Exemption from the 24/7 registered nurse responsibility – how to apply

Information for eligible providers about how to complete the application form for an exemption from the 24/7 registered nurse responsibility.


Department of Health and Aged Care

Exemption from 24/7 Registered Nurse Responsibility

How to Apply

Wednesday, 12 April 2023

Presented by:


Mark Richardson

Assistant Secretary, Residential Care Funding Reform Branch, Department of Health and Aged Care


Dr Melanie Wroth

Chief Clinical Advisor, Aged Care Quality and Safety Commission

Angus Algie

Director, Residential Care Funding Reform Branch

Patrick Newton

Director, Residential Care Funding Reform Branch

[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Exemption from 24/7 registered nurse responsibility – how to apply’, ‘Mark Richardson’, ‘Assistant Secretary’, ‘Residential Care Funding Reform Branch’, ’12 April 2023’, ‘health.gov.au/aged-care-reforms’]

[The visuals during this webinar are of each speaker presenting in turn via video with reference to the content of a PowerPoint presentation being played on screen]

Mark Richardson:

Hello everyone and welcome to our webinar on how to apply for an exemption from the 24/7 registered nurse responsibility. You have been invited to join today’s targeted webinar as you may be eligible for a 24/7 RN exemption. This webinar follows on from the previous webinar we held on the 15th of March which provided information about the 24/7 RN responsibility and the exemption framework.

As with previous webinars please note that today’s webinar is being recorded and will be available later for those who would like to watch it again or are not able to attend.

Before I go any further I’d like to acknowledge the traditional custodians of the lands on which we meet today. I’m in Canberra in Ngunnawal country and I pay my respects to Elders past, present and emerging. I would like to extend that acknowledgement and respect to any Aboriginal and/or Torres Strait Islander people joining us today.

My name is Mark Richardson. I am the Assistant Secretary of the Residential Care Funding Reform Branch at the Department of Health and Aged Care. I am joined today by Dr Melanie Wroth, Chief Clinical Advisor from the Aged Care Quality and Safety Commission, and Directors from the Residential Care Funding Reform Branch, Angus Algie and Patrick Newton.

There will be a Q&A session at the end of the webinar. You can lodge questions in the Slido box on the right hand side of your screen. If you can’t see Slido you can also access it via the Chat on the bottom right of your screen. We will attempt to respond to as many questions as possible at the end of the webinar. All questions and answers including ones that we may not get to will be available after the webinar and emailed to you.

We would also like to know what you thought of today’s webinar and whether you intend on applying for an exemption. This will help us help you with our planning. As a result if you could complete the short survey at the end of today’s session that would be most appreciated.

Changes to the legislation require approved providers that provide residential care in a residential facility to use an approved form to apply for an exemption from the 24/7 RN responsibility. As such the Department has developed an application form in consultation with the Aged Care Quality and Safety Commission for the purposes of the exemption process. The form has been designed to gather information that is necessary and relevant to the decision on whether an exemption from the 24/7 RN responsibility will be granted to a residential facility. The form contains three parts. Part A which provides some general instructions and information, Part B, the application form itself, and Part C which provides information about the 24/7 RN responsibility and the exemption framework including relevant definitions.

All eligible providers should have received a link to access the form on our website on the 3rd of April. I hope by now most of you have had a look at the form if you intend to apply for an exemption.

Before I go further I want to go over the exemption criteria again for those who may not be aware or didn’t get a chance to attend the webinar we held on the 15th of March where we stepped eligible providers through the exemption framework including the criteria for granting of an exemption. It is important to understand that an exemption from the 24/7 RN responsibility can only be granted if all of the following requirements are met for your residential facility. First the facility is located in a Modified Monash Model or MMM 5, 6 or 7 area and the facility has no more than 30 operational places on the day a decision for an exemption is made and you have taken reasonable steps by having alternative clinical care arrangements in place to ensure that the clinical care needs of your care recipients will be met.

We have heard that some providers are considering reducing their operational places in order to apply for an exemption. Please note that this will not guarantee that an exemption will be granted because the provider will still need to demonstrate that they have appropriate alternative clinical care arrangements in place.

This slide provides a screenshot of Part A on page 2 of the application form. As I mentioned earlier it provides some general instructions and information about the purpose of the form, information sharing between the Department and the Commission and a privacy notice about how we manage the personal information collected in the form. There is some key information on this page that I would like to point out including that the Department will share information collected with the Commission. In practice what this means is that we’ll provide the contents of an application received to the Commission through a secure channel. The Commission will then provide to the Department information that is relevant to the decision maker’s consideration of whether the steps taken to meet the clinical care needs of residents are reasonable and information about sanctions and certain notices issued to the provider that the decision maker must have regard to in making their decision on whether to grant an exemption for your facility.

The second part is who can sign the form once it has been completed. The Act requires that only certain people at the organisation can sign this form and they are a director of the body corporate if the approved provider is not an authority of a state or territory or local government body and is a body corporate that is incorporated or taken to be incorporated under the Corporations Act 2001. A member of the approved provider’s governing body if the provider is not an authority of a state or territory or local government body and is not a body corporate. And lastly one of the approved provider’s key personnel if the provider is an authority of a state or territory or local government authority.

The next few slides will cover Part B which is the application form itself and begins on page 3 of the form. I will go over some of the key fields in the form that are relevant to the approved provider and residential care services section of the form and then hand over to Melanie who will cover the information you need to provide in regard to your rostering and alternative clinical care arrangements.

The form is available as a PDF form which means you can fill it out using the latest version of Adobe Acrobat Reader or you can print it off and complete it by hand. Where possible we recommend that you complete the form electronically as this will make it easier for all parties involved including yourself.

You can also save the form to complete later if you need more time to gather information to complete each section. If you experience any issues saving the information in the application form you may need to download the latest version of Adobe Acrobat Reader software which should then allow you to save the data in the form fields.

Now as I explained during the previous webinar an exemption from the 24/7 RN responsibility will apply to the residential facility where care is being provided to residents. If you have more than one facility for which you are looking to seek an exemption you will need to complete a separate form for each facility.

I’d like to remind everyone that for the purposes of the 24/7 RN responsibility a residential facility is a building or complex of buildings inclusive of their immediate surrounds used for the purpose of delivering residential aged care. This is different from a residential care service.

On this page you will need to fill out the approved provider details. This should be pretty straightforward. The reason we need this information is because an exemption is granted to the approved provider of the residential facility even though it is applied at the facility level. I want to draw your attention to Section 2 on page 3 which collects information about your residential care service or services that provide residential care to the residential facility for which you’re seeking an exemption and where we have included a preamble with some important information about collocated services and how you can find out the MMM classification for your residential facility by using the Health Workforce Locator Tool and selecting the 2019 MMM classification filter. We encourage you to do this quick and simple check to ensure that your residential facility meets the MMM criteria.

If you have collocated services that operate from the one single residential facility you need to provide details for the main service in Section 2 and details of the other service or services in Section 2.1 on pages 5 and 6 of the form which I’ll get to in a moment.

The important point to note here is that the operational places for each collocated service are combined for the purposes of an exemption from the 24/7 RN responsibility. This means that a facility is not eligible for an exemption if the combined number of operational places exceeds 30.

Page 4 of the form is where you will need to fill in all the details for the main or only residential service that provides residential care through the residential facility for which you are seeking an exemption.

As you can see on the screen you will need to provide your service NAPS or RACS ID, the name of the services, its physical street address and importantly the MMM classification. You also need to provide the number of operational places for the service.

To avoid doubt this should be the number of operational places for the service identified in question 2A and not the combined number of operational places for the residential facility as a whole if it is a collocated service. To help the Commission understand whether your staff mix and any on-call arrangements are appropriate for your cohort of residents and their point in time clinical needs you will need to provide some high level information about your residents including the number of residents at the residential care service identified in this section – that is question 2A – that are receiving complex clinical care in the box in the red circle on the bottom right of the screen and the type of clinical care these residents need. The information should include but not be limited to care such as Schedule 8 medication administration, complex wound management and blood or other intravenous infusions including those for palliative and end of life care. Please do not disclose any personal or identifiable information here about your residents such as names and dates of birth because this is not required for the purpose of assessing the appropriateness of your alternative clinical care arrangements and more importantly to protect the privacy of their data.

As I mentioned before that if you have collocated services at the same facility you must provide details for the other services in Section 2.1 on pages 5 and 6 of the form. For clarity collocated services are defined as two or more residential care services that belong to the same approved provider and operate out of a single residential facility. The building or buildings of the residential facility can be at a single address or it can be across neighbouring addresses that effectively form a single location.

If an exemption is granted it will apply to all the services that make up the one residential facility. To avoid doubt a residential care service that operates through different residential facilities or buildings that are not geographically collocated in such a way to meet the ordinary meaning of a facility must meet the 24/7 responsibility separately at each residential facility.

In terms of the information we collect in this part of the form it is essentially the same as the information we collect in Section 2. However it is important that you clearly identify the services by providing their correct service NAPS or RACS ID and the number of operational places at each service.

I will now hand over to Melanie who will take you through Sections 3 to 6 of the form which collects information about your staffing roster and alternative clinical care arrangements.

Dr Melanie Wroth:

Thanks Mark. I’m Melanie Wroth. I’m a geriatrician and Chief Clinical Advisor to the Aged Care Quality and Safety Commission. As Mark explained at the beginning of this webinar the Department will share with the Commission information collected in the application for an exemption. This is so that we at the Commission can provide information to the Secretary of the Department or their delegate that is relevant to the consideration of whether the steps you’ve taken to meet the clinical care needs of the care recipients in your residential facility are reasonable in the circumstances while an exemption is in force.

Remember why an on-site RN adds important value in both clinical care terms and the management of clinical incidents or deterioration urgent responses in an emergency. When you don’t have an RN on site we need information on how these matters are being handled so that residents are not at risk of harm. So if you bear that in mind, that those are the things we’re considering when we are assessing your information and providing information to the Secretary. So for our role in this process we’re particularly interested how you’re rostering your clinical staff and allied health team to provide as much clinical coverage as possible. So you’ll need to provide the full roster of care staff for all roles. This information will help us understand when and how often your alternative clinical care arrangements may need to be utilised in the absence of an RN on site and on duty.

You will need to provide enough detail so that someone who’s unfamiliar with your arrangements can readily understand them. Please note that any examples given are not an exhaustive list. You will need to provide supporting documentation about your alternative clinical care arrangements. You will also need to attach to your application your protocols, policies and procedures for managing the escalation of clinical issues and this includes end of life care when there isn’t an RN on site and on duty. These will need to be clearly understandable for example for new staff to actually use in an urgent setting.

In Section 3 on page 7 of the form which you can see an extract on this slide you must provide a copy of your current roster for your clinical and allied health team and all care staff for a period of no less than one month. This roster should show clear designation of roles, times of shifts and any overlaps to support the information provided in your application. You can use the free text on this page of the form to provide any additional details about your roster, on-site staff and on-call clinician arrangements. This includes RNs, GPs and nurse practitioners. Any additional information you provide about your rostering arrangements should include attempts you have made to provide 24 hour RN coverage wherever possible such as exploring split or 12 hour shifts.

If the space provided is not sufficient you can attach a separate document with more information. You can do this for any of the free text fields in the form and clearly indicate the question the additional information relates to. If you complete the form electronically using the Adobe Acrobat Reader however the font size will adjust automatically to allow you to provide the relevant information within the space available.

Section 4 on pages 7 to 11 of the form collects information evidence about your on-call arrangements with an off-site RN, GP, nurse practitioner and/or a specialist telehealth service to support care staff when an RN is not on site. This includes specifics of when that off-site person is available and what happens when they are not. We’ve included in the form examples of common on-call clinician arrangements. It’s unlikely that a single strategy or alternative clinical care arrangement will be a sufficient substitute for on-site RN expertise and facilities may well need to implement a combination of strategies in order to mitigate the risks to resident care and safety that can arise whenever an RN is not present.

For example your alternative arrangement in the evening may well be different from an alternative arrangement in the middle of the night. In any circumstance you must provide evidence of all your alternative clinical care arrangements to support your application for an exemption from the 24/7 responsibility.

Going back to the common on-call clinician arrangements you can see in the enlarged part of this slide that we’ve included an option under Section 4.1 to select collocation with a hospital or acute or sub-acute healthcare unit that is not operated by the same service provider. If this is relevant to you you should select and fill in the details. That is if you’re located with or within close proximity of a healthcare facility such as a hospital or acute or sub-acute unit and you have clinical escalation pathways in place to access clinical care from their RNs or other clinically qualified practitioners for your residents to ensure that they receive appropriate and timely assessment and treatment where there is no RN on site and on duty at your own facility.

Things to consider include the time it will take for an offsite RN able to attend and this may not be just travel time. So we would like to know whether it’s going to take an RN ten minutes to be on site or whether it’s going to be 40 minutes or longer as clinical risk in the interim is obviously something we would need to take into account and what you are expecting the person on site to do in that timeframe. And also include what is the next step if the on-call person is not available or not answering.

Another common arrangement included in the next few pages are on-call arrangements with external or contractual RNs with GPs or nurse practitioners and in some cases specialist or other telehealth services. Looking at page 8 of the form now you’ve got the option to select on-call arrangements with an RN that is contracted or external to your facility under section 4.2. The information we collect about your on-call RN arrangements includes whether it’s via telephone or video, in person attendance or both. You also need to let us know the duration of the arrangement in place, that is whether it’s an ongoing or a fixed term interim arrangement, the start and end dates of the arrangement, the length of time in minutes it would take for the RN or other practitioner to get to the facility for in-person attendance for example in the middle of the night. The information you provide here is particularly important as it will help us understand if this arrangement is appropriate in instances where a rapid response to clinical risks and deterioration is required, and also details of the contact person or agency if we need to confirm this arrangement.

If you have more than one on-call arrangement with RNs you can provide details for the other arrangements in the free text field in the section of the form or as an attachment. Don’t just omit it.

Under 4.3 of the form on page 9 you can see that you have the option to select on-call arrangements with a GP or nurse practitioner if it’s applicable to your facility. The type of information you need to provide about this arrangement is really the same as for on-call arrangements with an RN in relation to their availability and how they’re accessed. This includes consideration of what knowledge of current systems and residents these on-call clinicians have and how they will access current and comprehensive clinical information about each resident if the need arises.

And lastly you can select an arrangement with an on-call specialist telehealth service at Section 4.4 on page 10 if you have one in place. For example this might be a telehealth arrangement with a wound specialist or palliative care specialist. The Commission considers telehealth to be one means of improving a resident’s access to timely clinical care and advice. The availability of telehealth including after hours and overnight needs to be detailed if it is to be used as an alternative to having an RN on site and on duty.

Other arrangements need to be explicitly in place when telehealth is unavailable. So most telehealth is not available as a 24 hour service. There also needs to be sufficient technology support for telehealth consultations including the skills of the on-site staff who will be accessing and operating it. This includes ensuring that residents and relevant family can participate as they would in other consultations including having access to the facility’s language interpretation service and such things as hearing aids and other supports where it’s required. So on-site staff need to have the required skills and knowledge to provide sufficient clinical information to the telehealth practitioner during the consultation. For example they might need to be able to provide them with current clinical observations and blood sugar etcetera, etcetera. I’m sure you can think of what might need to be known by somebody that you’re consulting.

There also needs to be a clear mechanism for the result of the consultation including any instructions to be communicated and recorded and responded to. Where the telehealth consultation recommends transfer to hospital or urgent review in person how this will occur needs to be explicit.

As for on-call RN and GP or nurse practitioner options the information we collect in this section includes the duration of this arrangement and contact details should we need to confirm that arrangement with the specialist or the telehealth service. Again there is also a free text field for you to provide information if you have more than one arrangement in place with a specialist telehealth service.

So moving on. As I mentioned earlier on-call clinician arrangements are just some of the common examples of alternative clinical care arrangements that may be provided to ensure the clinical needs of residents are met at all times. You may have deployed other alternative models of care that are not covered by these common types of arrangements and you can let us know about these in Section 5 on page 11 of the form which you can see here on the slide. You should describe the specific arrangements that you have in place so that the detail is clear and attach evidence of this to your application.

In order for the Commission to understand how your alternative clinical care arrangements work in practice you must attach to your application your protocols, policies and/or procedures for managing the escalation of clinical issues including end of life care in the absence of an RN who’s on site and on duty as I mentioned earlier. This may include flowcharts and guidance materials that set out your governance arrangements for planning, assessing, delivering and escalating clinical care needs.

This is important as on-site clinical staff need to have the skills of detecting when clinical care needs need to be escalated.

If you don’t have existing documents to evidence these arrangements please use the free text in Section 6, the free text field on page 12 of the form to describe how your clinical escalation protocols and on-call arrangements will work in practice. The evidence you provide or the description you give must explain when and how your escalation arrangements are utilised in the absence of an on-site RN, how on-site staff will be supported by an on-call clinician during instances where physical clinical care delivery is required such as the administration of controlled or Schedule 8 drugs, other high risk medications such as anticoagulants, insulin and other diabetic medications, and also for the administration of PRN medication or as required medication.

You must also provide evidence of how you’ve considered current clinical issues that need to be managed. That’s in your current resident cohort. So if you have residents for example with diabetes, epilepsy or changed behaviours you need consideration of where support is dependent on a single or small number of key people, what is the contingency if they’re suddenly unavailable. So if staff are told to call a particular person and that person doesn’t answer the phone what is that staff member to do then?

Moving on. In addition to providing documented evidence of your clinical escalation processes you should also provide the following information on pages 13 and 14 to enhance our understanding of your clinical governance arrangements and capabilities to deliver clinical care if you do not have an RN on site. So this includes information about whether the on-call clinicians, the RN, GP or nurse practitioner with whom you’ve established an on-call arrangement are already familiar with the circumstances and conditions of your current residents. And you will appreciate why this makes a difference. If they’re not how do you ensure that the on-call clinicians understand your service and your residents and your expectations of their responsibilities? For example what is required from them and how do you enable the handover of a care recipient’s information? How do on-call clinicians access care recipients’ clinical records remotely? Where do they record their consultation and recommendations? How will they communicate this to you if it’s not in your system? How will they involve the resident and enable their participation in the consultation?

Information about your contingency arrangements, that is the processes you would follow in the event that the nominated on-call clinician is not available, need to be considered by you and communicated to us on the form. You’ll need to include any barriers that you’ve considered when accessing ambulance, hospital or other emergency medical services such as long travel times. If clinician escalation is required and there are long travel times involved how do you manage these and what advice is being given to the staff on the floor in the interim and how?

Any service agreement established with other clinical care providers or services in the area such as local outreach, palliative care outreach, wound specialists or allied health services need to be communicated to us. As you will understand these will vary greatly from area to area and you will be familiar with what’s available in your own area. How do you access these services, when are they available to you and what do you do when they’re not available?

Include detail of the routine clinical management of current residents. For example if equipment is being used – and I’m talking about such things as spacers, CPAP machines, trachi tubes, suction, enteral feeding or tube feeding, oxygen delivery and sensor systems – include detail about what’s being used and where appropriate consider who is left to use them and what their skills are because we’ll want that information later on. Include detail of care that’s needed in current residents such as specific complex pressure care, wound care, continence care, anything that makes clinical care more complicated or more difficult in your current residents. Look at medication, include both regular and PRN. PRN or as required medication gives discretionary use to the person who’s there on the floor and this is a particular risk when that person is not a registered nurse and a person who may not have a robust understanding of the appropriateness when to use the PRN medication and what the risks involved are.

There are likely to be legal issues and capability issues in relation to medication administration and monitoring and you need to be well aware of what those are and demonstrate to us that those are being managed when an RN is not on site. You may need to include detail of restricted practice use and behaviour support so that how care is delivered by the people who are there when an RN is not there is very clear to us and hopefully also to you.

So lastly on page 15 you must attach to your application evidence of your workforce training strategies that set out how all on-site staff, on-call and agency staff are trained to manage escalation and on-call processes and workforce recruitment strategies to fill vacant RN positions. So what you have been doing and what you’re proposing to do to fill these vacant positions. And there are also free text fields in Section 7 for you to describe how your workforce training strategies are targeted to make sure that all staff regardless of whether they’re on-site, on-call or agency understand both the escalation and/or on-call processes you have in place.

You need to describe how you are going to ensure that these staff have the right skills. And that may include first aid or necessary qualifications so that they can effectively respond to residents who have deteriorated and require clinical escalation when there is no RN on site. So you might go through an exercise yourself of thinking about what if. What if this happens to this resident at a time when an RN is not on site? Will the response be sufficient? And the details of why you think that response is going to be sufficient will be the sort of information you can include in this section.

Your current and future workforce recruitment strategies to fill the vacant RN positions needs to be included and this should include any challenges you experience in attracting and retaining RN staff. This information will help us to understand whether based on your individual circumstances the steps you’ve taken even where it may not be possible to recruit and retain an on-site RN.

You may wish to include evidence of specific training of on-site staff including where relevant to individual resident needs.

So thank you. I hope I’ve described the information you would be using to satisfy yourself that the clinical care needs of your residents are being met at all times is the same sort of information that we will be requiring in order to assess the adequacy of what’s happening and to provide information to the Department.

I’ll hand back now Mark to take you through the rest of the form.

Mark Richardson:

Thanks Melanie. Look I think that was really useful so thank you for stepping everyone through those parts of the form. Look the last parts of the form should be relatively straightforward. Section 8 of the form on page 16 provides a list of some of the main workforce programs available through the Department to support providers particularly those in rural and remote areas. We’re interested to know if you have accessed any of the following programs in the last 12 months. The Rural Locum Assistance Program or Rural LAP which provides qualified aged care locums as a temporary workforce solution while you recruit and attract permanent staff and to cover staff leave and continuing professional development. The Rural LAP also provides incentives to encourage permanent aged care workforce retention in MMM 4 to 7 rural and remote areas. The Workforce Advisory Service, access to free, independent and confidential advice to assist services with workforce planning. And lastly the Business Advisory Service which is access to free, independent and confidential advice to help assist services with business management.

Now these are workforce initiatives available to support growing, skilling and enabling the aged care workforce for providers. There are also other available programs aimed at aged care workers such as the Aged Care Registered Nurse Payment, the Aged Care Nursing and Allied Health Scholarships and the Aged Care Transition to Practice Program just to name a few. You can find out more about these programs on our website by typing in ‘Working in aged care’ in the search field. Please be assured that your response to Section 8 will not impact on your eligibility for an exemption. We are collecting this information to understand to what extent these services are being accessed and to also raise awareness that these services are available to you.

Also on page 16 Section 9 contains a checklist of the types of documents that Melanie mentioned that must be provided with your application including your staffing roster with a minimum of one month’s planning, evidence of your alternative clinical care arrangements, your clinical escalation protocols and procedures and your workforce training and recruitment strategies. We strongly encourage you to do a thorough check of your application to ensure it contains all the required information before you submit it to us. This will help avoid any unnecessary delays in the processing of your application.

Again if the spaces provided on the form are insufficient you may attach a separate document with more information and clearly indicate the questions the additional information relates to.

The last section of the application form is Section 10 on page 17. This is where one of the authorised persons I outlined at the beginning of this presentation must sign the form on behalf of the approved provider that is seeking an exemption for the residential facility.

Finally we have in Part C which is pages 18 to 20 some key information about the 24/7 RN responsibility and the exemption framework including some key definitions and the eligibility criteria which I covered during the previous webinar held on the 15th of March and earlier during this presentation. Some information in Part C that I want to point out are that the granting of an exemption from the 24/7 RN responsibility to an approved provider in relation to a residential facility does not remove or otherwise alter any of the approved providers’ other obligations under the Aged Care Act 1997 and relevant subordinate legislation including the Aged Care Quality Standards, the reporting requirements in respect of the 24/7 RN responsibility that apply to all approved providers and the registered nurse component of the care minutes responsibility commencing on the 1st of October 2023.

If a decision is made to grant an exemption we are required by legislation to make publicly available the following information about the exemption. The name of the approved provider and residential facility, the period for which an exemption is in force and any other conditions that apply to the exemption. As a condition of an exemption the approved provider must also notify the care recipients in their residential facility that have an exemption in place.

That completes our presentation for today and I’m happy to open up to some questions and answers.

I think we need to go to the Slido or maybe it’s just me.

Here we go.

So we’ve got a question here. Sorry.

Q:        If we are approved for an exemption will this reduce our current AN-ACC funding or is the supplement an additional amount that those who meet the 24/7 RN requirements will receive on top of the AN-ACC funding?

So look I can answer that one. So look the supplement is on top of your AN-ACC subsidy funding. So it’s an addition to. I think it’s probably important to point out that the 24/7 supplement will be paid to facilities with up to 60 operational beds or 60 occupied beds I should say. After those 60 beds our calculations indicate that your AN-ACC subsidy is sufficient to cover a 24/7 nurse. So yes it will be on top of your AN-ACC funding.

We have another question here.

Q:        Will services across the road from each other count for collocation?

Look I think the best thing to do is to get in contact with us around those sorts of situations. There’s an email address which we’ll get to at the end of the slides and in fact you’ve probably got access to it already, where we can sort through some of those scenarios. So look I think that’s probably the best thing to do and we can gather some further information to you about I guess the nature of that arrangement in terms of whether it’s collocation.

Angus do you want to add anything there?

No? Okay. Look the next question is:

Q:        Is the exemption allocated to the provider or to the RAC? ie if the RAC has an exemption and is taken over by another provider is a new exemption application required from the new provider?

Look that’s a good question. What that would trigger – we haven’t gone through it in the presentation but there is a requirement or one of the conditions if your exemption is approved would be a change in circumstance notification. From my point of view I guess the purchasing of a facility by another provider would be a change in circumstance and I think that would require you to get in contact with us.

Angus Algie:

Mark I’m going to jump in on that one.

Mark Richardson:

Go for it Angus.

Angus Algie:

The exemption applies to the approved provider in relation to a residential facility. And while it would be certainly very good practice to give us a change of circumstance warning that there is a change happening the new provider would need to establish an exemption in relation to it. So the wording is that it applies to an approved provider in respect of the facility.

Mark Richardson:

Yep. So would require a new application effectively.

Yep. Okay. Next question.

Q:        Where an exemption is granted and the RAC finds it can later meet the requirements and remove the exemption are they able to reapply if circumstances require, eg sudden loss of nursing staff, or can they rely on the original exemption?

So yes you can reapply. So just going through that question again. Where an exemption is granted and the RAC finds it can later meet the requirements and remove the exemption are they able to reapply if circumstances require? Look the short answer is just yes, reading through that question again. You can definitely reapply.

Angus Algie:

However Mark I think the key point there is that it would need to be a new application and basically to the extent that things haven’t changed you could reuse the information. However each application – it would need to be in the form of a new application.

Mark Richardson:

Yep. Agree. Thank you Angus. And I’ve got another question here.

Q:        When do applications close?

Look we don’t have a closure date on the applications. The exemption period runs up until 1 July 2024. So look you’re able to put in I guess an application at any point noting that the responsibility starts on the 1st of July 2023, so in the next ten weeks or so. Obviously the sooner you put in your application the more likely we are to be able to process it and I guess if we think so I guess provide an exemption so that it’s in place before 1 July and the responsibility starts. But there’s no timeframe. You can apply at any point.

Another question.

Q:        How often is the exemption reviewed?

Look that’s a really good question. Melanie I might throw to you about some of the arrangements the Commission will have in place in terms of monitoring exemptions.

Dr Melanie Wroth:

So if an exemption is granted the Commission would be continuing its business as usual in terms of monitoring the risks and taking action where providers are not sufficiently well protecting their residents from harm. And that may well lead to us having additional information that may be available to us since the exemption was granted and so that may well trigger communication with the Department. But the mere fact of the exemption does not absolve a provider of responsibility to manage the risks so that would be what we are looking at both in assessing the information that is provided in the application form and assessing any information that’s provided to the Commission or received by the Commission in the course of its action subsequent to the application.

Mark Richardson:

And if you don’t mind Melanie I’ll just quickly add to some of that I guess from the Department’s point of view. Look as I think I touched on before you will be required to notify us if you do have a change in circumstance. The exemption will be for up to 12 months from 1 July 2023 to 1 July 2024. You will be required even if you have an exemption to provide the monthly 24/7 RN report. That report will be by exception in terms of when an RN is not on site and you’ll be required to provide that information for each day of every month. If an RN isn’t on site part of that I guess information that we’ll be looking for is for the reasons and also the alternative arrangements you have in place. So that information will be provided to the Commission and that will go in part I think to the ongoing monitoring of whether or not appropriate arrangements are in place consistent with the application that you’ve made.

Another question here.

Q:        Can a residential facility receive the 24/7 RN supplement if granted an exemption from the 24/7 RN responsibility?

No. So if you’re granted an exemption to the 24/7 responsibility you will not receive the supplement. I guess that was a decision of Government. So no you don’t receive the supplement if you have an exemption in place.

Angus Algie:

Mark it’s possibly worth adding to that though that – this goes back to one of the earlier questions – that a provider can opt a facility out of being exempt if it finds that it can meet 24/7. And then likewise as we noted it can reapply.

Mark Richardson:

That’s a very good point. Yeah. So if you start delivering or you can as was outlined in the presentation there is an expectation that you’ll continue to try to recruit an RN and deliver 24/7 RN care. If you do achieve that you can opt out and start to receive the supplement. So there’s that financial incentive to do so.

Look the next question.

Q:        What happens if I submit an application for an exemption by early May and a decision is not made until late July? Will my exemption be backdated?

No. Your exemption won’t be backdated. It will be effective from the date of the decision.

And if you don’t have an exemption in place then you’ll be subject to the normal I guess monitoring and compliance procedures from the Commission. Melanie, Angus, I don’t know if you want to add anything to that?

Angus Algie:

Simply to say that as you say Mark it will commence from the date of decision and the period of the exemption will be in the notice.

Dr Melanie Wroth:

And from my point of view Mark it’s the risk management and the wellbeing of the residents that the Commission will be looking at both in the interim period and after the exemption. The fact of the exemption is not the main thing we would be looking at. It’s risks and health and welfare.

Mark Richardson:

Great. Thanks Melanie. Look I think this next one is probably for you Melanie.

Q:        What is the difference between a specialist telehealth service and generalist telehealth service? For example consultation with a GP.

Dr Melanie Wroth:

So there are many different models of telehealth now that have sprung up recently. A generalist telehealth service for example with a GP is usually a consultation type service where it takes the place of an in-person consultation. So there would be a reason that the person needs to or wishes to access that practitioner. And so that is sort of quite different from a specialist service which may be part of an outreach service. It may be a particular area of expertise such as a palliative care specialist or a wound care specialist or a pain management specialist where you want to access particular expertise. It might be on the advice of a GP or it might be instead of a GP where there’s a particular need. And it would depend less on what’s available locally because telehealth obviously you can access anywhere. There are requirements around telehealth consultations though. And so that specific telehealth service where it’s a consultation may be different from a more general advice situation. So telehealth is in my view a formal arrangement where there’s a formal consultation whereas some of the other contingency arrangements can be in relation to something suddenly going wrong where you need advice urgently where you haven’t had time to set up a formal consultation.

There are some services now where you can have semi-urgent consultations with for example a GP and that would be – the telehealth goes to how the person is remunerated for it and what arrangements there are. So that would be quite a different arrangement, a telehealth service for example if you’re ringing the local hospital for advice or if somebody from the ambulance service is giving you advice while they’re on their way or if you’re ringing an RN for general advice about medication management if you are working in a service and you don’t know where things are. So how to access the drug cupboard if you’re an agency person. You might need to ring for offsite advice about that. So it’s really the circumstances of what advice you require and who’s giving that advice.

Mark Richardson:

Great. Thanks Melanie. That was really good. Thank you. Look the next question I think it’s probably a combination of myself and you too Melanie. The next question is:

Q:        We’re not eligible for an exemption but are having difficulty recruiting. Is there a process we need to follow prior to the 1 July 2023 commencement of 24/7?

Look there’s not a particular process per se but what I’d encourage you to do is to access the workforce programs that I mentioned before if you’re having difficulty recruiting, such as the Rural Locum Assistance Program that I mentioned. But there are others. So I’d encourage you to get in touch or have a look on our website, get in touch with our network if you have contacts I guess with the people on the ground. But I think this also comes Melanie I think to the Commission and how you would treat I guess facilities that aren’t delivering 24/7 and what you would expect to see from them from your point of view.

Dr Melanie Wroth:

So what we would expect to see is that very robust attempts to comply with the 24/7 nursing requirement have been undertaken. So you can imagine there’s a difference from somebody asking around or putting one ad in the local paper. That’s very different from somebody who’s really taken many different steps across many different possibilities including agencies and advertising and various other ways. So we would look at how seriously and robustly the attempts have been made and where attempts are not successful do you continue to do the same thing or do you start looking elsewhere. And we would also crucially look at along the lines we’ve been talking how you’re managing the risks of being in that situation. So if you’re in that situation despite all good attempts then we still want to know that your residents are safe and what you’re doing about that. There would still need to be alternative arrangements. If you’re a larger service then you may need to have many different alternative arrangements there to cover what happens with the complex and likely broader needs of your individual residents. So all of the things that keep your residents safe that you will be looking at we will be looking at those too.

Mark Richardson:

Great. Thanks Melanie. That was really useful. Look the next question is – and we may only have time for a couple more – but the next question is:

Q:        With an exemption will you no longer have to report on My Aged Care?

So look I think we touched on this in the presentation but the short answer once again is yes. All providers legally will be required to provide that monthly report. But look from a practical perspective just to I guess say again that information will be passed through to the Commission. So that will help with an ongoing understanding of your delivery of 24/7 and its consistency with your application. But I should also add the exemption as I mentioned before will go for up to 12 months to 1 July 2024. There may be a further exemption process. So this information will feed into I guess how that would work and I guess ongoing policy as well.

We’ve also got another piece of work around areas of workforce shortage. So understanding I guess the types of alternative arrangements and how they may relate to different areas around the country is important from our perspective too. Angus I can see you leaning in. Do you want to add anything?

Angus Algie:

Can I just actually add one thing there which is the reporting in relation to this will be through GPMS which is a new platform. We will have further communication specifically about reporting. I won’t attempt to say anything specific about it however we will have dedicated communications about how reporting will work.

Mark Richardson:

Yep. Great. Okay. Look this might be the last question unfortunately. We’ll have to answer some of the others I guess offline as we said at the start.

Q:        What will be the repercussions of non-compliance in the short, medium and long term?

Look I’ll start I guess and then I’ll throw to Melanie. But look non-compliance, I guess if you aren’t delivering 24/7, you wouldn’t receive the supplement if you have 60 beds or less. So that would be the first I guess repercussion. But I guess from a compliance point of view over to you Melanie.

Dr Melanie Wroth:

Yeah. And that would be absolutely on a case by case basis where we would look very closely at the reasons for the non-compliance, what’s been done to try to address those reasons and to return to compliance, and also as I’ve already said what the provider is doing to manage the risks through all of the 24 hour period with close looking at times where there isn’t an RN on site, what’s happening to the residents and how can we be sure that if something does go wrong that what’s in place is sufficient to manage those risks. So it would be effort and reasons and risk would be the three takeaway.

Mark Richardson:


Angus Algie:

Mark I think we should look at the very last question.

Mark Richardson:


Q:        If we have any questions related to the form after this webinar is there someone we can reach out to?

Look the short answer is yes. If we go to the last slide, so look there’s an email address there. So we would encourage you to I guess get in contact with us through that email address. We do have a team here within the Department of Health who will be able to help you with completing that form. So look most definitely. If you have further questions we really do encourage you to get in contact with us. We’re very keen to make sure that I guess the information you provide first up through that form is sufficient in order to process that application. So please do reach out.

Look the last thing I just want to say very quickly before we reach two o’clock is thank you for your time today. We really do appreciate it. Just a reminder if you could fill out that survey that would be most helpful. It will help us I guess manage things on this end so we can help you. And once again we will have the questions that you asked today and the answers to those questions, we will publish those in the coming weeks.

So look if you want some further information on where to find the form and other bits and pieces of information on the 24/7 responsibility I think there’s also a QR code that you can scan right now. Once again I would encourage you to do that. But look thank you very much for your attendance. It’s much appreciated. And we hope that was helpful. Thank you.

[Closing visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Thank you’, ‘If you have any questions after the webinar, please email them to exemptions@health.gov.au’, ‘Application form’, with image of a QR code, ‘24/7Info’, with image of a QR code, ‘24/7 Guidance’, with image of a QR code’, ‘health.gov.au/aged-care-reforms’]

[End of Transcript]


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This video provides information about how to complete the application form for an exemption from the 24/7 registered nurse responsibility, including the types of evidence required to support the application.

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