Response 224135591

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2. Are you answering on behalf of an organisation? If so, please provide your organisation's name.

Please select one item
Ticked Yes
Anglicare Sydney

3. Do you give consent for your submission to be published in whole or in part?

Please select one item
Ticked Yes

More detail about you

4. What role best describes you? Please select all that apply.

Please select all that apply
Aged care consumer, including family and/or carer
Ticked Aged care service provider
Aged care worker/professional
Aged care advocate
Peak body - consumer
Peak body - provider
Peak body - professional
Other - please specify below

5. Do you identify with any special needs groups, or, does your organisation provide support or services to any special needs groups? Please select all that apply.

Please select all that apply
Ticked People from Aboriginal and/or Torres Strait Islander communities
Ticked People from culturally and linguistically diverse (CALD) backgrounds
People who live in rural or remote areas
Ticked People who are financially or socially disadvantaged
Ticked People who are veterans of the Australian Defence Force or an allied defence force including the spouse, widow or widower of a veteran
Ticked People who are homeless, or at risk of becoming homeless
Ticked People who are care leavers (which includes Forgotten Australians, Former Child Migrants and Stolen Generations)
Ticked Parents separated from their children by forced adoption or removal
People from lesbian, gay, bisexual, trans/transgender and intersex (LGBTI) communities.

6. Where do you live, or, where does your organisation operate? Please select all that apply.

Please select all that apply
Ticked NSW

7. What is your location, or, the location where your organisation operates. Please select all that apply.

Please select all that apply
Ticked Metropolitan

8. If you are an aged care service provider, please select all the types of care your service delivers.

Please select all that apply
Ticked Residential care
Ticked Home care
Ticked Commonwealth Home Support Programme services
Ticked Transition care
National Aboriginal and Torres Strait Islander Program services
Multi-purpose services
Innovative care services
Ticked Short term restorative care services

9. If you are an aged care service provider, which option below best describes the size of your organisation?

Please select one item
Ticked Large
Very large

General questions about the draft standards

10. Do the consumer outcomes in the draft standards reflect the matters that are most important to consumers?

Please select one item
Yes, always
Ticked Yes, mostly
Yes, sometimes
Don't know

11. Are the organisation statements and requirements in the draft standards achievable for providers?

Please select one item
Yes, always
Ticked Yes, mostly
Yes, sometimes
Don't know

12. Are the draft standards measurable?

Please select one item
Yes, always
Ticked Yes, mostly
Yes, sometimes
Don't know

13. Are there any gaps in the draft standards? If so, what are they?

Please select one item
Ticked No

14. Is the wording and the intent of the draft standards clear?

Please select one item
Ticked Yes, always
Yes, mostly
Yes, sometimes
Don't know

Specific suggestions about each draft standard

16. Do you have any specific suggestions in relation to draft Standard 1: Consumer dignity, autonomy and choice? If so, what are they?

Text box Standard 1 Consumer dignity, autonomy and choice
Anglicare Sydney strongly supports inclusion, respect, autonomy and choice for consumers and has initiated a number of innovations, particularly in the residential aged care service stream to enhance choice and independence. One example is our Rhythm of Life Program which is a new approach by creating the delivery of services in a way and at the time the resident chooses – including meals, lifestyle programs and personal care. It is an holistic program which has been fully implemented across 16 of our 22 facilities and which is now being implemented in the remaining 6 residential facilities which have been recently added to the organisational suite of services as well as our community aged care services, and Anglicare at Home. The aim of the Rhythm of Life is to implement contemporary and best practice models of care to enrich the everyday lives of our residents, families and staff. The success of this program which is being continuously monitored and evaluated is a clear indication to Anglicare that such an approach does indeed enrich the wellbeing and dignity of residents and their families. This program recognises the uniqueness of each resident and their families which deserves respect and is supportive and encouraging of people in decision making, maintaining and developing meaningful relationships, ensuring a safe and comfortable feeling in an ‘at home’ environment. Resident and family preferences are acknowledged and valued. However it is also important to note that there can be a tension where the needs of consumers may not be congruent with their preferences eg in relation to safety, clinical care, medication, and people with fluctuating capacity. For example a resident might have an assessed clinical swallowing deficit but expresses a preference for a birthday cake on their birthday which may therefore entail a risk to their safety. It is important therefore that the family and resident are made aware of the risks but that we can enable this to happen in as safe a context as possible. This tension between safety and choice is often seen most clearly in cases where people are living with dementia and their safety can be at risk depending on the level of restriction in the environment. However this can in some cases be mitigated by an innovative use of technology. Recently Anglicare has trialled use of GPS watches in an inner city site where residents with dementia (and capacity to manage roads and answer the phone) can go outside and walk in their local community but where they can be monitored and where they can ring in if they are in trouble or they can be guided back home as the watch is also a phone. Such technology has liberated those with dementia who hate the feeling of being locked in and unable to move around. Innovations to find the least restrictive environments for people will generate additional cost in terms of technology, staffing and education. There may also be some challenges around how choices and preferences should be prioritised when those of the consumer are different to their family and/or carers – a particular issue if the consumer has limited or even fluctuating capacity for decision making because of dementia or mental health issues. Sometimes consumers do not have the capacity to make a decision but know what they prefer. Trying to identify preferences under these circumstances requires careful management and an understanding of the person’s history from their family. Also it is important to identify resident’s preferences and choices before they come into care so their wishes can be understood and respected. Also it is important to ensure that the wider health team – such as visiting GP’s – are aware of the importance of the needs and preferences of the consumer. However health practitioners are not currently covered under these Standards and so challenges may arise in the development of an agreed care plan. It is also important to ensure a wider collaborative process with an interdisciplinary team in the development of care plans enabling advocacy on the part of the consumer. Anglicare Sydney also considers that a wider education in relation to Advanced Care Directives would be important to implement particularly with health practitioners and GP’s.

17. Do you have any specific suggestions in relation to draft Standard 2: Ongoing assessment and planning with consumers? If so, what are they?

Text box suggestions in relation to draft Standard 2: Ongoing assessment and planning with consumers
Anglicare Sydney strongly supports joint planning in partnership with consumers and their families/carers and co design in the delivery of in home support. This approach optimises health and wellbeing, preserves autonomy and choice and delivers a higher quality of life. Ongoing evaluation of the consumer needs and preferences is key to ensuring that the quality of life is maintained. The current funding model encourages dependency which is counter to the intent of the draft Standards. Therefore Anglicare Sydney considers that it is important to ensure that both the funding mechanisms in residential aged care (eg ACFI) and the Standards are congruent and aligned.

18. Do you have any specific suggestions in relation to draft Standard 3: Delivering personal care and/or clinical care? If so, what are they?

Text box suggestions in relation to draft Standard 3: Delivering personal care and/or clinical care
Anglicare Sydney strongly supports provision of personal and clinical care that is based on consumers’ needs and preferences in order to optimise their wellbeing and functioning. It is important to note at this stage that sometimes safety and consumer preferences may not align and some balancing and negotiation of the two may be required to generate a positive outcome. It is important to understand this tension in the development of a care plan where there may well be safety issues, not just for the resident but for other residents and staff for which care and responsibility must also be considered. It should also be acknowledged that while best practice personal and clinical care usually align with hospital standards, for services being delivered in the home it is sometimes difficult to ensure these standards are achieved so it is important that the context in which such care is delivered is considered when compliance to the Standards is critical. There will need to be increased education and training for staff in relation to infection prevention and control and antimicrobial stewardship – a cost which will need to be considered in any funding model designed to support the new Standards. Other costs for care in the home will be incurred in relation to the purchase of Personal Protective Equipment and upskilling staff in its use. For care being delivered within the home the worker may well identify unmet clinical needs for the consumer and provide referrals to relevant services, but there is a question as to the responsibility of the worker in addressing the clinical needs, especially if the consumer does not want them addressed or refuses to take up the referrals. Clarity re the accountability of the service provider in such a situation is required where consumer choice is key.

19. Do you have any specific suggestions in relation to draft Standard 4: Delivering lifestyle services and supports? If so, what are they?

Text box suggestions in relation to draft Standard 4: Delivering lifestyle services and supports
Anglicare Sydney strongly supports facilitation of consumer access to those services and supports which will enhance wellbeing and quality of life. It is important to ensure that such lifestyle services reflect choice and preference and enable participation, connection, inclusion and builds an individual’s social capital. Anglicare Sydney acknowledges that even for people living with significant dementia a range of activities and supports can facilitate connection and maintenance of social relationships as well as improve or maintain cognitive function, wellbeing and self-esteem. It is important to identify what is meaningful for people and supporting their opportunities to experience it. At one of our sites a pilot initiative has led to the development of what has been called ‘The Club’. Using Montessori principles a dedicated space was created offering a range of different individualised and specialised activities for residents to choose to participate in. People can enjoy working individually or in groups. The Club opens for the morning and residents are escorted in, given a warm welcome and are free to choose what they would like to do. A balcony and sunroom provide technology options such as IPads and computers and music with headphones. It provides a sense of community, choice, autonomy and social connection.

20. Do you have any specific suggestions in relation to draft Standard 5: Service environment? If so, what are they?

Text box - specific suggestions in relation to draft Standard 5: Service environment
Anglicare Sydney supports the need to ensure a safe, clean and comfortable service environment and continually renews and refurbishes our services to ensure high standards are maintained.

21. Do you have any specific suggestions in relation to draft Standard 6: Feedback and complaints? If so, what are they?

Text box suggestions in relation to draft Standard 6: Feedback and complaints
Ensuring continuous improvement and quality standards are significantly dependent on feedback from all key stakeholders – consumers, families, carers, staff and others who play a role in the delivery of services for the individual. Anglicare Sydney thus supports the inclusion of this standard across all aged care services and considers compliance with such a standard will ensure consistency of services in both delivery and quality.

22. Do you have any specific suggestions in relation to draft Standard 7: Human resources? If so, what are they?

Text box suggestions in relation to draft Standard 7: Human resources
Anglicare Sydney acknowledges that key to the delivery of effective and quality aged services is a well-trained, skilled and available workforce. However it is important to note that there is currently a significant shortage in the availability of skilled workers in the sector which is not just an agency issue but also a systemic one. Health Workforce Australia estimates that there will be a shortage of 100,000 nurses by 2025. In 2010, the then Department of Health and Ageing estimated that the aged care workforce would need to increase between two and three times before 2050 in order to provide care to the growing number of aged care residents. Other challenges include the ageing of the aged care workforce itself, the increased competitiveness in the labour market due to ageing and issues in retaining and attracting workers. Use of casual workers to fill gaps can lead to a highly casualised and unhappy workforce without security or long term engagement and loyalty to a particular agency. There are also issues in terms of ensuring consistency of quality of care and training. It should also be noted that as consumer choice and preference is prioritised it may be increasingly difficult to match client preferences with the staffing pool – it will require greater diversity in the mix of staff – especially in the delivery of care in the home. People often express a preference for a particular race or gender in the delivery of a service which may be difficult to achieve with a given pool of staff. For some of our in home services there is a need to subcontract and these subcontracting arrangements need to ensure that the new Standards will be incorporated and understood by those contractors. Anglicare Sydney does not support defined ratios in definition of the term ‘adequate’ in the Standard because of the significant range of variables operating in differing aged care contexts. Service providers will also need to consider developing appropriate recruiting strategies to ensure that all staff present with the appropriate ‘attitudes and attributes’, and clarity around what this means would be helpful in any future iteration of the Standards.

23. Do you have any specific suggestions in relation to draft Standard 8: Organisational governance? If so, what are they?

Text box - suggestions in relation to draft Standard 8: Organisational governance
Clear and effective governance – from Board level to service site – is critical in ensuring ongoing sustainability in the delivery of quality aged care services and Anglicare Sydney supports the inclusion of this Standard. Anglicare Sydney supports the need for co-design in the planning, development and delivery of aged care services and the need to partner with other relevant agencies and bodies.

Other Comments

24. Do you have any other comments or suggestions about the draft standards?

Text box - any other comments or suggestions
Anglicare Sydney supports in principle the merging of the four standards (Accreditation for Residential Care and Short Term Restorative Care, Home Care Standards, NATSIFACP and Transition Care, Home Care) into a national single set of standards. The merging of standards will improve compliance, give greater confidence in the system and have the facility to ensure a more consistent quality of care across the sector. Anglicare Sydney also supports an approach where not all standards will apply equally to all areas of care – given the diversity in the aged care service provision. Additionally we support in principle the increased focus on the consumer and consumer choice – encouraging flexibility, holistic and responsive care – an approach which has been adopted across both our residential and community aged care services. Anglicare Sydney also supports the merging of the standards if it leads to less red tape and a more seamless, effective and standardised approach to standards compliance particularly if there is a significant focus on outcomes for consumers and residents creating an expectation and an assurance that regardless of the context of the service delivery the standard of care and service will be the same.