From July 1, 2019, the Aged Care Quality and Safety Commission requires all organisations providing aged care services in Australia to be compliant with the new Aged Care Quality Standards. [1] These will now apply to all aged care services including residential care, home care, flexible care and services under the Commonwealth Home Support Programme. 

So, what’s different? There are eight Aged Care Quality Standards. A key aspect is a very strong focus on partnership with the consumer of the services. Aged care providers will need to demonstrate ‘how’ they partner with each consumer. Assessment and planning having a focus on optimising health and well-being in accordance with the consumer’s needs, goals and preferences.

The new standards are a departure from the focus on the organisation’s systems and processes, instead of being written in the first person, of the consumer. For instance, Standard One (which is considered a ‘Foundation Standard’ in that it supports all other statements) has the consumer outcome: I am treated with dignity and respect and can maintain my identity. I can make informed choices about my care and services and live the life I choose. Similarly, requirements are written in active terms like “The workforce can describe…”.

So how can Nurse Practitioners (NPs) help organisations to integrate the new standards into practice, and thus demonstrate compliance?

There is a significant focus on Dignity of Risk in the new standards. More than likely the NP will be the most senior clinician in an organisation. So NPs are well placed to help steer clinical and organisational decision making towards partnering with and supporting consumers to discuss and plan their care and services, as well as exercising their right to take risks to enable them to live the best life they can.

For the first time, there is overt reference to advance care planning and end of life decision making (Standard 2, requirement 3(b). This goes beyond being able to show that an organisation has a copy of a consumer’s advance care directive on file. There needs to be evidence that the organisation offers timely, culturally safe and appropriate conversations with the consumer and others the consumer wishes to involve. NPs can help establish organisational systems and processes, as well as providing clinical expertise, in having these conversations, either directly or mentoring other staff.

Standard 3: Requirement 3:C focuses on care when consumers are ‘nearing the end of life’. Palliative Care and ‘End of Life’ in terms of whether this is the last days, week are not defined in the Standards or Guidance materials. The requirement states ‘the needs, goals and preferences of consumers nearing the end of life are recognised and addressed, their comfort maximised and their dignity preserved’. Organisations need to reflect on how they work with others outside the service such as palliative care specialists to improve the consumer’s end of life care.

The Guidance and Resources publication available from the Aged Care Safety and Quality Commission website includes some references relating to palliative or end of life care. Additional appropriate resources for consideration include the National Policy Statement on Palliative Care and Dementia [2] and guidance materials from the ELDAC Toolkits. [3]

Considering the varying models of NP practice in palliative and aged care, it would be helpful for organisations to be guided on how specialist palliative care, aged care and even primary care can work together to provide palliative care in the community and residential settings.

Where to find more information:
The new Standards and Guidance material (4.05MB pdf) [4] describes the Commission’s expectations and provides supporting information, suggested practices, examples and evidence required to ensure compliance. It also provides an indication of the matters that Quality Assessors will consider in assessing compliance. 

References

1. Aged Care Quality and Safety Commission. Aged Care Quality Standards [Internet]. 2019 [updated 2019 Jul 4; cited 2019 Jul 10].
2. Palliative Care Australia (PCA), Dementia Australia. Position Statement: Palliative Care and Dementia (157kb pdf). Canberra; PCA: 2018 May.
3. ELDAC. What is and ELDAC toolkit? [Internet]. 2019 [cited 2019 Jul 10].
4. Aged Care Quality and Safety Commission. Guidance and Resources for Providers to support the Aged Care Quality Standards (4.05MB pdf). Canberra: Aged Care Quality and Safety Commission; 2019 May.

Peter Jenkin, Nurse Practitioner (Palliative Care), Resthaven