New aged care regulatory model: how it will work – Webinar

[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Webinar’, ‘New aged care regulatory model: how it will work’, ‘14 November 2024’]

[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]

Rob Day:

Yuma everyone. Hello and good afternoon. To begin our webinar today let’s acknowledge that we are all meeting on traditional lands of Aboriginal and Torres Strait Islander people. I’m in Canberra where the Ngunnawal people are the traditional custodians and I also acknowledge other families and people with connection to the lands of the ACT and region. I acknowledge their continuing culture and offer my respect to their Elders past, present and emerging. And I’d also like to offer my acknowledgment and my welcome to any Aboriginal and Torres Strait Islander people who are joining us for the event today.

This afternoon we’re going to be providing you with an overview of the regulatory model that will be part of the new Aged Care Act including its benefits and features and how it will work. We will also look at the new registration process and how we are preparing providers for that as well as the functions and powers of the Aged Care Quality and Safety Commission under the new model. Finally we’ll provide an overview of the engagement activities underway to prepare providers for the new regulatory model.

I’m joined today by Simon Christopher who’s the Director of the Regulatory Model Strategy section and Leonie Anderson who’s the Acting Director of the Regulatory Model Implementation and Transition section in the Department of Health and Aged Care. We’re also joined by Emma Jobson who’s Acting Deputy Commissioner, Sector Capability and Regulatory Strategy from the Aged Care Quality and Safety Commission.

We should have some time at the end to answer questions so please put them in the Slido and we’ll try to get to as many of them as possible at the end of the session. I know that we’ve already got 70 pre-submitted questions and so there is a chance we won’t get to every question today. If that happens we’ll put together a question and answer pack that we’ll distribute at the end of the webinar. The number of questions also means that we won’t be able to answer service specific questions today. We’re also recording this session. So the recording and a transcript will be available in a few days after the webinar.

I’ll start with an overview of the regulatory model, going through what we have been working on following the recommendations of the Royal Commission into Aged Care Quality and Safety.

[Visual of slide with text saying ‘Section 1’, ‘New aged care regulatory model’, ‘Overview’, ‘Four pillars of the regulatory model’, ‘Benefits’, ‘Features’]

The Department has been working on the new regulatory model since 2021 following the Royal Commission’s findings that an improved regulatory model was needed for aged care that both protected people from harm and encouraged good providers. The Royal Commission also pointed out the need for a rigorous assessment of those wanting to provide Australian Government funded aged care services to ensure that they were able to provide high quality and safe care to older people on a sustainable basis.

The policy design of the new regulatory model informed by two public consultation papers has fed into the drafting of the Aged Care Bill which is before Parliament at the moment. The new model seeks to drive culture change across the aged care sector and adopt a more relational approach to regulation aimed at building stronger working relationships, deeper trust and more transparency in the sector. The Royal Commission found that the current regulatory framework had contributed to substandard levels of care making it no longer fit for purpose and that’s the reason that we need to make this change. The new regulatory model aims to address these shortcomings by putting older people at the centre of regulation, empowering them and addressing risk in a proportionate way.

I’m now going to hand over to Simon Christopher to go into a bit more detail on the model including the pillars that support it, the benefits and the features. Thanks Simon.

Simon Christopher:

Thanks Rob. Good afternoon everyone. The regulatory model aims to improve outcomes and protections for older people. It will promote care that is person-centred and rights-based, fit for purpose, safe and high quality, monitored at the right level based on a risk proportionate regulatory approach, is transparent and welcomes feedback and complaints to provide restorative outcomes for older people, and is innovative and continuously improving to meet the needs and expectations of older people.

These aims have been summarised into four pillars. Rights-based, person-centred, risk-based and continuous improvement. These pillars support the rights-based approach being taken through the new Aged Care Act. So let’s unpack each of the pillars a little more.

The first pillar rights-based means that we value the wants and needs of older people, ensure they are treated with respect and protect them from harm, abuse and neglect. In practice this links to the Statement of Rights. Section 24 of the Aged Care Bill states that registered providers delivering funded aged care services to individuals must take all reasonable and proportionate steps to act compatibly with the Statement of Rights. Additionally section 361 of the Bill states that the rules will make a provision in relation to how complaints may be made to the Complaints Commissioner about a registered provider acting in a way that is incompatible with the Statement of Rights.

The second pillar person-centred means that we work in partnership with older people involving them to make choices about their care, valuing their wants and expectations and being responsive to their needs. Ultimately it encourages providers to deliver safe and high quality care. In practice this expectation is set by the Code of Conduct which describes how aged care providers, their governing persons and workers must behave and treat people receiving aged care. Person-centred care is also a key aim of the Strengthened Aged Care Quality Standards which set the standard for the level of care older people can expect to receive.

The third pillar risk-based means that the model takes a risk proportionate approach to regulation putting the right tools in place to promptly identify and respond to risks, ensuring older people are confident in the risk oversight so they feel protected. I will go into risk proportionate approach of the model a bit later on when we talk around the registration categories and linkages to the Strengthened Quality Standards.

The final pillar continuous improvement means that we support providers to build their capability and continuously improve their services to deliver high quality care. The overarching aim of the new regulatory model is to strengthen and better protect the rights of older people and enhance the delivery of services provided to them. The Department in its new role as system governor has an important role to play in managing the integrity and continuously improving the efficacy of the new regulatory model to ensure it continues to meet this aim. Like with the risk proportionate approach I’ll go into a little bit more detail on continuous improvement from the provider perspective shortly particularly looking at the new graded assessment approach to audits.

One of the key benefits of the new model is the introduction of universal provider registration. We might just move to the next slide if we could.

A single registration for each provider across all aged care programs. If a provider delivers multiple programs such as the Commonwealth Home Support Program, Home Care and residential aged care, they’ll only need to register once under the new regulatory model. This includes if they are registered in multiple registration categories. This will improve transparency of which providers are operating in the sector and how they are working, require only one set of consolidated obligations specific to each registered provider, improve regulatory oversight. The model also includes a system that is easier for older people and providers to access and navigate. This will include a complaints process that provides greater focus on restorative resolution approaches and visibility of outcomes. There will be stronger regulatory powers for the Aged Care Quality and Safety Commission which Emma will provide more detail on shortly. Finally there will be support to providers to build their capability with a focus on continuous improvement and innovation.

We might just move on to the next slide. As I just mentioned universal provider registration is one of the key changes to the new regulatory model for aged care. Providers will be registered in one or more of the six registration categories which has grouped service types on similar characteristics of those services. On commencement of the new Act providers will be allocated a renewal date that recognises the recency of audits or contacts from the Commission and allows for the orderly management of the Commission’s national audit program. This means provider registrations will be progressively renewed over the coming years. Following a new registration approval or renewal decision providers will generally be registered for three years. The Commissioner will have the ability to extend or shorten a registration period. Provider registration renewal will move the way we regulate to the provider level rather than at a residential care home level or a service level as is currently the case. 

There will no longer be accreditation of residential homes or quality assessments of home care providers. Moving forward audits will be used to inform a registration of renewal or registration decision and include a graded conformance assessment rating against the Strengthened Aged Care Quality Standards to help differentiate provider performance, moving away from a previous binary met/not met approach. All residential care homes will still be audited as part of a registration or renewal process. A provider register will also be established as a single source of truth on registered providers allowing providers operating in the sector, older people and their families and carers to transparently understand aged care services.

Providers must follow a Code of Conduct as I mentioned earlier and other conditions of registration and obligations relevant to their registration categories and services they are registered to provide. Registration conditions are applied flexibly and risk proportionately. All conditions for all providers, category specific conditions for some and provider specific conditions are set by the Commission on an individual basis to manage specific risks.

Finally the eligibility requirements to be registered will be expanded beyond constitutional corporations to include non-corporations such as sole traders and partnerships under the new Act.

So we’ll just move to the next slide. Here is a detailed table of the final proposed registration categories. It highlights the risk proportionate application of obligations and how the Strengthened Quality Standards will apply. The Quality Standards are performance-based standards that establish the key quality outcomes for older people across several standard focuses. The Quality Standards are a critical element of the new regulatory and registration models as they support the change of approach in audits moving to a more relational approach which supports continuous improvement of provider service delivery. They also remain an ongoing condition of registration where applicable meaning non-compliance action can still be taken during a registration period outside of audits for failures against a particular standard. They are a base expectation to be built on and continually improved. 

However the Quality Standards are just one tool to monitor the delivery of quality care and as the slide shows do not apply to all aged care providers. The proposed six registration categories have been developed by grouping service types by complexity of delivery and the associated risk. Categories 1 to 3 include less complex, lower risk services and care environments. Categories 4 to 6 include the more traditional, higher complexity, higher risk services and care environments. As we move to a more risk proportionate regulatory approach the Quality Standards will apply to categories 4 to 6 acknowledging the higher associated risk. This does not mean that providers in categories 1 to 3 are not expected to provide care and services in a safe and competent manner in line with the older person’s rights. It simply means the mechanisms to achieve this are more proportionate to the care and services being delivered.

Let’s move into a bit more detail on the conditions and obligations which are expected of all providers. Just move to the next slide please. There will be core conditions that apply to all registered providers. The Code of Conduct for aged care sets standards of behaviour for aged care providers, the responsible persons of governing bodies and aged care workers. Compliance with the Code ensures safe, respectable and quality care for older people. As happens now the Commission will monitor compliance and can take enforcement action for breaches of the Code. Registered providers must comply with worker screening requirements to ensure that workers are suitable to deliver care, services and support. Registered providers must have practices in place that ensure they deliver services consistently with the rights and principles in the new Act. There will be other conditions that apply to all registered providers but the detail on how to evidence and implement those conditions will differ based on the registration category and other factors such as the type of entity they are and the setting in which they operate. Most conditions are already in place in the current framework however under the new model the evidence requirements to demonstrate these have been met will be graduated and risk proportionate.

The details are still being worked on through the subordinate legislation drafting process. The conditions on the slide are not an exhaustive list but provide useful examples including requirements to implement an internal complaints and feedback management system, compliance with applicable fees and payment requirements, record keeping practices for specified records consistent with the personal information requirements under the Privacy Act and the new Act, reporting specified information including continuous disclosure requirements to the regulator and/or the Department. Some of the required reporting will be routine while other reports will be in response to particular changes of circumstances or incidents. For example this could include reporting on the care and services provided such as monthly care statements in a residential space, the occurrence of serious incidents through the Serious Incidents Response Scheme, Quality Indicator data, financial and prudential matters, workforce vaccination status and care minutes where applicable.

I hope this part of the session has been useful for the audience. Thanks everyone. I know we had a bit of a glitch with slides there and they will be available post the presentation. Back to you Rob.

Rob Day:

Great. Thanks very much Simon and thanks all for your patience while we worked through that issue with the slides. I’ll now hand over to Emma Jobson to talk about the registration, monitoring and enforcement processes that the Aged Care Quality and Safety Commission will be undertaking under the new reg model. Thanks very much Emma.

Emma Jobson:

[Visual of slide with text saying ‘Section 2’, ‘How providers will be regulated under the new model’, ‘Registration’, ‘Monitoring’, ‘Enforcement’]

Thanks Rob. Good afternoon everyone. I’m Emma Jobson, the Acting Deputy Commissioner for Sector Capability and Regulatory Strategy at the Aged Care Quality and Safety Commission.

[Visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Aged Care Quality and Safety Commission’, ‘Regulating under the new Regulatory Model’, ’14 November 2024’, ‘Emma Jobson’, ‘Acting Deputy Commissioner’, ‘Sector Capability and Regulatory Strategy’, ‘Aged Care Quality and Safety Commission’]

So thank you for the opportunity to speak to you today. I’m excited to share with you how the Commission will regulate under the new regulatory model. Next slide.

So this slide gives you an overview of what I will cover today. Firstly I will take you on a quick tour of how the Commission’s functions have been reframed under the new Aged Care Act. You heard earlier about the new regulatory model and I will take you through how a rights-based approach intersects with this and what is changing for the Commission in how we regulate in aged care. Next slide please.

So I think it’s important to start by looking at how the new Act will reframe the Commission’s functions including placing a stronger focus on the rights of older people. As you can see on the slide our functions are grouped into four main areas. Safeguarding, engagement and education, registration of providers and the Complaints Commissioner. The safeguarding functions have been strengthened to uphold the Statement of Rights as well as continuing to protect and promote the safety, health and wellbeing of older people. We enact these functions using our monitoring and compliance powers to hold providers and workers accountable in meeting their obligations and in so doing the Commission and providers will be required to consider older people’s rights under the Statement of Rights and their views and wishes.

Engagement and education functions will go beyond simply providing information and will support the Commission to continue engaging with older people and their supporters to understand their experiences in aged care. So we will continue to engage with providers and workers on their obligations and promote best practice in caring for and engaging with older people.

So as you heard earlier the registration of providers will replace the previous approval functions and extend the Commission’s role to include variation, suspension and revocation of providers’ registration as part of our enforcement role. This will ensure only those who are able to deliver good care can operate in the aged care sector.

And lastly the Complaints Commissioner will be responsible for the complaints function which includes managing feedback and complaints about providers and workers’ compliance. Complaints are an important part of supporting older people and providers to resolve issues and uphold older people’s rights. Next slide please.

The key principle of a rights-based Aged Care Act is to place older people and their wellbeing at the centre of everything that the Commission, providers and workers do. It instils a right for every older person receiving aged care to have quality and safe aged care and to be able to complain freely and without reprisal when things go wrong. It also supports a culture where older people are empowered to make choices about the care they receive as opposed to the care that is simply provided. These rights also make all providers, governing bodies and aged care workers more accountable to older people. 

So in practice this accountability is realised through provider and worker obligations and these will include a requirement to demonstrate they understand the rights of older people under the Statement of Rights, to have practices in place that are designed to ensure their delivery of aged care services is consistent with the Statement of Rights, to deliver aged care services in accordance with an older person’s wishes and preferences consistent with the Strengthened Quality Standards, to practice open disclosure with older people, their supporters and representatives when things go wrong. And to abide by the Code of Conduct for aged care, to continuously improve towards the delivery of high quality care and effectively manage complaints. And this includes participating in restorative engagement processes to resolve issues in a way that is meaningful to older people.

So we have a huge program of transformation within the Commission that will help us and the sector and older people make this transition together to a rights-based approach. We’re going to continue to develop resources on this rights-based approach and you can expect to hear a lot more from us as we get closer to the implementation of the new Act.

Next slide please.

So I’m sure some of you may be familiar with our regulatory diamond. It started its life as a regulatory compliance pyramid. The top half of the diamond explains how we respond to risk when providers are willing and able to do the right thing and we can see that they deliver high quality care. It shows our expectations don’t just stop at care that is compliant. Older people and the general community expect more and so do we. So this part of the diamond also explains how we safeguard older people by publishing information about best practice care and sector performance which support providers to compare and continually improve.

The bottom half of the diamond shows how we monitor all providers all the time through ongoing surveillance and risk-based monitoring. When things go wrong the intensity of our engagement with a provider is proportional to the assessed level of risk and is managed through our provider supervision model. You can see this through the addition of the tiered provider supervision status along the bottom left of the diamond. These graduated responses show how we hold providers to account and ensure that they remedy and prevent reoccurrence of a problem while they also restore the trust of the older people they care for. If a provider does not make sufficient progress we will take compliance or enforcement action proportionate to the level of risk to older people in the provider’s care. And the greater the risk the more serious our action will be. If a provider does not make sufficient progress in situations where there are unacceptable failures in care this can include a managed exit for a provider from the sector.

Next slide.

So like the regulatory diamond we just looked at you may have also seen this diagram that’s in our regulatory strategy which is available on our website. This is our risk for balance model which demonstrates the different ways we detect, analyse and respond to risk. You will see on the left of the diagram are some of the data sources we use in our risk detection and analysis and how often they are collected. These include regulatory data such as serious incident reports and complaints and data reported by providers such as Quarterly Financial Reports and Quality Indicators. So we bring these data together through risk profiling which is shown at the top of the diagram. We do this through the use of risk models that help us determine which providers are higher risk than others and also point to specific issues such as preventable infections or inappropriate use of restraint. We use our risk models to deliver targeted and preventative campaigns such as our current focus on food, nutrition and the dining experience in residential aged care. And I’ll talk to you more about how we respond to sector risk a little later.

But our risk analysis and detection including using risk models allows us to be proactive, taking action before risks either materialise or escalate. And in regulating under the new Act we will continue to invest in our capability to detect and analyse risk and take proactive action.

Next slide please.

So to get where we need to be by 1 July 2025 we are currently working hard to develop and reconfigure our regulatory operating model in the Commission and business processes. But our operating model is based on the five key ways in which we regulate providers, workers and the sector and these include complaints management and information coming to us through enquiries and other sources, registration and provider audits, managing provider and worker risk, our enforcement obligations and how we respond to sector wide risk. And I’ll now step through each of these five pathways.

Next slide.

So the first pathway I’d like to go through is managing complaints, enquiries and other information and I’ll step through these points. Restorative engagement. Restorative engagement is increasingly underpinning the Commission’s approach to good complaints handling. In aged care restorative engagement is important where there are ongoing relationships between the older person, their family and supporters and the provider and workers. Restorative engagement recognises the importance of accepting and acknowledging harms as a means of repairing and resetting ongoing relationships. It is about empowering the older person to be heard and understood on the things that matter to them and empowering them to ask questions. Providers will need to work with the older person to identify the most appropriate remedy response. The remedy should be fair, practical and proportionate to the seriousness of the issue. The practice of restorative engagement builds on existing provider obligations for open disclosure.

The new complaints function will also further empower older people and their supporters to make complaints and have their rights upheld. The Commission is committed to providing clear pathways for older people and their supporters to raise concerns so we can ensure their rights are upheld when providers may not be meeting their obligations.

And I’ve already spoken about the Commission’s data driven approach to how we identify and respond to risk. So the information that comes to us from complaints is also one of the most important sources that helps us identify when things are going wrong and in turn also allows us to focus our support to where the sector needs it most.

New slide please.

So you heard earlier about registration of providers under the new Act but I would like to briefly revisit the topic. As you heard those who wish to deliver funded aged care services must first register as a provider with the Commission. So this foundational step ensures that every provider in the system meets the requirements for delivery of quality care. It is how the Commission ensures those who come into and stay in the sector are meeting their obligations to provide high quality, person-centred care to older people. The Commission will assess each entity against a set of requirements which includes both general criteria and specific requirements depending on the service types they intend to deliver and are applying for.

As you have already heard today providers can be registered in one or more categories based on the types of care and services they plan to deliver. The providers in specific categories such as residential care must also be audited against the Strengthened Aged Care Quality Standards. So this audit is crucial in the registration process as it provides insight into the provider’s current level of conformance and encourages ongoing improvement and informs registration and renewal decisions. So we want providers to see this function in the context of both supervision and if needed enforcement.

The Commission may vary the registration of a provider and add a condition to a provider’s registration when there is a high risk to older people. This can be done at any time including when they first register. We can also remove a provider from a registration category. We will only add a condition to a registered provider if we decide it is necessary. The condition will be in proportion to any non-compliance or risk relating to delivering aged care services needing to be managed. Where there are severe risks to the safety of older people or a provider is no longer suitable to deliver aged care services we can also suspend or revoke a provider’s registration. A registered provider can also ask us to vary, suspend or revoke their registration. So this oversight allows the Commission to respond swiftly if a provider fails to meet obligations and helps to protect the quality and safety of aged care services. Next slide please.

So our approach to provider supervision means that every provider has a supervision status based on their level of assessed risk. The Commission engages and intervenes more intensively with providers with higher supervision status peaking at the heightened level. The four levels of supervisory status in order of increasing risk and resourcing are risk surveillance, targeted supervision, active supervision and heightened supervision. A provider’s supervision status is informed by our ongoing collection of intelligence and risk analysis as well as the outcomes of our regulatory engagement with them. A provider’s supervision status can move across the supervision spectrum as the Commission receives new intelligence and information.

Our engagement through provider supervision incentivises providers to manage their performance, risks and non-compliance. It also provides an opportunity for providers to show us that they acknowledge the problem and can work with the older person to remedy it. So while we’re willing to work in partnership with providers the onus is on them to work with older people to come back to compliance and to do so in ways that restore the trust and confidence of people they care for. 

The Commission’s effectiveness in safeguarding and protecting older people’s right to quality aged care depends on our ability to hold high risk providers and individuals accountable. Provider supervision gives us the framework and the tools to work with providers who need to demonstrate they are compliant with their responsibilities. Importantly we are always clearly communicating to the provider that their choices matter and determine their direction of travel. If providers engage with us in a positive way and acknowledge their non-compliance including to the older people they care for and move quickly and effectively to address the shortcomings they will move back towards the risk surveillance status as we continue to monitor them. But if they are reluctant or resistant to making the required changes then we intensify our use of regulatory tools. Ultimately that could lead to being found unsuitable to provide Government subsidised aged care and exiting the sector. 

The benefits of a regulatory model focusing on the provider rather than individual services become obvious. Where a problem in a particular service is fixed at the provider level it is more likely to stay fixed because the provider has taken responsibility for it. Even better the problem is less likely to occur in other services operated by that provider for the same reason. The provider has taken responsibility for addressing it across all its services. So we see this as a far more effective way of encouraging all providers to achieve a sustainable lift in the performance of their services whether they have one or many. And for this reason providers can expect the Commission to have a much greater focus on engaging at the provider level for significant risks and issues. It’s important to know we are already using provider supervision so the transition to the new Act in 2025 will be seamless.

Next slide please.

Now I’d like to talk to you briefly about the tools the Commission uses to verify and respond to risk. The choice of tool we use is informed by the nature of the risk to older people, the area of non-compliance in the type of evidence needed and whether the provider is willing and able to identify and manage any risks and non-compliance themselves. So we use a range of analytical tools to monitor providers and understand risk to older people and each provider’s compliance with their obligations. These are used as part of the Commission’s provider supervision model for ongoing risk surveillance, targeted, active or heightened supervision.

The first tool is targeted enquiry which is an initial monitoring response we undertake to collect and verify information about potential risks or harms. It’s used to determine if additional monitoring or other interventions are required to address potential risks or compliance issues and determines where we focus our efforts under provider supervision. 

The second tool is to conduct a review. We conduct reviews with a provider as a preventative monitoring response to risks identified throughout profiled data and intelligence. We use reviews to identify and respond to potential risks or non-compliance, supporting the provider to continuously improve. We also translate what we learn through reviews into further sector education and this may mean we engage with providers at their premises or online and virtually.

The third type of monitoring tool is inspection. This is a timely and heightened monitoring response to confirm the presence and extent of risk or harm to older people. Inspections use our regulatory powers to collect evidence against provider obligations under the Act. During an inspection we seek timely risk assurance of identified risk and if we find these are unmanaged we may direct providers to take certain actions to mitigate these.

And lastly investigation. This is a heightened monitoring response we use for detailed examination of serious allegations or incidents of non-compliance or misconduct that result in a risk or serious harm. We do not need permission from a provider to gather evidence and we may seize sufficient evidence to support timely enforcement actions to hold providers and/or workers accountable against their obligations.

Next slide please.

So this slide shows the ways in which the Commission can manage non-compliance under the Act and gives us multiple ways. These include engaging with the provider to understand and reach agreement on a response which may include seeking an update to a provider’s plan for continuous improvement and monitoring the outcome. Issuing a requirement for action. This is a notice specifying a range of actions a provider must take regarding a concern or non-compliance. This may be things such as requiring a provider to conduct enquiries or investigate and reporting their findings to the Commission.

And also issue a compliance notice. We will do this where there is evidence of non‑compliance and this may include non-compliance that is related to a significant failure or systemic patterns of conduct. And as we do now we may issue an enforceable undertaking which is an agreement with a provider to take or cease certain actions to bring them back to compliance. Enforceable undertakings must be volunteered by a provider but accepted by the Commission. And we may initiate new conditions of a provider’s registration or vary existing ones and these can be quite specific with regard to requiring or preventing specific actions such as admitting new residents or delivering training. 

So you can expect to hear more from us soon on our regulatory approach and as I mentioned earlier we will publish an updated regulatory strategy before the new Act commences. Next slide please.

So the Commission’s effectiveness in safeguarding and protecting older people’s rights to quality aged care depends on our ability to hold high risk providers and individuals such as workers accountable. We use enforcement actions to apply a consequence where there are unacceptable failures in care and impacts on older people including their rights. These actions reinforce that all providers and workers must meet their obligations and it deters future non-compliance and reinforces the safeguards that protect older people. Next slide please.

So under the new Act the Commission is proposed to have enhanced enforcement capability. This includes issuing a banning order, adding our ability to ban providers, infringement notices, seeking civil penalties or an injunction through court, referring a matter for criminal prosecution and varying, revoking or suspending a provider’s registration as we’ve discussed.

So where non-compliance has resulted in significant harm to older people or is serious or systemic in nature the Commission may take enforcement action. Enforcement actions are designed to apply penalty and enforce a consequence for the non-compliance. So we will use enforcement actions where our data and information tell us a provider cannot be compliant with their obligations. When a provider remains non-compliant or the risk to older people is severe providers move to the bottom of the regulatory diamond and under heightened supervision. This means they are either failing to ensure that their behaviours and practices comply with the legislation or safeguarding older people. 

They may also not be taking timely and sufficient action to remedy risk that has significant impacts on the people in their care. So this includes circumstances where a provider or worker has failed to take agreed actions under a supervised non-compliance notice and management process or where our information tells us they have breached the Code of Conduct. Next slide please.

So I spoke before about how the Commission uses a data driven approach to identify providers who may not be meeting their obligations but we also use this approach to identify emerging sector or provider group risks and trends. Responses to sector risk may include a planned program of education, communications, publication of resources for the sector or support risk‑based monitoring activities. So this allows us to take a preventative approach so we can provide education and information to the sector on broad issues on how to manage the risks proactively before they become a larger problem. This preventative approach sometimes referred to as preventative regulation is designed to lift and sustain providers’ capability and performance in the delivery of safe and high quality care and services.

In 2024 the Commission is focused on the following key sector-wide risks. Infection prevention and control, food, nutrition and the dining experience, provider workforce-related responsibilities for care minute and 24/7 RN coverage targets, strengthening governance and practicing open disclosure and managing serious incidents. And we’ll continue to monitor sector risk to ensure our targeted programs lift sector capability under the new regulatory model. Next slide.

So finally what does the future regulatory landscape look like and what will you see from us? This slide provides a nice overview of some of the key changes and activities in the Commission. A rights-based approach sits at the top of what will be our new regulatory model and will shape the Commission’s regulatory strategy for 2025-26. This will clearly outline what we expect from providers and workers, what older people can expect and how new aged care regulation will shape the sector. Like the Commission I’m sure providers are thinking about how they will be responding and supporting the rights of older people to quality aged care. We’ve spoken extensively here and elsewhere about how we’ve adopted a data driven approach to risk surveillance, monitoring of providers at all times, and this capacity will only increase as we develop better evidence to manage risk. Provider supervision is already being implemented across the Commission and we’ll seamlessly transition to embrace our new compliance and enforcement powers from 1 July 2025.

So we are already enhancing our engagement with older people and the sector through our regular sector updates and reports and we will adapt our campaign work as new issues arise. Next slide please.

As already mentioned the Commission will continue to support providers, workers and older people with resources as we move toward the implementation of the new Act. The links on the screen are some very useful resources we already have and I would encourage you to look at our current regulatory strategy and we will publish a further update to the strategy before the new Act commences. But our current version has plenty of information that will flow through including our provider supervision model. You may have also seen the Reform for Better Aged Care information on our website. It provides resources and information for providers, workers and older people about how we are changing our business. We are very committed to keeping you regularly informed as we move towards implementation of the new Act. Next slide please.

That brings me to the end of the presentation today so again I want to thank you for the opportunity to speak with you today and to share with you how the Commission will regulate under the new regulatory model. It is certainly an exciting time for aged care and we look forward to going on this journey with you. Thank you.

Rob Day:

[Visual of slide with text saying ‘Section 3’, ‘Looking ahead’, ‘How we are preparing providers/deeming’, ‘Engagement and communications’, ‘Building provider awareness’]

Great. Many thanks Emma. Definitely an exciting time for all of us. I’m now going to hand over to Leonie Anderson who’s going to run us through the deeming, engagement and communication activities that are underway to support providers with the transition to the new regulatory model and hopefully we’ll touch on at least some of that second top question there around the training and resources that will be available to providers. Over to you thanks Leonie.

Leonie Anderson:

Thanks Rob. Thanks everybody. So when the new Act starts existing aged care providers will be set up as registered providers from day one and we’ll be transitioning providers into the new regulatory model automatically. This process is called deeming. Providers will then operate under the new regulatory model and the related obligations of registration categories will apply at that time. Deeming allows for a planned, orderly transition between regulatory frameworks. This will maintain continuity of service ensuring all older people receiving care experience no interruption in the aged care services that they rely on.

Through the deeming process the Department will move providers to the new registration categories based on the services they currently deliver or in line with Funding Agreements in place at the time of deeming. To progress this we need to confirm provider entity details such as an ABN or company structure. It’s important to understand that we’ll be taking a staged approach to communicating the applicable obligations to providers as these details become clearer with the completion of the subordinate legislation or the rules that describe those expectations.

While the Department is responsible for deeming our colleagues in the Aged Care Quality and Safety Commission will oversee provider registration and renewal applications once the new Act starts.

If we could move to the next slide please. This slide demonstrates how existing providers will be deemed from the current model into the new regulatory model. It’s also important to note who will not be deemed as part of this process. So at the bottom there you can see that subcontractors for aged care providers won’t be deemed. They’re not going to be deemed as registered providers but can continue to deliver services if they are contracted by a registered provider.

They’ll be known as associated providers under the new Act and in short these arrangements can continue as they are today. You’ll see here that once the new model is fully operational some program cohorts will be replaced by and/or grouped into various distinctive programs. And I’ll just run through those. 

Residential care will remain in its own distinct cohort in the new model. Home Care Packages and Short Term Restorative Care will be replaced by the Support at Home Program which will commence with commencement of the new Act. Commonwealth Home Support Program will transition to the Support at Home Program no earlier than 1 July 2027 and will be known as a specialist aged care program in the interim. And the National Aboriginal and Torres Strait Islander Flexible Aged Care Program, Multi-Purpose Services and Transition Care Program will also be known as Specialist Aged Care Programs.

Moving onto the next slide please. Thank you. This slide provides a snapshot of the spread of registration categories providers will be deemed into noting that our data may change in the leadup to the introduction of the new Act based on other activities such as grants for example. Indicatively around 60% of providers will be registered across a combination of registration categories 1 to 6, around 18% will be registered into categories 1 to 3 only, 2% registered into categories 4 to 5 only and around 21% into category 6 only.

We’ve received a number of queries around which categories providers will be deemed into and this information will be provided as part of the validation survey we’ll be sending to providers fairly soon.

If we can move to the next slide. Thank you. We’ve started the deeming process by contacting providers to confirm their key contact or nominated contact person. All providers should now have received the nominated contact survey and we encourage you to complete this as soon as possible if this hasn’t been done as yet. Once we’ve confirmed the appropriate contact person we will then reach out to that nominated provider contact steadily asking them to review and then confirm their registration details and proposed registration categories. This email will come from a legitimate third party email address which you can see there at the bottom of the slide. Providers can give feedback throughout this process and we will provide additional advice and support where needed. We expect this process will be largely finalised by the end of the year.

Once the rules used to produce the data have been validated this will be fed into the Department’s IT system that will then transform current providers into registered providers as we’ve described when the new Act commences. The information around this will be maintained in what will be known as the provider register.

As this is a staged process not all providers will be contacted at the same time but the main thing is that we need to keep the process moving and making sure that we have your confirmed nominated contacts. So if you haven’t completed this already please fill this out. We’d appreciate that be done as soon as you can.

More information on the deeming process can be found on our website and website updates are being made routinely. You can also keep up to date with changes through subscribing to our weekly e-newsletter, the Your Aged Care Update.

The Department’s ICT team is making substantial changes to support the requirements of the new Act. This includes a focus on helping providers to log into the system, report and be compliant with the obligations that apply to them based on their registration categories. We’re aware that many providers in the CHSP or home services space won’t have used the systems before so we’re preparing resources to support you. We also appreciate that many providers haven’t been regulated under the Aged Care Act and they may not have engaged with the Aged Care Quality and Safety Commission in the past, and we’re working on resources to support these engagements as well.

In the lead up to the Act commencing the Department will be communicating more information with providers about the obligations that will apply to them and their registration. And to support this we’re developing an obligations visualisation tool that will allow providers to easily identify the obligations that will apply to them. This work is still underway as the Aged Care Bill progresses through Parliamentary processes and the supporting legislation known as the rules are developed and finalised.

There will be consultation on the rules as they become available and this will occur later this year and early next year. So keep an eye out for these and we encourage you to provide feedback through the consultation process.

Moving to the next slide we have a range of existing resources to support providers to understand the new regulatory model and you can see these here on the screen. These include updates to our website as well as a provider booklet with more detailed information. There will be more resources coming out next year as we prepare for commencement of the new act and we’re looking to run another webinar early in 2025 and we’ll communicate the details to you about this in due course.

So for any questions or feedback you can contact us at the email address on the screen which is agedcareregmodel@health.gov.au and we’d welcome any suggestions on the types of resources or tools that would benefit you as we move towards implementing the new regulatory model so that we can consider this as part of our work. Thanks Rob. I’ll hand back to you.

Rob Day:

[Visual of slide with text saying ‘Section 4’, ‘Questions and answers’]

Great. Thanks Leonie. And look let’s jump straight into questions because we’ve only got about six minutes left and a lot of really interesting questions. Just to reiterate for those that we don’t get to today we will be doing a written Q&A document that we’ll publish after the webinar as well.

Emma the top question there is around the cost of registration and renewal so I might ask you to deal with that one please.

Emma Jobson:

Thanks Rob. So I’m guessing that this question may be asked because people are aware that the Commission currently charges fees for applications to become an approved provider. Government will make decisions on whether registration and renewal activities are charged for and how much the fees will be. So at the moment I’m unable to have exact costs for registration and renewal today but any fees will be publicly consulted on before the start of the new Act.

Rob Day:

Great. Thanks very much Emma. And look I think Leonie did a fairly good job talking about the resources that are already available in the answer to that second question, but also reiterating we’re going to keep rolling those out, both the Commission and the Department resources to support providers. And please take seriously that offer to email at that email to let us know what would be helpful to you as a provider.

In terms of the third question around the risk of regulatory burden and perhaps providers feeling like they need to leave the sector I think my high level answer to that would be I know this sounds like a lot because we’re talking about a whole new Aged Care Act and a whole new regulatory model coming in at once, but actually what we’re trying to achieve is a more streamlined, more accessible set of obligations for providers. The way the regulatory system has been set up at the moment has been obligations, reporting requirements, enforcement mechanisms added on to the 1997 Aged Care Act over time to respond to particular circumstances. And that’s left us with about 607 obligations on providers at the moment and that’s really hard for providers to keep track of. It’s really hard to hold providers to account for. And so although this system sounds like a lot the idea of coming up with a single consistent set of obligations based on registration categories is actually intended to streamline and make that easier. 

We’ll also be doing some work from day one of the new Act taking effect to monitor the impact that the regulatory system is having on the aged care system as a whole in terms of both those goals of protecting older people from harm and making sure that we’re encouraging providers to offer great service. And so we’ll be monitoring and able to adjust along the way if we’re not seeing those two goals met.

Simon did you want to add anything to that answer?

Simon Christopher:

Rob just probably to the last part of that question which was will unregistered providers increase, and just to reiterate that the new model is universal registration so there won’t actually be unregistered providers in the aged care space. They’ll need to be registered with the Commission to be able to receive subsidies or funding from Government.

Rob Day:

Great. Thanks Simon. And look I’m going to keep hogging the limelight in the interest of speed. In terms of Steve Neil’s question there about care management as a clinical service we’re alert to that and have been working in tandem with the Support at Home team as the subordinate legislation is drafted. And the way we’re dealing with that particular challenge Steve is in looking at which of the Quality Standards apply to category 4 providers, making sure that the relevant parts of the Standards for clinical care, particularly clinical governance will apply.

And in terms of the next question about worker screening I know that’s a really hot topic. My colleagues are working very closely with state and territory governments to finalise that. It is a slightly more complicated process to get agreement because we do need all the states and territories on the same page. But the final result will be a single screening system for workers both in the disability system and the aged care system. I am told – I checked in with them yesterday – that they hope we are really close to being able to release at least the scope and coverage of the screening system in the very near future.

I’ve probably got time for one more.

I’m just trying to think which is a good one to jump to next.

So I might just quickly touch on the question of the high quality definition in the Act. I know that’s been a hot topic for the sector as well. And I think worth being really clear that the definition of high quality care is intended to be an aspirational statement for the whole sector to work for providers and Government and the regulator. The obligations that providers are expected to meet from day one of the Bill will be the Aged Care Quality Standards where they apply and the obligations that are associated with the registration category. But I’d also point out that there are things in that statement about high quality care that I find it really hard to think we need to talk about funding to attach to when you talk about treating older people with care and kindness. That is something that I think is a legitimate expectation of the system right now and I know is happening in aged care providers right now.

I’m afraid that’s probably where we’re going to have to leave it. We’ve hit three o’clock. Let me thank you all very much for your time today. Thank you to our three speakers and to all of you who’ve been participating in the call. As I mentioned at the beginning the recording of this presentation will be available in a few days. We’ll also work through all those other questions that we haven’t had time to get through and publish those in a question and answer document.

When the webinar finishes a short survey will pop up and we’d really appreciate your feedback. It will take about a minute to complete and it will help us make sure that the next webinars are even better for you. And I also encourage you to email us at agedcareregmodel@health.gov.au if you have any more questions about the new regulatory model. Thanks everyone and have a great afternoon.

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