Evidence-based Care in Aged Care 

The recent publication of a research study by the Australian Institute of Health Innovation highlighted some major areas of concern in the aged care sector. The study focused on the level of adherence to evidence-based care in aged care across 14 different care areas.

What is evidence-based care?

Evidence-based care (or evidence-based practice) involves integrating up-to-date, best practice research with clinical knowledge and experience, and the preferences of the older person. As research and knowledge about a specific clinical care area evolves, an organisation should be reviewing their own processes to ensure that they’re still delivering care that best addresses the needs of older people. Organisations should also ensure that they have effective processes to integrate new or revised evidence into the way they deliver services.

Some factors that may contribute to a person not receiving evidence-based care include: 

  • When an organisation doesn’t regularly check for the latest developments in clinical care areas; 
  • Using outdated, not well supported, or contraindicated evidence as a basis for care;  
  • Failing to adapt care practices to the needs of each older person based on their preferences; and  
  • Failing to implement practices that are based on the latest available evidence. 

Evidence-based care in standards

The requirement to deliver evidence-based care is included in both the National Safety and Quality Health Service Standards (NSQHS) and the strengthened Aged Care Quality Standards (ACQS). Findings of the Aged Care Royal Commission recommended that:

The aged care system should adopt evidence-based and continuous improvement strategies to allow for transparent measurement and reporting of the quality of care being delivered to older people.

Evidence-based (or “evidence-informed”) practice is also a quality indicator of a number of the NDIS Practice Standards, such as those for: 

  • Quality Management; 
  • Responsive Support Provision; and 
  • Behaviour Support.

The Findings of the Research Study

The findings demonstrate that, while some areas of care have relatively high levels of adherence to an evidence-based approach to care, there are also areas that are shockingly low.

On average, the adherence rate across all indicators studied was just over half (53.2%), with a high of 81.3% for continence care, and a low of 12.2% for mental health/depression related care.

Data from Australian Institute of Health Innovation (2024)

Some of these findings match recent results of the Residential Aged Care Quality Indicators from July-September 2023.

Some improvement opportunities

One area of concern is the low adherence to evidence-based practices in medication management, given the high prevalence of polypharmacy in aged care residents, with over a third of aged care residents prescribed nine or more medications.

Another area for improvement is in falls management, where the current ‘best practice’ guidelines date back to 2009. Despite a relatively higher adherence rate to evidence-based care, the trend in falls has remained steady over the past few years, with nearly a third of aged care residents experiencing a fall each quarter during that period. The steady trend reflects the need for continued work to improve knowledge and understanding of clinical care areas in order to aid improvement. New research has informed draft Updated Fall Prevention Guidelines for Residential Aged Care Services, which are currently in a consultation phase. Looking forward,  hopefully the updated guidelines will drive an improvement in fall prevention when they are released, and provide a useful resource for organisations to review their falls management processes and procedures.

A statistically significant area in the recent Quality Indicators that supports the importance of evidence-based care is in continence care. Of the aged care residents who were assessed, 78% were recorded with incontinence, however, only 4% of residents were recorded as having incontinence-associated dermatitis. This indicates that the high level of adherence to evidence-based care in this area is resulting in better outcomes for older people, drastically reducing their likelihood of experiencing incontinence-related issues.

Where to for providers?

This is an opportunity for providers to reflect on their own approach to evidence-based care and practices, especially in the areas of low adherence identified in the research study. In addition, Outcome 5.5 (Clinical Safety) of the Strengthened Aged Care Quality Standards goes into greater detail about many of these areas of care. More specific requirements surrounding specific clinical care areas should act as a tool to guide organisations in providing the level of care older people require.

The Australian Commission on Safety and Quality in Healthcare has some guidance for supporting evidence-based practice, while the NDIS Quality and Safeguards Commission has released their Evidence-Informed Practice Guide, which is a helpful resource to help you consider improvements to processes and procedures.  

BNG and improving care

For further assistance, we have up-to-date policies for many of the areas of care evaluated in the research study, including: 

  • Policy: Promoting Emotional Wellbeing in Aged Care 
  • Policy: Oral Health 
  • Policy: Nutrition, Meals and Hydration
  • Policy: Continence Management
  • Policy: Falls Prevention
  • Policy: Pain Management 
  • Policy: Pressure Injuries
  • Policy: Clinical Deterioration 
  • Policy: End of Life Care and Palliative Care 

In addition, we have information sheets for some topics that provide more in-depth information in areas such as: 

  • Emotional Wellbeing in Aged Care 
  • Nutrition, Meals and Hydration 

Need a refresh on clinical care areas?

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DRC: Supported Decision-Making

Continuing our blog post series on the Disability Royal Commission’s Final Report, today we look at supported decision-making. This topic is a strong focus of Volume 6: Enabling autonomy and access, and reflects findings from several Public Hearings including Public Hearing 30 and Public Hearing 32. The recommendations target a move away from substitute decision-making in favour of supporting participants to make their own decisions wherever possible, increasing participant autonomy. 

The recommendations centre around legislative protections for supported decision-making, particularly advocating for the following supported decision-making principles in Recommendation 6.6: 

  • Principle 1 – Recognition of the equal right to make decisions  
  • Principle 2 – Presumption of decision-making ability 
  • Principle 3 – Respect for dignity and dignity of risk 
  • Principle 4 – Recognition of informal supporters and advocates 
  • Principle 5 – Access to support  
  • Principle 6 – Decisions directed by will and preferences 
  • Principle 7 – Inclusion of safeguards 
  • Principle 8 – Co-designed processes 
  • Principle 9 – Recognition of diversity 
  • Principle 10 – Cultural safety 

While the principles in their entirety haven’t yet been codified or integrated into the Practice Standards, they do act as guidance for best practice decision-making processes for providers. At present, there is some inconsistency between jurisdictions regarding the protections and approach to decision-making rights and capability. Some jurisdictions already have aspects of these principles in their existing legislation, whereas others do not.  

Implementation of the Recommendations of the DRC would therefore mean people with disability would maintain the same rights when it comes to making their own decisions regardless of where they live in Australia.  

Principle 1 - Recognition of the equal right to make decisions

The first principle affirms that every person has an equal right to make decisions. People living with disability should not be excluded from making decisions about their lives. Recognising this principle is central to the concept of supported decision-making, as it places the person at the centre of their own care, with support to exercise their right to make decisions, rather than others making decisions for them. 

Principle 2 – Presumption of decision-making ability

This principle sets out a base line assumption that everyone is capable of making their own decisions. A person should never be treated as if they’re incapable of making decisions – an inability to make a decision on one topic or area does not exclude a person from making other decisions. Having a disability cannot be the sole justification for determining that someone does not have decision-making ability. Instead, that assessment should be made based on the specific and unique circumstances of the decision being made and the person’s understanding of that decision and its consequences. A person’s disability should only be relevant in assessments where that disability impacts their ability to make or carry out decisions, and should never be an automatic exclusionary factor.  

Recommendation 6.7 focuses further on decision-making ability, endorsing legislative changes that change how capacity (or capability) assessments are undertaken, with the starting point for these assessments being an assumption that a person is capable, moving the burden of proof to those seeking to prove incapability, rather than the added burden on people with disability to prove that they are capable.  

Principle 3 – Respect for dignity and dignity of risk

A major part of the ability to make decisions is the right to make decisions that involve some level of risk. Where a person with disability understands the potential risks involved in making a decision, but elects to make that decision anyway, they should be able to make that choice in the same way any other person is allowed to. Supported decision-making processes should help people with disability to understand the potential risks involved in their decisions, and advise, but should not actively discourage particular choices simply because there may be a level of risk to the participant.  

Principle 4 – Recognition of informal supporters and advocates

This principle highlights the important role of informal supporters, advocates and the support network for people living with disability. In addition to formally recognised roles, where a person or group may be legally recognised as a supporter, others involved in a person’s life or care may also participate in the supported decision-making process.  

Principle 4 advocates that people in these categories should be acknowledged and respected. Strong informal support relationships may help avoid reliance on more complex formal supported decision-making arrangements, and avoid substituted decision-making. The involvement of people whom a participant knows and trusts may make it easier to convey support in a more tailored manner, and more effectively achieve positive outcomes. 

Principle 5 – Access to support

Whose responsibility is it to provide information to people requiring support? Recommendation 6.13 is that public advocates and public guardians should provide “information, education and training on supported decision-making to people requiring supported decision-making and their families, private supporters and representatives (present or prospective), disability service providers, public agencies, the judiciary, tribunal members and legal representatives”.  

The wide scope of this recommendation both highlights access to information as an integral aspect of decision-making, and indicates supported decision-making as best practice even outside support services.  

For providers, information and education may include accessibility aids such as Easy English or interpreted resources to help participants understand their rights, the decision-making process, and potential outcomes from each decision. These types of aids may also be useful additions for other areas of focus in the principles, particularly Principles 9 and 10 which focus on diversity and cultural safety. 

Principle 6 – Decisions directed by will and preferences

The DRC report asserts that “a principled approach to supported decision-making requires a person’s stated or perceived ‘will and preferences’ to be at the centre of decision-making“.  

This principle directs that, just as those without a disability are not required to rationalise their decisions or prove that their choice is in their best interests, people with disability should have the same rights to make decisions about their own life, even where the decision may not be the ‘best’ option.  

It’s important to understand that the will and preferences of an individual are those expressed or indicated by that individual, and this is not the same thing as an organisation’s view of what is in the ‘best interests’ of that person.  The ‘best interests’ approach should not be used, as it can override the choice of a participant, and take away their autonomy and right to dignity of risk.  

For situations where a participant may be unable to express their will or preferences, for example where they are medically incapable, non-verbal, or there is limited access to communication aids, processes should be in place to refer to what they want or would want, for example using care plans to record their choices in advance, using a care record to determine a pattern of choices they’ve made in previous situations, and their feedback about their care in those situations, or involving trusted support persons who can provide insight into what they would want.  

Principle 7 – Inclusion of safeguards

People living with disability may be at greater risk of abuse or undue influence when making decisions. Principle 7 highlights the importance of safeguards in supported decision-making processes, in recognition of the potential imbalance of power between participants and their supporters/representatives.  

Recommendations connected to the inclusion of safeguards include: 

  • Recommendation 6.9, which recommends decision-making representatives as a last resort and strict guidelines on represented decisions to protect the autonomy of participants, and  
  • Recommendations 6.35 and 6.36, concerning the elimination of restrictive practices, including as a method of coercion or to influence the behaviour of a person with disability.  

Principle 8 – Co-designed processes

Processes for supported decision-making should be designed with the input of various stakeholders who will be able to provide insight into their requirements for supported decision-making policies and procedures. That way, people with disability have the opportunity to share their lived experience, and how different approaches may impact their lives.  

Principle 8 specifically highlights the involvement of people with cognitive disability, their supporters and representative organisations in co-design, however best practice could also include the involvement of staff, and ensuring the group of people consulted reflects the diversity of the organisation and recipients of care. On an individual level, participants should also be given the opportunity to co-design their own experience with decision-making. 

Co-designing these systems should also be a continuous process. As the demographics of your organisation change, so too do the needs of participants.  So, feedback, complaints and consultation processes become a vital part of identifying areas of improvement, to ensure that the organisation’s supported decision-making processes still meet the needs of participants.

Principle 9 – Recognition of diversity

Principle 9 focuses on ensuring the diverse experiences, identities and needs of people with disability are considered and recognised. It is connected to Principle 10 (Cultural safety), but focuses more on the individual’s specific background, and how their varying needs and experiences intersect with one another.  

The principle recognises differing approaches may be necessary for different participants. Therefore, a flexible and adaptable approach to decision-making should be adopted for organisations to best respond to the diverse needs of their participants.  

Organisations should consider how they can tailor their existing processes to meet the different needs of each individual with disability.  For example, by giving participants with cognitive disability more time to make decisions so they can consider them in another environment, or access support to understand their decision options. Recommendations 6.1, 6.2 and 6.3 all connect to this principle, regarding the need for increased accessibility in information, resources and communication, particularly relating to Auslan interpreters, and access to interpreters more generally.  

Also included in this principle are mental health and trauma-informed care considerations, recognising that people with disability who are affected by mental health or have experienced trauma may require different support.  

Principle 10 – Cultural safety

Principle 10 places focus on First Nations people and culturally and linguistically diverse people with disability. In addition to addressing the diversity requirements of Principle 9, organisations should also evaluate the cultural safety and suitability of the service environment.  

Public Hearing 30 raised questions about the ways in which a person’s culture may impact their decision-making ability, and also how culture can act as a support in the decision-making process. Organisations should ensure that their supported decision-making processes and service environment are culturally safe, and sensitive to the cultural needs of each participant, maintaining connections to culture and community.  

One way for organisations to improve their cultural safety is by collaborating and connecting with local cultural organisations. Having an established network may support organisations by providing advice on culturally appropriate supported decision-making strategies, as well as providing access to people within a person’s cultural community who may act as informal supporters for that person when making decisions. 

Where to next?

Most of the reforms in the DRC recommendations are targeted at government level rather than provider level, but they do also indicate the direction of best practice for providers and possible next steps for reform.  

Current reform work in the Aged Care sector also has supported decision-making as a focus, reflecting a broad cross-sector scope and changing attitudes to decision-making. Recommendation 10.6 would codify supported decision-making in the National Disability Insurance Scheme (Quality Indicators for NDIS Practice Standards) Guidelines 2018 (Cth), codifying specific actions for providers.  

To aid providers in actioning their supported decision-making requirements, Recommendation 10.7 endorses a co-designed practice guide on supported decision-making for service providers that is consistent with the decision-making principles.  

Supported Decision-Making and SPP

In line with the increased focus on supported decision-making in both the DRC recommendations and the Aged Care sector, we’ve recently updated and expanded on our supported decision-making resources, including: 

  • Info: Supported Decision-Making (Easy English) 
  • Policy: Supported Decision-Making and Dignity of Risk 
  • Policy: Supported Decision-Making and Dignity of Risk (NDIS) 

Our Easy English resource in particular may be useful for providers to improve their communication around supported decision-making, particularly for providing information to those with increased communication barriers. 

Catch up on our previous DRC blog post entries:

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Preparing for new Aged Care Provider Governance requirements

On December 1, 2023, further changes to the Aged Care Act regarding provider governance will come into effect. The changes aim to strengthen the governance and leadership of aged care providers, while increasing the levels of accountability and transparency of aged care governing bodies. The culture and values of a provider are set at the top levels of the organisation, meaning that an effective and strong governance system is integral to the success of the organisation in practice.  

 Broadly speaking, the new requirements align with: 

  • Standards 6, 7, & 8 of the Aged Care Quality Standards; and, for those looking ahead,  
  • Standards 2 & 5 of the Strengthened Aged Care Quality Standards Pilot Draft.

Who has to comply?

Approved providers of residential, home and flexible aged care services must comply with the provider governance requirements, including providers involved in short-term, multi-purpose and transition care. Providers who became approved on or after 1 December 2022 will already be subject to these requirements, and any provider approved prior to this date must ensure compliance from 1 December 2023 

Providers operating under grant agreements such as the Commonwealth Home Support Programme (CHSP) or National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NATSIFACP) are not required to comply with the provider governance changes. However, they should consider whether aspects of these requirements could be implemented in their organisation as best practice governance.  

What are some of the key requirements?

Who’s on the governing body?

There are new requirements about the skills and qualifications of governing body members, designed to ensure that governing bodies have a strong mix of experience and expertise to drive the right culture and governance systems across the whole organisation. The key requirements are: 

  • The right mix of skills, experience and expertise: Providers should appoint board members who can challenge and analyse how the organisation operates, hold management to account, and who have skills and experience that are relevant to the services their organisation provides.  
  • Experience in clinical care: At least one member of the governing body must now have experience in providing clinical care, in order to provide insights and perspectives of their experience. The input they provide will be important guidance in making decisions about the clinical care operations of the organisation. The type of clinical experience required is not specified, as it will differ amongst providers, but it should be relevant to the care and services provided.  For example, if a large proportion of the clinical care provided to older people involves physiotherapy, it would be good practice to have a person with physiotherapy experience as a Board member.
  • Majority of independent non-executives: A majority of the governing body members must now be independent non-executive members. This change is designed to reduce conflicts of interest for those serving on boards, and ensure that decisions are made objectively and in the best interests of care recipients. There is no prescribed definition of “independent non-executive members”, so whether a person is independent or not will be a matter for each organisation to determine. Organisations should consider whether each candidate for Board membership is able to perform their duties independently, without the influence or conflict of any outside or personal interests. Some examples of people who would not be independent would include:
    • Paid staff members of the organisation; and
    • Owners of the organisation, including shareholders and employees of parent or holding companies.

Some providers don’t need to meet the governing body requirements

If a provider is one of the following, they are exempt from these requirements: 

  • Approved providers that are a state, territory or local government authority; 
  • Providers who have fewer than 5 members in their governing body and provide care to fewer than 40 care recipients; and 
  • Approved providers that are Aboriginal Community Controlled Organisations (ACCOs). 

If these circumstances change, the organisation will be required to comply, for example if they begin to provide services to 40 or more care recipients.  

Additionally, providers who cannot meet the governing body requirements may apply to the Commission for a determination, but this should only be attempted after exhausting all possible avenues for meeting the requirements, and is not designed to be a permanent exemption from compliance. In particular, providers in rural or remote areas might face greater difficulties in finding suitable members to serve on their governing bodies, although this is not an automatic justification for exemption. Organisations should use alternative attempts to facilitate compliance, such as online meeting software or networking with other providers in similar situations to find candidates, before making an application.  

Advisory body requirements

The new changes set out various requirements for advisory bodies, specifically a quality care advisory body and a consumer advisory body. Advisory bodies are groups that assist governing bodies by providing advice and information about specific issues. They are separate from the governing body and don’t have the responsibilities of a governing body. 

The quality care advisory body

This advisory body is designed to support the governing body with their decision-making and continuous improvement, by identifying and reporting on any issues of concern relating to the quality of the care provided by the organisation.  

The quality care advisory body must provide a written report to the governing body at least every 6 months, and can also provide feedback at any other time.  The report will be based on the quality care advisory body’s review of a range of performance indicators, including: 

  • Feedback and complaints about the quality of care; 
  • Any regulatory action taken, or performance reports provided, by the Commission; 
  • The organisation’s progress against its continuous improvement plan; 
  • Information about staffing arrangements; 
  • Any reportable incidents; and 
  • Feedback and details about the quality of food provided (for residential aged care providers). 

The governing body must provide a written response to feedback and reports from the quality care advisory body, in which it responds to the issues identified and sets our proposed actions to address those issues. 

Organisations don’t need to create a new body for this purpose if an existing body or group meets all the requirements and performs the same functions. Membership of the quality care advisory body must include:  

  • a member of the organisation’s key personnel (ideally not someone who is on the governing body) who has experience providing aged care;  
  • a staff member who is directly involved in providing aged care or clinical care services; and  
  • a member representing the interests of older people/care recipients (for example, a care recipient, family member, carer or representative).  

It is recommended that the chairperson of the quality care advisory body is independent, and not an executive of the organisation. 

The consumer advisory body

At least once every 12 months, organisations must make a written offer to older people to establish a consumer advisory body, and invite them to join it (or to join an existing consumer advisory body, if one or more already exist).  It is not mandatory to actually have a consumer advisory body, however it is mandatory to make the annual offer in writing to establish one. 

This body provides the governing body feedback, concerns and suggestions from the consumer perspective, highlighting areas of focus that the governing body may otherwise miss, and helping to incorporate the views and wishes of consumers into how services should be designed and improved . Issues, concerns and feedback a consumer advisory body provides must be considered by the governing body in their decision-making and continuous improvement processes, and a written report must be provided to the consumer advisory body explaining how their feedback has been considered. 

Additional provider governance changes

  • Governing bodies need to make sure their staff have appropriate skills, qualifications and experience to fulfil their roles when delivering aged care services, including providing staff withy professional and skill development opportunities; and  
  • Organisations that are a wholly-owned subsidiary of another body corporate (known as a holding company) which is not an approved provider must ensure their constitution requires company directors to act in the best interest of older people rather than prioritising the interests of their holding company. 

Commission resources

The Aged Care Quality and Safety Commission has created several fact sheets on provider governance changes: 

They have also published responses to common questions about the new governing body requirements, which could be a good place to start if you have further questions about how the governing body requirements and determination process work.  

BNG resources

We’ve created 5 new templates and revised some of our existing policy documents to help providers with their new governance requirements: 

  • Template: Consumer Advisory Body Terms of Reference 
  • Template: Invitation to join Consumer Advisory Body 
  • Template: Written response to Consumer Advisory Body Report 
  • Template: Quality Care Advisory Body Terms of Reference 
  • Template: Written response to Quality Care Report 
  • Policy: Provider Governance (Aged Care) 

These new resources join our existing package of provider governance resources that we released in late 2022, which includes: 

  • Policy: Key Personnel 
  • Template: Key Personnel Suitability Checklist 
  • Template: Key Personnel Declaration and Undertaking 
  • Template: Governing Body Requirements Checklist 

We also have a whole range of aged care self-assessment modules in SPP including for: 

  • The current Aged Care Quality Standards 
  • The Strengthened Aged Care Quality Standards Pilot Draft 
  • Clinical Governance 
  • The Aged Care Prudential Standards 
  • The Aged Care Code of Conduct 
  • Provider Governance Reforms 

Ensure you're ready for provider governance reform.

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Changes to nutrition in aged care are coming… are you ready?

The Royal Commission’s Recommendation

One of the major changes coming to Aged Care is the strengthening of the Aged Care Quality Standards based on the findings and recommendations of the Aged Care Royal Commission. A key area of focus of the Royal Commission was the nutrition, hydration and dining experience of residents in aged care.

The Royal Commission recommended:

imposing appropriate requirements to meet resident nutritional needs and ensure meals are desirable to eat, having regard to a person’s preferences and religious and cultural considerations. 

New requirements

Following the review of the Quality Standards, the Pilot Draft of the Revised Quality Standards now contains Standard 6: Food and Nutrition. This is a completely new standard, which will apply only to residential aged care services.

Standard 6’s expectation statement for older people is: 

I receive plenty of food and drinks that I enjoy. Food and drinks are nutritious, appetising and safe, and meet my needs and preferences. The dining experience is enjoyable, includes variety and supports a sense of belonging. 

Standard 6 notes that access to nutritionally adequate food is a fundamental human right, and draws attention to the fact that food, drink and the dining experience can greatly impact a person’s wellbeing. The Standard sets out a number of new concepts for aged care providers, including new or enhanced actions and requirements to: 

  • Partner with older people on how to create an enjoyable food drinks and dining experience;  
  • Monitor and continuously improve food services in accordance with the feedback of older people;  
  • Regularly assess the nutritional and dining needs of each older person;  
  • Review menus in partnership with both older people and health professionals;  
  • Promote choice about what, when, where and how older people eat and drink;  
  • Offer and enable access to snacks and drinks at all times;  
  • Ensure sufficient workers are available to assist in the dining experience;  
  • Ensure that the dining experience promotes belonging and enjoyment; and 
  • Offer older people the opportunity to share food and drinks with their visitors.  

New resources from the Commission

The Commission has recently released some new resources to help providers better understand the importance of choice in food and drink in aged care, as well as the dining experienceThe full list of the Commission’s resources includes information for providers, staff and consumers, and can be found here. Some of the key new resources are:

How SPP can help

To assist providers get up to speed with the new food and nutrition requirements that will be in Standard 6, we’ve recently summarised all necessary information into a helpful information sheet. We have also incorporated the new and enhanced actions and requirements of Standard 6 into our comprehensive policy document.  

  • Info: Nutrition, Meals and Hydration 
  • Policy: Nutrition, Meals and Hydration (Aged Care) 

Other resources for service providers

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Victorian social services framework- what’s changing? 

Currently, Victorian social service providers are required to comply with multiple different sets of regulations depending on the services they offer. Ensuring compliance with overlapping registration, reporting and regulatory requirements overburdens these organisations, in some cases requiring duplicate reporting or conflicting requirements between different frameworks.

In order to streamline the various social services frameworks, the Victorian Department of Families, Fairness and Housing recently released a Consultation Draft of the Social Services Regulations 2023. They are designed to provide a single cohesive regulatory framework for all registered social service providers in Victoria. The new framework aims to both increase efficiency of the social service system by simplifying registration and reporting requirements for providers, and improve the safety of Victorian consumers who engage with the social service system. 

When is the new Victorian social services framework coming into effect?

Following the conclusion of the consultation period on July 16 2023, the final version of the regulations is expected to be published in late 2023, with the scheme commencing on July 1 2024.

Who will it apply to?

There are approximately 700 providers operating in Victoria that will be covered by the scheme, including providers of: 

  • child protection services and secure welfare services delivered by the department; 
  • community-based child and family services,  
  • out of-home care services for children and young people;  
  • disability support services; 
  • family violence services, including services for perpetrators;  
  • sexual assault services; 
  • homelessness services; and 
  • supported residential services. 

What are the main features of the new framework?

As a comprehensive scheme, the framework will encompass multiple stages of regulatory compliance, from establishing the requirements for providers, to monitoring compliance. Some of the key features of the framework include: 

  • The Victorian Social Services Standards; 
  • The establishment and appointment of a new, independent Social Services Regulator; 
  • A Worker and Carer Exclusion Scheme; and 
  • Mandatory registration requirements for organisations providing services within the scope of the scheme.

A brief explanation of each of these features is below, however more in-depth information is also available on the Department’s website.

The Standards

The new Victorian Social Services Standards are the core requirements that registered service providers will need to comply with. The six Standards are: 

  1. Safe service delivery  
  2. Service user agency and dignity  
  3. Safe service environment 
  4. Feedback and complaints  
  5. Accountable organisational governance 
  6. Safe workforce 

The Standards are available to view on Page 56 of the Draft Social Services Regulations, for providers looking for more specific details on each requirement.  We’ve also summarised them in a document that you can access after you log in to SPP.  

The Regulator

The new Social Services Regulator replaces the existing Human Services Regulator and will be appointed in the second half of 2023. They will be granted monitoring and enforcement powers to aid their response to any risks of harm in service provision and will be actively involved in checking workers and carers’ suitability against the Exclusion Scheme. 

The Worker and Carer Exclusion Scheme

The Worker and Carer Exclusion Scheme will replace the Victorian Carer Register and act as a safeguard against risks of harm for service users.  Providers wishing to employ workers or carers will need to request the regulator to check each individual against the database to ensure that they do not pose a risk of harm before they are employed.  


Service organisations within the scope of the framework must be registered to confirm the suitability of the organisation itself and its key personnel to provide services to its users. Suitability matters include: 

  • Criminal history;  
  • A history of fraud;  
  • Findings of misconduct; 
  • Whether registration to provide a social service has been revoked, or has had any conditions/sanctions/restrictions placed on it; and  
  • Whether the person/business has been insolvent. 

Registration will also assess a provider’s arrangements, such as their governance structures, insurance and financial capacity, and determine whether the provider and its key personnel have sufficient qualifications, skills and experience to deliver safe and quality services to its users. 

SPP and the new Victorian Social Services Standards

To help you understand all of the requirements and intended outcomes of the new draft Social Services Standards, we’ve built a new self-assessment module in SPP. Of course, if there are any changes made to the final form of the Standards later this year, we will update our module for those changes. 

And for providers who have been using our existing self-assessment module to follow the current Human Services Standards, we have a mapped self-assessment in the new Standards, so that you can quickly compare the two sets of standards and identify any additional areas of work required.

Are you ready for the new Victorian Social Services Framework?

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Sexual harassment and discrimination… what you need to know

Several legislative changes have come into effect recently, resulting in new protections against workplace sexual harassment and discrimination. Both the Fair Work Act and Sex Discrimination Act have received updates 

The updates impose a duty on employers to take proactive and meaningful action towards the elimination of workplace sexual harassment and discrimination.

The Fair Work Act

The most important changes to the Fair Work Act include:  

  • Specific definitions of sexual harassment and the meaning of sexually harassed at work;  
  • Clarification of the meaning of a ‘worker’;  
  • Inclusion of sexual harassment as a valid reason for dismissal; and 
  • New powers of the Fair Work Commission to grant orders to stop sexual harassment. 

The Sex Discrimination Act

Some of the key changes that have been introduced to the Sex Discrimination Act include: 

  • Prohibition of conduct that results in a hostile workplace environment based on gender; and 
  • New investigatory and compliance powers of the Australian Human Rights Commission (commencing December 2023 to allow employers time to ensure compliance).  

These legislative updates require employers to take steps to prevent sexual harassment and discrimination in the workplace before it occurs, rather than responding to incidents when they occur. 

For more information about the new legislative changes, see this summary from the Fair Work Ombudsman.

How we can help

To help you stay across these changes, we have revised two of our resources relating to discrimination and workplace conduct to reflect the updated definitions and expanded processes relating to sexual harassment and gender-based discrimination in the workplace.

The two updated resources are:

  • Policy: Harassment and Bullying; and  
  • Policy: EEO, Equity and Diversity.

You can find the updated resources in our Reading Room under the ‘workplace relations‘ -> ‘human resources‘ subtopics. 

Ready to improve workplace protections?

Sign up to SPP to access resources to help your organisation’s workplace compliance.

What makes a good Quality Management system?

Managing and continuously improving quality is the core business of every service provider. Quality management is the action you take to make sure that you always provide the best possible service to your clients. It involves:

  • Evaluating your services to ensure they align with performance indicators contained in relevant standards;
  • Listening to clients, workers and other stakeholders, and valuing their feedback;
  • Understanding what is working well;
  • Identifying where improvements are needed; and
  • Taking action in order to best meet the needs of clients, workers and other stakeholders.

All major sets of Standards require organisations to have effective quality management and continuous improvement systems in place.

The quality improvement process

Quality improvement is not a singular action. It requires a cycle of continuous improvement, in which you are reviewing your systems, services and processes to evaluate whether you are providing the best possible service to each client. 

This cycle is commonly known as the ‘Plan/Do/Check/Act’ cycle and follows four key stages.


The planning stage involves evaluating the current state of your organisation and identifying where improvements can be made. In this phase, you should reflect on how you are delivering the services you are providing, your organisation’s compliance with relevant Standards, and feedback and complaints received to determine areas for improvement. Any incidents and near misses that have occurred should also inform your evaluation. The results of this evaluation should be used to plan ways that your service provision can improve, set goals and identify actions to put the plan into practice.


The next step of the quality improvement cycle is to action your planned changes. This could involve implementing improvements in stages, or testing variations of a planned change to determine the best solution in practice. Relevant stakeholders should be informed of the changes, and what that could mean for them. Adequate resources should be allocated for the purpose of executing the changes successfully, whether that involves extra funding, increased staffing, or more time. It is important that you document the decisions made during this stage, as this data will be used in the next stage of the process.


During the checking stage, you should be analysing both qualitative and quantitative results from the changes, to determine whether they are achieving the expected outcomes and resulting in better services. Feedback from stakeholders should be sought on their experiences with the changes, as well as any comments they have on further improvements. You should consider reflective questions during this stage to aid evaluation, such as:

  • Are the improvements delivering the outcomes as we intended?
  • What were the major gaps in our service delivery from our planning process, and have we addressed these gaps?
  • Are there any unforeseen outcomes from the changes?
  • Are there further improvements we can make, or can we make the process more efficient?


In this part of the cycle you should decide whether or not to implement the changes based on your evaluation. If the evaluation results demonstrate the changes were not successful, you should revert back to the planning stage to repeat the process and determine a new plan that is based on learnings from the unsuccessful trial.

If the results do show improvements meeting or exceeding your established goals, you should implement the changes and incorporate them into your regular service delivery. You should inform all stakeholders of the changes, including the differences between the old and new procedures, and ensure that all workers are trained in the new processes. Make sure you also update your policy and procedure documents where appropriate, to reflect the changes you’ve implemented.

Feedback, Complaints, Incidents and Near Misses

One of the most important ways you can gather information about the services you provide is through the information you receive from stakeholders, including workers, clients and their support people. Efficient and accessible feedback and complaints mechanisms ensure that those who are impacted can easily communicate their opinions and experiences with the service. In particular, if there is a lived experience disconnect between your clients and decision-makers in your organisation (for example services for children or young people), feedback is an important way to broaden perspectives in the quality management process.

In addition, encouraging clients to work in collaboration with your organisation to tailor services to their unique needs allows you to both provide the best possible service to your clients , as well as meet wider standards obligations. The requirements in many sets of standards include partnering with clients and providing culturally competent services for each individual. Meeting these standards requirements is part of consistently providing the best possible service to your clients and ensuring quality care.

So, what does a good quality management system look like?

An effective quality management system underpins your organisation’s approach to service delivery, and provides the framework for how you deliver quality and safe services for each individual.  Quality management should be incorporated as a core facet of the service and be explained clearly in your quality management policies and procedures, as well as policies on related areas.

Your quality management system should:

  • Be founded on core policies and procedures that are communicated and understood across your organisation, so that your approach and processes are transparent to everyone, set clear expectations and responsibilities for workers and the organisation, and are consistently followed;
  • Be supported by other, related policies and procedures covering areas such as:
    • risk management;
    • compliance monitoring;
    • complaints management; and
    • incident reporting
  • Be integrated with your Standards compliance status;
  • Allocate responsibilities to team members for identified improvements; and
  • Be easy to manage, and provide you with up-to-date reports on compliance, improvements identified and how you are tracking towards achieving them.

In conclusion, having a good quality management system is important for organisations to ensure they are providing the best possible services for their clients as well as fulfilling their standards obligations.

Improving your quality management system with SPP

SPP has a wide variety of information sheets and templates available to help you reach your quality management goals, from a template quality improvement register and quality improvement plan to a sample quality management and continuous quality improvement policy. We also have a “Towards Best Practice” self-assessment module on Continuous Improvement.

In addition, we have a range of resources on related topics like risk, complaints, and incidents support the delivery of quality service. 

Need QMS resources?

Take out an SPP trial to see our quality management resources and more!

Cultural diversity and cultural competence in service delivery

The Australian population is incredibly diverse and multicultural. With this diversity comes the challenge of ensuring that all individuals, regardless of their cultural background, have equal access to services and support. 

Organisations providing services to the public must be prepared to respond to the diverse and individual needs of each client and ensure that the organisation and its staff are culturally competent.  

What is cultural competence?

A culturally competent organisation: 

  • understands and responds to the unique needs of individuals from diverse cultural backgrounds; and 
  • improves feelings of cultural safety for clients and staff, making them feel that their background, values, identity and needs are respected and valued for the diversity they bring to society and to the organisation.  

When a client feels culturally safe, they feel as if the organisation cares about them as an individual, and that they are seen as a person, not simply part of a homogenous group. Meeting someone’s cultural needs can indicate that an organisation will take care to meet a person’s other unique needs.

And what is cultural diversity?

Cultural diversity encompasses many forms or aspects of identity, including:

  • Cultural identity
  • Ethnic identity
  • Nationality
  • Class
  • Education
  • Language
  • Religion
  • Spiritual views
  • Gender
  • Sexuality
  • Political orientation
  • Age

Each one of these factors will contribute to a person’s identity, how they see the world and their needs when receiving services. 

It is important to note that a ‘one-size-fits-all’ approach to cultural competence will not adequately address the needs of clients, as multiple aspects of their identities intersect to create unique strengths and vulnerabilities. 

Organisations must therefore prioritise a flexible and adaptable approach to service delivery, and ensure staff are able to respond effectively and appropriately to the varying and individual needs of each client.

Strategies for cultural competence

1. Culturally diverse staff

Having a diverse workforce allows an organisation to have broad perspectives of how different actions may impact on people from varying cultural backgrounds and provide insight into changes to improve the cultural safety of clients. Having staff available who share their cultural background can help clients feel that their cultural identity and needs will be respected and valued during their time engaging with the service. In addition, a diverse workforce helps staff improve their cross-cultural communication skills, which can then flow on to better communication outcomes for clients.

2. Ongoing reflection on services

Cultural competence is not a singular action. As the diversity of the organisation’s clients and staff changes, the organisation must constantly reflect on the services it provides and whether they are appropriate for the current demographics. To improve their cultural competence, especially where client demographics have changed, it may be appropriate to partner or consult with local cultural or community groups to ensure the service meets cultural needs.

3. Client involvement in service delivery

The unique experiences of each client means that what they need from a service may be equally as unique. Allowing clients input into aspects of their experience with your organisation allows them to receive a service that is appropriate for them, improving their sense of cultural safety and their perception of the service. In residential services, this is especially important in making the service feel like a ‘home’ for residents.

Cultural diversity and compliance

Cultural diversity is increasingly being incorporated into quality standards for services. This means organisations must be culturally competent and have strategies for engaging with diverse clients in order to meet their standards obligations. 

All of the major national and state/territory standards have cultural diversity requirementsHere are just a few, by way of example only: 

  • Aged Care Quality Standards

  • Australian Service Excellence Standards

  • Human Services Quality Framework (Qld)

  • Human Services Standards (Vic)

  • National Safety and Quality Health Standards (and a number of aligned standards)

  • National Principles for Child Safe Organisations

  • NDIS Practice Standards

  • RACGP Standards

Self-assessments for all of the above standards are available for providers in SPP. 

BNG and Cultural Diversity

We’ve recently updated some of our cultural diversity and cultural competence resources to better assist service providers with their cultural competence.  

  • Good Practice Guide: Cultural Competence 
  • Info: Cultural Diversity 
  • Policy: Diversity and Cultural Inclusion

Other resources for service providers

Aged Care Diversity Framework action plans four action plans to assist aged care providers when engaging with diverse clients, Aboriginal and Torres Strait Islander clients, CALD clients and LGBTI clients. All four action plans are available as self-assessments on SPP. 

The Centre for Cultural Diversity in Ageing has developed the Inclusive Service Standards and accompanying supportive resources to assist aged care providers in the development and delivery of inclusive services to all clientsSPP also provides a self-assessment for the Inclusive Service Standards. 

Ready for cultural change?

Sign up for a free trial of SPP for resources to help your organisation’s cultural competence.

Psychosocial hazards and psychological safety in the workplace

Potential risks to physical safety in the workplace are often easy to identify. However, potential psychological hazards aren’t always as easy to spot, yet can cause just as much harm to a person who is impacted by them.

As an employer, you have a duty to protect your employees from risks to their health, including psychological health. It’s important to note that every jurisdiction has different laws and regulations about psychological safety. Your obligations as an employer will be shaped by the rules that apply to you, however much of the guidance available is useful for employers as best practice even where it is not mandatory.

What are psychosocial hazards?

A psychosocial hazard is a hazard that arises from, or relates to, 

  • the design or management of work, 
  • a work environment, 
  • plant at a workplace, or 
  • workplace interactions and behaviours 

and has the potential to cause psychological harm or injury (Work Health and Safety Regulations 2011 (Cth) section 55A).

Depending on the nature of the workplace, some psychosocial hazards may always be present, while others may temporarily arise due to some change in working conditions. For example, the risk of emotional trauma connected to the loss of a patient in aged care is high and ever-present due to the nature of the work, whereas a psychosocial hazard connected to working increased hours due to staff shortages because of illness is likely to be temporary in nature. In many cases, one or more hazards will interact, and the effects compound to create a greater risk of harm.

Types of psychosocial hazard

There are three broad categories of psychosocial hazards that employers must manage: 

  1. The working environment – includes hazards such as working in high risk areas, working in remote or isolated areas or working unusual shift patterns. 
  2. The work itself – does the work require unusually high or low levels of mental load, does the work involve exposure to traumatic events or material, and is the workload unreasonably high? 
  3. Interpersonal conflicts  including between staff, poor management of the workforce, or mistreatment of staff by consumers. 

Personal issues faced by staff outside the working environment may compound their risk of psychological harm. While employers can’t control these hazards, they may be able to work with staff to ensure that the workplace does not contribute to the staff member’s risk of psychological injury.  

Appendix A of the model Code of Practice – Managing psychosocial hazards at work 2022 (Cth) provides a detailed example list of common psychosocial hazards, and potential control measures for each.

What is the current legislative status?

Most states and territories have implemented the model Work Health and Safety laws. As of April 1 2023, some jurisdictions have updated their Work Health and Safety Regulations and introduced a Code of Practice to specifically cover psychological safety and psychosocial hazards. Victoria’s psychological safety falls under its Occupational Health and Safety Act, and reforms are currently underway to better incorporate psychological safety into the existing occupational health and safety regulations.

See the below table for a brief summary of the psychological safety legislative requirements per jurisdiction, or refer to Safe Work Australia for more detailed information. 

What do I have to do to manage psychosocial hazards?

In all jurisdictions, employers have a duty to ensure the health and safety of their workers where “reasonably practicable”. This includes considering: 

  • whether the hazard was reasonably foreseeable; 
  • the potential severity of the harm that could occur; 
  • whether the organisation or its management knew or should have known about the hazard; 
  • whether there are any available and suitable methods of controlling the risk from the hazard; and
  • the cost of managing the risk. 

Other benefits of good psychological safety

In addition to making sure you’re meeting your legal obligations, good management of psychosocial risks can flow on to benefit the organisation. 

Demonstrating care for the wellbeing of employees and making work a mentally healthy place can boost staff retention rates, while staff who aren’t affected by psychological injury are less likely to require time off work, leading to more predictable and consistent rostering.  

Checking in with the workforce about psychological health can aid the organisation in understanding the challenges and difficulties staff are facing, while reviewing policies and processes for psychological safety can lead to operational changes improving service delivery.  

How SPP can help

We’ve updated these resources for you, which are available in SPP’s Reading Room: 

  • Info Sheet: Psychological Safety in the Workplace
  • Policy: Psychological Safety for Staff

Ready to improve psychological safety?

Sign up to SPP and see how our resources can help you become a psychologically safe workplace!