DRC: Support Coordination

The Final Report from the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (DRC) acknowledged the very important role that support coordination plays for participants, particularly those who are at risk. Support coordination is essential to ensuring that participants can exercise proper choice and control over their life and the supports they receive.

However, the DRC did raise some concerns about the current responsibilities of support coordinators, the conflict of interest risks, and the quality and consistency of the services being provided.  

Roles and responsibilities of a support coordinator

The DRC reiterated the role of support coordination supports being to assist NDIS participants in connecting with other funded supports. Support coordinators are also expected to build participant capacity and capability to understand plans, navigate the NDIS and exercise choice and control. The DRC added that support coordination services are required to broker arrangements between participants and providers in line with the participant’s wishes and budget and ensure that the participant is receiving services which represent value.

Under the current NDIS Rules, support coordinators are required to ‘act with integrity, honesty and transparency’, as laid out in the Code of Conduct. The National Disability Insurance Agency (NDIA) further clarified this requirement, stating that to comply with the Code of Conduct’s requirements, support coordinators must:

  • recommend and provide supports and services appropriate to the needs of the participant;
  • maintain integrity by declaring and avoiding any real or perceived conflicts of interest; and
  • avoid engaging in, participating in, or promoting sharp practices.

Conflict of interest

Conflict of interest in relation to support coordination was identified as an issue in the Tune Review, the NDIS Review and now the Royal Commission. The DRC agreed with the NDIA’s position that it is not appropriate for providers to deliver coordination services as well as regular supports to the same participant. Recommendation 10.2 suggests that the NDIS Rules be changed to make it clear that support coordination and other funded supports should be delivered by separate providers. Recommendation 10.2 acknowledges that in some cases the separation of support coordination from other funded supports is not possible, and recommended there be some limited exceptions where it is acceptable for the one provider to be providing both support coordination and supports, such as in rural or culturally and linguistically diverse communities.

Quality of support coordination

The DRC’s investigation of support coordination providers found considerable variation in quality between individual support coordinators. Common complaints from DRC hearings included:

  • lack of accountability,
  • little or no contact with participants, and
  • a lack of understanding about the services available to participants.

Recommendation 10.4 suggested that the NDIS Quality and Safeguards Commission should examine the quality of support coordination services.

The DRC raised concerns for participants, particularly those who are at risk of violence, abuse, neglect and exploitation if their support coordinators are not at a quality consistent with the expectations of the NDIA or the Commission.

The DRC discussed the need for better training and monitoring for support coordinators, including the addition of new modules to the Workforce Capability Framework. This was reinforced in Volume 8 of the DRC’s Final Report, which went into detail about the need for better training of support coordinators providing services to participants who are navigating the legal system.

Expansion of support coordination funding

The DRC recommended that more funding for support coordination in participant plans is needed to address risks and ensure participants receive adequate supports. The Final Report called on the NDIA to ensure that all participants who are identified as being at higher risk of violence, abuse, neglect or exploitation, particularly those in supported accommodation, receive funding to access support coordination services.  

How BNG can help

We have several templates which may be helpful in the delivery of high quality and transparent support coordination, including:

  • Policy: Support Coordination and Plan Management;
  • Policy: Conflict of Interest;
  • Template: Conflict of Interest Register; and
  • Template: NDIS Service Agreement.

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DRC: Human Rights

Upholding the human rights of participants is a common theme that underpins the discussion and Recommendations published by the Disability Royal Commission (DRC). Whilst most of the human rights Recommendations are directed at the federal, state and territory governments, several Recommendations are related to human rights requirements for providers.

The United Nations’ Convention on the Rights of People with Disability (CRPD) is the foundation of the DRC’s investigation into the human rights of people with disability. The CRPD lays out Australia’s obligations in relation to the human rights of people with disability. There are eight guiding human rights principles that underlie the CRPD (the Human Rights Principles), as follows:

  1. Respect for inherent dignity, individual autonomy (including the freedom to make one’s own choices), and independence of persons;
  2. Non-discrimination;
  3. Full and effective participation and inclusion in society;
  4. Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity;
  5. Equality of opportunity;
  6. Accessibility;
  7. Equality between men and women; and
  8. Respect for the evolving capacities of children with disabilities and respect for the right of children with disabilities to preserve their identities.

The DRC found that the above Human Rights Principles were not adequately protected and upheld under Australian law or policy and practice.

The DRC's key human rights Recommendations

Recommendation 10.1 of the DRC final report suggests that the NDIS Quality and Safeguards Commission should develop a program to ensure that human rights are embedded in the design and delivery of each NDIS Provider’s services. The specifics of the program are not clear, however the final report suggests that the program will give regulators oversight of providers’ implementation of human rights policies and procedures.

Accompanying Recommendation 10.1 are several recommendations from Volume 4: Realising the human rights of people with disability. These Recommendations endorse the enactment of a disability rights act, which would enshrine the human rights of people with disability in Australian law.

The DRC made a distinction between actual and potential impacts on the human rights of people with disability.

Potential impacts

Potential impacts include identified risks to the legal and human rights of people with disability. Potential impacts should be identified and addressed before they happen. This can be dealt with through an organisation’s risk management system.

Actual Impacts

Actual impacts on human rights include breaches of a person’s human rights which have already happened. Addressing actual impacts may require remediation and should be dealt with as a priority.

Embedding human rights in service provision

Implementing policies and procedures related to human rights is an essential first step that NDIS Providers should take to stay ahead of new requirements stemming from the DRC. Implementation should include:

  • Assigning responsibility
    Ensure that responsibility for the organisation’s human rights impacts is assigned to a senior staff member or a committee.
  • Training
    The workforce should be made aware of their responsibilities in relation to human rights, and understand how they can ensure human rights are being upheld.
  • Assessment
    Assessing the organisation’s services and identifying the potential human rights impacts will help the organisation to prevent potential impacts from becoming actual impacts.
  • Monitoring and review
    The organisation should regularly review its performance in relation to human rights. Any breaches or impacts should be addressed as soon as possible.
  • Complaints and grievances
    Complaints, feedback and grievances in relation to human rights impacts should be taken very seriously and investigated as soon as possible by the organisation.

How BNG can help

We have developed a new Human Rights policy template to help providers stay on the front foot in relation to human rights. The policy template will help you understand the central principles of the CRPD and embed human rights in service delivery.

This blog post is the third in our series of posts on the Disability Royal Commission. You can see the other blog posts in the series here.

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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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DRC: Complaints Management

Now that the Disability Royal Commission (DRC) has released its final report, we will be publishing some blog posts on a number of the report’s key themes.  

Our posts are intended to help providers understand the changes to the disability system that the DRC is recommending, so that they can consider whether they need to adjust or improve how they provide services.  It is also a great time for providers to  review their policies and procedures. Note that the Australian Government has not yet accepted the recommendations of the DRC, so they are subject to change further down the track.

This first post is about complaints management, and how providers can get on the front foot to ensure complaints processes are what they should be.

Complaints management principles

Recommendation 11.5 suggests that states and territories develop specific guidelines to help organisations implement complaint handling systems which are accessible and responsive to people with disability.

The DRC outlined ten core principles which the guidelines should reflect, which are:

  • creating a rights-focused complaints culture;
  • encouraging people with disability and others to speak up;
  • making adjustments to enable participation;
  • supporting the person with disability, their family and others in complaint processes;
  • respecting complexity, diversity and cultural difference;
  • providing clear information about how to complain, and multiple pathways to complain;
  • working respectfully and effectively alongside police;
  • conducting safe and inclusive investigations, that are trauma-informed;
  • providing tailored outcomes and redress; and
  • using complaints data to drive continuous improvement in service provision and complaint handling.

Barriers and accessibility in complaints and feedback

One of the key concerns outlined by the DRC was the lack of accessibility in complaints systems. They raised a series of concerns related to things such as:

  • inaccessible policies and processes,
  • a lack of options for raising concerns,
  • potential victimisation, and
  • fear of not being believed or treated or taken seriously, among other things.

To ensure that your organisation’s complaints management does not create barriers, regularly review your policies and procedures and check that they are in line with (and promote) the principles of natural justice.

It is also important to ensure that policies are well communicated and can be easily understood.  For example, adopting an Easy English complaints policies which addresses the communication needs of participants can assist in making your complaint handling processes easier to understand. 

Strengthening complaints systems

The Executive Summary of the DRC report contains recommendations for measures which NDIS Providers can implement to strengthen their existing complaints management systems, including the following:

  • Creating a dedicated complaints management team or individual
    This team or individual should be separate from those delivering services. Their primary role is to increase the engagement with participants and their support networks to ensure that complaints are addressed appropriately.
  • Prioritising complaints based on risk
    This involves assessing each complaint separately to determine its severity, and using a triage system to address complaints which have the most potential risk to participants.
  • Establishing lines of communication
    A common theme from the DRC’s investigation of complaints systems is confusion arising from lack of communication. This includes participants not knowing whom to contact, as well as not feeling comfortable to speak up.
  • Record keeping
    Strong record keeping practices, including documenting the conclusion and resolution of complaints, are central to good complaints management.
  • Organisational culture
    Developing a culture that encourages and welcomes feedback is essential to complaints management, and will help inform continuous improvement activities.

Responding to complaints

The DRC stressed the importance of adequately responding to complaints and concerns. Providers should acknowledge the complaint when it is made, and actively involve participants and their families in the investigation and resolution of a complaint.

Poor communication between service providers and participants can result in feelings of distrust and anxiety.

To address this, providers should communicate regularly with participants about the progress of their complaint and ensure that participants are aware of their rights in relation to complaints.

How we can help

We have a number of resources to help providers with complaints management:

  • Policy: Complaints Management
  • Info: Complaints Management
  • Policy: Complaints (Easy English)
  • Policy: Child Safe Complaints Management
  • Template: Complaints Register
  • Template: Complaints Information for Clients
  • Template: Complaint Process Tracking Form
  • Template: Complaint Submission Form
  • Template: Complaint Response Letter

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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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Latest from the Disability Royal Commission

The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (the DRC) is set to deliver its final report by 29 September 2023. Ahead of the final report, we’ve been tracking some of the common themes that have emerged from the latest Public Hearings, to identify likely recommendations that we might see in the final report.

Public Hearing 32 examined violence, abuse, neglect and exploitation of people with disability, and the role that provider policies and procedures play in safeguarding participants. Public Hearing 32 was the final time in the DRC’s process that service providers were examined, so it is a useful insight into the recommendations for providers that we might see in the final report.

There are some common themes throughout the Counsel Assisting submissions to Public Hearing 32 for which we have developed resources. Our resources will help providers to get on the front foot in terms of best practice service delivery.

Safeguarding

Preventing and responding to violence, abuse, neglect and exploitation of people with disability is not a new concept for NDIS providers, however Counsel Assisting submissions to the DRC identified a number of processes which should be implemented by providers to ensure that the rights of participants are upheld, including:

  • implementing proper recruitment, training and oversight processes to ensure that all workers understand and uphold the core rights of participants. This includes exercises such as conducting reference checks and querying gaps in employment history; and
  • implementing appropriate redress processes, including the important step of making apologies when redress is required.

Trauma–Informed Care

Public Hearing 32 introduced the concept of trauma-informed care to the disability sector, particularly in the context of cultural safety for Aboriginal and Torres Strait Islander participants. Providers should incorporate principles of trauma-informed care into all aspects of the organisation, recognising that everyone may have a history of trauma, and that everyone’s responses to trauma and needs arising from trauma will be different.

Establishing effective trauma-informed care procedures contributes both to a safer care environment for participants, and to care that is person-centred and tailored to the unique needs of each participant.

Supported Decision-Making

Supported decision-making is another area that has been closely examined by the DRC. Understanding each participant’s will and preferences was highlighted as central to supporting the decision-making process. Organisations should presume that every adult participant has the ability to make decisions that are directed by their will and preferences, unless there is evidence otherwise.  Organisations should implement processes to seek to understand and document each participant’s will and preferences, and then ensure that they and their families are actively involved in all decisions.

While it was not explicitly called for in the Counsel Assisting submissions, a clear emerging principle in this area is that substitute decision-making should be a last resort only.  An organisation’s supported decision-making processes should prioritise supported decision-making in partnership with the participant, and only utilise substitute decision-makers as a last resort, when someone is unable to assist in making a decision, or does not want to make a decision.

Human Rights & Dignity

Clearly understanding and protecting all participants’ human rights is an issue which has been consistently raised by Counsel Assisting submissions, and the DRC more broadly. Enshrining each participant’s human rights in policies and procedures is a core governance concept for NDIS Providers. The DRC has pointed out that, whilst providers should have a human rights policy, it is essential to ensure that the processes outlined in the policy are clearly communicated to, and understood by, all workers so that they are consistently implemented and followed in practice, throughout the organisation.

Co-design

Co-design was also a common theme throughout Public Hearing 32. There are some guiding principles of co-design which providers should follow, including:

  • Representation in the design process, particularly including people with lived experience and diverse cultural representation;
  • Effective leadership and acceptance of change;
  • Education and training for staff;
  • Empowering staff to make change;
  • Communication and information sharing to draw on the experiences and expertise of other providers; and
  • Monitoring, evaluation and continuous improvement.

For more information about co-design, see our blog post on the topic.

How we can help

We have developed and updated several resources to help you implement processes to address the above common themes. These resources include:

  • Policy: Safeguarding (Responding to Abuse);
  • Info: Safeguarding (Responding to Abuse);
  • Policy: Supported Decision-Making and Dignity of Risk (NDIS);
  • Policy: Supported Decision-Making and Dignity of Risk;
  • Policy: Trauma-Informed Care;
  • Policy: Trauma-Informed Care (Disability); and
  • Policy: Trauma-Informed Care (Child Safe).

We are also in the process of developing resources for:

  • Human rights and dignity of risk; and
  • Inclusive co-design.

Towards better practice!

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Code of Conduct for Aged Care comes into effect today!

We have previously written about the introduction of a Code of Conduct for Aged Care. The Code has now been finalised and applies to approved providers, aged care workers, and governing persons from today, the 1st December 2022.

The Aged Care Quality and Safety Commission has published a Code of Conduct for Aged – Guidance for approved providers document, and we encourage providers to review this guidance, where they can find useful examples of what the Code looks like in practice.  Our self-assessment modules for the Code, available on SPP are a great resource for organisations looking to ensure their readiness for the Code.

Also coming into force today are a number of responsibilities relating to provider governance, including:

  • Notifying the Quality and Safety Commission of material changes to provider suitability
  • Consideration of suitability of all key personnel
  • Notifying the Quality and Safety Commission of changes regarding key personnel
  • Ensuring appropriate staff qualifications, skills and experience
  • Reporting on providers’ operations and statement of compliance

We have developed a package of resources to assist aged care providers with these new governance requirements, including the following:

  • Self-assessment module for Provider Governance responsibilities
  • Policy: Provider Governance (Aged Care)
  • Policy: Key Personnel
  • Template: Key Personnel Suitability Checklist
  • Template: Key Personnel Declaration and Undertaking
  • Template: Governing Body Requirements Checklist

You can find these new resources in the Reading Room of your SPP or ACCPA Quality Portal account, by searching for “aged care governance”.

Looking for assistance managing your aged care obligations?

Get ready for the revised Aged Care Quality Standards

Reforms to the aged care sector continue, with the recent release of a consultation draft of the revised Aged Care Quality Standards (‘Quality Standards’). The new Quality Standards have some key differences compared to the existing standards – they are significantly more detailed, and represent a move away from the higher-level approach of the existing standards. There is definitely a lot for providers to take in, so let us help you get up to speed with our overview of the key changes.

Why are the Quality Standards changing?

The Royal Commission into Aged Care Quality and Safety found that the existing Quality Standards are not sufficiently ‘comprehensive, rigorous and detailed’.

The Royal Commission identified specific areas of improvement for the Quality Standards, including the need to:

  • reflect the needs of people with dementia;
  • better recognise diversity and improve cultural safety for Aboriginal and Torres Strait Islander people;
  • strengthen requirements in relation to governance and human resources;
  • describe more detailed requirements relating to food and nutrition; and
  • improve clinical care.

The revisions to the Quality Standards were also informed by engagement with the sector, an independent review, and comparison with existing standards for health care and disability support – the National Safety and Quality Health Service (NSQHS) Standards, and the NDIS Practice Standards.

What will the new Quality Standards look like?

Standard 1: The Person

Standard 1 focuses on important concepts including dignity and respect, older person individuality and diversity, independence, and culturally safe care.

The new Standard 1 remains fairly similar to existing Standard 1: Consumer dignity and choice in the current Quality Standards, with a focus on the older person.

Outcomes

  • Person-centred care
  • Dignity, respect and privacy
  • Choice, independence and quality of life
  • Transparency and agreements

Standard 2: The Organisation

Standard 2 is intended to hold the governing body responsible for fulfilling the requirements of the Quality Standards and delivering safe and quality care. Standard 2 goes into more detail than the current standards by itemising more requirements for systems that providers should have in place (including requirements regarding partnering with older people, accountability and quality systems, workforce planning, and emergency and disaster management).

Outcomes

  • Partnering with older people
  • Quality and safety culture
  • Accountability and quality systems
  • Risk management
  • Incident management
  • Feedback and complaints management
  • Information management
  • Workforce planning
  • Human resource management
  • Emergency and disaster management

Standard 3: The Care and Services

Standard 3 describes the way providers must deliver care and services. It sets out more detailed requirements regarding how providers assess each older person’s needs, goals and preferences, document this in a care plan and use this to inform the way care is delivered. Standard 3 includes a new requirement that providers implement a system for caring for people living with dementia.

Outcomes

  • Assessment and planning
  • Delivery of care and services
  • Communicating for safety and quality
  • Coordination of care and services

Standard 4: The Environment

Standard 4 focuses on the physical environment, which must be clean, safe and comfortable and enable freedom of movement for older people. Standard 4 also sets out requirements regarding infection prevention and control systems.

Outcomes

  • Environment and equipment at home
  • Environment and equipment in a service environment
  • Infection prevention and control

Standard 5: Clinical Care

Standard 5 describes the responsibilities of providers, with respect to the delivery of clinical care. Standard 5 articulates more detailed and technical requirements for clinical care compared with the existing standards, including in areas such as technical nursing, advance care planning, continence, falls and mental health. This standard was developed by the Australian Commission on Safety and Quality in Health Care, and aligns with the NSQHS Standards.

This standard will apply to providers delivering clinical care, whether it is in an older person’s home or a residential environment.

Outcomes

  • Clinical governance
  • Preventing and managing infections in clinical care
  • Medication safety
  • Comprehensive care
  • Care at the end life

Standard 6: Food and Nutrition

Standard 6 sets out requirements regarding what older people can expect of the food and drink they are provided in residential care services. It includes the requirement that food and drink is appetising, nutritious and safe, and that the dining experience is enjoyable. Having a dedicated standard for food and drink is a new development, and represents a greater focus on this area.

Standard 6 will apply only to residential care services.

Outcomes

  • Partnering with older people on food and nutrition
  • Assessment of nutritional needs and preferences
  • Provision of food and drink
  • Dining experience

Standard 7: The Residential Community

Standard 7 is about the residential community, and focuses on continuity of care, security of accommodation, and strategies to help older people maintain relationships.

Standard 7 will apply only to residential care services.

Outcomes

  • Daily living
  • Planned transitions

Other noteworthy changes

  • Use of the phrase ‘older person’/’older people’ – The term currently used to refer to a person receiving services under the existing Quality Standards is ‘consumer’, however the Aged Care Quality and Safety Commission acknowledges that this term is not generally well-received by older people. The new term used throughout the revised Quality Standards is ‘older person’.
  • More requirements, that are more detailed – The current Quality Standards are outcomes-focused and consist of eight standards, which include a consumer outcome, an organisation statement and a number of requirements. The new Quality Standards describe more detailed expectations for providers, with an increase from 42 requirements to 31 outcomes with 142 supporting actions. This may look like an increase in the regulatory burden for providers, but the intention is to provide greater clarity to providers, by being more specific about how to achieve the outcomes laid out in the Quality Standards.

Similarities with NDIS Practice Standards

The updated Quality Standards will align structurally with the NDIS Practice Standards, by following a ‘modular’ format and using outcomes and actions (called ‘quality indicators’ in the Quality Standards). The two sets of standards don’t have identical content, but there are plenty of similar themes, and the same pieces of evidence may be used by a provider to satisfy outcomes across both sets of standards. For example, an organisation’s incident management policy may be used to demonstrate compliance with the incident management outcome across both sets of standards.

Government is also considering regulating providers through a registration model, similar to the NDIS Practice Standards. Employing a registration model means that, “requirements for market entry and ongoing provider responsibilities would be applied proportionately, based on the provider’s registration category. A provider’s registration category would be determined based on the types of care and services the provider is seeking to deliver and the risks associated with them”. This is similar to how the NDIS Practice Standards currently operate.

What does the rollout look like?

There will be some time before the new Quality Standards are up and running.

Currently, the Department of Health Aged Care is holding a public consultation process for the Quality Standards, and providers are invited to take part.

Following the public consultation, Aged Care Quality and Safety Commission will conduct a pilot of the new Quality Standards, to test an updated audit methodology for the Standards.

Providers can expect guidance materials and further updates on the revised Quality Standards in early 2023.

Looking for more information?

The Commission has released a number of helpful resources for the new Quality Standards, including both a summary as well as a detailed Consultation Paper, and a summary and detailed document setting out the new Quality Standards themselves.

To understand the intention behind the new Quality Standards, as well as what all of the requirements are, you might like to take a look at the Commission’s Summary Consultation Paper, as well as the Summary draft of the Quality Standards.

Do you need assistance meeting the Aged Care Quality Standards?

The draft Aged Care Code of Conduct is here

As part of a recent suite of reforms set out in the Royal Commission Response Act, the Department of Health and Aged Care is introducing a Code of Conduct for Aged Care. An exposure draft of the Code has been released, and the Code will come into effect from 1 December 2022.

So, what does this new Code mean for providers and their workers? And how can you prepare for this new requirement?

An overview of the Code

We’ve been keeping close to developments relating to the Code, and aim to keep our customers up to speed as the Aged Care Quality and Safety Commission publishes new information. Here are some key pointers:

  • The Code of Conduct has been introduced to “improve the safety, health, wellbeing and quality of life for people receiving aged care and to boost trust in services”.
  • It sets out standards of behaviours for approved providers, governing persons, workers, volunteers and contractors to ensure services are delivered in a safe, competent and consistent manner.
  • The policy intent for the Code is not to create new obligations for providers; but rather to focus on the protection of older Australians by setting out the suitable standards of care, and ensuring that there are consequences for poor conduct.
  • The Code will take effect from 1 December, and will apply to residential aged care, home care, and flexible care providers. The Code will not apply to Community Home Support Programme (CHSP) and National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NATSIFACP) providers.
  • The Commission will be able to issue banning orders to aged care workers and governing persons who breach the Code – however, this measure will only be taken in the most serious cases of poor conduct.
  • The Code is in draft form but should be finalised in the near future.

Your responsibilities and how you can prepare

The responsibilities outlined in the Code are consistent with existing legislation, the Aged Care Quality Standards and the Charter of Aged Care Rights, as well as community expectations and consumer expectations. As an example, the Aged Care Quality Standards include concepts such as affording consumers dignity and respect, which feature in the Code.

The Code is also consistent with the NDIS Code of Conduct, which will be familiar to some providers who work across both the aged care and disability sectors. Both Codes have a strong focus on the individual’s right to receive quality care and share many of the same obligations.

Compared with the NDIS Code, the Aged Care Code does have additional requirements for treating people with dignity and respect, valuing diversity, and providing care, supports and services free from violence, discrimination, exploitation, neglect, abuse and sexual misconduct. These additional requirements address key concerns raised by the Royal Commission into Aged Care Quality and Safety. Whilst the Codes are very similar, they will be regulated separately.

The Aged Care Quality and Safety Commission has emphasised that the Code of Conduct does not create new obligations, in the sense that providers and workers delivering care in accordance with existing regulations should already be meeting the Code. However, there is one new responsibility providers should be mindful of in relation to the Code, and that is: providers must take reasonable steps to make sure workers and governing persons comply with the Code.

The Commission has made clear that providers need to ensure their aged care workforce (including employees, volunteers and contractors) understands and acts consistently with the Code. Some steps you can take to ensure your workforce is ready include:

  • ensuring that workers have read and understand the Code and relevant guidance;
  • ensuring workers undergo regular training and professional development that helps them comply with and uphold the Code;
  • ensuring workers understand the consequences of not complying with the Code; and
  • supporting workers to resolve concerns identified in relation to their compliance with the Code.

Next steps

Make sure you have familiarised yourself with the draft Code and have a plan to prepare your workforce.

For more detail on the Code, please access the draft Code of Conduct for Aged Care: Guidance for providers.

Looking for assistance managing your aged care obligations?