Report on the Operation of the Aged Care Act 1997 - 1 July 2008 to 30 June 2009

10 Complaints Investigation Scheme

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The Aged Care Complaints Investigation Scheme (CIS) commenced operation on 1 May 2007 and was established through changes to the Aged Care Act 1997 and the introduction of regulations under the Act - the Investigation Principles 2007. The CIS covers both residential and community aged care services subsidised under the Act. The CIS is a free service with offices in each state and territory.

Anyone can contact the CIS with a concern, including care recipients, family members, care providers, staff members and health professionals. Complaints can be made openly, anonymously or on a confidential basis and can be about anything that affects the quality of care for aged care recipients.

The CIS has the power to conduct investigations on its own initiative and issue Notices of Required Action, where an Approved Provider is found to be in breach of their responsibilities under the Act.

CIS complaints activity

The CIS received 12,573 contacts between 1 July 2008 and 30 June 2009. Approximately 63 per cent (or 7,962) of these contacts were considered ‘in-scope’ cases – that is, relating to an Approved Provider’s responsibilities under the Act – and subsequently investigated. The remaining 37 per cent (or 4,611 cases) were either addressed through the provision of information or were ‘out-of-scope’ of the scheme and were therefore not investigated, although they may have been referred to the appropriate body to deal with. Complaints that are not within the parameters of an Approved Provider’s responsibility under the Act are classified as ‘out-of-scope’ cases.

Victoria received the highest number of contacts during the reporting period, with 34 per cent (or 2,743) of the total number of in-scope cases and 32 per cent (or 1,467) of the total number of out-of-scope cases recorded Australia-wide. New South Wales recorded 26 per cent (or 2,083) of the total number of in-scope cases and 26 per cent (or 1,187) of the total number of out-of-scope cases. Queensland recorded 17 per cent (or 1,390) of the total number of in-scope cases and 20 per cent (or 918) of the total number of out-of-scope cases. South Australia and Western Australia recorded 17 per cent (or 1,348) of the total number of in-scope cases and 18 per cent (or 820) of the total number of out-of-scope cases. The smaller jurisdictions of Tasmania, Northern Territory and the Australian Capital Territory recorded 5 per cent (or 398) of the total number of in-scope cases and 4 per cent (or 219) of the total number of out-of-scope cases.

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Figure 5: Identification of complaints as in-scope or out-of-scope from 1 July 2008 to 30 June 2009, by state and territory

Table 39: In-scope and out-of-scope cases created in 2008-09

Cases	NSW	VIC	QLD	SA	WA	TAS	NT	ACT	Total
In-Scope	2,083	2,743	1,390	815	533	197	70	131	7,962
Out-of-Scope	1,187	1,467	918	268	552	59	63	97	4,611
Total	3,270	4,210	2,308	1,083	1,085	256	133	228	12,573

In 2008-09, 12,327 cases were finalised. Approximately 63 per cent (or 7,726) of these finalised cases were in-scope cases. The remaining 37 per cent (or 4,601) were out-of scope being finalised at ‘intake’ or shortly thereafter. The number of cases finalised in 2008-09 will include cases received in 2007-08.

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Figure 6: Cases finalised – in-scope and out-of-scope 2008-09

Table 40: In-scope and out-of-scope cases finalised in 2008-09

Cases	NSW	VIC	QLD	SA	WA	TAS	NT	ACT	Total
In-Scope	2,142	2,613	1,324	770	511	181	67	118	7,726
Out-of-Scope	1,181	1,463	918	268	552	59	63	97	4,601
Total	3,323	4,076	2,242	1,038	1,063	240	130	215	12,327

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Most commonly reported issues

CIS cases often incorporate more than one issue. Seventeen issue keywords are currently identified and reported against. During the reporting period, 15,759 individual issues were identified. The majority of these issues (67 per cent) were grouped under the following five keywords:

• Health and Personal Care (main issues included continence management, clinical care and infectious diseases);
• Abuse (main issues included reportable assaults and other types of abuse such as verbal, psychological or emotional abuse, financial issues, rough handling, neglect and discrimination, including religious, racial, cultural, sexual and gender-based);
• Consultation and Communication;
• Personnel; and
• Physical Environment.

Figure 7: The five most commonly reported issues from 1 July 2008 to 30 June 2009

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Referrals to external agencies

During the course of investigating a case, the CIS may refer issues to an external agency more appropriately placed to deal with the matters raised. For example, criminal issues are referred to the relevant state/territory police service, while issues that relate to the conduct of a health professional are referred to the relevant health professional regulatory body, such as the Nurses Registration Board, Medical Board and the Health Care Complaints Commission.

Between 1 July 2008 and 30 June 2009, the CIS made 1,629 referrals to external agencies. Approximately 89 per cent (or 1,455) of these referrals were made to the Aged Care Standards and Accreditation Agency Ltd. Of these referrals approximately 66 per cent were requesting a support contact, 32 per cent were for information regarding matters considered to be non urgent and the remaining two per cent were for a review audit of a home.

Figure 8: Breakdown of the 1,629 referrals to external agencies from 1 July 2008 to 30 June 2009

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Site visits

CIS officers may visit either the Approved Provider’s premises or the aged care service during the course of investigating a case. Visits may be announced or unannounced.

The CIS conducted 3,151 site visits between 1 July 2008 and 30 June 2009. This means that a site visit was undertaken in 40 per cent of all in-scope cases. Approximately 41 per cent (or 1,304) of these visits were announced. The remaining 59 per cent (or 1,847) were unannounced.

Site visit figures for each of the states and territories are shown in Figure 9.

Figure 9: The number of site visits, by state and territory, from 1 July 2008 to 30 June 2009

Breaches identified

In 2008-09 a total of 1,093 breaches were identified Australia-wide as a result of an investigation. Victoria had the highest number of breaches with 328 (or 30 per cent). New South Wales reported 297 breaches (or 27 per cent) and Queensland reported 205 breaches (or 19 per cent). Both South Australia and Western Australia identified 178 breaches (or 16 per cent). The remaining 85 breaches (or 8 per cent) identified were in Tasmania, the Australian Capital Territory and the Northern Territory.

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Figure 10: Breaches identified from 1 July 2008 to 30 June 2009, by state and territory

Notices of required action

Of the 1,093 breaches identified in 2008-09, 925 did not result in a Notice of Required Action being issued as the matter was remedied immediately through a negotiated outcome, or it was referred to another agency. (Note that case numbers cannot be totalled as they transcend financial years.)

A Notice of Required Action (NRA) is issued when an Approved Provider is found to be in breach of their responsibilities under the Act or Principles and has not already taken action to address the breach. Each NRA sets out the details of the breach, what the provider must do to address the breach and the timeframe in which this action must be taken. The intention of a NRA is to give the provider an opportunity to address the breach before compliance action is considered. An NRA may cover more than one breach.

Table 41: Notices of required action (NRAs) at 30 June 2009

NRA complied with	107
NRA referred for further compliance action (not complied with)	18
NRA action period not yet elapsed (NRA open)	56
Total NRAs issued	181

Between 1 July 2008 and 30 June 2009 the CIS issued 181 NRAs. Of those, 107 were complied with at 30 June resulting in no further action against the Approved Provider, 18 were referred for further compliance action and for the remaining 56, the period in which the Approved Provider had been allowed to implement the required action had not yet elapsed. NRAs were issued in all states and territories (refer to Figure 11).

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Figure 11: Notices of Required Action issued from 1 July 2008 to 30 June 2009, by state and territory

External review

The Aged Care Commissioner is a statutory office created under the Act. The functions of the Commissioner are outlined in the Act and include:

• examining, in response to a complaint or on their own initiative, the Secretary’s processes for handling matters under the Investigation Principles 2007;
• examining decisions made by the Secretary under the Investigation Principles 2007 which are identified, by those Principles, as being examinable by the Commissioner;
• making recommendations arising from the Commissioner’s examinations, to either confirm the Department’s original decision, or set aside the original decision (and replace it) or vary the original decision (and replace part of it); and
• examining complaints about the Agency with regard to the accreditation of Australian Government subsidised aged care services. This includes the power to examine complaints about the conduct of a person carrying out an accreditation audit or support contact, but does not include the power to examine complaints about accreditation decisions.

The Aged Care Commissioner can also conduct an ‘own motion’ examination, that is, to undertake a review of the scheme’s processes or the conduct of the CIS even when a request for a review has not been received.

Ms Rhonda Parker was appointed Aged Care Commissioner from 1 May 2007 to 30 April 2010. The Aged Care Commissioner is required to produce an annual report, for presentation to the Minister for Ageing and to Parliament, on the operations of her office.

The Aged Care Commissioner’s annual report will be made available on the Commissioner’s website at: http://www.agedcarecommissioner.net.au

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Review of Examinable Decisions

From 1 July 2008 to 30 June 2009 the Aged Care Commissioner completed 125 reviews of examinable decisions, representing approximately 2 per cent of finalised in-scope cases.

After the Secretary receives a recommendation from the Commissioner about an examinable decision the Secretary must, taking into consideration the recommendation, reconsider the original decision.

In 2008-09 the Department completed 125 internal reconsiderations, five of these internal reconsiderations related to reviews completed by the Aged Care Commissioner in 2007-08.

In all except nine instances the Delegate, on reconsideration, agreed with the Commissioner’s recommendation. Of the nine, five related to a recommendation to vary the original decision, three related to a recommendation to set aside the original decision and one related to confirming the original decision. The Department partially agreed with the Commissioner’s recommendations in a further three instances.

Table 42: Reviews of examinable decisions, from 1 July 2008 to 30 June 2009

Aged Care Commissioner recommendations to confirm the original decision	Aged Care Commissioner recommendations to set aside the original decision	Aged Care Commissioner recommendations to vary the original decision	Total
62	16	47	125

Aged Care Commissioner Reviews of the CIS Processes

The Aged Care Commissioner completed 14 reviews of CIS investigation process in 2008-09. The Commissioner provided the Department with 12 final reports. Two cases were conciliated without final reports. As at 30 June 2009, the Department has responded to five of the final reports.

The Aged Care Commissioner did not commence any ‘own motion’ reviews.
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