Single Aged Care Quality Framework - Options for assessing performance against aged care quality standards

•site audit by the Quality Agency to assess performance against the Accreditation
Standards
• interviews with consumers or their representatives about the quality of their care and
services
• consideration of relevant information that consumers, the public, the Aged Care
Complaints Commissioner and the department give to the Quality Agency
• publication of the accreditation decision that the Quality Agency has made, including the report on the site audit
• monitoring of ongoing performance against the Accreditation Standards by the Quality
Agency.

• self-assessment should be abolished. We do not permit the police to investigate the police. Why would we do so in aged care?
- Other features of existing assessment/monitoring should be strengthened. For example, what is not disclosed about the site audit is that the Agency monitors 'a point in time'. At that 'point in time', the service generally has had the opportunity to remove, improve or conceal care/quality failures. The 'point in time' audit is used by the assessors as an rationale NOT to take seriously the egregious care failures that occurred at a different point in time. The Quality system creates considerable outrage by apparently denying egregious care failures, as the assessors did not actually witness them. In our case, the physical assault on one resident by another last November was not sufficient cause for the Quality Agency to find that the provider had failed to meet its care obligations; the physical assault on a Quality assessor the following month WAS. It undermines the credibility of government processes when a service that has met all its outcomes with flying colours in October and in December meets only 40, with 'serious risk of harm' identified and the external advisors called in. It was a matter of satisfaction that the sanctions occurred; it was a matter for dismay that they did not occur when the victim of the assault was merely a frail aged resident with dementia.
- the witness of consumers and representatives is not taken seriously. Assessors do not give equal weight to the evidence of consumers compared with the claims of the provider. If government is seeking to create a 'consumer driven system' it simply must treat consumers as having real rights, including the right to withhold payment for consistently poor services.
- publication of the accreditation decision and 'report of site audit' does not give proper information. It publishes a 'checking the boxes' approach that provides no useful consumer information. If the government is serious about creating a consumer driven system, then consumers' ordinary consumer rights must be protected in aged care law, mandated systems and contracts with providers.
- Monitoring ongoing performance may be useful if the Quality Agency publishes information on care failures or successes in between formal accreditation visits. This would be in accord with creating a consumer driven approach, which relies on as much accurate information as possible.

"Regardless of which quality assessment option is adopted, it is proposed that any new
arrangement would be more inclusive of consumers and that there would be a greater
focus on seeking the views of consumers about whether they experience safe, quality
care and services that are consistent with their needs and preferences."
This limited statement is the only description of consumer involvement in any proposed system. Seeking 'greater inclusion of consumers' is a weak motherhood statement that does not give confidence. By contrast, all the other measures give greater latitude to the providers for self assessment, or to the Agency to assess services without having to actually visit them. None of these options describe a consumer driven system. They describe a provider-preferred system. They describe a system in which the consumer LOSES the limited protections they have now.

The present system of assessment and monitoring clearly pleases no one, not providers, not government and not consumers. Government obviously seeks to put limits on its ever increasing financial commitment to aged care. The Quality Agency is a major drain on public resources that fails to satisfy. The creation of notions such as 'proportionate risk' simply create public outrage. The lack of real financial penalties applicable to the sector inhibits continuous improvement and indeed compliance with commonly held standards.
Big is not beautiful in aged care, and even less so in assessment and monitoring. Abolish the Quality Agency (and indeed abolish the Aged Care Complaints scheme). Hand over one year's funding and direct state governments create LGA based assessment and monitoring services. That is, Federal government should get out of aged care altogether.

Local assessment and monitoring schemes will increase safeguards for consumers. Such an option should include representatives from local government, advocacy services, providers, and consumers, including the frail aged themselves and their relatives, for a limited period. Ideally, these should be elected or appointed by several different organizations. You would not restrict consumer representation to Redacted text COTA, for example. A LGA based assessment service would have local knowledge and connection. It should be independent and critically, should have the power to withhold funding to services that are persistently unwilling to improve or spend any of their considerable profits on providing the services they have been contracted to provide.
The Minister's final act should be to mandate that specific care standards be specified in each and every contract a provider issues. This will give consumers the rights that they ought to have under consumer law. Aged care should NOT be part of the health system. It should be a consumer driven service with varied options depending on price, like any other service. For that to happen, the frail aged must have their consumer and indeed human rights returned to them. The market works if market forces are allowed to operate; all government has been doing since the unpleasantness with Bronwyn Bishop and the kerosene baths is to protect big business and big churches at the expense of the individual, and of the market. What the providers have is a business that is 100% subsidized, lacks transparency and accountability, and with a considerable power imbalance between contracting parties. There will be a massive electoral price to pay for this, and soon.

Naturally. Once the standards are agreed, and the LGA assessment and monitoring schemes established (with real powers and the ability to impose real penalties) all the federal organizations that presently exist, effectively for show, can be abolished. No longer will consumers have to apply to a remote federal complaints commissioner, who does not have the power to fix anything at all, and who creates outrage by claiming an issue has been resolved when it has not. Consumers can apply to the LGA team who can apply the agreed standards in a way that is satisfactory in the local context. For truly egregious failures, the consumer can go to the courts under consumer law. The providers ("organizations") can spend their time and your money providing a better service, instead of focusing on the creation of perfect set of paperwork that guarantees nothing, and only encourages everyone to separate real care from the paper representation of care.

Australians are rightly concerned with equity. That is why we tend to have national systems, to try to create a level of equality of experience around the country. However the concern for equity can minimize excellence. In the context of care of the frail aged, the highly general nature of the standards create exactly the reverse of what is intended - equity - and are simply subject to highly subjective interpretation by the Quality assessor. There is no avoiding interpretation of 'standards' until the day comes when quality indicators are actually mandated. Let those who interpret be from local communities, who are answerable to local communities. Let the market actually operate, rather than trying to manipulate it for the benefit of the providers against the interests of the citizens. The Baby Boomers will not send the providers broke (check their P&L statements, I have) but they might cause a lot of trouble for governments who think they can fool all of the people all of the time.