Introduction to the Changes

The Strengthened Quality Standards and underlying audit methodology are part of a broader revision of the overall regulatory model being introduced with the new Aged Care Act, slated for 1 July 2024. This raft of changes is designed to improve the care of older people by pushing towards a more consultative and relationship-based regulatory model. This means greater support, engagement, trust, and forming relationships between the sector and registered providers. The goal is a more transparent regulatory model that will deliver safe, higher-quality care.

Registration Categories

Understanding registration categories guides application and assessment against the Strengthened Standards. Registration categories will determine which providers are assessed against what standards. All providers will be assigned a registration category(ies) based on the service types they deliver. There are currently six proposed service categories, with residential care (category 6) assessed against all seven Quality Standards. Services delivering nursing and complex care management (category 5) will be assessed against Standards 1-5, whereas services providing personal and social care in the home or community (including respite) will be evaluated against Standards 1-4. Providers delivering services in categories 1,2, and 3 will not be subject to audits.

Outcomes Legislated New Act

The fundamental changes within the new regulatory model, including the revised audit methodology and focus on outcomes, sit within the new Aged Care Bill 2023, which is currently in exposure draft form. Once through the parliamentary passage, achieving the outcomes of the new Standards will be mandated.

Graded Assessments

The new audit gradings aim to better differentiate between the performance of providers. The hope is that the new gradings drive continuous improvement.

Audit Grading	Proposed Description	Guide
Exceeding	Conformance with every standard. Provider can demonstrate that for an outcome, an effective system and process have been established, implemented and reviewed continuously.	TBC (as per draft document)
Conformance	Provider can demonstrate that for an outcome, an effective system and process have been established, implemented and reviewed continuously.	TBC (as per draft document)
Minor non-conformance	Opportunities for improvement. Some gaps have been identified, but the gap is not systemic (only relevant to a minor aspect of the system or process) and is not high-risk to the health, safety, and well-being of older people or workers.	The gap is isolated or one-off. The provider self-identifies the gap. Low risk, low impact gap and can be rectified quickly.
Major non-conformance	Systemic, high-risk gaps that pose a clear risk to the health, safety, and well-being of older people or workers. Lack of effective systems and processes. Cannot demonstrate continuous improvement.	Frequent gaps. Not self-identified. Significant impact. High consequence. This cannot be rectified quickly.

New Auditing Principles

The new audit framework is designed to ensure that the latest audit process is consistent and fair. Auditing principles, including fairness, independence, and an evidence-based approach, aim to achieve this. A consistent approach and scalable system are intended to help auditors reach similar conclusions and avoid wide discrepancies in performance results.

Audit Methodology

Auditors, in line with the auditing principles outlined in the Draft: Audit methodology, evidence mapping, and associated templates (page 8), will draw on two key references when auditing:

• Audit methodology
• Evidence mapping framework

Meeting Obligations

Studying and applying key guidance resources for providers will help them understand the intent of the new Standards, organise activities and education, and revise systems or create new processes to help them meet the standards.

Demonstrating Conformance

Demonstrating conformance against the Standards will rely on a provider's ability to articulate specifically (describe, using evidence) that the provider and service meet each outcome of the Standards (as determined by their service registration category). The ability to clearly describe how the provider meets the specific outcome will be dependent upon a provider having a clear understanding of and ability to implement the actions of each outcome. Put simply, a provider needs to understand that the actions associated with each outcome can help achieve the result.

Auditor Evidence

Auditors will analyse evidence to determine to what extent the evidence gathered against each Outcome conforms with its requirements and intent. A provider must conform to each Outcome.

Audit Process

Audits will be conducted in three phases: preparation, delivery, and reporting. They can be registration or re-registration audits. Auditors will determine gradings and prepare findings against each Outcome.

Stage	Stage 1 - Audit Preparation and Desktop	Stage 2 - Audit Delivery	Stage 3 - Audit Reporting
Objective	Planning and preparation prior to on-site activities	Gather detailed evidence	Prepare and determine findings
Key Document	Request for Information (RFI) Pre-audit preparation tool (PAPT) (self-assessment tool)	Paper and electronic documents, including Strategies Policies Procedures Registers Meeting minutes Reports Care minutes Progress notes Assessments Incident data Complaints data	Preliminary audit report
Details	Desktop only	Desktop and on-site	Desktop only
Activities	Internal regulatory data reviewed by the Commission Pre-audit meeting conducted (virtual) Desktop evidence review commences.	Evidence gathering occurs through virtual interviews and on-site observations with: Governing body Workers Older people and their representatives Consumer advisory bodies	Audit gradings confirmed against each Outcome. Provider Response

Ausmed's Updates

Ausmed is introducing two critical updates to the Ausmed LMS. The focus of any educational initiative is to close or narrow the identified gap in knowledge, skill, practice, or confidence of the learner(s). The goal is to target the intended learning cohort or staff group/job role/team with the right education to achieve the desired learning outcome. L&D teams will be able to search and find activities by outcome, not just by the Standard. The Ausmed Library has over 1200 resources. We want to make sure L&D teams can quickly respond to the need for an educational activity.

Useful Resources

The Commission developed the following set of materials, guidance, and resources to support providers holistically. Each resource aims to help providers, services, staff, and governing bodies better understand the new Standards. They clarify changes, introduce new key concepts, and help providers consider how to best apply the guidance to their specific services. It is recommended that they be read as a package, not in isolation.

Standards Guidance	Audit Methodology	Evidence Mapping
Primary resources for providers Help understand the intent of each standard Ideas for systems and processes Clarify new concepts	Used by auditors for the audit process Describes the audit process Explains what providers can expect from the audit process Including how to prepare	Used by auditors during an audit Outlines examples of questions and observations that may be requested during an on-site audit Includes what additional evidence may be required

Full list

• The Strengthened Aged Care Quality Standards – Final draft
• Draft Guidance for Providers: Introduction
• Draft Guidance for Providers: Standard 1
• Draft Guidance for Providers: Standard 2
• Draft Guidance for Providers: Standard 3
• Draft Guidance for Providers: Standard 4
• Draft Guidance for Providers: Standard 5
• Draft Guidance for Providers: Standard 6
• Draft Guidance for Providers: Standard 7
• Draft Audit Methodology
• Draft Evidence Framework
• Draft Guidance for Aged Care Workers
• Draft Pre-Audit Preparation Tool
• Draft Request for Information Template - Category 4 & 5
• Draft Request for Information Template - Category 6
• Glossary
• Framework Analysis (Provided for Information, Not for Review)
• Royal Commission into Aged Care Quality and Safety Final Report: Care, Dignity and Respect
• Australian Government Response to the Final Report of the Royal Commission into Aged Care Quality and Safety
• Aged Care Bill 2023 Exposure draft
• New Aged Care Act: Defining high-quality care
• Supporting Sector Readiness for the New Strengthened Aged Care Quality Standards (Webinar)

Author