Mandatory care minutes

Tuesday, 5 September 2023

Presented by:

moderator:

Mark Richardson

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

Speakers:
 

Peter Edwards
Executive Director, Compliance Management Group, Aged Care Quality and Safety Commission

Stephanie Kaiser
Acting Assistant Secretary, Workforce Branch, Department of Health and Aged Care

[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 latest residential aged care funding reform webinar. As with previous webinars today’s event is being recorded and will be available later for those who would like to watch it again or who are not able to attend. The slides are also available on the Department’s website and you can access these by scanning the QR code on this slide. We will also use QR codes throughout today’s presentation so please have your mobile phones ready.

Before I go any further I would like to acknowledge the traditional owners and custodians of the lands on which we are meeting today. I am in Canberra on the lands of the Ngunnawal and Ngambri people. I’d like to pay my respect to their Elders past, present and emerging. I would like to also extend that acknowledgment and respect to any Aboriginal and Torres Strait Islander people who are here with us today.

My name is Mark Richardson. I am the Assistant Secretary of the Residential Aged Care Funding Reform Branch at the Department of Health and Aged Care. Joining me today is Peter Edwards, Executive Director of the Compliance Management Group at the Aged Care Quality and Safety Commission and Stephanie Kaiser, Acting Assistant Secretary of the Workforce Branch in the Department.

[Visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Mandatory care minutes’, ‘Mark Richardson’, ‘Assistant Secretary’, ‘Residential Care Funding Reform Branch’, ‘Department of Health and Aged Care’, ‘Steph Kaiser’, ‘A/g Assistant Secretary’, ‘Workforce Branch’, ‘Department of Health and Aged Care’, ‘Peter Edwards’, ‘Executive Director’, ‘Compliance Management Group’, ‘Aged Care Quality and Safety Commission’, ‘Department of Health and Aged Care – Tuesday 5 September 2023’, ‘health.gov.au/aged-care-reforms’, with image of QR code]

We will respond to as many questions as possible during the question and answer session at the end of the presentations. You can lodge questions in the Slido box on the right hand side of your screen and also vote on questions you would like us to answer. If you can’t see Slido you can also access it via a link in the chat on the bottom right of your screen. If we don’t have time to get to your question today we’ll answer the most common questions in a Q&A document published on our website and all questions will be used to inform updates to our care minutes resources.

There will be live polls throughout this webinar which you can also access through the Slido box or through links in the chat.

We really appreciate your feedback so we can improve future webinars for you. So please take the time and let us know what you think of today’s webinar through completing the short survey provided at the end of today’s session.

Before I go on we know many providers are familiar with the mandatory care minutes responsibility and they’re already delivering their service level care minute targets. Please stick with us. We’ll keep the presentations brief and allow more time than usual for questions and answers.

And one more thing. I just want to take the opportunity to remind providers that your 24/7 registered nurse monthly report is due by the 7th of September or Thursday this week.

In this webinar I will cover a range of topics including a brief review of care minutes, changes in care minutes allocations from 1 October and the new process for calculating your care minute targets, the sector’s progress on delivering care minutes, a new care minute and 24/7 registered nurse quality assurance program called the Care Time Reporting Assessments, and changes we are considering for the staffing star rating. I’ll then hand over to Peter Edwards for an update on the enforcement policy for care minutes. Finally we’ll review some of the steps providers can take to prepare for the mandatory care minutes and the workforce opportunities we have available to help you recruit and retain staff will be covered briefly by Stephanie Kaiser before moving to questions and answers.

I’ll begin by quickly recapping why the Government is implementing mandatory care minutes. In 2021 the Royal Commission into Aged Care Quality and Safety highlighted the importance of staffing levels to the quality of residential aged care. The Royal Commission recommended a minimal care time responsibility for the sector based on the resident case mix of each service. Government is implementing this through the mandatory care minutes policy with the goal of making sure each service has the staff they need to provide safe and quality care to all residents and making staff time transparent and accountable.

If you’re new to the sector or to check your understanding you may be wondering what the care minutes policy means for providers. Briefly care minutes refers to the direct care time that people living in Government funded residential aged care receive from registered nurses, enrolled nurses, personal care workers and assistants in nursing. Personal care workers and assistants in nursing are considered the same category of care worker for the purpose of care minutes. Only these three specified categories of care worker can deliver care minutes. Other care delivered by staff such as allied health and lifestyle workers is still very important and funded under AN-ACC but are not counted as part of care minutes.

Every service receives its own quarterly care minute targets based on the resident case mix in a prior three month period. This includes an overall target that can be delivered by any of the specified categories of care worker and a sub-target that must be delivered by a registered nurse.

It’s important to remember that care minute targets are a minimum standard. If you meet your care minute targets, that is both your overall care minutes and your registered nurse care minutes, you can expect an average three star staff star rating. To get a four or five star staff rating providers need to provide care above and beyond their mandatory care minute targets.

Funding for care minutes commenced on the 1st of October 2022 with the introduction of AN‑ACC. As most of you would be aware the funding preceded the introduction of the targets to provide support to help boost your staffing levels so that you could deliver your targets when they become mandatory from the 1st of October 2023.

The legislative basis for mandatory care minutes will be specified in the quality and care principles using the Aged Care Act’s existing power in paragraph 54-1(h) of the Aged Care Act. We expect the amendments to the subordinate legislation to commence by the 14th of September 2023.

I’d like to take a moment to emphasise that enrolled nurses are a critical part of care minutes. They are funded under AN-ACC and Government expects providers to continue to utilise them in their care delivery models. Separate to the care minute requirements residential aged care services are required to ensure that their workforce is sufficient and is skilled and qualified to provide safe, respectful and quality aged care consistent with the needs of their residents and Aged Care Quality Standard 7.

Providers reducing their enrolled nurse workforce are at risk of not meeting this quality standard.

The skills mix within residential aged care services including having an appropriately qualified nursing workforce will be monitored by the Aged Care Quality and Safety Commission as part of their regulatory functions.

From October this year the amount of enrolled nurse minutes each service delivers will be published alongside the staffing star ratings on the My Aged Care website. It’s important to understand this doesn’t mean Government is introducing targets for enrolled nurse care minutes. Government is doing this to ensure there is visibility and transparency over the use of enrolled nurses and the amount of care time provided by these workers within the overall care minutes component of this responsibility.

In addition the National Aged Care Mandatory Quality Indicator Program requires that providers report on critical areas of care impacting the health and wellbeing of older people. The QI Program was expanded earlier this year in April to include a suite of new quality indicators. A workforce quality indicator reporting the percentage of staff turnover including enrolled nursing is included in recognition of the importance of staffing and continuity of the provision of high quality care. The QI Program data is available on the Australian Institute of Health and Welfare GEN My Aged Care website at the national, state and territory level.

Again I’d like to remind providers that allied health and lifestyle services are not included in care minutes. For allied health the Royal Commission recommended a level of care appropriate to each resident’s needs. Generally services will employ an allied health professional to treat a specific condition of a resident while nurses and other care minute workers service the ongoing needs of all residents. This means allied health is an individual level responsibility for the provider whereas care minutes are a service level responsibility. Once again allied health is funded under AN-ACC and required under legislation for all residents who need it. Under the Aged Care Act providers of residential aged care are required to provide allied health services where these services are needed to maintain a resident’s level of independence in activities of daily living. Additionally providers are also responsible for delivering intensive, short term therapy for a resident to reach a level of independence at which stage maintenance therapy will meet their needs.

Government is also expanding the Quality Indicator Program to include additional staffing quality indicators with a particular focus on allied health professionals.

Lastly I’d just like to reiterate that lifestyle services are funded under AN-ACC and required under legislation but are not within the scope of care minutes.

We are keen to learn about the changes providers have made to prepare for care minutes. Please take a moment to respond to our open poll in the Slido box on the right hand side of your screen. We will share some of the answers here in the webinar.

[Visual of slide with text saying ‘Slido open poll’, ‘What changes have you made to prepare for care minutes?’, ‘health.gov.au/aged-care-reforms’, ‘Department of Health and Aged Care’, ‘5 September 2023’]

As was announced in this year’s Budget there will be changes to care minute allocations associated with each AN-ACC class to better align care minutes with funding. These new allocations will be used to calculate the care minute targets that will apply from 1 October 2023.

The first table on this slide shows the new care minute allocations for each of the AN-ACC classes compared to what they are now. You can see there are reductions for the minutes associated with AN-ACC classes 2 to 7 for residents with lower care needs and increases to the minutes associated with AN-ACC class 1 for palliative care residents and AN-ACC classes 9 to 13 for those with higher care needs.

The second table shows the changes that will apply to the three respite classes with decreases in the care minutes allocations for the lower care needs classes. That is class 101 and class 102 and an increase to class 103 to reflect the higher care needs of residents assigned to this class. For all services funding will better align with the true costs of staffing to deliver care minutes when they are mandatory so that you are funded to provide residents the care they need.

This change response to analysis of actual AN-ACC classification data and newly available QFR wage data which showed care funding to care minute targets and the costs associated with delivering care minutes were not consistent across the AN-ACC classes.

We’re ensuring correct alignment between resident classes, funding and care minutes removing any incentive for providers that select residents classified at a certain level of care to maximise funding.

 

For most services these changes will average out across residents in a service and there will be very small changes if any to service level care minute targets.

If you haven’t already we encourage you to use the AN-ACC funding and care minutes estimator to estimate your targets now for the 1st of October 2023. You can bring up the estimator with a QR code that will be displayed on a slide at the end of this presentation.

I’d like to emphasise that the refinements the Government is making are entirely in line with the flexible design of the AN-ACC funding model. We expect that the care minute allocations associated with each AN-ACC class will continue to be refined to ensure funding is aligned with care minutes and that residents receive the right level of care. Moving forward we expect changes will be based on the latest Independent Health and Aged Care Pricing Authority or IHACPA costing study on the relative care time and cost between different resident types or AN‑ACC classes. IHACPA’s current residential aged care costing study is expected to be completed during the first half of 2023 and will form the 1 July 2024 price.

We are also changing the timeframe used to calculate care minute targets so that you have them before the start of a quarter. Some of you may have already seen this diagram but we think it is important to go over how the targets for the October to December quarter will be calculated. As you can see here they will be derived from your resident case mix of June to August with targets provided on the 15th of September. As a provider it’s important to be aware that residents who do not have a classification by the end of the calculation period will not be included in the calculation of targets. Likewise changes to the resident case mix after the calculation period will not impact targets for the delivery period. This is so fluctuations in your resident case mix do not impact your ability to plan for and deliver care minutes. That said your service level targets apply to every resident in care. This does not mean that you have to give your quarterly care minute targets to every resident. The amount of care each resident receives should be based on their individual care needs with the service level care minute targets delivered on average across all residents over the quarter.

As care minutes become mandatory the Department is required by law to publish service level care minute targets as soon as practical after they are calculated. This makes targets visible for residents, family members, workers and other interested individuals and organisations. The Department plans to fulfil this requirement by publishing targets for every service on our website with new targets added each quarter.

The first targets will be published in the week of the 18th of September 2023. We also plan to add data on care minutes delivered to the website as it becomes available. Taking into account the timeframe from the Quarterly Financial Report and validation of the reports this means the care minutes delivered will be added about four months after the publication of a quarter’s targets.

From about March/April 2024 the Government is also considering publishing a dashboard on sector level care minutes performance, for example the percentage of services that are delivering care minutes nationally or a breakdown of care minutes performances across service locations or by states and territories.

We covered the changes to care minute allocations and calculation of targets in detail in the May residential aged care Budget webinar. So please check that webinar if you need more information. You can bring up the webinar recording, slides, transcript and post-webinar Q&A document with the QR code displayed on this slide.

I’d now like to pass on some good news. As you can see on this slide since 2021 we have seen an upward trend in the average care minutes delivered per operational bed day as the sector brings on more staff to meet care minute targets. We are also seeing an increase in registered nurse minutes. However we have seen a small drop in care time provided by enrolled nurses which we’ll be watching closely as enrolled nurses as I mentioned before are a valuable component of quality aged care.

With the 24/7 RN responsibility now in place and care minutes about to become mandatory it is important to ensure that reporting is accurate. This month we will start our rollout of the new Care Time Reporting Assessments Program. Care Time Reporting Assessments will examine the accuracy of the care minutes and 24/7 registered nurse information included in the Quarterly Financial Report and the 24/7 registered nurse reporting. These targeted and random assessments will examine documentation held by a service that confirms the accuracy of their reports. We will support providers with educational information if a reporting error is made in good faith and if needed we’ll update the published reported care minutes and star ratings for a service.

Where misreporting is deliberate you should expect proportionate compliance action which may include referral to the Commission. Debt recovery will also be undertaken where appropriate for example overpayment of the 24/7 registered nurse supplement in cases where a service did not meet the specified staffing threshold.

So to go into a little bit more detail about this as a starting point this year we engaged Ernst & Young to draft a methodology for the assessments. We are now preparing to conduct our initial assessments and will refine the methodology over time with assessments starting in New South Wales, Victoria and the ACT this month. We plan to have assessments in all states and territories starting before the end of the year.

Assessments will be flexible to account for the variety of residential aged care models. They will also ensure procedural fairness so that all services have a reasonable opportunity to be heard before decisions.

Our goal is for every provider to have an assessment within 18 months of the 1st of October this year to make sure that the sector has a chance to refine record keeping and reporting practices early in the care minutes responsibility. After that we plan for each service to have an assessment every three years minimum with extra random and risk-based assessments.

So the Department is exploring making the delivery of care minute targets an essential condition for a three star staffing star rating. This would align the label an acceptable level of care with the mandatory requirements. Currently services that have not achieved their care minute targets can still receive a three or four star rating in recognition of targets not yet being mandatory and that services have been building towards the responsibility. This change would ensure that only providers that meet their care minute targets which represents appropriate care can get a staff rating of three stars or higher.

So we’re interested in hearing from you about what you need to deliver mandatory care minutes. I’d encourage you to take a moment to enter key words in the word cloud poll in the Slido box on the right hand side of your screen. The word cloud will show the most common words entered by webinar attendees.

I’ll now hand over to Peter Edwards, Executive Director of the Compliance Management Group at the Aged Care Quality and Safety Commission to talk more about the Commission’s enforcement approach on care minutes.

Peter Edwards:

[Visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Aged Care Quality and Safety Commission’, ‘Engage’, ‘Empower’, ‘Safeguard’, ‘Care Minutes’, ‘The Commission’s role and approach’, ‘5 September 2023’, ‘1800 951 822’, ‘agedcarequality.gov.au’]

Look thanks very much Mark and hello everybody. It’s really great to be with you all. I talk to a lot of providers in my role and I know that care minutes and RN 24/7 coverage is a topic that providers have a lot of interest in. And so it’s good to have an opportunity to spend a few moments talking about our compliance approach.

I’ll start by saying that it’s important to recognise what the Commissions’ role is as the regulator and that’s essentially to ensure that consumers of aged care services can trust the services they receive are safe, high quality and delivered in a way that meets their needs. One of the ways the Commission fulfils its role is by using the information and intelligence it receives to identify and respond to areas of non-compliance with aged care obligations that actually have the potential to expose consumers to risk.

Individual care delivered by an appropriate mix of staff is an obvious way providers can work to support consistent delivery of safe, high quality care. It’s for that reason the Commission maintains an interest in how providers are tracking in relation to their compliance with care minute obligations.

Although we maintain an interest in how a provider is tracking in respect to their care minute targets it’s very important to understand that a failure to meet them will not be viewed in isolation. Rather we will consider that information as a source of intelligence that helps us to build a picture of service and provider level risk.

Although there is an expectation that providers will actively work to comply with their care minute obligations our regulatory response will be titrated to the level of risk any failure contributes to potential adverse impacts on consumers. A provider that is non-compliant with a specific responsibility but can evidence their ongoing effort to comply while demonstrating they’re able to provide safe, quality care to consumers is unlikely to be subject to formal regulatory action.

That said we obviously do want to see providers have a plan to manage the root cause of not meeting their care minute obligations that will enable them to eventually meet the required targets. The Commission recognises that each provider’s plan will differ depending on their unique circumstances.

The Commission will actively monitor risks for consumers with regard to how approved providers are responding to their care minute responsibilities. Monitoring action may require direct engagement with a provider to help us understand the level of risk and the causes of it. Such monitoring may take the form of performance assessment contacts which can focus on the root cause of the care minute requirements not being met, for example Standards 7 and 8, and the potential impact of reduced care minutes, for example Standards 2 and 3.

When it comes to monitoring the Commission may focus on the capability of onsite staff to suitably manage the specific needs of current consumers. Capability is informed by a number of considerations, for example staff knowledge and experience, their familiarity of the site, the training and support provided to them, embedded sound policies and procedures and the availability of technological and external support such as telehealth. Care minute data may also inform the Commission’s assessment of risk about the effectiveness of a provider’s workforce strategy and governance. If care minutes are not being met further investigation may be needed to determine the underlying cause for this if we are seeing risk.

Where a provider is not meeting their care minute obligations and are placing consumers at risk of harm or are being wilfully non-compliant proportionate compliance or enforcement action will be taken by the Commission to reduce the risk faced by residents caused by the non‑compliance.

Where there is significant and repeated non-compliance and a provider’s response is found to be insufficient and/or there are severe and immediate risks to consumers the Commission will take escalated action where that is necessary.

I’ll finish by noting that the Commission accepts there will be many occasions where there is a level of technical non-compliance with care minute obligations that is not translating into risk to consumers as the provider is seeking to optimise the use of staff to contain risks through well governed scheduling of their workforce. So if a provider is technically non-compliant with their care minute obligations but providing quality and safe care the Commission will work with providers while they improve their care minute compliance based on the plan that they have in place. What we ultimately want to see in all cases are providers that show a willingness and capacity to do what is necessary to achieve compliance with all of their obligations and a demonstrated commitment to deliver high quality and safe care. For that reason we will sometimes intervene where we see a pattern of lower risk technical non-compliance if we consider it is the result of a provider being unwilling to take their obligations seriously by having an adequate plan in place to achieve their targets over time.

Thanks for listening and I hope that’s helpful and I’ll hand back to you Mark.

Mark Richardson:

Thanks Peter. I think that was very useful so thank you. Look I think the next point here is to just remind everyone what you can do to be well prepared for the 1st of October this year when care minutes become mandatory. If you haven’t already I’d suggest that you use the care minutes estimator to estimate your targets and also remind you that from the 15th of September you’ll be able to check your service level care minutes targets on the My Aged Care Service and Support Portal. And from February next year these targets will also be made available on the Government Provider Management System or GPMS.

I’d also give your staffing and recruitment policies and plans a check. Make sure you have practices in place to deliver care minutes now and into the future. If you are facing recruitment challenges you need to be able to show the Commission that you are making reasonable ongoing efforts to recruit and retain staff. Finally remember that there are no plans for exemptions to care minutes and that delivery of care minutes impacts your staffing star rating.

I’ll now hand over to Stephanie Kaiser for a summary of our aged care workforce initiatives.

Stephanie Kaiser:

Thanks Mark. So as many of you would be aware there are a number of opportunities for providers to get some support from the Government on growing their workforce. So there is a QR code at the bottom of this slide which you can look at. So recruitment and retention of aged care workers is critical for care minutes and the Department has implemented a number of programs to develop the aged care workforce. This means more opportunities and development programs and higher wages for aged care workers. We encourage you to explore our workforce programs especially the new round of nursing scholarships which have just opened. We also have programs for clinical placements and transition to practice to help your nurses develop their skills. You can find out more information on our aged care workforce web page or as I mentioned by using the QR code on the slide.

Mark Richardson:

Great. Thanks Steph. Once again that was great. Look one final thing before we go to the question and answer session. I’ve been asked just to provide some important information regarding the additional 2023 COVID-19 vaccination dose. So look the Australian Technical Advisory Group on Immunisation or ATAGI as they are better known has updated their advice for the COVID-19 booster dose. It is recommended for people aged 75 or older to receive an additional dose if it has been six months since their last one.

People aged 65 to 75 should also consider an additional dose following discussion with their healthcare provider. Older age continues to be the biggest risk factor for severe COVID-19 disease. COVID-19 vaccination reduces the risk of serious illness and death.

Residential aged care providers are responsible for ensuring residents have access to recommended COVID-19 vaccine doses.

Providers should contact their primary care vaccine provider to organise COVID-19 boosters for residents as soon as practical and monitor residents’ vaccination status and follow up with those who are not up to date. And lastly the latest information is on the Department’s website. So for help to arrange COVID-19 vaccine boosters for aged care residents contact your primary health network or the Department.

I’d now like to open up to the questions and answers. We’ll have Peter and also Steph but we also have Angus Algie who will be joining us. Angus is the Director of our Legislation section in the Residential Care Funding Reform Branch. So thank you Angus for attending.

So I’ll just go through the questions. Look they’re in no particular order. The first question – and I’ll try not to repeat things because we will have questions that are very similar. The first question is:

Q:        What are the financial and compliance related consequences of not meeting our care minute targets?

Look I’ll start off with an answer to that one but then I think I should probably go to you as well Peter. So look I think in terms of care minutes there will be no financial penalty for not delivering care minutes. I guess another way of saying that will be there will be no reduction in your AN‑ACC funding. It’s true to say that that is different for the 24/7 RN supplement. As I think and I hope most of you are aware for those facilities that are eligible for that supplement, that is if you have 60 or less people in your facility and you’re also delivering above the threshold of 20 hours per day, you’re eligible for that supplement. Now if it turns out I guess that you aren’t I guess delivering those 20 hours there is recourse to I guess recover those payments. So that can occur in the 24/7 space.

But look I think apart from financial penalties I think the other important thing to probably point out is star ratings. So providers I guess will have the care minutes that they deliver published on star ratings and as a result that will be available for residents, their families and others to be able to see. So I guess there will be transparency in terms of what you’re delivering. But look I think those are probably the important points. Peter would you also like to add to that?

Peter Edwards:

Yeah. Look thanks Mark. And it’s a good question and I know from talking to providers it’s a question that’s causing a level of concern about what the Commission will do where we see non‑compliance. And so look I think the key message I want to send you all is that where a provider is able to demonstrate a willingness to take all reasonable steps to comply with their care minute responsibilities the regulatory response will be different from the action we take if a provider is unable to demonstrate a suitable response and plan or deliberately avoids compliance with their obligations and that is placing consumers at risk.

So the Commission is unlikely to take escalated compliance action in cases where a provider is actively showing that they are working towards trying to meet their targets and they have systems in place to ensure that they are also meeting their reporting responsibilities.

Where we have situations where a provider is more reluctant and resistant to doing what is needed then we’ll take a proportionate response based on the level of risk we are seeing that non‑compliance causing. So the range of things we might do, we may well issue a caution letter really just highlighting the non-compliance to remind providers of their responsibilities. We may issue a direction to a provider to take a particular course of action such as revise their continuous improvement plan. And in the small number of cases we may need to issue a non-compliance notice or a notice to agree where we are seeing a high level of risk and a level of resistance in the provider taking the necessary action to remediate that risk.

So really that’s probably all I’ll say in response to that question. Because I just want to reassure providers that essentially we don’t look at that data in isolation of all the other information we have available. What we’re primarily concerned about is risk to residents and so it’s that which we respond to. Thanks Mark.

Mark Richardson:

Great. Thanks Peter. That was very comprehensive so thank you. Well the next question here, I’ll read it out first, but I think it probably will involve Peter, myself and Steph.

Q;        We are unable to reach our care minute target for RNs without using agency staff. This cost is enormous and we are struggling financially.

Peter I think if you don’t mind we might start with yourself.

Peter Edwards:

Yeah. Look thanks Mark. And I saw a range of similar questions coming through. So I’ll probably start by saying this. We all accept that having the right type of care available to residents when they need it is obviously important so having or working towards having RNs available 24/7 is a good thing, just as having the right number of direct care staff available at the right time. That said as I mentioned in my answer to the previous question the Commission’s interest around compliance with these workforce related measures is always focused on the risks that any reported care gaps is causing residents.

So as I said in my talk earlier we do not look at compliance with workforce obligations in isolation and where we are seeing providers with care gaps who are mitigating the risks those care gaps potentially could cause then our level of regulatory interest is going to be lower. So when we see 24/7 RN gaps or care minute gaps we are very interested in what alternative arrangements a provider has in place to manage risks to residents in this case and particularly as they work towards attracting and retaining the staff they need to meet those targets in a financially sustainable way.

So it’s probably useful for me to sort of underscore this point as our primary interest as the regulator is really to ascertain whether and how the provider is managing the risks of those care gaps and ensuring the safety and quality of care they are providing while they work towards meeting those targets.

Now some of the information that we are particularly interested in when we consider the totality of risk that sits around a provider is the provider’s financial situation. That’s because the Commission does want to identify emerging financial viability issues as early as possible. And that’s actually in recognition that a sudden financial shock or failure can pose other consequences for residents. And also we want to ensure that providers who hold refundable accommodation deposits can pay them back when due and we also want to avoid providers putting themselves at risk of potentially trading while insolvent.

So where a provider such as the provider that put this question up is concerned about their financial situation we certainly are keen to engage with those providers as a preventative regulatory strategy on our part because the earlier we can do that the more potential options are available for us to work with you. But just so you’re aware we also do work quite closely with the Department and where we consider necessary we will refer a provider to consideration of potential program support where we think that may be indicated. But I’ll perhaps hand back over to the Department to talk about that in a bit more detail.

Mark Richardson:

Great. Thanks Peter. Look thank you. I think that was a very comprehensive answer so much appreciate that. So look you’re spot on. I guess the Department has a role here. I think what we might do is I’ll outline a couple of the viability support programs that I’m aware of but then Steph I might throw to you as well just to quickly I guess recap some of the workforce initiatives that we have in place as well. But in terms of the viability support programs there are two that I guess jump to mind. One is the Service Development Assistance Panel and the other is the Business Advisory Service and Workforce Advisory Service Program. So I guess just to provide – and you should jump online onto our website and look up both of those that I just mentioned. You’ll get a lot more information I think on those than what I can provide you right now.

But the Service Development Assistance Panel, that’s primarily for providers that are located in rural or remote areas, in other words MMM5 to 7, or who provide care to Aboriginal and Torres Strait Islander people. And it’s basically free professional support to those providers. The Business Advisory Service and Workforce Advisory Service Program that I mentioned, once again I guess it’s a free service, it’s independent and it’s also confidential which I think is very important, and it provides advice to help a provider with their operations. So once again that would include business management, financial strategies and also I guess how to address workforce challenges. As far as I’m aware – but once again jump online and you’ll be able to I guess get some further information. As far as I’m aware that program is expected to open later this year in 2023. But look I think those are the two as I said viability support programs that jump to mind that help answer that question.

But Steph I think workforce initiatives come into this as well so if you don’t mind giving us a summary of that, that would be great.

Stephanie Kaiser:

Yeah. So one of the big things obviously is the wage rise for aged care workers which will make it a lot more attractive for people to be directly employed by aged care providers hopefully closing the gap between what some of the staff are earning in agencies versus being directly employed in aged care. But I do acknowledge that particularly in some areas like rural and remote areas it’s very hard for providers to find permanent staff. So we also have some programs that providers can use to grow particularly their nursing workforce. So I touched on them before. We’ve got a clinical placements program which is for nursing students but is a good opportunity to introduce people to working in your service, introduce nurses to working in aged care, so that hopefully they will return later in their career. So a bit of a more long term strategy. We also have an aged care transition to practice program which is for nurses who’ve recently graduated from university to get their first job in aged care. So again a more long term strategy.

We also have the aged care registered nurses payments program and agency staff generally are not eligible for that payment unless they’ve been working with the same aged care provider for a six or 12 month period. So mostly that payment goes to directly employed staff and that payment is a payment of up to $6,000. There’s been one round of the program already which has provided payments to over 34,000 nurses and the next round is due to open in November. So keep an eye out for that and use that in your attraction and retention strategies. And again as I mentioned before take a look at the website because there’s a lot more detail there about the programs and how you can access them.

Mark Richardson:

Fantastic. Thanks Steph. Once again that was great. Really appreciate that. Look the next question that I could see here I’ll read out. I think it’s an answer for myself.

Q:        What is the incentive for good providers to meet these targets when so many places are saying they won’t meet them?

So look hopefully this isn’t too cheeky in response but look I think my first point would be hopefully good providers – I guess the incentive is providing good quality care to their residents first and foremost. Particularly if you’re a good provider I’m hoping that that’s top of mind. But in terms of other I guess incentives that you may have to deliver I guess your care minutes when others may not be, first and foremost as I said before your care minutes and your performance will be measured and will be published on the star ratings website. So that will be available for residents, families and others to see. That I guess will enable people to actually compare services. So I think that transparency is very positive.

But look the other thing to say is that we will be I guess providing all of this information that we collect, that is the care minutes information to the Commission. Peter’s provided quite a lot of information I think today already around how the Commission plan on regulating care minutes, that that information will be provided to the Commission for that purpose. And lastly I think once again I should probably just remind everyone that we are introducing a new compliance program so that we can make sure that I guess facilities are reporting their care minutes and their 24/7 RN information accurately. And at the end of the day that comes back down to I guess the staffing star rating and also I guess the Commission in terms of regulatory responses. We want to make sure that I guess what’s reported is accurate so we’ll be making sure that there’s a compliance program out there having a look at your records and so forth and that everything is accurate. But I think that probably answers that question.

Look the next question I have here is:

Q:        I am an assistant in nursing in residential aged care. How do I know my employers will follow the law with the mandate for the minutes?

So look I think probably the first thing to say here is that – once again jumping backwards – I guess workers will be able to see like everyone else the care minutes that are reported by a facility through star ratings. So if you are a worker – and maybe it comes back to my previous answer around compliance to a degree – if you’re a worker who thinks that I guess your provider might be over reporting you will be able to I guess compare your views with what’s published on star ratings. As part of the compliance program that I mentioned before we will look to provide a facility for workers to get in contact with the Department and provide information that’s consistent with the facilities that the Commission also provides for workers to report on different events as well. So look there will be facilities out there for workers to be part of this process and to make sure that I guess providers are reporting accurately and delivering care minutes as per the new legislated responsibility.

The next question.

Q:        As part of the mandatory care minutes does the organisation have to provide any proof such as progress notes entry for each resident each day?

So I think here the first thing to say is that – and it comes back to the presentation. Hopefully this was answered as part of my talk. But care minutes is a facility level target. It’s not an individual target. So there’s no expectation that we would want to see records around specific residents and the care time delivered for a specific individual. It will be more about rosters, so being able to view I guess information around registered nurses, enrolled nurses, personal care workers and reporting that information in the QFR. So it’s not about I guess that individual care time. It’s more about the average target that the service is trying to deliver which I think is the important point here.

Okay. The next question.

Q:        Can an RN facility manager or care manager minutes be counted as RN minutes?

Look I think the short answer is it depends. And look it’s a really good question. I’d encourage I guess everyone at this point to once again jump online on our website. We do have a care minutes and 24/7 guide. It goes into quite a lot of detail around the types of activities that can be counted towards care minutes. And look we’ll be utilising that guide as part of the compliance program I mentioned around the reporting accuracy. But look where a facility manager is providing care and they’re registered with AHPRA and they’re undertaking those types of activities, yes they can be included towards care minutes. However if a facility manager is undertaking I guess other roles such as rostering or facility level tasks they can’t be counted towards care minutes. And in the QFR we’re expecting you to apportion those and once again we’ll be checking that apportioning is part of the compliance program.

Next question. Peter I think this one is probably for you.

Q:        Due to staff shortage in aged care settings most homes will not be able to meet the criteria. What are the impacts?

Peter Edwards:

Thanks. Thanks Mark. And look as I said during my talk, at the beginning of my talk, I talk to a lot of providers and I understand from talking to providers particularly in regional areas they are struggling to sort of attract and retain and there’s various external pressures that are presenting challenges for some providers in getting suitably skilled and competent staff in place. So we take the circumstances of an individual provider into account when we’re assessing the reasonableness of their workforce plan and strategy to attract and retain. Because obviously for some regions it’s going to be harder than for others so we do take that into account. But as I said we titrate that against what we’re seeing in respect to risk because we obviously want to make sure that people are well cared for in the meantime if those gaps are larger than expected.

But a lot of what we’re going to be doing in relation to care minutes is very similar to what we’re doing in relation to 24/7 RN coverage. So probably the best thing for those who are interested is to go and have a look at the regulatory bulletin that we released around 24/7 RN coverage back in April. I think that provides a fairly comprehensive account of the position we’ll take in trying to work with providers first and foremost in helping those providers to get to where they need to be who are willing and wishing to sort of move in the direction that is needed. So look that’s just a plug for the regulatory bulletin essentially because I think it is quite an accessible document and it's available on our website.

Mark Richardson:

Great. Thanks Peter. And I agree. I think that was a very good document. So thank you once again and great answer. Look the next question is – and I’ll answer this one.

Q:        We have two lifestyle staff. One is a coordinator who plans and runs the program but the other is an assistant who works directly with the residents. Do the assistant’s minutes count?

So look great question. I guess once again jumping back to the presentation there are a limited number of professions that can be counted towards care minutes. That’s registered nurses, enrolled nurses, personal care workers and assistants in nursing. So a lifestyle assistant cannot be counted towards care minutes I guess is the short answer on that basis. Now as I said in the presentation that does not mean that lifestyle workers aren’t important in terms of residential aged care. They’re enormously important. And also they’re funded through AN-ACC is the other important thing to state. And when I say that they’re important it is part of the aged care legislation so it’s something that once again the Commission can look at in terms of a vision of those sorts of services.

Look I think there’s lots of other questions that are coming through but I don’t think we have time. We’re getting very close to three o’clock so I think I should probably wrap it up now. I’m sorry we didn’t get through as many questions as I’m sure some of you would have liked but we will publish I guess answers to all the questions that have come through today on our website moving forward. But look once again want to thank you for attending today. And please take the time to let us know what you thought of today’s webinar. Your feedback is very important to us. It helps us improve and provide a better service for you moving forward. So thank you.

[Closing visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Useful links’, ‘Care minutes and 24/7 registered nurse responsibility guide’, with image of QR code, ‘AN-ACC funding and care minutes estimator’, with image of QR code, ‘My Aged Care Service and Support Portal’, with image of QR code, ‘Enquiries’, ‘My Aged Care provider helpline – 1800 836 799, or anaccoperations@health.gov.au’, ‘health.gov.au/aged-care-reforms’]