New residential aged care quality indicators launched 1 April 2023

[The visuals during this webinar are of each speaker seated behind a long table speaking to camera with reference to the content of a PowerPoint presentation being played on screen, with Auslan interpreter signing on screen]

Joshua Maldon:

Welcome to the Quality Indicators webinar that we’re going to be running today. I want to say a big thanks in advance to you all for taking the time to connect with us. I know how busy you all are.

My name is Josh Maldon. I’m the Assistant Secretary of the Choice and Transparency Branch in the Quality and Assurance Division in the Aged Care Group in the Department of Health and Aged Care. I did want to let you know from the outset that we are recording this session. It will be available on the Department’s website in the coming weeks alongside copies of the slide deck.

Before we formally start I did want to hand to my fellow panellists just to introduce themselves. Emma.

Emma Cook:

Good afternoon. I’m Emma Cook, Director of the Star Ratings Section within the Department of Health and Aged Care.

Michael Gurney:

And I’m Mike Gurney. I’m the Director of Intelligence and Analysis at the Aged Care Quality and Safety Commission.

Joshua Maldon:

Thank you Emma and thank you Michael. I did want to begin today by acknowledging the traditional owners and custodians of the land on which we are virtually meeting today. So this webinar is being broadcast from the lands of the Ngunnawal and the Ngambri people. I want to pay my respects to Elders past, present and emerging and also extend that respect to any Aboriginal and Torres Strait Islanders that are here with us today.

So in terms of today’s presentation what we did want to do is take you through the key information about the upcoming changes to the QI Program which are due to come into effect from the 1st of April 2023. In particular we wanted to provide information about the relevant background, some context to build your understanding, the new quality indicators and how these are going to be reported, how we’re going to support you through guidance materials and resources, what the next steps will be. We’ll do a little bit of myth busting with you and we’ll also have some time for questions at the end. Also obviously any questions that we don’t get to through the session we’re more than happy to compile those in frequently asked questions after the presentation.

Whilst this webinar itself is intended primarily for providers we certainly welcome older people and their representatives who are joining us. We’ll also outline the upcoming communications and resources that will help you understand the changes to the QI Program. So again I want to encourage you to post your questions in the chat as we go through the webinar and we’ll have a substantial question and answer session at the end to go through those.

So again just before we get into the actual quality indicators I did want to outline some context to you, why these are important and the objectives of the QI Program. So by way of background the Royal Commission into Aged Care Quality and Safety absolutely recognised the role of quality indicators in measuring and improving the quality of aged care. Quality indicators were at the heart of a number of recommendations which highlighted that aged care quality needs to be defined, understood and be capable of being measured. And the current data in the system is fragmented and it makes it difficult to determine the extent of substandard care and also provides a lack of information if you like about service quality to inform consumers, provider quality development as well as government policy and risk-based regulation.

So in response, the Royal Commission highlighted that to have a consumer-centred system the voices of people receiving aged care must be at its centre. To address the problem the Royal Commission recommended a comprehensive approach to quality measurement and reporting with three linked elements. Indicators to measure quality, benchmarking for continuous improvement and a star ratings system for comparing the performance of providers. In response to the Royal Commission recommendations the Australian Government is delivering a comprehensive reform agenda to improve transparency, capability and accountability in aged care. To support transparency through a quality measurement we’re introducing new quality indicators and consumer experience and quality of life reporting to put consumers at the centre of the system.

So what are quality indicators? Quality indicators measure important areas of care that affect people’s health and wellbeing. It was originally introduced to support quality improvement serving as a cornerstone in measuring and monitoring crucial areas in residential aged care. The objectives of the QI Program – and this is really important – first and foremost it’s about supporting providers to measure, monitor and improve the quality of care at a person level. Similarly the program supports government to make improvements at a system level through evidence-based policy and regulation. And finally it aims to provide older people in Australia, their families, their representatives with more information about the quality of aged care services when making choices about their care. This includes the publication of QI Program data through Star Ratings.

So the QI Program was developed over time to the five quality indicators which have been in place since July 2021. We’ve been increasing those across further crucial areas of care consistent and in line with the recommendations of the Royal Commission. Importantly we’re aware of around half of providers who already measure a number of these and more through third party benchmarking companies. And a key point I really wanted to stress to you today is that the end game is not a prevalence of zero. To talk more on the new quality indicators I’d like to hand over to Emma Cook.

Emma Cook:

[Visual of slide with text saying ‘New quality indicators’]

Thanks Josh and thanks again to everyone for joining us today. So to talk through the new quality indicators these were developed through a really rigorous process which many of you will have been a part of and I should take this opportunity to thank everyone who’s been involved in this process and codesign and extensive consultation.

So the new quality indicators were developed through the process that you can see which comprised fundamentally of research which looked to identify internationally well-established measures, extensive consultation to find out which areas of care are important to older Australians and their representatives, as well as providers and stakeholders more broadly.

Advice from technical experts in order to refine quality indicators and to ensure that these are aligned with contemporary evidence and best practice guidelines. Then we stepped into a pilot process, that’s where the thanks comes in, it sought volunteer participants from across residential aged care providers nationally and tested these measures to assess feasibility, appropriateness and inform minor adjustments to ensure that these measures were best suited to the Australian aged care context.

So the pilot process provided broad support for these measures and identified that they had appropriate attributes for the QI program, utility in supporting quality improvement and were feasible for quarterly data collection which is able to be completed through largely routine care and record keeping requirements.

The Minister agreed to the introduction of the new quality indicators in September which was announced last year. We’ve encouraged providers to commence collection and recording of quality indicator data however this will become a requirement under the Aged Care Act from 1 April 2023.

So here you can see the new quality indicators which are at the lower half of the graphic on the screen in addition to the existing quality indicators that comprise the QI Program on the top half of the screen. As I’ve said we’ll start collecting from 1 April 2023 over the months April, May and June and in line with current reporting requirements providers will then be required to submit their quality indicator data between 1 and 21 July 2023.

We’ll now take a closer look at the new quality indicators. And I should call out that there’s a QR code on your screen now which you can use and that will take you to the really detailed guidance on the quality indicator collection and submission requirements in the QI Program Manual Part A. So while we’ll be providing this summary today and hopefully a nice overview it’s important to note that the full requirements are outlined in that manual and it’s important that you refer to and adhere to those.

I recognise that it’s a lot of information that we will be stepping through and so what I might do is hand over to Josh to get us started and we’ll alternate in walking through these measures.

Joshua Maldon:

Lovely. Thanks Emma. So we’re going to start firstly today with activities of daily living or ADLs. One of my favourites given my keen interest in reablement. So why is this one important? The ADLs quality indicator is important because it recognises feedback that we had from older people on the importance of maintaining functionality as well as independence and ultimately quality of life. Yes. People’s functionality will continue to decline and we are well aware of that. However even in residential aged care through strategies such as reablement the compression of physical decline is possible and not only does it lead to better outcomes for people but it also reduces the intensity of care that’s required.

So in simple terms the quality indicator measures the percentage of care recipients who experience a decline in the activities of daily living or ADLs. In terms of data collection and reporting an ADL assessment is completed each quarter, it’s compared with the previous quarter and that’s how we determine decline. The ADL assessment tool that we use is the Barthel Index of Activities of Daily Living and we have details of those, as Emma said, included in the QI Program Manual. This is meant to be done on or around the same time and is based on the care recipient’s actual performance over the previous 24 to 48 hours. It’s established using the best available evidence. Direct testing is not required and you should report the number of care recipients who experience a decline in their ADL assessment score of one or more points from the previous quarter, those that were assessed for the ADLs QI, those who had an assessment score of zero in the previous quarter and also those who were excluded from assessment because they were absent from the service or receiving end of life care or they didn’t have an assessment score from the previous quarter. Emma.

Emma Cook:

All right. So the second domain is incontinence care. So why is incontinence care important? Well this was really recognised in particular by older Australians and their representatives and highlighted during consultation as one of the key areas of care that they wanted to see improvement in and that they would be interested in when making choices about their care. And this was largely because of its importance both in terms of a person’s dignity and wellbeing in receiving good continence care but also because of the clinical risks and aspects of the measure.

So this really brought to the forefront the importance of this measure and its utility in supporting improvement in residential aged care. And while it’s a measure that is quite internationally leading and one of the first of its types it has the hallmarks of a very good quality indicator and should be a really positive step forward. So the quality indicator is the percentage of care recipients who experienced incontinence associated dermatitis. The incontinence associated dermatitis tool is the Ghent Global IAD Categorisation tool which is included at the back of the QI Program Manual. The tool assesses IAD severity across four sub-categories based on visual inspection or assessment of the affected skin areas. And so it can be helpful to think of this incontinence care quality indicator, in my view, as quite similar to the pressure injuries quality indicator in that there’s not a requirement that everyone’s assessed at the same time or that it has to be systematic. That it’s really about doing it on or around the same time at least on a quarterly basis largely as part of a person’s personal care and normal care routine, and that those observations are made and then assessed by someone appropriately qualified to do so safely and accurately in accordance with the tool.

And based on this you should report the number of care recipients with incontinence who experienced IADs, incontinence associated dermatitis, against each of the sub-categories, the number of care recipients assessed for incontinence with incontinence, the number of care recipients excluded from incontinence care assessment because they were absent from a service or excluded from incontinence assessment because they did not have incontinence. So again really important to highlight that this is about people who experience incontinence and assessing where those people are experiencing incontinence associated dermatitis and what stage that is in a really similar pattern to what you currently do for pressure injuries quality indicators. And the other fields are intended to capture the remainder of the population at your service.

Joshua Maldon:

Lovely. So the next one we’ll move on to hospitalisation. So why is this important? It recognises the importance of having timely hospital data to support continuous improvement at the service level. And the current available hospitalisation data more broadly is fragmented, it’s incomplete and it also has a time lag which limits our ability to use these both from a continuous improvement perspective but also as part of a national quality indicator program.

Again, no one’s looking for a zero score. It’s absolutely expected that when people need care from a hospital that they receive this. So in terms of the quality indicator itself the hospitalisation quality indicator measures the percentage of care recipients who have one or more emergency department presentations. So the data collection and reporting, what we do is collecting this data, it involves a single review of the care records for each care recipient for the entire quarter. And what you should be doing is reporting the number of care recipients who had one or more emergency department presentations during that quarter, those that were assessed for hospitalisation, those who had one or more emergency department presentations or hospital admissions during the quarter and those that were excluded because they were absent from the service for the entire quarter.

Emma.

Emma Cook:

Thanks Josh. So the next measure is the workforce measure, so the workforce domain. And this measure, why is it important? The workforce quality indicator was developed with a focus on continuity of care. It was highlighted by the Royal Commission and certainly by older Australians and their representatives through consultation the absolute importance of continuity of care to establish consistent and meaningful relationships with those people who are providing quite intimate and daily care and how critical that is as well as highlighting the improved quality of care outcomes that older Australians can benefit from from that continuity of care.

So the quality indicator is the percentage of staff turnover. It relates to key roles; so service manager, registered nurse, enrolled nurse, personal care staff or assistants. Data collection and reporting. Now this is largely done through record audits, so existing staffing records and auditing those, and you’ll be looking at the number of staff who were employed at the start of the quarter in those specified roles, the number who stopped working during the quarter at the service in the specified roles, and the number of staff who worked any hours during the previous quarter in the specified roles.

So staff are considered employed when they have worked at least 120 hours in the previous quarter. They are then determined to have stopped working this quarter and there is a break in work of at least 60 consecutive days. So in essence they were employed because they worked enough hours to be classified as employed last quarter. So they came into this quarter and if a person hasn’t worked at the service for over 60 days – and coming back to the heart of this quality indicator around continuity of care – as far as the care recipient’s concerned this person’s been missing for two months and it’s a break in continuity of the relationship and in that staff member being able to recognise changes or respond to quickly changes in care needs.

So that’s the staffing measure.

Joshua Maldon:

Lovely. Thank you Emma. So we’ll now jump into the consumer experience. So again, why is this one important? This one as I said before was really at the heart of the Royal Commission which said that one thing we need to do better as a system at a national level as well as a service level is hear the voices of people receiving care. And as we move towards a consumer-centred system it’s really relevant to hear those voices and let them shape the system that we’re designing.

So the quality indicator itself measures the percentage of care recipients who report good or excellent in terms of their experience of the service. For data collection and reporting, the assessment tool that we use for consumer experience is the Quality of Care Experience Aged Care Consumers or the QCE. It’s available in self-completion, interviewer/facilitator completion as well as proxy completion versions. So a suitable version of the QCE assessment must be offered to each care recipient for completion around the same time every quarter.

So you should report the number of care recipients who reported consumer experience through each completion mode, scored against the categories of excellent and good, those that were offered a consumer experience assessment for completion, those who report consumer experience through each completion mode against the categories of moderate, poor and very poor and those that were excluded because they were absent from the service for the entire quarter or they chose not to complete the consumer experience assessment in that quarter. Emma.

Emma Cook:

Thanks Josh. And for the final domain which is quality of life, this is similar to the previous in that it comes back to that philosophical shift towards putting the voice of older Australians at the centre of the aged care system and recognises the importance of that in frequently hearing back from care recipients, understanding their experience, understanding their quality of life and seeking to improve and ensure that people enjoy the best possible quality of life.

This measure, similarly, is a quality indicator that measures the percentage of care recipients who report good or excellent quality of life. It uses an assessment and reporting tool, the QOL-ACC, so Quality of Life Aged Care Consumers tool, which is available in three versions. The self‑completion, interviewer facilitated completion and proxy completion. We’re really fortunate to have had Flinders University in parallel to the Department of Health and Aged Care’s work been progressing the development of these tools and developing two six question surveys which go to consumer experience and quality of life respectively. This means that these two really important but different measures – with consumer experience being more about how somebody feels about the service that they’ve been delivered and the quality of life measure providing a more holistic measure of that person’s reality versus their broader expectations and values. We’re really fortunate that we’ve got these two surveys that you can have side by side in just 12 questions. Whereas often you’ll come across experience or satisfaction surveys that in isolation would be a lot more.

So there’s no problem with doing these surveys as one follows the other or in doing them separately. But it’s important that we look at both because they are distinct concepts. A suitable version of the QOL-ACC assessment should be selected and offered for each care recipient to complete around the same time each quarter. You should report then on the number of care recipients who reported quality of life through the completion of the mode, scored against the categories of excellent and good. You should report on the number of care recipients offered a quality of life assessment for completion and the number of care recipients who reported quality of life through each completion mode, scored against the category of moderate, poor and very poor.

You should also report on the number of care recipients excluded because they were absent from the service for the entire quarter or they chose not to complete the quality of life assessment for the entire quarter. Copies of the assessments including the user guides to support administration and scoring are available in the QI Program Manual Part A.

Joshua Maldon:

[Visual of slide with text saying ‘Reporting & quality improvement’]

Lovely. All right. Thanks Emma. And what we might do now is move on to the reporting and quality improvement piece.

Emma Cook:

Sure thing. I think I’m up for that as well. So what we’re doing here is a little bit of a sneak peek of some of the submission platforms and reporting platforms that you’ll be interacting with for these new quality indicators. So while we know that from 1 April you’ll be reporting the existing lot this will be from around mid-year when you’re reporting on these new measures that are the focus of today’s session.

So many providers will be familiar with quality indicator data submission process and interacting with the My Aged Care Provider Portal. And this will follow a really similar pattern but here we’re introducing the Government Provider Management System or GPMS which will be a new platform that you’ll be seeing increasingly and as it becomes released and gradually adds functionality or new applications you’ll be introduced to as it becomes useful to you.

So quality indicators will appear as a tile on GPMS and users with appropriate access that organisation administrators will need to assign will then be able to access that tile.

So here’s an example of the landing page. So you’ll be used to the landing page when you appear in My Aged Care and similarly once you login, go into quality indicators, you’ll see a list of services. There’s some important changes. There’s increased functionality that uses different colours and status symbols upfront to make it really easy for you to keep track of which services have been started, which services have been submitted and which ones are requiring your attention. There’s also search fields and functions that will allow you to more quickly search for the service that you’re looking for in order to support your quick data submission.

Jumping through to the next slide once you’ve selected on a service that you’re looking for you’ll see along the left hand side there will be – and this isn’t final I should say this is current state of working and there’s likely to be further refinements. But there will be each quality indicator and you’ll have a really helpful checklist that will show again how you’re progressing through your data submission for that quarter. When you go to enter the data into the fields you can see there, for each quality indicator, there will be enhanced validations that will allow you to understand where an error may have occurred quite quickly in the data process. So something may show up if for instance you enter more care recipients having pressure injuries than what you have at your service. We’ll automatically flag that and say it looks like you made an error. Maybe you accidentally typed an extra zero at the end of a figure. And that will automatically flag that that needs your attention to help you submit data once, submit it accurately and to be able to use this information to support improvement. If you experience that validation issue we’ll also give you help text to prompt you to what the likely cause is and how you can fix it.

So this will be a really important piece of enhancement, will help you to submit more seamlessly and we’ll start to look at bringing in bulk data submissions as well that will help providers to do more than one service’s data submission in a single step process. So what we’re highlighting is that we’re mindful of the additional reporting and that we’re really seeking to create efficiencies and to help you to do it once, to do it as quickly as possible and to make this process as seamless as can be.

I should highlight again data submission. In order to submit data you need to submit all quality indicators and they all must be complete and then submitted within the 21 day period. That’s important because if a single QI is skipped you won’t be able to submit the set. So quite an important thing to highlight.

Now through to the next slide you’ll see again just an example but in addition to the submission processes that we’re really seeking to enhance and to help providers in the data submission process we’re also helping providers to use the data to support improvement. We’re developing further enhanced reports that will allow you to look at an individualised service report card, look at comparative data. It may be from national statistics, it may be from services of similar demographic or offering to your own, or it may be to look at your own performance across services within your organisation over time to really engage in implementing interventions, assessing the impact of those and hopefully then rolling them out further and continuing that continuous quality improvement cycle.

In addition to this, and as has always been the case, we’ll continue to publish quality indicator data on the AIHW’s website, the Australian Institute of Health and Welfare GEN Aged Care data website. Now this is at a national, state and territory level and that will be the case for these new quality indicators. There’s currently no commitment to publish at a service level or as part of Star Ratings. And that’s a really important point is that while your current QIs are published in star ratings the new quality indicators are not currently planned for publishing through Star Ratings. And so we really do want you to engage in data submission, using the data to improve and to understand how we can deliver the best possible quality of care to older Australians. And to Josh’s earlier point, there’s not an expectation of zero tolerance. But really just know that that’s the intent. We will have those national statistics that you can see in your reports and in those individualised reports available on the AIHW’s website at a national, state and territory level only at this stage.

And finally QI Program resources. So, many of you will know that on the Department of Health and Aged Care’s website there’s a huge number of resources available both for the current QI Program and current quality indicators and all the expanded quality indicators. So the key guidance material as we’ve been highlighting through this presentation are the QI Program Manual Part A. Now that’s the absolute prescriptive manual that stipulates all the requirements to adhere to the QI Program reporting. There are QI Program Manual Part B which is improvement focused and QI Program Manual Part C which is IT focused and has to be delivered closer to when we actually launch those portals and new IT builds that will allow you to submit data. But this is to reassure you that if you have QI Program Manual Part A that’s what you need. You need QI Program Manual Part A to collect data and to submit data as you’re required to do from 1 April.

We’ve got data recording templates, quick reference guides, frequently asked questions, information modules and a range of other materials that I’d encourage you to go and explore to help you to familiarise yourself and staff working at your service with the quality indicators.

All right. So that’s I guess where we’re currently up to. Improvement, reporting, the sneak peek of where we’re heading with the IT and all of the resources that are available to you at the moment on the Department of Health and Aged Care website or using the QR code on your screen. In terms of next steps I might pass over to Josh.

Joshua Maldon:

[Visual of slide with text saying ‘Next steps’]

Thanks Emma. So the next steps are we’re going to be launching the new quality indicators from the 1st of April. So the data submission will follow that same cadence that we follow now. So at the end of the quarter for the three weeks, so in this case July, from the 1st to the 21st, that’s when your data submission will be required for the new quality indicators as well as the existing suite.

So as Emma said we’ll continue to support quality improvement through delivering tailored resources. They’ll be available on our website and also in conjunction with our colleagues such as Michael over at the Commission. Those resources are really intended to help services understand their quality indicator data and undertake those quality improvement activities to improve performance.

In terms of quality indicators for in-home aged care this is currently on ice but we are set to continue this as we gain greater clarity on the enduring system design in the home care space. So further details will be publicly communicated when those are available.

[Visual of slide with text saying ‘Mythbusting’]

So before we move into questions and answers we wanted to do a bit of a myth busting session. This is based on feedback that we’ve had, conversations with the sector, some of the questions that we’re asked, and so we thought to potentially filter out some of the key questions and answers that we’ve received previously this is a good way of addressing it.

So we might jump to the first one which is myth number one, that providers will need to pay licencing fees to use the new assessment tool. Emma.

Emma Cook:

No is the short of it. So the Department has sorted those out for you to ensure that you get, as I said, the benefit of contemporary evidence-based and best practice based materials. So the manual includes all the required assessment tools for providers to use. The Department has licenced these tools for non-commercial use by approved providers of residential aged care in order to comply with QI Program reporting. The copyright notice in the QI Program Manual sets out the permitted uses of the sublicence. So no payment is required.

Joshua Maldon:

Cool. Thanks Emma. We might jump through to the next one. So myth number two there. So data will need to be collected for the activities of daily living or ADLs quality indicator prior to the 1st of April 2023. And again I might jump to you Emma.

Emma Cook:

So again no is the short answer. So I should say that where a service already has this information and certainly since Government announced and the Minister announced the new quality indicators from September we’ve been encouraging providers to adopt these tools and to start to look at bringing these into practice. So certainly if a service has ADL data that they can use as the comparative data point to complete QI Program reporting then we’d encourage you to use that. However, if services don’t have that comparative data from before April then the care recipients meet an exclusion criteria, so you can report similar to unplanned weight loss quality indicators at the moment where if somebody’s not there for the comparative weight you note them down as a number and then you put in the comments the reason. So you would follow the same pattern here where you would include that person in the number and then you would note down the number of people that didn’t have a comparative ADL assessment.

Of course by next quarter we’d expect that absolutely, unless somebody’s new, pretty well everyone’s going to have that comparative ADL assessment. But that’s how you would deal with reporting requirements in this quarter.

Joshua Maldon:

Cool. Thank you Emma. So we might jump to myth number three there which is the consumer experience assessment tool or QCE will replace the annual resident experience survey. So the resident experience survey is also something that’s managed within the Choice and Transparency Branch. And, no in a nutshell. Quarterly reporting of consumer experience using the QCE for the purposes of the QI Program won’t replace the independent workforce undertaking those annual resident experience surveys. So the QCE tools need to be offered to care recipients and collected quarterly by providers to provide you with regular feedback to support quality improvement.

We will continue with the resident experience survey annually with an independent workforce. We might look at changing the assessment questions over time. So we think that this could shift to using the questions from both the QCE and the QOL-ACC but this is something that would be in a future state and would need consideration by Government before we move to that.

All right. Myth four. The new quality indicators will contribute to Star Ratings. Emma.

Emma Cook:

So I guess as I touched on, no is the short of this one as well. The new quality indicators will not contribute to the Overall Star Ratings or to the Quality Measures Rating. So those will continue to use only the first five quality indicators; pressure injuries, physical restraint, unplanned weight loss, falls and major injury and medication management. And for the time being there’s no planned date that the new quality indicators will contribute to Star Ratings. The focus is absolutely on submitting accurate data, using it to support improvement and the information will be published only at a state, national and territory level on the AIHW GEN Aged Care data website.

Joshua Maldon:

Cool. Thank you Emma. Myth five, workforce data will only need to be reported from the July to September reporting quarter. I can speak to that one. So providers must collect and report workforce data from the 1st of April 2023. So the data collection for the workforce quality indicator requires the number of staff employed in the designated roles, meaning they worked 120 hours or more in the previous quarter. All staff are included, so irrespective of the type of employment, so including casual, contractors and agency staff. So worked hours are collected and reported by providers as part of the Quarterly Financial Reports. If time recording functions aren’t available in accounting systems services should use service level rostering records instead.

The QFR frequently asked questions, which are available on the Department’s website, they provide guidance on the reporting requirements under the QFR and that includes recording internal, contracted and agency staff hours. So the agency or contractor staff, we encourage you to speak to your provider to ask for invoices that provides that information, so the staff, the roles, the hours worked etcetera.

Next myth. All right. Quality indicator data is not monitored. Michael I think you could definitely pick this up from the Commission’s perspective.

Michael Gurney:

Thanks Josh and Emma. Look I’ll give two answers to that. They should be monitored and they will be monitored. Certainly if we think about Star Ratings and quality indicators they are good programs in a sense. So from a provider perspective the Quality Indicator Program plays a really big part for providers ensuring that their systems are in place to collect the data that supports their operations for effective quality management and clinical governance within the system. We think regular monitoring of these data should inform providers about continuous improvements at their services and promote the health and wellbeing of individual residents.

From the Commission’s point of view, quality indicator information gives the Commission valuable regulatory intelligence and data to enable the Commission to more effectively detect, analyse and respond to risks to consumers. Intelligence and data informs the Commission’s risk profiling of providers and the prioritisation and the scope of our monitoring activities such as assessments against the Aged Care Quality Standards. It also supports the development of sector education, campaigns and targeted regulatory approaches of particular issues.

Happy to go into a little bit more detail if we wanted. The Commission routinely use indicator data and risk profiling to inform our decisions for which services to prioritise for monitoring against the Quality Standards. Our regulatory officials also consider quality indicator results when assessing risk, in particular complaints, incidents or non-compliance. I’ll give you an example of that one. We look at quality indicator data for information on issues like pressure injuries or unplanned weight loss and unexplained physical restraint when complaints or an incident comes up to get some plausibility and to understand a provider’s general performance.

And probably the key point there is if there’s any disconnect or insight that doesn’t mean there’s a non-compliance. It just informs upon how we approach our regulatory activities. We certainly are increasingly using quality indicators to inform analysis of sector performance and identify issues and opportunities for education and improvement. An example of that is our food and nutrition and dining campaign. The QI data along with financial data, resident experience and other Commission intelligence is currently being used to inform how we target those programs. The QI data directly helps us to detect and address risk in the delivery of food and nutrition and dining services.

Just a couple more points. The QIs also form a critical part of developing a view of the sector performance over time. This allows the Department, in particular, and the Commission and providers to really consider what improvements in performance might look like and how those improvements can be achieved to benefit older people in residential services. And the indicators themselves, the new indicators, I think they’re really going to help because they will give us more indications about delivery of care which is what we’re here for. We will continue to work with the Department to identify any potential issues with reporting and including providing advice to services about how to report the data correctly if they come through to us.

Key point is where there is evidence of ongoing non-compliance with the obligations the Commission can consider regulatory actions under its compliance and enforcement policy. Ultimately could be things like issuing a notice of non-compliance but we will consider those as a proportionate regulator with other information.

Joshua Maldon:

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

Thanks Michael. All right. Lovely. So we might jump into the question and answer session. So again thanks Michael for joining us from the Commission’s perspective to pick up any of those questions. Emma we’ve also got who will speak to any of the technical specifications.

So just looking at the questions now I can see they’ve jumped straight into detail which is good.

Q:        If the care recipient did not have incontinence do they still need to be assessed for IAD?

Emma?

Emma Cook:

No. So as I will have touched on in outlining the quality indicator for incontinence care. For the purposes of the QI Program care recipients who do not have incontinence are excluded from IAD assessment but are reported. So you’ll still have to say the number of care recipients or residents at your service who do not have incontinence but you don’t need to assess those people because you may not be doing so as part of routine care obviously. So no is the short answer.

Joshua Maldon:

Cool. All right. Lovely.

Q:        Do all residential aged care services have to participate in the QI Program?

Emma?

Emma Cook:

So the same as how the QI Program currently runs in that the QI Program is mandatory for all Commonwealth subsidised residential aged care providers including residential respite services. But in terms of the services that are excluded from the QI Program reporting this is outlined in our FAQs and I believe includes flexible care including transition care, short term restorative care program, MPS services and NATSIFAC services.

Joshua Maldon:

Lovely. All right. Thank you Emma. And again people are asking:

Q:        Are there templates to support the recording of data for each quality indicator?

Emma Cook:

Yeah there are. So again I’d encourage you to have a look at the newly updated QI Program materials which of course include updated recording data templates to include the new quality indicators. These are really useful guides and can be used to help you to collate the data in that if you put in the data for each care recipient it will collate the overall numbers that you need to report for your residential aged care service. There’s also helpful instructions in another accompanying kind of guidance.

Joshua Maldon:

Cool. All right. There’s one I can probably answer around home care.

Q:        Are QIs planned for home care?

This is something we spoke about earlier actually and we said that it’s on ice effectively. So as you’ll recall we did do a piece where we went out and we did do some research, we did some consultation, we did some analysis and look at what would be feasible in home care from a quality indicator perspective. But at this particular stage because the home care program design is in a state of flux what we’ll be doing is revisiting that piece in the context of a new design for home subject to Government decisions. My answer to people if they ask if it will happen, I suspect yes because we are trying to design an end to end aged care system but there’s some work that we’ve got to do first.

So the next question is probably for you Michael.

Q:        Who does the sector send enquiries to about the program?

Michael Gurney:

Yes. Sure. Interpretations of the indicators for reporting purposes will be handled by the Commission from next week with support from the Department. We have an email address. It’s QIProgram@agedcarequality.gov.au and the team there will be able to get you on the right track for reporting.

Joshua Maldon:

Cool. Thank you Michael. We’ve got another incontinence question.

Q:        If the care recipient did not have incontinence do they still need to be assessed?

I already answered that. Sorry guys. Who’s working with this list? It’s me. We have one around hospitalisation quality indicators which I’ll jump to next.

Q:        Are planned presentations to the emergency department reported as part of the hospitalisation quality indicator?

So Emma are you happy to take that one?

Emma Cook:

Yeah. And the answer is yes. So for the purposes of the QI Program emergency department presentation occurs when a care recipient presents to an emergency department or urgent care centre, and whether this is planned or unplanned, then that is counted.

Joshua Maldon:

So just looking at the hospital ones again Emma.

Q:        Are GP referrals to the emergency department reported?

Emma Cook:

Yeah. And again if a care recipient is attending the emergency department it’s counted as hospitalisation and whether that was planned, unplanned, a GP referral or the platform that that’s done through, it is counted under reporting for the hospitalisation quality indicator.

Joshua Maldon:

Cool. All right.

Q:        If a care recipient is unable to complete the QCE-ACC or QOL-ACC assessment due to cognitive impairment are they excluded?

I can pick that up. So look no, in a nutshell. So an appropriate version of the tool should be offered to each care recipient for completion around the same time every quarter, something we talked about before. And providers should support care recipients with cognitive impairment to access the most appropriate version of the assessment. They include the interview facilitated or of course a proxy completion version. Again there’s further detail around that in the Quality Indicator Program Manual.

All right. We’ve had a question come in around the workforce QI. I’ll probably hand it to you Emma.

Q:        How do providers report for employees that are employed across two positions in a single service?

Emma Cook:

So the criteria for the quality indicators are outlined in terms of what constitutes the specified roles or what are the key roles you’re reporting against, what employee is defined as based on that 120 hour criteria and then what stopping work is counted as with the 60 day space.

So if a person is working across two roles and employed in those two roles then you would report them against those two roles. And whether that was at a single service or across sites you would report based on the criteria that’s set out in the Manual.

Joshua Maldon:

All right. Lovely. Thanks Emma. And I think the next question is going to be for you Michael. So it’s around:

Q:        What is the penalty for services that don’t submit all their QI data?

Michael Gurney:

Look apart from the exceptions mentioned by the Department for the first quarter of the new indicators, submission of QI data is mandatory. And the Commission is always a proportionate risk-led regulator that will take into the fact non-submission. But we are getting increasingly active with providers about non-submission under some of their other obligations. For example, we’ve recently for non-submission with the Quarterly Financial Report we’ve issued a number of non‑compliance notices. But it has to be I think sustained non-compliance. If I think that there’s technical reasons why it doesn’t get submitted the Commission will take that into account into considering any regulatory response. So it’s hard to say black and white. I mean case by case basis.

Joshua Maldon:

Thank you Michael. I just want to say thanks for all the questions that are coming in. We’ve got a lot flowing through. We’re clearly not going to get to them all with time starting to run against us. So I might float two remaining ones. One was around whether respite residents are included in the collection of all quality indicators. So that’s something that I can certainly pick up.

So all care recipients receiving residential aged care, including respite, need to be included in the QI Program data collection. So they were residing at the service during the selected assessment period and provided they also don’t meet the exclusion criteria. So again, in respite you have to offer those QCE-ACC and also QOL-ACC tools.

Another question on the QCE and QOL-ACC tools is:

Q:        When should we use different versions of the tools?

This will be our final question. Emma I might throw it to you.

Emma Cook:

Yeah. So again there’s a lot of guidance in the QI Program Manual Part A and in the back section that contains the tools themselves. Lots of scripting which is really useful to familiarise yourself with the tools, what the questions are seeking to ask and how to select the most appropriate. So while I’ll cover it off here I certainly encourage you if there’s any other questions to have a look at the really detailed guidance material contained. The way that I think of it really is that there’s the self-completion version. Now this is ideal and if it can be offered it should. It’s largely suitable for people with no or mild cognitive impairment and services are really encouraged to facilitate anonymous completion of this by people independently.

Now then there’s the interviewer facilitated version. This can be offered – I often think of it as being offered to people who require largely physical assistance. So it might be that they can’t hold the pen, they can’t see, they just need a little bit of support to get their views and to pen that down onto the survey itself. And there’s scripting that’s provided in the Manual. So I see that largely as the interviewer facilitated or assisted version where somebody couldn’t be left to complete it themselves but they’re pretty comfortable in hearing and responding to the questions that you’re asking. And that doesn’t have to be done with the support of a staff member. It can be used by a staff member but it may also be used by an informal carer or other people at the service to support gaining really honest and open feedback.

And then there’s the proxy completion version and this can be offered to care recipients with moderate or with severe cognitive impairment who are unable to complete the assessment independently. And so that’s the point when you would refer to the proxy completion tool that’s also contained in the Manual.

Joshua Maldon:

Cool. Lovely. Look thank you so much Emma. Just conscious of time and that you all have other commitments. So again just want to remind you to check out the website, the suite of QI Program resources. As well as this webinar, we’ll also get the slide deck up in the next couple of weeks. We’ll also put out some frequently asked questions around common questions that were asked today. I do want to note there was a fair few questions that we didn’t get through. We have captured those and we will look to respond to those. So I want to say thank you for how much you’ve contributed to the session through asking those. And again please don’t hesitate to reach out to the Department or the Provider and Assessor Helpline with further questions.

So again a big thank you to you all for making the time to connect with us here today and thanks Emma and thanks Michael.

Emma Cook:

Thanks everyone.

Joshua Maldon:

See you later.

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