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Effectiveness of the Aged Care Quality Assessment And The Senate Community Affairs References Committee Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse and poor practices, and ensuring proper clinical and medical care standards are maintained and practised Final report April 2019 © Commonwealth of Australia 2019 ISBN 978-1-76010-955-4 (Printed Version) ISBN 978-1-76010-955-4 (HTML Version) This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Australia License. The details of this licence are available on the Creative Commons website: http://creativecommons.org/licenses/by-nc-nd/3.0/au/. Committee Members Chair Senator Rachel Siewert AG, WA Deputy Chair Senator Lucy Gichuhi LP, SA (from 10 September 2018, Deputy Chair from 13 September 2018) Members Senator Wendy Askew LP, TAS (from 2 April 2019) Senator the Hon Kristina Keneally ALP, NSW Senator Louise Pratt ALP, WA Senator Murray Watt ALP, QLD Substitute Members Senator Helen Polley ALP, TAS (for Senator Sam Dastyari from 16 August 2017 until 25 January 2018) Senator Helen Polley ALP, TAS (for Senator the Hon Kristina Keneally from 22 March 2018 until 3 April 2019) Participating Members Senator David Fawcett LP, SA Senator Rex Patrick NXT, SA Senator Dean Smith LP, WA Former Members Senator Slade Brockman LP, WA (from 17 August 2017, Deputy Chair from 21 August 2017 until 10 September 2018) Senator Jonathon Duniam LP, TAS (until 27 June 2018, Deputy Chair until 21 August 2017) Senator Sam Dastyari ALP, NSW (until 16 August 2017) Senator the Hon Kristina Keneally ALP, NSW (from 15 February 2018 until 22 March 2018) Senator Steve Martin NATS, TAS (from 27 June 2018 until 2 April 2019) Senator Linda Reynolds LP, WA (until 17 August 2017) iii Secretariat Jeanette Radcliffe, Committee Secretary Kate Gauthier, Principal Research Officer Cathy Nunn, Senior Research Officer Hannah Dibley, Senior Research Officer Michael Kirby, Senior Research Officer Kathleen McGarry, Acting Senior Research Officer Carol Stewart, Administrative Officer Kate Morris, Administrative Officer PO Box 6100 Parliament House Canberra ACT 2600 Phone: 02 6277 3515 Fax: 02 6277 5829 E-mail: [email protected] Internet: www.aph.gov.au/senate_ca iv Table of Contents Committee Members ........................................................................................................................ iii Terms of Reference ............................................................................................................................ ix Abbreviations ..................................................................................................................................... xi List of Recommendations .............................................................................................................. xiii Chapter 1—Introduction .................................................................................................................... 1 Interim report ....................................................................................................................................... 2 Recent reports, reviews and reforms ................................................................................................. 4 Reviews of aged care ................................................................................................................ 4 Recent reforms of aged care regulation ................................................................................. 5 Royal Commission into Aged Care Quality and Safety ...................................................... 6 Focus of continued inquiry ................................................................................................................. 6 Report outline ............................................................................................................................ 7 Conduct of the inquiry ............................................................................................................. 7 Chapter 2—Delivery of clinical care ................................................................................................ 9 Clinical care in the aged care context ................................................................................................ 9 What is clinical and medical care? .......................................................................................... 9 Current clinical environment ................................................................................................ 10 Outcomes of clinical care ....................................................................................................... 11 Missed care .............................................................................................................................. 14 Committee view ...................................................................................................................... 15 Aged care: supported accommodation or health care? ................................................................ 15 What are RACFs funded to provide? ................................................................................... 19 Committee view ...................................................................................................................... 20 Responsibility for clinical care standards ....................................................................................... 20 Committee view ...................................................................................................................... 24 RACF model of care ........................................................................................................................... 24 Informal model of delegated care ......................................................................................... 26 Clinical governance ................................................................................................................ 27 Committee view ...................................................................................................................... 33 Specialist clinical care ........................................................................................................................ 34 v Palliative care .......................................................................................................................... 35 Pain management ................................................................................................................... 37 Mental Health .......................................................................................................................... 37 Dementia .................................................................................................................................. 38 Restrictive practice and medications ................................................................................... 41 Committee view ...................................................................................................................... 44 Chapter 3—Regulation of clinical care ......................................................................................... 47 Recent regulatory reforms ................................................................................................................ 48 New aged care regulator ........................................................................................................ 48 Retaining the accreditation approach to aged care regulation ......................................... 51 Aged Care Workforce Strategy Taskforce ........................................................................... 52 Charter of Aged Care Rights ................................................................................................. 54 New aged care regulation standards ................................................................................... 55 Committee view ...................................................................................................................... 55 Concerns with new standards .......................................................................................................... 56 Model of care ........................................................................................................................... 56 Clinical governance ................................................................................................................ 59 Staffing levels .......................................................................................................................... 60 Professional standards ........................................................................................................... 64 Medications.............................................................................................................................. 65 Palliative care .......................................................................................................................... 66 Wellness and reablement ....................................................................................................... 67 Dementia care, mental health and restrictive practice ...................................................... 68 Committee view ...................................................................................................................... 71 Aged Care Commission Assessors .................................................................................................
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