The powers granted to the Aged Care Quality and Safety Commission that allow assessors to enter any Commonwealth-funded aged care facility in Australia to perform audits, have forced aged care operators to breach state legislation that was implemented to reduce the spread of COVID.
Aged Care Quality and Safety Commissioner, Janet Anderson, told Inside Ageing the Commission is using the full range of its regulatory powers to closely monitor and respond to the COVID-19 pandemic across Australia in response to the pandemic, and to support to aged care services in managing the increased risks of a COVID-19 outbreak.
Between 1 March and 16 October 2020, assessors carried out 1097 infection control monitoring visits to residential aged care services across Australia. Nearly a third of these visits (363) were in Victoria, though the Commission would not confirm which facilities its assessors had visited.
“Short notice site visits temporarily replaced unannounced visits based on public health advice and other clinical advice, including from the Commission’s Chief Clinical Advisor. Unannounced visits resumed in June 2020 when they could occur safely and re-accreditation audits resumed in August 2020,” she said.
Across Australia, at the end of October, 216 residential care facilities had experienced a COVID-19 outbreak and 2049 aged care residents had contracted the virus. Most cases were in Victoria (1986), followed by NSW with 61, and one each in Queensland and Tasmania.
In New South Wales and Victoria such visits contradict COVID-related orders that have been issued by the respective State Governments to limit who can enter an aged care facility to minimise the risk of further outbreaks in aged care. In both states, lists of who can enter aged care facilities have been developed. Neither specifically refer to quality and safety assessors.
Despite the strict visitation rules in place that have limited family members from having contact with residents, the Commissioner confirmed that unannounced visits and re-accreditation audits have continued to include interviewing at least 10 per cent of the consumers (and/or their representatives) living in the facility and that the proportion of consumers interviewed is frequently higher.
A number of aged care providers have told Inside Ageing that assessors who visited residential care facilities over the last six months have not followed the infection prevention measures in place and when asked not to enter the facilities for a variety of reasons, they have refused to leave.
Providers have also expressed concern about the distances travelled by assessors, with examples given of people living in greater western Sydney travelling to regional and remote areas of New South Wales to carry out audits.
LASA CEO Sean Rooney said the peak body has “received a number of worrying reports of similar situations in Victoria and South Australia”.
“This is an alarming allegation that potentially puts residents and staff at risk. Whilst we appreciate and support the need for appropriate regulation of services, in practice this needs to take account of the infection protection and control measures in place,” Mr Rooney said.
But the Quality and Safety Commissioner says assessors are just doing their jobs.
“Under the Aged Care Act, the Safety and Quality auditors have authority to enter any aged care service – with consent – to hold providers to account for the quality and safety of the care they provide and in doing so, auditors are exercising functions and powers of the Commission under Commonwealth legislation that are recognised by State and Territory Health Authorities,” Ms Anderson, said.
“During the pandemic the Commission has regularly reviewed and adjusted its regulatory activities based on risk to ensure the safety of consumers, staff and our own workforce. This includes undertaking risk assessments prior to conducting any onsite visits to minimise any infection risk,” Ms Anderson said.
“Quality assessors undertaking site visits undergo daily screening based on expert medical advice by the Commission regarding any fever or symptoms of acute respiratory infection; contact with a confirmed case of COVID-19 or persons awaiting test results; as well as a temperature check. Quality assessors also undertake PPE training to meet best practice and state-based requirements.”
When asked how many complaints it has received during this period, the Commission would only provide data for the 2019-20 financial year.
The aged care peak bodies have called for greater transparency around the Commission’s practices including complaints against assessors.
“Where potential problems with screening or infection control practices of auditors are identified by the Commission, these should be investigated, with the results and actions shared consistent with open disclosure principles,” Mr Rooney said.
Nicholas Brown, Acting CEO of the Aged Care Guild said everyone entering an aged care home must comply with the screening process recommended by the CDNA and AHPPC.
“Providers are working as hard as they can to protect vulnerable senior Australians in their care and prevent COVID-19 from entering their homes. Especially during a public health emergency, everyone has an important role to play and we all need to adapt the way we work to ensure the safety and security of residents in care, inclusive of the regulator, governments and providers,” Mr Brown said.
Providers can lodge complaints about how audits are being handled through the Quality and Safety Commission’s website and should also inform their peak body.
*In New South Wales, an extensive list of who can visit residents in aged care facilities including emergency and law enforcement personnel, is outlined in the Public Health (COVID-19 Aged Care Facilities) Order (No 3) 2020. This list does not include Quality and Safety Commission auditors or regulatory personnel.
In Victoria, a factsheet issued by the Department of Health and Human Services that was updated in early October, in addition to practicing physical distancing, respiratory etiquette and hand hygiene, visits to residents may only occur if the visitor is a parent, guardian, carer, partner or support person of a resident; if they are providing support that cannot reasonably be delivered via electronic or non-physical means; if they are a caregiver; or if they are providing language support to enable the care team to provide care. Residents can only have one visitor per day, visitors can only visit the resident and are restricted to certain areas.
In Victoria, providers are responsible for decisions to lockdown in the context of existing obligations under the relevant Australian Government legislation, and facilities may be closed to visitors to keep vulnerable residents safe or may restrict visits to include close family only.