What is Accreditation?

A: Accreditation is the evaluation process which aged care homes must undergo to continue receiving residential care subsidies from the Australian Government.

What is the Accreditation process?

The main components of the accreditation process are:

• The approved provider and service conducts a self-assessment;
• The approved provider submits an application, including the self-assessment report;
• A team of at least two registered aged care quality assessors conducts a desk audit examining the application;
• The same team conducts a two to three day site audit which includes interviews with residents, their families, staff and management;
• The Agency considers the assessment team's findings, any submission from the approved provider and any other relevant information, including input from the Department. It decides whether or not to accredit the service, and if granted, the period of accreditation as well as the form and frequency of support contacts and whether the service must make improvements;
• The Agency informs the provider of the decision;
• The Agency publishes the team's report and the Agency's decision on the Agency's website (2004a); and
• The approved provider manages compliance with the Accreditation Standards and the Act and ongoing continuous improvement to the service throughout the period of accreditation. At the same time, the Agency conducts support contacts to monitor compliance with the Accreditation Standards and the Act and, to assist the service to undertake continuous improvement;
• Re-application prior to expiry of the Facility’s existing period of accreditation.

Who is responsible for Accreditation? (Who assesses the quality of aged-care homes?)

A: An industry-funded body called the Aged Care Standards and Accreditation Agency (ACSAA) is responsible for the accreditation of aged-care facilities, in line with the current federal government policy of self-regulation by industry.

What are the Accreditation Standards?

A: Homes are assessed against four Accreditation Standards:

• Management Systems, Staffing and Organisational Development;
• Health and Personal Care;
• Resident Lifestyle and
• Physical Environment and Safe Systems

Each standard is divided into a number of Expected Outcomes. There are 44 Expected Outcomes across the four Accreditation Standards. Other information that may also be considered in the evaluation process including whether the home meets other responsibilities under the Aged Care Act 1997.

Tell me more about "Self-Assessment"?

Self-assessment is performed by the approved provider, against each of the 44 expected outcomes and forms part of the application process for accreditation and reaccreditation.

What is a "Desk Audit"?

A desk audit is a review of the results of the self-assessment and supporting documents, and any other information provided to the Agency by the Department of Health and Ageing, including information about certification status, prudential arrangements, concessional resident ratios and complaints matters. During the desk audit the assessment team identifies any issues requiring follow-up at site audit.

What is a "Site Audit"?

A: A "Site Audit" is the evaluation process which aged care homes must undergo to continue receiving residential care subsidies from the Australian Government. If a home meets all the requirements of accreditation, they are normally accredited for a period of 3 years.
These reports are usually titled: Decision to Accredit; Site Audit Report

Prior to the audit, a home is obliged to inform residents and relatives about the upcoming audit - informing them when the accreditation site audit will occur and that they have an opportunity to talk to members of the assessment team in private. The team must interview at least 10 per cent of residents or their representatives.

Following a site audit, the assessment team prepares a report. The Agency then makes a decision about whether or not to accredit the home, and if so, for how long the home should be accredited.

What is a "Review Audit"?

A:A review audit is a more extensive audit of the home against all the Accreditation Standards. Review audit decisions and reports are (eventually) published on the Accreditation Agency's website. These reports are usually titled:

• Decision to Vary Accreditation: Review Audit Report - Not to revoke/to vary
• Decision not to Revoke Accreditation: Review Audit Report - Not to revoke/to vary
• Decision not to Revoke Accreditation: Review Audit Report - Not to revoke

Where a home fails to comply with the Accreditation Standards, the Agency may decide to vary the accreditation expiry date. The variation would usually be to shorten the period of accreditation. The Agency will advise the provider in writing of the decision and the reasons for the decision, and the new accreditation expiry date. If there are any findings of non-compliance the Agency will set a timetable for improvement.

The Agency assists the home to achieve a timetable for improvement by conducting support contacts (this may be via telephone or visits). Failure to remedy non-compliance within the timetable set will result in the Agency recommending to the Department of Health and Ageing that sanctions be imposed on the provider.

Why aren't "improvement guidelines" for non-compliant homes published on the Aged Care Standards and Accreditation website?

A: The agency openly encourages non-compliant homes to make a "submission", thereby avoiding legislative requirements (Accreditation Grant Principles 1999) that require "improvement outlines" to be published. This explains the absence of "improvement outlines" published for non-compliant homes on the Aged Care Standards and Accreditation website.

Another industry-friendly initiative gem from the Accreditation Agency: "While not specifically provided for in the legislation, the Agency has a policy of natural justice, which allows homes five days to make a submission following a support contact. All homes should use this opportunity to state their case."
[ACSAA - The Standard - May 2007 special edition: Preparing for an unannounced visit]

What is a "Type 4 Referral Review Audit?"

A: A review audit conducted at the request of the Department of Health and Ageing under Section 3.21 (6) of the Accreditation Grant Principles.

What are "Support Contacts"?

A: "Support contacts" can be carried out via telephone or in person. If a support contact (the term used in the legislation) is not via telephone, it may consist of a visit which generally takes between a half and a full day, which usually involves two assessors. The assessment teams use assessment modules and these take a thematic approach to assessment of care for residents.

The form and frequency of support contacts to homes is decided on a case-by-case basis by the Accreditation Agency.

Are the reports of the "Support contacts" made available to the public on the Accreditation Agency website?

A: No, these reports are not published. The report, however, is sent to the provider and in some cases to the Department of Health and Ageing.

Does the Accreditation agency record whether a "Support contact" was "announced" or "unannouced"?

A: Up until 2006 when aged care legislation was amended to enable Agency assessors to conduct unannounced visits, the Agency did not record whether a support contact was announced or unannounced.

What is an "Unannounced Visit"?

An unannounced visit (sometimes referred to as a "spot check") is a support contact or review audit that is carried out by an assessment team without prior notification. Despite the change in legislation allowing assessors to turn up "unannounced", they are not able to access the facility unless the approved provider has consented to the access.

The Agency has advised that if facilities notify them of key dates that may not be great days to have an unannounced visit, they will take this into account. Facilities should do this to minimise the likelihood of disruption to scheduled events. If the Agency arrives to conduct an unannounced support contact and the facility has valid reasons why this is inconvenient and should not proceed then the most senior staff member on duty may consider refusing the Agency permission to enter.

Up until approx. 2007, an "unannounced visit" was a visit conducted with up to 30 minutes notice. The Accountability Principles 1998 s1.7 required that Agency assessors must give the approved provider of the home written notice of a visit.

What is a "Sanction"?

A: A sanction is a penalty imposed by the Department of Health and Ageing on operators of residential aged care facilities in cases of what they deem to be serious non-compliance with the provisions of the Aged Care Act 1997. Consideration of the non-compliance such as:

• whether non-compliance is minor or serious
• whether it has occurred before; and
• whether it threatens the health, welfare or interests of the residents

When a sanction is imposed, letters are sent to the residents of the facility and their nominated family members/carers advising them of the sanction, and that the approved provider (operator) has been asked to hold a meeting with the residents and families to explain how necessary improvements will be made.

One or more (multiple) sanctions may be applied depending upon the nature of the non-compliance/s.

Different (and multiple) sanctions may be imposed depending on the circumstances of the non-compliance, but they may include:

• revocation of approved provider status (*only in vary rare cases is this exercised)
• loss of Commonwealth subsidies for new residents (not existing residents) or revocation of allocated places (beds)

Are any fines imposed on a sanctioned nursing home?

No fines are imposed, and all government funding for existing residents is unaffected.

Who imposes sanctions?

A: While it is the Aged Care Standards and Accreditation Agency that recommends sanctions, it is the Secretary of the Department of Health and Ageing that imposes them.

The ACSAA recommends to the Department to impose sanctions if:

• non-compliance at a home represents serious risk to the health, safety and well-being of residents
• a home is still non-compliant at the end of its Timetable for Improvement
• if following a site audit or review audit, there is non-compliance and recommending sanctions is considered warranted.

* Related link: Current Sanctions (Department of Health and Ageing)

How long after a home has been accredited, does it take to be able to view a report?

A: According to the legislation, a home’s report should be "published" (made available to the public) between nine and 12 weeks after the site audit, where a reconsideration of the Agency’s decision is not sought.

If a reconsideration of the Agency’s decision is requested, the publishing of the report can take a further 11 weeks - or even longer in some cases.

Use Accreditation Agency reports as an indication only, remember that accreditation is only a snapshot of "minimum care indicators" in a facility observed over (on average) 1-3 days (during office hours) - over the course of an audit (depending upon the number of residents, and size of the assessment team), and license it to operate for a period usually amounting to 3 years. Accreditation Agency Site Audits are always announced, and facilities have plenty of notice to prepare before a survey team arrives and thus shield its obvious deficiencies from view.

The ACCT believes that once a home has been assessed as being below community standards, everyone has the right to know why. There should be full transparency when the lives of vulnerable older people are at risk.

Why are only the current reports of nursing homes published on the Accreditation website, and not any previous reports published?

A: In August 2005, when ACSAA redeveloped its website with a re-vamped site launched in August 2005. Unfortunately, a review deemed that the "old reports were receiving very few 'hits', and yet were taking up considerable website space".

It appears that no consultation with consumer based groups had been done, ACC were certainly not made aware of this change.

How long does it take to obtain a report when requested in writing?

A: Responses from the minister's office claim: "This information is not recorded. If the request is for a copy of a report to be emailed it is generally provided within 24 hours. Requests for copies to be posted via mail can take slightly longer."

The ACC team have have received complaints from members of the public about their inability to obtain reports in a timely manner.

*Related links:

• Reports on Homes (search) (ACSAA)
• Agency Visits to homes (ACSAA)
• Accreditation Standards (ACSAA)