[Opening visual of slide with text saying 'Australian Government, Department of Health and Aged Care (with logo)', '24/7registered nurse responsibility exemption', 'Mark Richardson, Assistant Secretary, Residential Care Funding Reform Branch', '15 March 2023', 'health.gov.au/aged-care-reforms', with the main speaker connecting via videoconference and visible on the right-hand side of the screen]
[The visuals during this webinar are of participants connecting via videoconference and visible on screen while speaking, with reference to the content of a PowerPoint presentation being played on screen]
Mark Richardson:
Hello everyone and welcome to our webinar on the 24/7 registered nurse, or RN, responsibility and the exemptions framework for this responsibility. You have been invited to join today's targeted webinar as you may be eligible for a 24/7 RN exemption.
Please note that today's webinar is being recorded and will be available later for those who would like to watch it again or who were 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 on Ngunnawal country and I pay my respects to Elders past, present and emerging. I'd 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'm also joined today by Emma Jobson, Executive Director of the Regulatory Policy and Intelligence Branch from the Aged Care Quality and Safety Commission, 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.
In today's webinar I'd like to cover a number of topics about the 24/7 RN responsibility exemptions framework, including the eligibility criteria for an exemption from the responsibility, the difference between a residential facility and a residential care service and what this means for the 24/7 responsibility and exemption eligibility, the types of residential service models including some scenarios, the types of alternative clinical care arrangements you may have in place in the absence of an RN onsite at all times which is a key criterion that must be satisfied in order for an exemption to be granted, what supporting evidence you may need to include in your application for an exemption, the application process itself and roles of the department and the Aged Care Quality and Safety Commission, how the Commission will monitor compliance with the new responsibility, reporting requirements from 1 July 2023 and lastly the 24/7 RN supplement that will be available from 1 July 2023 to help providers without an exemption to employ more RNs.
We are keen to hear what's on your mind and you'll have an opportunity during today's session to ask questions and submit questions through the Q and A function on Webex. To do this at the bottom right-hand side of your screen select 'Q and A' and type your question and submit it to the panel. We will attempt to respond to as many questions as possible at the end of today's 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. There's a short survey at the end of today's session for you to let us know what you think.
Before I talk about the eligibility requirements and how to apply for an exemption to the 24/7 RN responsibility I want to speak about why the government is implementing this responsibility for providers to have at least one RN onsite and on duty at all times from 1 July 2023.
In its final report the Royal Commission into Aged Care Quality and Safety found that routine care of older people in residential care often did not meet expectations for assistance with activities of daily living with many examples of substandard care, and identified that staffing levels are critical to the quality of residential care.
Recommendation 86 of the Royal Commission's final report recommended that there should be a minimum staff time standard for residential care, including having at least one RN onsite per residential facility at all times.
Now I want to emphasise that the 24/7 responsibility is not the same as the care minute responsibility, that is the requirement for the sector to provide on average 200 minutes of care time delivered by RNs, enrolled nurses, personal care workers and assistants in nursing with at least 40 minutes of that staff time provided by an RN. In response to Recommendation 86 the government committed to ensuring that residents at residential facilities will have access to an RN at all times from 1 July 2023.
The policy objective for the 24/7 RN responsibility is to reduce the risk of resident harm by ensuring qualified and experienced care staff are always available to identify and address potential risks. The responsibility also gives residents better access to clinical care in residential facilities when they need it and allows RNs to manage some issues as first responders which improves residents' safety and prevents unnecessary trips to hospital emergency rooms.
The legislation underpinning the new responsibility provides for the granting of an exemption for the 24/7 RN responsibility to an approved provider in respect of a residential facility. And this is the reason why we're here today, so that we can explain what an exemption means for you and your facility and help you understand what you need to do if you want to apply for an exemption.
But first I want to go through the eligibility criteria which a residential facility must satisfy for an exemption to be granted. The three primary criteria are (1) the facility must be located in a Modified Monash or MMM 5, 6 or 7 region using the 2019 MMM classifications. Based on the MMM classifications MMM 5 is small rural towns, MMM 6 is remote communities and MMM 7 is very remote communities.
(2) The facility must have no more than 30 operational places, that is allocated places excluding provisionally allocated and offline places. And (3) that the provider has taken reasonable steps to ensure that the clinical care needs of the care recipients in the facility will be met during the period for which an exemption is in force. What this means in simple terms is that you must have in place robust alternative clinical care arrangements to ensure that the clinical needs of all your residents are met in the absence of an RN rostered onsite and on duty around the clock.
In addition before a decision is made on whether or not to grant an exemption we will take into account any sanctions or notices that the Aged Care Quality and Safety Commission has imposed on a provider in respect of the residential facility which may affect the facility's sustainability or suitability I should say for an exemption to the 24/7 RN responsibility. We will also be guided by any other information held by the Commission about an approved provider and its services that relates to the granting of an exemption. I'll talk a bit more about what this means later on in the presentation.
Next I want to explain to you the difference between a residential facility and a residential care service because this is critical to the policy intent and operation of the 24/7 RN responsibility.
Changes to the Aged Care Act, 1997, advised that the 24/7 RN responsibility applies to all approved providers of residential aged care services in respect of a residential facility.
So 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.
In simpler terms a residential facility is basically a physical location or site through which you deliver residential care to residents. It is not the same as the concept of a residential care service which is the entity through which residential care subsidy is paid to the approved provider and is linked to a residential aged care service ID or RACS ID.
This aligns with the Royal Commission's recommendation that the minimum staff time standard should require at least one RN onsite per residential facility at all times, that is at least one RN is physically present to respond to the clinical care needs of residents at the facility, and the policy objective of the measure which is to raise the quality of care being delivered in residential facilities across Australia and enable RNs to manage issues as first responders.
For around 95% of residential care services one residential care service is associated with one residential facility. However we know that a relatively small number of residential care services are located with one or more other service at a single residential facility.
A good example is where what was historically a hostel and what was historically a nursing home on a single site still occupy adjacent buildings and retain separate RACS IDs. For the purposes of the 24/7 RN responsibility we consider these to be co-located services and as such they are only required to have 24/7 RN coverage across the multiple services that make up the one residential facility.
Now it is important to note that the operational beds for the co-located services are combined for the purposes of determining eligibility for exemption. That is the combined operational places at the residential facility must be no more than 30 to be eligible for an exemption.
And for clarity we only count co-located services as a single facility where they have the same approved provider. We are also aware that there are a very small number of services that have structured their business model so that care is delivered at multiple physical locations. For the purpose of the 24/7 RN responsibility we consider these to be split services and they'll be required to have at least one RN onsite and on duty at each site associated with the one service. This is because the different locations are considered different facilities. Split services may apply for an exemption for each facility as long as they meet the criteria for an exemption. Co-located services and split services make up the remaining 5% of residential care services.
To illustrate what I described in the previous slide we have here a simple scenario where there are two services operating out of the same residential facility in a MMM 6 location. Both services, Service A and Service B, belong to the same approved provider. Service A has 12 operational places and Service B has 16 operational places, bringing the combined number of places to 28 beds at the facility. Because the services operate from the one single residential facility they are considered to be co-located for the purposes of the 24/7 RN responsibility. And as the services are located in MMM 6 with 28 combined operational beds the approved provider is eligible to apply for an exemption from the 24/7 RN responsibility in respect of this facility.
To avoid doubt, if the combined number of operational places for Service A and Service B exceeds 30 beds the residential facility will no longer be eligible for an exemption and will be required to have at least one RN onsite and on duty at all times.
This slide shows how the 24/7 RN responsibility and exemption process operates for a service with 100 operational places that are split across three different facilities across three neighbouring small regional towns in a MMM 5 region.
As you can see facility A has 30 operational places, Facility B has 25 operational places and Facility C has 45 operational places. As I explained earlier split services are required to comply with the 24/7 RN responsibility at each site because they are considered separate facilities.
In this scenario Facility C is not eligible to apply for an exemption because the number of beds at the facility exceeds the threshold of 30 operational places. This means the provider must ensure that there is at least one RN onsite and on duty at all times at Facility C from 1 July 2023. However this facility may be eligible to receive the 24/7 RN supplement which I'll cover at the end of this presentation.
Now Facility A and Facility B are eligible to apply for an exemption because they meet the eligibility criteria, that is each facility has no more than 30 operational places and are located in a MMM 5 region.
If you're a split service with up to 30 operational beds where the facilities are not strictly co-located but are closely located, for example the facilities are located across the road from each other, then I encourage you to reach out to us to discuss your situation as you may be considered co-located for the purposes of an exemption.
Our contact details will be displayed at the end of this presentation. Don't worry if you can't take down the details in time. We will email everyone a copy of the presentation following today's webinar.
The third scenario I'm going to talk about is when both residential care and overnight health care are delivered at the same campus by the same provider such as a state or territory government regional or rural health campus. I'd like to look at two cases we've been asked about.
In the first case residential care and health care are delivered in physically different buildings or distinct parts of a building by different staff. In this case it should be assumed an RN will need to be onsite and on duty at all times in the residential part for the 24/7 RN responsibility to be met. However appropriate arrangements between the residential care and health care parts of the campus to ensure that clinical care needs of residents are met may contribute towards applying for an exemption from the responsibility, assuming the residential care facility meets other exemption criteria.
In the second case both residential care and overnight health care are delivered in a common building purposely designed to deliver both services. There is common staff responding equally to residential care recipients and health care in patients as needed, much like the multipurpose services. To avoid doubt please note multipurpose services are not within scope of the 24/7 RN responsibility for now.
In this second case 24/7 RN coverage at this explicitly dual-purpose residential health care facility would likely meet the responsibility. Please note however that only residential operational places in the dual-purpose facility would count toward the exemption and supplement thresholds.
We invite anyone potentially in either of these circumstances to contact us after this presentation to discuss.
I'll now hand over to Emma from the Aged Care Quality and Safety Commission who will cover the third exemption criteria, which is that a facility must demonstrate that reasonable steps have been taken to ensure that the clinical care needs of the care recipients in a facility will be met during the period for which an exemption is in force, as well as the types of evidence you'll need to provide support in your application.
Over to you Emma.
Emma Jobson:
Thanks Mark and hello everyone. So my name is Emma Jobson, I'm the Executive Director of the Regulatory Policy and Intelligence Group in the Aged Care Quality and Safety Commission. And we also have with us here today the Chief Clinical Advisor from the Commission, Dr Melanie Wroth. And Dr Wroth will be available to assist with any further questions regarding alternative clinical care arrangements in the Q and A session at the end.
So for the exemptions process the Commission will have a role in providing advice to the department on the alternative clinical care arrangements that you have in place and whether your application demonstrates that you have taken reasonable steps to ensure your care recipients' clinical care needs will be met at all times.
So we will be looking at the alternative clinical care arrangements and processes for the times when a registered nurse is not onsite and on duty. This is to ensure that safe and quality care is delivered in line with the Quality Standards and other obligations under the Aged Care Act.
So there are some alternative clinical care arrangements shown on this slide that the Commission may consider to be reasonable steps taken by a facility for the purposes of mitigating clinical risk in the absence of an RN onsite and on duty.
So this may include some of the more common on-call arrangements such as an on-call advisor where a more qualified clinical staff member including a registered nurse, nurse practitioner, general practitioner or relevant medical officer is on call to advise and provide guidance to a less-qualified clinical staff member such as enrolled nurses who are onsite. This may include on-call arrangements using specialist telehealth services.
There are also on-call attendance arrangements where a qualified clinical staff member, for example a registered nurse, nurse practitioner and general practitioner or medical officer, is on call to attend a facility when their particular skillset is required. A variance to these could include on-call agency arrangements where an agency is contacted to provide staff at short notice or on-call ambulance arrangements where ambulances are used as a service's rapid-response escalation pathway.
Other types of arrangements or risk mitigation strategies can include co-location with or located within a short distance of health facilities as Mark was just outlining, such as local hospital or sub-acute health care facilities where clinician escalation pathways are in place to ensure that a resident is transported directly to the local hospital for further assessment and treatment.
Or workforce management strategies where facilities may schedule their registered nurse attendance around the needs of their vulnerable or high-needs residents. For example the first administration of Schedule 8 medications for one resident may be due at 5:00am with the final resident requiring a dose at 2:00pm. So this may then dictate the start and finish times of a registered nurse's shift.
There are a few key points we want to convey about how you consider your alternative care arrangements. So the first is that it's important that you understand the arrangements and strategies listed in the slide and that we may talk about today are not exhaustive. Ultimately the steps that you take should be dependent on the specific circumstances of your service and the individual care needs of your residents.
Secondly it's unlikely that a single strategy or alternative clinical care arrangement will be a sufficient substitute for onsite RN expertise. And you may need to implement a combination of strategies in order to mitigate the risk to resident care and safety that can arise when an RN is not present.
And thirdly that the clinical care needs of your consumers change. So you will need to demonstrate a thorough understanding of the clinical care needs of your consumer cohort at the service at any given time. So for example you will need to demonstrate how you will monitor these changes and how any alternative clinical care arrangements in place will be reviewed and adjusted to ensure they continue to meet the clinical care needs of your consumers.
So to support our assessment on whether reasonable steps have been taken you must include evidence, including documentation, with your application. This may include contractual arrangements with other written agreements for the alternative clinical care arrangements such as with on-call registered nurses, general practitioners, health services, agencies and other clinical care support as described in the previous slide.
It may include clinical escalation pathways to ensure clinical care needs are met in the absence of a registered nurse onsite and on duty, such as policies and procedures with defined points of accountability to ensure that they are carried out.
It may include your ability to meet residents' assessed routine, that is non-emergency clinical care needs such as the administration of Schedule 8 medication. For example this may include a summary of residents requiring clinical specialisation and strategies to manage these residents' needs in the absence of a registered nurse.
Your evidence may include policies and procedures to monitor and manage changing clinical care needs over the course of the exemption period, or workforce management strategies such as rosters demonstrating that clinical personnel with the required qualifications are onsite at the required times.
So this list is not intended to be exhaustive. So you can also provide any other evidence or documents on the alternative arrangements, either new or existing, and how they have been applied to manage the clinical care needs of your residents.
In preparing your application we encourage you to start by considering your current arrangements for when a clinical issue occurs and a registered nurse is not onsite. You can consider if there are gaps where a resident might not be safe or responded to in a timely way.
So we are keen to hear from you today, your questions around your alternative clinical care arrangements. We may be able to respond to some of those in the Q and A but we will also be providing advice as part of the department's response to your questions for this webinar.
So I'll hand back to Mark to take you through the application process.
Mark Richardson:
Thanks Emma. That was great. Thank you.
Look moving on. As Emma said we'll have a look at the application process now.
Look the first key point is applications for exemptions can be submitted from the 3rd of April. To apply for an exemption you need to use an approved form which we will email to you on Monday the 3rd of April. The form contains instructions and guidance information to help you complete your application, including the types of evidence you must provide to demonstrate that there are appropriate alternative clinical care arrangements in place.
On this slide we have a simple map of the application process.
So step 1. Once you've completed your application form you must submit it, along with your supporting documentation as per what Emma outlined, by email to the department at exemptions@health.gov.au.
Step 2. Upon receipt of your completed application we will do an initial assessment to check that your facility is located in a MMM 5, 6 or 7 area and has no more than 30 operational beds.
If your residential facility does not meet either of these two criteria it is not eligible for an exemption and you'll be notified at this point. If your residential facility meets the MMM and size criteria we will check that you have attached the necessary documentation to support the alternative clinical care arrangements you have in place. If there is not enough information at this point we'll pause the assessment and contact you for further information.
It is therefore important that you take the time to complete the form correctly and provide all the relevant information to ensure that your application can be processed in a timely manner. I encourage you to contact us early by emailing our inbox, that is exemptions@health.gov.au, if you need help completing your application. If you have provided a completed application we will forward the information you have provided to the Commission for assessment.
The role of the Commission as Emma just described earlier is to provide the department with expert advice on the appropriateness of alternative clinical care arrangements and whether it meets the criteria that reasonable steps have been taken to ensure that the clinical care needs of residents at your facility will be met during the period an exemption is in force.
Step 3. The Commission will assess the alternative clinical care arrangements you have in place and provide advice to the department, including any additional information about sanctions and notices imposed on the provider that may affect the facility's suitability for an exemption.
As mentioned earlier this advice will include any other relevant information about your organisation and services that is relevant to the granting of an exemption from the 24/7 RN responsibility.
Where there is non-compliance it will be considered in relation to a provider's ability to deploy the alternative clinical care arrangements described in their application. However it must be noted that an exemption is unlikely to be granted in cases where the non-compliance indicates immediate and severe risk to residents.
I want to assure you that if there isn't sufficient information in your application the Commission will let us know so that we can request further information from you before they provide their advice to the department.
Step 4. The advice from the Commission will be used to inform the departmental delegate's decision whether or not to grant an exemption from the 24/7 RN responsibility for your facility.
Step 5. Finally we will notify you of the outcome of your application in writing.
Hang on, I'll just move on and turn on my light.
So look if an exemption is granted it will be effective from 1 July 2023 or the date of the notice of decision, whichever is later. If an exemption is not granted you will have the right to request a review of the delegate's decision or reapply for an exemption. Details on how to request a review will be provided in the decision letter.
We encourage you to put in your application as early as possible to allow us sufficient time to consider the information and, if the eligibility criteria are met, ensure that an exemption for your facility is in place by 1 July.
This slide will focus on the Commission's and the department's role in relation to compliance and monitoring following the exemption process, as well as your obligations as an approved provider. I'll now hand back to Emma to take you through the Commission's role.
Emma Jobson:
Thanks Mark. So in general the Commission's role as the aged care regulator is to assess risk to residents, monitor provider performance and respond to any non-compliance with responsibilities under the Aged Care Act. The provider responsibilities with regard to the 24/7 RNs enhance the Commission's existing monitoring of issues related to workforce, including through the assessment and audit against the Quality Standards.
There are specific requirements under the Quality Standards that are applicable to the delivery of safe and effective clinical care and services, workforce planning and competency, and governance systems including clinical governance frameworks. This means that the Commission's quality assessors will be particularly interested in a provider's performance with regard to Quality Standards 2, 3, 7 and 8.
From 1 October 2023 you will also need to meet your mandatory care minute requirements. So the Commission's focus will always be to understand compliance with workforce related responsibilities through the lens of risk to consumers and any negative impact on the delivery of quality and safe care.
The Commission understands that some services operate in areas of workforce shortage which affects their ability to recruit RNs and other care staff. So when engaging with a provider about their compliance with the 24/7 RN responsibility the Commission will have regard to the circumstances of your service and any factors that might affect your ability to meet the 24/7 RN responsibility. This will include consideration of the efforts that you are making to recruit and retain the required staff and the steps you are taking to ensure the clinical care needs and expectations of your residents are met.
Where there are concerns about this the Commission will respond in a way that is proportionate to the issues identified, including the risk posed to residents and the nature of your response. Where there are gaps in your response and unmanaged risks to your residents the Commission may take compliance and enforcement action such as issuing non-compliance notices or, in the case of severe and immediate risk, imposing sanctions.
Now where an exemption is granted you will not be in breach of the 24/7 registered nurse responsibility if you do not have an RN onsite and on duty at your facility and you will not be subject to compliance and enforcement actions and sanctions associated with breaching that responsibility. However you may be subject to monitoring by the Commission to ensure that the alternative clinical care arrangements which informed the exemption are in place and effective. You may also be monitored with regard to your existing responsibilities under the Act and Quality Standards as part of the Commission's usual regulatory functions.
The Commission will share information with the department as Mark said that may affect your facility's eligibility to maintain an exemption, including any changes to your alternative clinical care arrangements or other compliance actions.
I'll hand back to Mark.
Mark Richardson:
Thanks Emma.
Look to go into the department's role. Look we're here to monitor all providers against their obligation to submit a monthly report, which I'll cover in the next slide, in respect of each facility where residential care was provided, this includes facilities that have an exemption in place, and provide this information to the Commission to support their regulatory activities relating to the 24/7 registered nurse responsibility. In addition we will undertake an audit program to check that what has been reported to the department reflects the actual level of registered nurse coverage at the facility.
Now I want to mention it is a condition of an exemption that you must notify the department in writing of any material changes to the information given to the Secretary in the Department of Health and Aged Care in the application for the exemption, including any additional information the Secretary has requested. For example this includes circumstances where the number of operational places increases to more than 30 or there has been a change to the alternative clinical care arrangements you have in place.
You can let us know of any material changes through a Change of Circumstance Form which will be available later and before 1 July 2023.
Where the change of circumstance relates to the alternative clinical care arrangements that are in place you must provide documentation to support the change arrangements. Depending on the nature of the change you have notified us about we may seek advice from the Commission, like the process for the initial exemption application, on whether the changes will have any material impact on your facility's ability to maintain an exemption.
Please note being exempt from the 24/7 registered nurse responsibility does not mean you are exempt from the registered nurse component of the care minutes responsibility. This is a separate government measure to increase care time and access to clinical care for residents.
Now let's take a look at the reporting requirements associated with the 24/7 RN responsibility. As I touched on before all providers will be required to submit a monthly report in respect of each residential facility where residential care was provided regardless of whether or not an exemption is in place. Providers will need to report the information you can see on this slide through the My Aged Care Service and Support Portal.
Reporting is by exemption, where you only need to report every period of 30 minutes or more that a registered nurse was not onsite and/or not on duty at each residential facility for each day in the month, the reason an RN was not onsite and/or on duty for each period and the alternate arrangements that were made to ensure clinical care needs were met while an RN was not onsite and/or on duty or that alternative arrangements were not made for each period.
You have the option to submit this information on a daily basis or submit all the information at the same time at the end of the month. The reporting function has been set up in a way that allows you to submit data as frequently as you wish.
The information you submit will also be used to support the Commission's regulatory activities relating to the 24/7 RN responsibility as I mentioned earlier but more importantly to support policy development to better target exemptions in the future. We will provide you with more information, including updates of the My Aged Care Service and Support Portal guidance material, well before the reporting requirements start.
I'd now like to provide some information about the 24/7 RN supplement. I've talked at length about how residential facilities may be granted exemptions if they meet the eligibility criteria. However you do not need to apply for an exemption if you expect to be able to meet the 24/7 RN responsibility from 1 July, and instead opt to receive the 24/7 RN supplement if your facility meets the eligibility threshold for payment.
The government has allocated $473.4 million for the 24/7 RN supplement to help residential facilities that meet the requisite criteria to employ extra RNs to meet the 24/7 RN responsibility. This supplement is paid automatically to eligible services with up to 60 residents per day on average over the month. That is the supplement will be based on occupied bed days, not operational bed days.
As you can see on the table on this slide there are two supplement rates, one for services located in MMM 1 to 4 regions and the other services located in MMM 5 to 7 regions, that is rural, remote and very remote locations to account for the additional costs that come with working in these areas.
The maximum supplement amount is $21,416.67 per month for a MMM 1 to 4 facility with up to five residents and $61,083.33 per month for a MMM 5 to 7 facility with up to five residents. The maximum supplement payable decreases on a sliding scale as the numbers of residents at the facility increases. As mentioned the supplement cuts off for services with more than 60 residents per day on average over the month.
For clarity, if your facility is exempt from the 24/7 RN responsibility you are not eligible for the supplement. However, this is in response to one of the pre-submitted questions we received prior to the webinar, you can opt out at any time during the exemption period if you're able to meet the 24/7 RN responsibility and receive the supplement instead.
Residential facilities with more than 60 residents will not receive a supplement as they are fully funded through the Australian National Aged Care, or ANAC, basic subsidy to deliver 24/7 RN care to its residents. And the supplement does not apply to flexible care services that are multipurpose services which are also not subject to the 24/7 RN responsibility.
To end today's presentation I'll briefly talk about what we are doing to inform the exemptions policy from 1 July 2024 which I'm sure many of you are keen to understand.
Government is introducing the exemption framework in two stages, the first stage being an exemption period of up to 12 months from 1 July 2023.
The settings for the exemption policy from 1 July 2024 is yet to be determined and will be informed by further analysis of the changing workforce conditions. This includes looking at whether a different exemption period would be appropriate. We have engaged an independent organisation to undertake research on behalf of the department to identify and develop evidence-based alternative arrangements for facilities that are unable to meet the 24/7 RN responsibility due to workforce shortages, and provide advice on whether exemptions to the care minutes skill mix requirements are appropriate.
This work will involve consultation with relevant clinical experts and the aged care sector to inform policy decision making on when and how to provide clinically-appropriate care alternatives based on current workforce constraints. We expect to have a final report on the findings of this research by the end of this year.
We are also looking to use the 24/7 RN reporting data and other available data to develop a model of aged care registered nurse workforce shortages. This model may support the development of future exemption arrangements based on identified workforce shortages in pacific regions. A scoping study is currently underway to identify modelling options and assess the feasibility of developing this model.
These two pieces of work will help refine the exemptions policy with effect from 1 July 2024.
So that completes our presentation today. And I'll now open up for any questions and answers.
We've got one question or we've got a number of questions coming through. The first I'll answer. The question is:
Q: With an exemption will the ANAC subsidy still be paid?
So the simple answer is yes. All approved providers that receive an exemption will continue to receive their ANAC payments. However an approved provider exempt from the 24/7 RN responsibility will not be eligible to receive the 24/7 RN supplement. I think I went through that earlier. Look I think that pretty much covers off on that.
Okay. I'll jump to another one here. Look there's a question here.
Q: Is there a deadline for exemption applications?
Look once again I'll answer that.
No. There's no deadline. So facilities could apply post 1 July. It just means the exemption period will be shorter if the exemption itself is granted.
We have another question here.
Q: Is the department considering how to assist rural people to get recertified if they are no longer registered?
I'm not exactly sure what this means to be honest with you. So look I'll pass on that and possibly we can answer that offline at another point.
I'm just having problems with my IT. Sorry.
Now any other questions?
Yeah. Look there's one here. Look the question is:
Q: Will there be any unintended consequences for star ratings for those that have an exemption granted?
Look that's a good question. Look once again the short answer is we're considering how we will report the 24/7 RN responsibility through the star rating system. How that will work hasn't been determined yet but look once we figure out that detail we'll come back to the sector.
I think another important point in relation to that is that as you're all aware star ratings is a retrospective provision of information. So it's likely that it won't be until December this year where we're reporting on I guess the September-quarter worth of 24/7 information depending upon how things work out. So there's a little bit of time to figure out those details.
Look we have another question here. And Melanie this one might be for you or potentially for Emma. The question is:
Q: Will virtual consultations or reviews out of hours be acceptable using telehealth or IT technology?
Dr Melanie Wroth:
I can start with that. It certainly is an acceptable model of care in certain circumstances. So it would obviously depend on circumstances of the individual resident and what that telehealth comprised of and what was subsequently going to happen. If the person needed for example to be transferred as a result of that consultation or if there was clinical care being directed as a result of that consultation, would those things be implementable.
There'd be many other things that would be taken into account. But the technology available and the support available for a resident to participate in that process etcetera would all need to be taken into account and that would be different in every service.
Mark Richardson:
Thanks Melanie. Look we do have another question now.
So I'll just read it out again and I'm happy to answer it. Not to hog all the questions.
Q: Will the 24/7 RN requirement be informing the star ...
Actually we just did that one.
Sorry. Jumping around a little bit.
Q: Can you confirm the reporting obligations? Is this on a daily basis or monthly basis which is reporting on a daily basis? Won't this be very time consuming when you have an exemption in place explaining why you can't get RNs?
So look the requirement will be that you provide a monthly report that's within seven days of the end of each month. But as I think I went through in the slide you will have an option of completing on a daily basis that report or you might do it every week for that month. It's really up to you. We've provided that option so that I guess it'll depend upon how you're managing I guess your time and your facility. We imagine for some facilities it might be more convenient to do this on a monthly basis, others might like to jump on and do it on a daily basis.
Why do we want to collect I guess information on alternative arrangements? Look that's important for us and it's also important for the Commission. I think Emma went through I guess the fact that having visibility of those arrangements, even if you have an exemption in place, will be important post 1 July. So knowing that I guess you're putting those things in place will be important.
Emma I don't know if you want to add to that.
Emma Jobson:
No. I'll just say Mark that's essentially the important information, particularly I guess monitoring exemption arrangements. It is actually a form of monitoring. You're providing advice to the department which will be shared with the Commission. So the better quality that advice is I think the less likely we might need to seek more information. So that's our approach to that initially as well.
Dr Melanie Wroth:
Can I add to that Emma?
That the detail of those alternative arrangements and how they would be operationalised in your particular service are really important as well. So in the previous example with the telehealth, if telehealth isn't available all through the weekend, all hours of the day and night, what then is the contingency for that and how quickly can it be set up? And if that does fall through, if let's just say you can't get through to telehealth, what are you then going to do? And does that person on the ground know what you expect them to do at all times, looking at such things as if they are new to the service or an agency staff?
You know there's often a big gulf between a policy and people on the floor being able to actually operationalise that and making sure that it is practicable. So even if it's just someone on call, what happens if that person doesn't answer the phone? Who's the person who triggers the escalation on the floor? Does everyone know who that actually is? Do they know what should trigger what?
And a registered nurse responding to something urgent is one aspect of it but a registered nurse overseeing safe clinical care is another. And so both of those things you would need to take into account and just going through a 'what if'. What if this arrangement that I put in place doesn't work for whatever reason or doesn't work at all times of the 24-hour period in the whole week and then what would that person do in that situation?
And also considering your individual cohort of residents. If you've got residents with particular needs do the alternative arrangements take that into account if you've got someone with a trachea, if you've got someone with palliative needs or if you've got someone with diabetes that's unstable or you've got someone with epilepsy? So all of those things need to be taken into account which is why the case-by-case basis of this is going to be so important.
Mark Richardson:
Thanks Melanie. And also thank you Emma.
Look the next question is once again I think one for myself to answer.
Q: How long is the exemption application process expected to take between application submission and response from the Department of Health and Aged Care?
Look that's a very good question. Look it will depend upon I think a number of different factors so effectively it's hard to say. There's potentially a large amount of documentation that the Commission will need to go through and other things that need to be taken into consideration. We'll do our very best to try to process as many exemptions as we can. The aim will be before 1 July but I can't give you an exact date I guess on when all these applications will be processed.
The next question.
Q: How will the provider be deemed eligible to receive the additional supplement if they meet the criteria being 60 beds or less and MMM 5 to 7 etcetera and haven't sought an exemption from meeting the 24/7 requirements?
Look once again I'll answer that one.
Look I guess when it comes to the supplement we have information in our system and that will be paid automatically through Services Australia. So we're clearly aware of the number of beds that you have, your occupied beds and so forth. Payments are being made through ANAC on that basis. And once again we're obviously aware of whether or not you're in a MMM - what MMM category you're in so we get those payments right. Once again we need to understand that for ANAC and the base care tariffs. So look that will happen without application. That'll be something that we manage through our ICT systems.
Okay. Next question.
Q: Is the exemption for facilities granted the exemption to be working towards gaining 24/7 RN coverage?
Q: Also if we were to reach RN 24/7 coverage but have gaps from time to time due to unexpected leave for example, would we still receive the RN supplement? Is there any wriggle room at all?
I'll answer that second question first and might jump backwards and re-read the first question.
So look in terms of the supplement, that is the financial payment so separate from quality and so forth, we are considering whether or not some sort of tolerance would be applied. The financial support for the delivery of 24/7 and enabling the sector to do that from a financial perspective is different from quality, and tolerance we think may be a good idea on that basis.
If you were to just miss out one shift for example in the month we think we would probably still want to fund the facility for the payment of that registered nurse. So look the expectation would be there would be some tolerance for the payment of the supplement.
But just going back to the first question.
Q: Is the expectation for facilities granted the exemption to be working towards gaining 24/7 RN coverage?
Okay. Look you have an exemption for 12 months. But yes I mean in short we would expect you to be working towards gaining 24/7 and continuing to try to recruit an RN, dare I say accessing our workforce programs, doing a range of other things, noting that the exemption is for only 12 months. As we went through before we're going through a number of consultancies. There may be another exemption period from 1 July 2024 but the expectation would be that you're trying to get to a point through that exemption period where you have an RN onsite 24/7.
Okay. Another question.
Q: If reporting is required for every 30-minute period where an RN is not on duty and onsite, will reporting be required for every lunchbreak - and I'm just jumping around a bit here, I just lost my place - where an RN is not on duty?
So look to go to the point I think, if an RN's on a lunchbreak but they're available, they're onsite and they're in the tearoom and they're available to help a resident, then they can be recorded as 24/7. So you wouldn't say there's an alternative arrangement in place or not report an RN being onsite in that circumstance.
So I think that probably goes to the heart of what that question was after. If not once again we'll try to provide answers to all of these things after this webinar and we'll be collecting the questions.
I think - no. Here we go. I've just got another one coming through I think.
No. I think that's it.
So look we're pretty close to time anyway. So look we might wrap it up there. I think we got through a large majority of those questions. As I said at the start if we haven't answered a question that you sent through we will endeavour to do that after this webinar and email I guess today's webinar and also some questions to you at a later date.
But look I should also add that it's important that you visit links that we have on our website. We often talk about this but there's a lot of information available through our website on 24/7 and also care minutes. There's a guide for all of that. So please go and have a read of that so that you can get yourself across some of the detail.
The last thing I'd like to say is thank you for attending today. We really appreciate your interest and engagement, the questions that were sent through.
And I should also note that we are looking to have another webinar in the middle of April after we've sent out those application forms on the 3rd of April to help step you through the completion of that form.
So you'll have a couple of weeks. You have a heads-up right now around the documentation and some of the evidence that may be required. As I said we will send that form through to you on the 3rd of April, you'll have a week or two to digest what you need to do and we'll have another webinar on the 15th to try to answer or help you complete that form.
But look once again thank you for your attendance today. That's it.
[Closing visual of slide with text saying 'Australian Government, Department of Health and Aged Care (with logo)', 'Thank you', 'If you have any questions after the webinar, please email them to exemptions@health.gov.au', 'Webpage: https://www.health.gov.au/our-work/care-minutes-registered-nurses-aged-care', 'Guidance: https://www.health.gov.au/resources/publications/care-minutes-and-247-registered-nurse-requirements-guide', 'health.gov.au/aged-care-reforms', with the main speaker connecting via videoconference and visible on the right-hand side of the screen]
[End of Transcript]
This video provides information about the exemption process for the 24/7 registered nurse responsibility, including the criteria for an exemption, the role of the Aged Care Quality and Safety Commission and reporting requirements.