Quality of Care Amendment Principles 2009 (No. 1)

Administered by Department of Health, Disability and Ageing

Legislation au F2009L04649 Not in force Legislative Instrument

Legislation content

 

EXPLANATORY STATEMENT

 

Issued by the authority of the Minister for Ageing

 

Aged Care Act 1997

 

Quality of Care Amendment Principles 2009 (No. 1)

 

The Aged Care Act 1997 (the Act) provides for the funding of aged care services.  Persons who are approved under the Act to provide residential aged care services (approved providers) can be eligible to receive residential care subsidy payments in respect of the care they provide to approved care recipients. 

 

Subsection 96-1(1) of the Act allows the Minister to make Principles providing for various matters required or permitted by a Part or section of the Act. 

 

The Quality of Care Principles 1997 (the Quality of Care Principles) is one of the sets of Principles made under the Act.

 

The purpose of the Quality of Care Amendment Principles 2009 (No. 1) (the Amending Principles) is detailed below.  The Amending Principles is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

Quality of Care Amendment Principles 2009 (No. 1)

 

A design anomaly in the Aged Care Funding Instrument (ACFI) is causing a number of permanent residents to be classified as requiring high level care when they do not require high level care services.  In addition, the level of disagreement between Aged Care Assessment Team (ACAT) assessments and ACFI appraisals has increased, adding to the number of requests for reassessment of residents by ACATs.

 

The purpose of these Amending Principles is to support changes to the ACFI definition of ‘high level of residential care’ that will occur from 1 January 2010.  The definition of ‘high level of residential care’ is being changed to ensure aged care homes are not expected to provide nursing care to residents who do not need this level of care.  The changes to the definition are being made through the Classification Amendment Principles 2009 (No. 1).

In addition to the changes to the definition, changes are needed to ensure that existing residents whose classification would no longer entitle them to a high level of residential care (because of the changes to the definition) do not face any unexpected increases in costs for services that they are currently eligible to receive at no additional cost.  While there may be no need for such residents to be provided with ongoing nursing care, it is possible that they may need some nursing services from time to time. These changes will ensure that, in such cases, residents will continue to be provided with these services at no additional charge, for as long they remain in the same home.

Consultation

The changes to the ACFI arrangements have been the subject of extensive consultations with consumers, approved providers and health professionals through the ACFI Technical Reference Group, the ACFI Industry Reference Group and the Ageing Consultative Committee.

 

Details of the amendments to the Quality of Care Principles are set out in the Attachment.

 


 

ATTACHMENT

NOTES ON CLAUSES

 

Clause 1 states that the name of the Amending Principles is the Quality of Care Amendment Principles 2009 (No. 1).

 

Clause 2 states that these Amending Principles commence on 1 January 2010.

 

Clause 3 states that Schedule 1 amends the Quality of Care Principles 1997.

 

Schedule 1 Amendments

 

Item 1

 

The Secretary for the Department of Health and Ageing (the Secretary) classifies each permanent aged care resident into one of 65 classifications, based on the resident’s level of approval for care (determined by an Aged Care Assessment Team (ACAT)) and on the provider’s appraisal of the resident using the ACFI.  A resident’s classification determines the level of basic subsidy payable in respect of the resident and whether the resident is deemed to require high or low level care. 

 

In order to address a design anomaly in the ACFI (which is causing a number of permanent residents to be appraised as requiring high level care when they do not require high level care services and adding to the number of requests for reassessment of residents by ACATs ) changes will be made, from 1 January 2010, to the definition of high level of residential care.  

 

Under the new definition, a classification would entitle a care recipient to a high level of residential care if the ACFI appraisal included:

(a) a high Activities of Daily Living (ADL) domain category; or

(b)  a high Complex Health Care (CHC) domain category; or

(c)  a domain category of medium or high in at least two of the three domain categories; or

(d) a high behaviour domain category and either: an ADL domain category other than nil; or a CHC domain category other than nil.

 

Under the proposed change of definition, some residents who currently receive high level residential care would no longer be eligible for such care and would instead be eligible for low level care.

 

To ensure that these residents do not lose their current eligibility to receive high care services if needed at no charge, the amendments described at Item 1 are being made to the Quality of Care Principles.

 

The effect of new paragraph 18.6(3)(d) in Item 1 is that, if a person was eligible for high level residential care on 31 December 2009 but, on or after 1 January 2010, would no longer be eligible (because of the changes to the definition of high level of residential care), then the person will continue to be eligible to receive high care services while the person remains at the same home (and assuming the person is not otherwise re-classified). 

 

The new subsection 18.6(4) clarifies that 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.

 

There will be no impact on the quality of care provided to residents.  Under Quality of Care and Accreditation arrangements, aged care services will continue to be required to provide the full range of nursing services to residents who need this level of care.

 

 

Overview

The Quality of Care Amendment Principles 2009 (No. 1) was enacted to address issues with the Aged Care Funding Instrument (ACFI) that led to permanent residents being incorrectly classified as requiring high level care. This issue caused disagreements between Aged Care Assessment Team (ACAT) assessments and ACFI appraisals, resulting in more requests for reassessments. The Minister for Ageing, under subsection 96-1(1) of the Aged Care Act 1997, introduced these Amending Principles to rectify the definition of 'high level of residential care', effective from 1 January 2010. This change ensures that aged care homes are not expected to provide nursing care to residents who do not need it, while also guaranteeing that existing residents who would no longer qualify for high level residential care due to the changes will not incur unexpected costs for services they are currently entitled to at no additional charge. This was achieved through extensive consultations with stakeholders and the implementation of the Classification Amendment Principles 2009 (No. 1).

Scope and Application

The Quality of Care Amendment Principles 2009 (No. 1) pertains to the Aged Care Act 1997 and specifically targets the Quality of Care Principles, which govern the provision of residential aged care services in Australia. This legislative instrument applies to approved providers of residential aged care services and the residents they care for, including those who are eligible for residential care subsidy payments. The changes outlined in the Amending Principles aim to rectify a design anomaly in the Aged Care Funding Instrument (ACFI) that has led to permanent residents being misclassified as requiring high-level care, thus impacting the accuracy of care assessments and increasing reassessment requests by Aged Care Assessment Teams (ACAT). The legislative changes commence on 1 January 2010, addressing the definition of 'high level of residential care' to ensure that aged care homes are not expected to provide nursing care to residents who do not need it, while also safeguarding existing residents from unexpected increases in care costs. The Amending Principles extend their application through amendments to the Quality of Care Principles, ensuring that affected residents continue to receive necessary care services without additional charges as long as they remain in the same residential care facility.

Key Provisions

The Quality of Care Amendment Principles 2009 (No. 1) (section 3) make amendments to the Quality of Care Principles 1997, particularly addressing the definition of ‘high level of residential care’ within the Aged Care Funding Instrument (ACFI). The primary purpose of these amendments is to rectify a design anomaly in the ACFI that has resulted in some permanent residents being classified as requiring high-level care when they actually do not (section 3, Item 1). This has led to an increased number of reassessments by Aged Care Assessment Teams (ACAT). The new definition of ‘high level of residential care’ specifies that a classification will entitle a care recipient to high-level care if the ACFI appraisal includes a high Activities of Daily Living (ADL) domain category, a high Complex Health Care (CHC) domain category, a medium or high domain category in at least two of the three domain categories, or a high behaviour domain category combined with a non-nil ADL or CHC domain category. This change aims to ensure that only those residents who genuinely need high-level care will receive it, while others will be reclassified accordingly. These amendments impose specific obligations on approved providers and ACATs. Approved providers must ensure that their appraisals of residents using the ACFI are accurate and consistent with the new definitions and classifications. They are also required to provide the appropriate level of care as determined by the resident's classification, ensuring that the quality of care remains high and that all necessary nursing services are provided by registered nurses (section 3, Item 1, new subsection 18.6(4)). ACATs, on the other hand, must conduct thorough and accurate initial and ongoing assessments of residents to ensure that their classifications reflect their actual care needs. They must also ensure that any required reassessments are conducted in a timely and efficient manner to avoid unnecessary disruptions to the residents' care. Failure to comply with these provisions could lead to civil or administrative penalties. While the specific penalties are not detailed in the explanatory statement, non-compliance with quality of care and accreditation standards can typically result in sanctions such as fines, suspension of funding, or other corrective measures. These penalties are intended to enforce adherence to the new standards and to protect the interests of residents, ensuring that they receive appropriate care without undue financial burden. The aim is to maintain high standards of care and to prevent any exploitation or mismanagement of the new classification system.

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