, the ACFI Coordinator at SCC (Tas):
- Greater policing of the ACFI system by the Department of Health
Andrew Crane, the former Director of Finance at SCC (Tas):
- Replace ACFI with a funding system that provides a fixed component plus claims for additional services such as lifestyle
Commissioner Tony Pagone (pictured above) (during Mr Crane’s evidence):
- Adding wellbeing and lifestyle to the items that providers can claim for under ACFI
Commissioner Lynelle Briggs (during Mr Crane’s evidence):
- Limits on how much profits providers can earn from providing services
SCC (Tas) CEO Richard Sadek:
- Aged care to be part of health services rather than a separate system and funded in that approach
- A new funding model based on a Medicare Levy-style system to provide for older people’s care
Senior Counsel Assisting Richard Knowles (during SCC (Tas)’s Chairmen Ray Groom and Stephen Shirley’s evidence):
- A person with a medical or clinical background to on the board of directors of aged care providers
- The Department of Health to assess the mix of skills and training of board members of approved providers and to make decisions as to whether approved providers should be approved, depending on the constitution of their board
- Directors of a board publicly attesting on an annual basis to the quality care in their organisation
- Residents to have input into Clinical Governance Committees
- Specific duties in regulations to require boards and directors some requirement to regularly inform themselves of the quality of care issues and the impact of their own decisions on quality of care issues
Former SCC (Tas) Chairman Ray Groom:
- A national program of formal training for new facility managers
Counsel Assisting Eliza Bergin (during Merridy Eastman’s evidence):
- A publicly available complaints register in all facilities and more transparent processes around complaints
Senior Counsel Assisting Peter Rozen QC (during the Anchor Excellence panel’s evidence):
- Boards of approved aged care providers to have a duty to consider quality and safety outcomes in their decision-making processes
The Anchor Excellence panel of advisers and administrators – National Administrator Cynthia Payne (pictured above), Consultant John Engeler, and Adviser Dr Marguerite (Maggie) Haertsch:
- The terms administrator and adviser be replaced with ‘compliance remediation specialist’ so providers better understand their role
- The Aged Care Act to have a clear definition of the duties and obligations of a compliance remediation specialist, and that undertake specific training and be certified by the Aged Care Quality and Safety Commission
- A register of compliance remediation specialists to sit with the Aged Care Quality and Safety Commission
- A standardisation of the reporting obligations during sanctions including a review audit after a facility is remediated and a ‘reset button’ on their accreditation
- The development of an assessment framework to track the improvements and the approved provider’s performance during the sanctions period and
- A requirement for a formal compliance remediation plan between the compliance remediation specialist and the provider.
Commissioner Briggs (during the Anchor Excellence panel’s evidence):
- ‘Health checks’ for aged care providers where they go through a rigorous process of either internal or external review about their performance against the standards and the expectations under the Aged Care Act
Anchor Excellence Adviser and Bupa National Administrator Cynthia Payne:
- A statement of quality and safety that could be made available to residents about what the organisation does as part of its quality management system, how it goes about informing itself that its systems are working and how it engages consumers in that process
Counsel Assisting Eliza Bergin (pictured below) (during the Wilson & Webster Consultancy Services panel’s evidence):
- A register of complaints for residents and families
- The Commonwealth to have more oversight over how providers spend the rebates and subsidies paid to providers for the purposes of monitoring whether it’s spent on care delivery
Bupa Managing Director Carolyn Cooper:
- ‘Attitude’ testing for aged care staff
- A wider use of benchmarking to ensure staff rosters are meeting standards and for that to be checked by the regulator
- A ‘care home health check’ to review facilities and their clinical risks
Commissioner Briggs (during Ms Cooper’s evidence):
- Longstanding staff to be involved in drawing up rosters
Governance Institute of Australia Policy Manager Catherine Maxwell:
- Boards to have a majority of independent directors
- Board members to serve a maximum of three terms or nine to 20 years
- Training in governance for board directors
Mr Rozen (during Ms Maxwell’s evidence):
- A due diligence duty being imposed on board members of aged care providers to ensure safety and quality of care provision
- Boards to set the ground rules about what they need to be told by the management
As you can see, like the workforce hearings, it was a one-sided affair in terms of ‘new ideas’.
There were several – mostly around the role of boards – that were raised multiple times by the Counsel Assisting teams, suggesting they are being seriously considered.
Firstly, that boards have a formal duty to provide safe and quality care to residents. As I pointed out in yesterday’s issue, board directors already have several statutory obligations – but witnesses suggested this could work.
The need for boards to be a majority independent and include a person with a clinical background was also flagged as sensible options.
Secondly, tighter regulation by the Department of Health and the Aged Care and Quality Commission (ASQSC) was also put forward.
The Counsel said the Department should have a role in checking the qualifications of board members – while Ms Cooper also said there was scope for a review of staff rosters (a shock suggestion).
The idea of a public complaints register that is available to residents and families also came up repeatedly – and is a measure that providers could look to put in pre-emptively.
Both the Commissioners were clearly keen for providers and their boards to be proactive in addressing risks.
Commissioner Briggs suggested annual ‘health checks’ for providers to ensure they are meeting standards which Commissioner Pagone agreed could be provided in the form of a report.
The Commissioners also expressed great interest in the idea of ‘attitude testing’ – ensuring that facility managers are the ‘right fit’ to run a home.
However, the Counsel Assisting dismissed the idea of national training for facility managers, saying it was the responsibility of providers.
Is this an idea that needs to be revisited?
Let me know your thoughts.
