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NEW TO AGED CARENON CLINICIANS

MARCH 2013

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OBJECTIVES

• To understand the legislation governing responsibilities and accountabilities in Aged Care

• To understand how the legislation and accreditation work in tandem

• To understand how to apply the Principles underpinning the Aged Care Act

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OVERVIEW

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THE AGED CARE ACT 1997

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THE AGED CARE PRINCIPLES

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TOGETHER WE HAVE THE AGED CARE SYSTEM!

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THE AGED CARE SYSTEM

• RESIDENTIAL CARE– Subject to the requirements of the Aged Care

Act 1997– Subject to the Aged Care Principles

• HOME (COMMUNITY) CARE– Subject to the requirements of the Aged Care

Act– Subject to the Aged Care Principles

• RETIREMENT VILLAGES– Subject to the Retirement Villages Act

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THE AGED CARE ACT

The Aged Care Act 1997 governs all aspects of

the provision of residential care, flexible care and

(Community Aged Care Packages) CACPs to older

Australians.

The Act sets out matters relating to the planning of

services, the approval of service providers and

care recipients, payment of subsidies, and

responsibilities of service providers.

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TYPES OF CARE

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RESIDENTIAL CARE

Residential aged care refers to high level care

(nursing homes),

low level care (hostels)

and

ageing in place services

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HOME (COMMUNITY) CARE

• As of 1 July 2013: – 4 levels of Home Care

• Level 1 (New Basic care, no case management)• Level 2 (Current CACP)• Level 3 (New Intermediate care level)• Level 4 (EACH/D)

- CDC: Consumer Directed Care- Consumer (or self) directed care allows people to have greater

control over their own lives by allowing them, to the extent that they are able and wish so to do, to make choices about the types of care services they access and the delivery of those services, including who will deliver the services and when.

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FLEXIBLE CARE• Delivered in either a residential or community care setting, • Five types

• Extended Aged Care at Home (EACH) packages• Extended Aged Care at Home Dementia (EACHD) packages, • Transition Care, • Multi-Purpose Service (MPS) places, and • Innovative Care.

As they are community based, EACH and EACHD services provided under flexible care arrangements form part of Community Care.

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TRANSITION CARE• targets older people who would otherwise be eligible for residential care.

• to enter transition care an older person must have been assessed as eligible by an Aged Care Assessment Team while they are an in-patient of a hospital.

• a person can only enter transition care directly after discharge from hospital.

• the program provides time-limited, goal-oriented and therapy-focused packages of services

• these packages include low intensity therapy (such as physiotherapy and occupational therapy), social work and nursing support or personal care.

• designed to improve older people’s independence and confidence after a hospital stay. It allows them to return home rather than prematurely enter residential care. The program also gives older people and their families and carers time to consider long-term care arrangements.

• can be provided for up to 12 weeks (with a possible extension of another six weeks) in either a home-like residential setting or in the community

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MULTIPURPOSE SERVICES

• recognises that the delivery of some health and

aged care services may not be viable in small rural and remote communities if provided separately.

• brings the services together to achieve economies of scale to support viability.

• deliver a mix of aged care, health and community services in rural and remote communities.

• Generally operated by state, territory and local governments, and are primarily located in hospital settings.

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INNOVATIVE CARE SERVICES

• support the development and testing of flexible models of service delivery in areas where mainstream aged care services may not appropriately meet the needs of a location or target group.

• the Aged Care Innovative Pool program - established in 2001-02, provides opportunities to use flexible care places to test new approaches to providing care for specific target groups.

• Example: Consumer Directed Care

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THE LEGISLATION

• The Act – gives the broad legal and policy framework to govern the operation of aged care

• The Principles – give the detail of how to operationalise the Act

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THE AGED CARE PRINCIPLES

There are a number of sets of principles made

under the Act, which provide further detail regarding

the matters set out in the Act.

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THE 22 PRINCIPLES• Accountability Principles 1998 (a. 2011)• Accreditation Grant Principles 2011• Advocacy Grant Principles 1997• Allocation Principles 1997 (s.1998)• Approval of Care Recipient Principles 1997 (a.2008)• Approved Provider Principles 1997• Certification Principles 1997• Classification Principles 1997• Committee Principles 1997 (revoked by Investigation

Principles 2007)• Community Care Grant Principles 1997• Community Care Subsidy Principles 1997

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THE 22 PRINCIPLES • Extra Services Principles 1997• Flexible Care Grant Principles 2008• Flexible Care Subsidy Principles 1997• Information Principles 1997 (a. 2011)• Quality of Care Principles 1997 (a.2011)• Records Principles 1997• Residential care Grant Principles 1997 (a.2008)• Residential Care Subsidy Principles 1997

(a.2008)• Sanctions Principles 1997 (a. 2008)• Users Rights Principles 1997 (a.2011)

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THE PRINCIPLES

IN

SUMMARY

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THE PRINCIPLES

Can be broadly grouped into three categories• Compliance• Funding• Quality

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COMPLIANCE

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WHAT IS COMPLIANCE?

The Aged Care Act 1997 (the Act) is the law

which governs the provision of aged care services,

residential and community.

In order to meet compliance, approved providers

must comply with the law (the Act). The Act provides

the why – that is, the broad legal and policy

framework while the Principles provide the how – for

example, the calculation of fees and charges

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ACHIEVING COMPLIANCE

Compliance is assessed by:• the Aged Care Standards and Accreditation Agency

(Accreditation Grant Principles)• the Department of Health and Ageing through the

office of Quality and Compliance (all principles and the Act)• the Complaints Resolution Scheme (all principles and the

Act)• Commonwealth Nursing Officers (ACFI Validators) (The

Residential Care Subsidy Principles)• State based regulators such as NSW Food Authority, Fire

and Safety Authorities (The Certification Principles)

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NON COMPLIANCE – WHAT HAPPENS

There are a range of penalties that my be

imposed upon an approved provider where there is a

failure to achieve compliance (breach) and are

dependant upon several factors such as severity, type

and history of non compliance.

These penalties are dealt with in the Quality of

Care Principles and Sanctions Principles.

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ACCOUNTABILITY PRINCIPLESThese Principles set out:

(a)various aspects of the access that must be given by an approved provider to persons for the purposes of

(i) certification review,

(ii) accreditation body

(iii) other responsibilities of the AP under the Act;

(b) requirements relating to police certificates and statutory

declarations for certain staff members and volunteers;

(c) discretion not to report a reportable incident

by an approved provider to a police officer or

the Secretary

(d) requirements for alleged or suspected

reportable assaults.

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AP RESPONSIBILITIES

Part 4.3 of the Aged Care Act 1997 is about the

responsibilities of an approved provider in relation to

accountability for the aged care provided by the

approved provider through an aged care service.

Sanctions can be imposed on an approved provider

that does not comply with its responsibilities under

Part 4.3 of the Act (see Part 4.4).

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AP RESPONSIBLITIESAccess• must be afforded to representatives of the secretary to inspect the

service • may exceed business hours• occur outside of business hours where the Secretary believes that

the information gathered at this time may be more relevant or in situations where there is possibility of serious harm or risk to residents

• notice to access must be in writing unless • it is part of a complaints investigation• It is part of a quality assessment (spot visit)• AP must allow access.• Representatives may not enter the service without consent• AP may refuse access or withdraw consent at any time during the

visit• Where access is refused or withdrawn, the AP may be sanctioned

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QUALITY

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ACCREDITATION GRANT PRINCIPLES

Give key timeframes and information regarding the

accreditation process for new and existing services.

Key Dates:- Assessment and decision to accredit

- For new services the accreditation body (the body) must inform the AP of its decision within 16 days

- For existing services the body must inform the AP within 28 days- The period for which accreditation is granted

- Site Audit- Notification to residents and representatives not less than

21 days of receiving advice of the dates

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ACCREDITATION GRANT PRINCIPLES

- Site Audit- The team must meet daily with the AP (or Key Personnel [KP]

of the AP- Meet 10% of the residents/representatives- Give a written report to the AP on the last day of the audit- The AP (or KP of the AP) may respond within 14 days

- Review Audit- When the body considers the AP is not meeting the accreditation standards - A change that the AP must tell the Secretary about (eg

suitability to provide aged care, key personnel)- Transfer of allocated places- Premises have changed since accreditation- Non compliance with arrangements for contact and

support visits- AP has requested reconsideration of a decision

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ACCREDITATION GRANT PRINCIPLESReview Audit- Same process as for site audit- Response to report is 7 days

Decision Following a Review Audit- The body to decide within 14 days whether it will

revoke or vary or not the accreditation period for the home

Dealing with Non Compliances (not met)- AP must give a revised CIP to the body within 14

days- A timeframe for improvement (TFI) is issued when

actions for improvement are not satisfactory

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ACCREDITATION GRANT PRINCIPLES

Publication of decisions

Are made available on the ACSAA website within

28 days from the last day when a request for

reconsideration can be made.

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Allocation PrinciplesThe process by which allocation of places through

which aged care is provided is undertaken. An AP

can receive subsidy under Chapter 3 of the Act only in respect

of which a place has been allocated.

These principles describe the process for applying for places

(ACAR, transferring of places, bringing new places on line (2

year timeframe with provision for extension) and variation of

allocation provision (for example the number of respite bed

days)

Places are distributed between regions, after which

applications for allocations are made and the places are

allotted.

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Approval of care recipient principles

These principles describe the types of care for which

care recipients can be approved and the lapsing of

certain types of approval if not taken up within the

requisite timeframe.

A care recipient must be approved to receive either

residential or community care before an AP can be

paid residential subsidy or community care subsidy

for providing the care. In some cases, approval to

provide flexible care (EACH, EACHD, Transition

care) is required before care subsidy can be paid.

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Approval of Care Recipient Principles

EACH, EACHD, High Care Permanent and

Residential Respite care (any level) approvals do not

Lapse

Transition Care and low level respite approvals lapse

if not taken up by the expiry date. For transition care

– 4 weeks after approval date and low level respite 1

year after approval date.

However, should the care recipient use either service

even for 1 day, the approval does not lapse.

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Approved Provider PrinciplesIrrespective of the type of care to be provided,

approval under 2.1 of the Act is a precondition to a

provider of aged care receiving subsidy under Ch 3 of the Act

for provision of care. These principles deal with a number of

matters that are important in operating the approval process –

suitability of people to provide aged care, including suitability

of KP, the applicant’s ability and experience (if any) to provide

aged care, the applicant’s record of financial management, the

applicant’s conduct as a provider (compliance with

responsibilities and obligations in relation to receipt of

payments for providing that care) and the applicant’s conduct

generally (conduct and experience other than as a provider of

aged care)

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Certification PrinciplesPart 2.6 of the Aged Care Act 1997 is about the

certification of residential care services.

Only if a residential care service has been certified under

Part 2.6 of the Act, may an approved provider:

(a)charge an accommodation bond or an accommodation

charge; or

(b) receive an accommodation supplement, a concessional

resident supplement or a charge exempt resident

supplement.

The Certification Principles deal with a number of aspects of

the certification process.

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Classification PrinciplesPart 2.4 of the Aged Care Act 1997 is about the

classification of care recipients.

Care recipients who are approved under Part 2.3 of the Act for

residential care, or some kinds of flexible care, are classified

according to the level of care they need.

A care recipient’s classification affects the amount of

residential care, or flexible care, subsidy payable to an

approved provider for providing care to the care recipient.

The Classification Principles deal with a number of aspects of

the classification of care recipients.

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Classification PrinciplesSuch issues include:- Classes of care recipients excluded from

classification (respite)- Classification levels (H,M,L)- Appraisals of levels of care needed (ACFI)- Suspending an AP from making appraisals (where

false, misleading or incorrect information is given in appraisal or reappraisal)

- When respite care classes take effect- Expiry and renewal of classifications (this in on

the claim form and the AP transaction statement)- Scores for the Question ratings (ACFI)

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Complaints PrinciplesDealing with a complaint

If the Secretary receives a complaint under

subsection 13A.5 (1), the Secretary must, in relation

to each issue raised in the complaint:

(a) decide to take no further action on the issue on the basis that section 13A.7 applies to the complaint; or

(b) quickly resolve the issue to the satisfaction of the complainant by giving assistance and advice to the complainant or approved provider to which the issue relates; or

(c) undertake a resolution process.

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Complaints Principles13A.7 No further action on an issue

The Secretary may decide to take no further action

Under paragraph 13A.6 (a) if one of the following

circumstances applies:

(a) the issue was not raised in good faith;

(b) the issue is, or has been, the subject of a legal

proceeding;

(c) the issue has been dealt with under these

Principles or the Investigation Principles 2007;

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Complaints Principles

(d) the issue relates to an event:

(i) that occurred more than one year before the complaint was given to the Secretary; and

(ii) that is not ongoing;

(e) the issue is subject to a coronial inquiry;

(f) a care recipient named in the complaint does not

wish the issue to be considered by the Secretary;

(g) the issue is better dealt with by another

organisation;

(h) having regard to all the circumstances, a resolution

process in relation to the issue is not warranted

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Complaints Principles

13A.8 Secretary may undertake resolution

process on own motion

(1)This section applies if the Secretary receives

information that raises an issue about an approved provider’s responsibilities under the Act or the Principles made under section 96-1 of the Act, from a source other than a complaint under section 13A.5.

(2) The Secretary may undertake a resolution

process in relation to the issue.

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Complaints Principles13A.9 Resolution process

(1) If the Secretary undertakes a resolution process in relation to an issue, the Secretary may adopt one or more of the following approaches to resolve the

issue:

(a)request the approved provider to which the issue

relates to examine and attempt to resolve the issue and report back to the Secretary;

(b) request the complainant (if any), the approved

provider and any other person to participate in a

conciliation process;

(c) undertake an investigation of the issue;

(d) refer the issue to mediation.

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Complaints Principles

(2) In adopting any of the approaches in subsection

(1), the Secretary may do one or more of the

following:

(a) analyse and review documents;

(b) visit the location at which the services are

provided by the approved provider or the offices

of the approved provider;

(c) discuss the issue with the complainant (if any),

the approved provider or any other person, in

person or by other means;

(d) request information from any person.

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Complaints Principles13A.14 Directions to approved provider

(1)If, as part of a resolution process, the Secretary is satisfied that the approved provider to which the resolution process relates, is not meeting the approved provider’s responsibilities under the Act or the Principles made under section 96-1 of the Act, the Secretary may give directions to the approved provider.

(2) The directions must require the approved provider

to take stated actions in order to comply with the

approved provider’s responsibilities under the Act

or the Principles made under section 96-1 of the

Act.

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Complaints Principles(3) Before the Secretary gives directions to the

approved provider, the Secretary must give a

written notice of intention to issue directions to

the approved provider.

(4) However, the Secretary may give directions to

the approved provider, without having issued a

notice of intention to issue directions, if it is

necessary to do so because prompt action is

required by the approved provider in order to

protect the health, safety or wellbeing of a care

recipient.

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Complaints Principles(5) The approved provider may respond to the notice

of intention to give directions.

(6) If the approved provider responds to the notice under

subsection (6), the approved provider must give the

response in writing to the Secretary:

(a) within 14 days after receiving the notice; or

(b) within such other time as specified in the notice.

(7) The Secretary may, after considering any

response from the approved provider, give written

directions to the approved provider directing the approved

provider to take stated actions in order to comply with its

responsibilities under the Act and the Principles made

under section 96-1 of the Act.

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Complaints Principles(8) If the Secretary gives directions to an approved

provider, the approved provider must comply with

the directions.

(9) If the approved provider fails to comply with the

directions, the Secretary may initiate action under

Part 4.4 of the Act.

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Complaints Principles

13A.15 Feedback on no further action

If the Secretary decides to take no further action on an issue

under paragraph 13A.6 (a), the Secretary must, as soon as

practicable, give the complainant, unless the complaint was

made anonymously, written feedback about:

(a) the Secretary’s decision to take no further action and

the reasons for that decision; and

(b) how the complainant may apply for reconsideration by the Secretary or examination of the Secretary’s

decision by the ACC; and

(c) any other appropriate feedback.

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Complaints Principles13A.16 Feedback on resolution process

(1) If the Secretary decides to end a resolution process under section 13A.13, the Secretary must, as soon as practicable, give the complainant (if any) and the approved provider to which the resolution process relates written feedback about:

(a) any key findings; and

(b) the Secretary’s decision to end the resolution process and the reasons for that

decision; and

(c) how the complainant or the approved provider may apply for reconsideration by the

Secretary or examination of the Secretary’s decision by the ACC; and the resolution process.

(d) any other appropriate feedback.

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Complaints Principles(2) However, the Secretary is not required to provide

feedback to a complainant if the complaint is

made anonymously or if the complainant withdraws

(3) The Secretary may give different feedback to the

complainant and the approved provider.

13A.18 Referral to other organisations

(1)Nothing in these Principles prevents the Secretary

from referring an issue to another organisation.

(2) A resolution process may continue even if the

Secretary has referred the issue to which the process

relates to another organisation under subsection (1).

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Complaints Principles13A.21 Application for reconsideration by

Secretary

(1)A complainant may apply to the Secretary for

reconsideration of a decision by the Secretary under paragraph 13A.6 (a) to take no further action on a complaint made by the complainant.

(2) A complainant (if any) or an approved provider to which a

resolution process relates may apply to the Secretary for

reconsideration of a decision by the Secretary to end the

resolution process under section 13A.13.

(3) However, an application cannot be made under subsection

(2) for reconsideration of a decision to end a new resolution

process undertaken

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Complaints Principles(4) An application under subsection (1) or (2) must:

(a) state the reasons (other than dissatisfaction with the

decision) why examination is sought; and

(b) be made within 28 days of the applicant being notified in

writing of the decision.

(5) The application may be made orally or in writing

13A.22 Reconsideration by Secretary

(1) Within 28 days of receipt of an application under section 13A.21, the Secretary must:

(a) confirm the decision to take no further action or to end

the resolution process; or

(b) decide to undertake a new resolution process

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EXTRA SERVICE PRINCIPLESPart 2.5 of the Aged Care Act 1997 is about the

process of allowing places in a residential care

service to become extra service places. Extra

service places involve providing a significantly higher

standard of accommodation, food and services to

care recipients. Extra service places can attract

higher resident fees, but a lower amount of

residential care subsidy is payable.

These Principles deal with various aspects of extra

service places

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QUALITY OF CARE PRINCIPLESPart 4.1 of the Aged Care Act 1997 is about the

responsibilities of approved providers for the quality

of the aged care they provide through their aged

care services.

The responsibilities of approved providers include

compliance with a number of standards set out in

these Principles. The standards are:• the Accreditation Standards• the Residential Care Standards• the Community Care Standards• the Flexible Care Standards

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QUALITY OF CARE PRINCIPLES18.6 Specification of care and services

(1) An approved provider of a residential care service must, for each item in Schedule 1, provide the care or service stated in column 2 of the item to any resident who needs it.

(1A) The care or service must be provided by the approved provider in a way that meets the

Accreditation Standards set out in Schedule 2 or the Residential Care Standards set out in Schedule 3 (as the case requires).

(2) If there is an entry in column 3 of an item in Schedule 1, the care or service mentioned in column 2 of the item consists of the matter

stated in column 3.

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QUALITY OF CARE PRINCIPLES18.3 Specification of Care and Services

(3) However, the services stated in Part 3 of Schedule 1 are required only for the

following residents:

(a) a resident who on 19 March 2008 was receiving a high level of residential care (as defined in the Act on 19 March 2008); or

(b) a resident who is receiving a high level of residential care (as defined in the Act on 19 March 2008); or

(c) a resident who is receiving a high level of residential care (as defined in the Act on or after 1 January 2010); or

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QUALITY OF CARE PRINCIPLES18.6 Specification of Care and Services

(d)a resident who:

(i) on 31 December 2009, was receiving a high level of residential care (as defined in the Act on 31 December 2009); and

(ii) on or after 1 January 2010, would be ineligible to receive a high level of residential care solely because of the amendment to the definition of high level of residential care made on 1 January 2010; and

(iii) is receiving residential care from the same aged care service from which the resident was receiving care on 31 December 2009.

(4)For residents described in paragraph 18.6(3)(d), if initial and on-going assessment, planning and management of care for residents (nursing services as described in Item 3.8 of Part 3 of Schedule 1) is required, it must be carried out by a registered nurse.

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QUALITY OF CARE PRINCIPLES18.6B Fire safety exception notice

(1)An approved provider must give to the Secretary a

notice (a fire safety exception notice) if the approved provider is notified by a State, Territory or local government authority that the approved provider is, in respect of a residential care service operated by the approved provider, non-compliant with any applicable State or Territory laws (including local by-laws) relating to fire safety.

(2) A fire safety exception notice must be given to the Secretary within 28 days of the approved provider being notified by the State, Territory or local government authority of the non-compliance referred to in subsection (1).

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QUALITY OF CARE PRINCIPLES

18.7 Accreditation Standards(Act, s 54‑2)

This Part sets out Accreditation Standards.

Accreditation Standards are standards for quality of

care and quality of life for the provision of residential

care on and after the accreditation day.

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QUALITY OF CARE PRINCIPLES

(1) The Accreditation Standards are set out in

Schedule 2.

(2) The standards deal with the following matters:

(a) management systems, staffing and organisational development;

(b) health and personal care;

(c) resident lifestyle;

(d) physical environment and safe systems.

(3) The accreditation standard for a matter consists of:

(a) the Principle for the matter; and

(b) the expected outcome for each matter indicator

for the matter.

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Schedule 1 Specified care and services for residential care services (section 18.6)

Note Subsection 18.6 (1A) provides that the care and services listed in Schedule 1 are to be provided in a way that meets the standards set out in Schedule 2 or 3 (as the case requires).

Part 1 Hotel services — to be provided for all residents who need them

Col. 1

Item

Column 2

Service

Column 3

Content

1.1 Administration General operation of the residential care service, including resident documentation

1.2 Maintenance of buildings and grounds

Adequately maintained buildings and grounds

1.3 Accommodation Utilities such as electricity and water

1.4 Furnishings Bed-side lockers, chairs with arms, containers for personal laundry, dining, lounge and recreational furnishings, draw-screens (for shared rooms), resident wardrobe space, and towel rails

Excludes furnishings a resident chooses to provide

1.5 Bedding Beds and mattresses, bed linen, blankets, and absorbent or waterproof sheeting

1.6 Cleaning services, goods and facilities

Cleanliness and tidiness of the entire residential care service

Excludes a resident’s personal area if the resident chooses and is able to maintain it himself or herself

1.7 Waste disposal Safe disposal of organic and inorganic waste material

1.8 General laundry Heavy laundry facilities and services, and personal laundry services, including laundering of clothing that can be machine washed

Excludes cleaning of clothing requiring dry cleaning or another special cleaning process, and personal laundry if a resident chooses and is able to do this himself or herself

1.9 Toiletry goods Bath towels, face washers, soap, and toilet paper

1.10 Meals and refreshments (a) Meals of adequate variety, quality and quantity for each resident, served each day at times generally acceptable to both residents and management, and generally consisting of 3 meals per day plus morning tea, afternoon tea and supper

(b) Special dietary requirements, having regard to either medical need or religious or cultural observance

(c) Food, including fruit of adequate variety, quality and quantity, and non-alcoholic beverages, including fruit juice

1.11 Resident social activities Programs to encourage residents to take part in social activities that promote and protect their dignity, and to take part in community life outside the residential care service

1.12 Emergency assistance At least 1 responsible person is continuously on call and in reasonable proximity to render emergency assistance

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Part 2 Care and services — to be provided for all residents who need them

Col. 1

Item

Column 2

Care or Service

Column 3

Content

2.1 Daily living activities assistance

Personal assistance, including individual attention, individual supervision, and physical assistance, with:

(a) bathing, showering, personal hygiene and grooming

(b) maintaining continence or managing incontinence, and using aids and appliances designed to assist continence management

(c) eating and eating aids, and using eating utensils and eating aids (including actual feeding if necessary)

(d) dressing, undressing, and using dressing aids

(e) moving, walking, wheelchair use, and using devices and appliances designed to aid mobility, including the fitting of artificial limbs and other personal mobility aids

(f) communication, including to address difficulties arising from impaired hearing, sight or speech, or lack of common language (including fitting sensory communication aids), and checking hearing aid batteries and cleaning spectacles

Excludes hairdressing

2.2 Meals and refreshments Special diet not normally provided

2.3 Emotional support Emotional support to, and supervision of, residents

2.4 Treatments and procedures Treatments and procedures that are carried out according to the instructions of a health professional or a person responsible for assessing a resident’s personal care needs, including supervision and physical assistance with taking medications, and ordering and reordering medications, subject to requirements of State or Territory law

2.5 Recreational therapy Recreational activities suited to residents, participation in the activities, and communal recreational equipment

2.6 Rehabilitation support Individual therapy programs designed by health professionals that are aimed at maintaining or restoring a resident’s ability to perform daily tasks for himself or herself, or assisting residents to obtain access to such programs

2.7 Assistance in obtaining health practitioner services

Arrangements for aural, community health, dental, medical, psychiatric and other health practitioners to visit residents, whether the arrangements are made by residents, relatives or other persons representing the interests of residents, or are made direct with a health practitioner

2.8 Assistance in obtaining access to specialised therapy services

Making arrangements for speech therapy, podiatry, occupational or physiotherapy practitioners to visit residents, whether the arrangements are made by residents, relatives or other persons representing the interests of residents

2.9 Support for residents with cognitive impairment

Individual attention and support to residents with cognitive impairment (eg dementia, and other behavioural disorders), including individual therapy activities and specific programs designed and carried out to prevent or manage a particular condition or behaviour and to enhance the quality of life and care for such residents and ongoing support (including specific encouragement) to motivate or enable such residents to take part in general activities of the residential care service

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Part 3 Care and services — to be provided for residents receiving a high level of residential care

Col. 1

Item

Column 2

Care or Service

Column 3

Content

3.1 Furnishings Over-bed tables

3.2 Bedding materials Bed rails, incontinence sheets, restrainers, ripple mattresses, sheepskins, tri-pillows, and water and air

mattresses appropriate to each resident’s condition

3.3 Toiletry goods Sanitary pads, tissues, toothpaste, denture cleaning preparations, shampoo and conditioner, and talcum

powder

3.4 Goods to assist residents to move

themselves

Crutches, quadruped walkers, walking frames, walking sticks, and wheelchairs

Excludes motorised wheelchairs and custom made aids

3.5 Goods to assist staff to move

residents

Mechanical devices for lifting residents, stretchers, and trolleys

3.6 Goods to assist with toileting and

incontinence management

Absorbent aids, commode chairs, disposable bed pans and urinal covers, disposable pads, over-toilet chairs,

shower chairs and urodomes, catheter and urinary drainage appliances, and disposable enemas

3.7 Basic medical and pharmaceutical

supplies and equipment

Analgesia, anti-nausea agents, bandages, creams, dressings, laxatives and aperients, mouthwashes,

ointments, saline, skin emollients, swabs, and urinary alkalising agents

Excludes goods prescribed by a health practitioner for a particular resident and used only by the resident

3.8 Nursing services Initial and on-going assessment, planning and management of care for residents, carried out by a registered

nurse

Nursing services carried out by a registered nurse, or other professional appropriate to the service (eg

medical practitioner, stoma therapist, speech pathologist, physiotherapist or qualified practitioner from a

palliative care team)

Services may include, but are not limited to, the following:

(a) establishment and supervision of a complex pain management or palliative care program, including

monitoring and managing any side effects

(b) insertion, care and maintenance of tubes, including intravenous and naso-gastric tubes

(c) establishing and reviewing a catheter care program, including the insertion, removal and replacement

of catheters

(d) establishing and reviewing a stoma care program

(e) complex wound management

(f) insertion of suppositories

(g) risk management procedures relating to acute or chronic infectious conditions

(h) special feeding for care recipients with dysphagia (difficulty with swallowing)

(i) suctioning of airways

(j) tracheostomy care

(k) enema administration

(l) oxygen therapy requiring ongoing supervision because of a care recipient’s variable need

(m) dialysis treatment

3.10 Medications Medications subject to requirements of State or Territory law

3.11 Therapy services, such as,

recreational, speech therapy,

podiatry, occupational, and

physiotherapy services

(a) Maintenance therapy delivered by health professionals, or care staff as directed by health

professionals, designed to maintain residents’ levels of independence in activities of daily living

(b) More intensive therapy delivered by health professionals, or care staff as directed by health

professionals, on a temporary basis that is designed to allow residents to reach a level of

independence at which maintenance therapy will meet their needs

Excludes intensive, long-term rehabilitation services required following, for example, serious illness or

injury, surgery or trauma

3.12 Oxygen and oxygen equipment Oxygen and oxygen equipment needed on a short-term, episodic or emergency basis

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QUALITY OF CARE PRINCIPLESPractical Applications

Part 3 of Schedule 1 describes those residents considered as high care residents

under the Act, irrespective of the “place” they occupy. This is to accommodate the

ageing in place provision under the legislation. For all residents who are high care

by virtue of their ACCR classification or because they have been assessed as high

care under the ACFI, Part 3 of Schedule 1 applies.

Those items listed under 3.8 Nursing Services must be delivered by a Registered

Nurse in order to comply with this principle.

The items listed in Schedule 1, Parts 1,2 and 3 and the Residential Care Standards

give rise to the 44 expected outcomes under the Accreditation Standards. A failure

to comply with the Quality of Care Principles in some aspect will result in a failure to

comply with the Accreditation Standards in the same aspect. Severe failures may

result in a breach in the legislation giving rise to TFI or sanctions.

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RESIDENTIAL CARE SUBSIDY PRINCIPLESPart 3.1 of the Aged Care Act 1997 is about residential care subsidy.

The residential care subsidy is a payment by the Commonwealth to

approved providers for providing residential care to care recipients.

The Residential Care Subsidy Principles deal with eligibility for the subsidy,

how it is paid and what amount is paid.

These principles outline how basic daily care fees are calculated and

payable, how supplements are calculated and paid and the requirements an

AP must meet in order to receive and to continue to receive the CAP

There are 3 requirements an AP must meet in order to continue to receive

the CAP (currently 8.75% of basic subsidy amount payable for a resident)• Staff training• GPFS• Workforce census

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RESIDENTIAL CARE SUBSIDY PRINCIPLES

Practical Applications

Administrative processes including:• Information on fees and charges applicable• Centrelink assessment forms• Residential Care Agreement• Resident’s handbook• RER• Medicare claim form• Medicare payment statement• Education records• Participation of workforce surveys• Completion of Annual Prudential Compliance Statement by 31 October

each year• Completion of the GPFS by the 30 November each year (in order to

continue to receive the CAP).

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SANCTIONS PRINCIPLESPart 4.4 of the Aged Care Act 1997 is about the

consequences of non-compliance with an approved

provider’s responsibilities under Part 4.1, 4.2 or 4.3 of

the Act. Sanctions can be imposed on the approved

provider.

A number of sanctions are set out in section 66-1 of

the Act.

These Principles deal with a number of matters that

are important in operating the sanctions process.

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SANCTIONS PRINCIPLES

An advisor or administrator may be appointed instead

of revocation of approval (as an AP)

The sanctions notice will set out the non compliance(s)

against which the sanctions have been issued, the type

of sanctions imposed and the duration of the sanctions

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SANCTIONS PRINCIPLES

Practical Applications

The process:• Sanctions notice is received• AP is given a list of administrators or nurse advisers• AP chooses a candidate from the list• The Secretary (DoHA) either accepts or rejects the

nomination within 14 days• Within 7 days the Secretary must notify the AP in writing of

the decision• If the decision is not to appoint the proposed candidate, the

AP may appeal. If the AP does not appeal, the AP must nominate another appointment to the Secretary within 7 days

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USER RIGHTS PRINCIPLESPart 4.2 of the Aged Care Act 1997 is about the

responsibilities of an approved provider to the users

and proposed users of the provider’s aged care

service.

The Part sets out a number of user rights, and the

provider’s related responsibilities. Other rights and

responsibilities are set out in these Principles.

An approved provider’s failure to meet its

responsibilities may lead to sanctions being imposed

under Part 4.4 of the Act.

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USER RIGHTS PRINCIPLES23.27A Purpose of Part (Act, s 57-1)

This Part (including the Prudential Standards) is, with

the provisions of the Act, intended to deal with all requirements

about payment and protection of accommodation bonds.

23.27 Purpose of Division (Act, s 57-2)

This Division specifies the information about accommodation

bonds that an approved provider must provide to a care

recipient before the care recipient enters the provider’s

residential care service or flexible care service.

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USER RIGHTS PRINCIPLES

The Four Prudential Standards

– the Governance Standard effective from 1 February 2012

– the Disclosure Standard effective from 1 October 2011

– the Liquidity Standard

– the Records Standard.

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USER RIGHTS PRINCIPLES