The new Standards reinforce expectations rather than introduce new concepts

Providers have shared with us their concerns and uncertainties about how the new standards will impact their Additional Services (AS) programs. To allay your concerns, we will publish a series of insights highlighting how robust AS programs, including those designed and implemented by us, will meet the enhanced action items (requirements) under the new standards.

In this insight, we consider Standards 1 and 2.

Standard 1: The Person

Outcome 1.4: Transparency and Agreements

Informed Decisions

1.4.1 ‘Prior to entering into any agreement or care commencing (whichever comes first), the provider gives older people information to enable them to make informed decisions about their care and services.’

AS programs should be discussed, and complete details should be provided to prospective residents and their advocates prior to admission. This is especially the case where the AS program is a condition of entry.

Where the program is optional, we recommend inclusion of provisions that cover any optional program in the resident agreement before care begins.

Discussion, information and inclusion are hallmarks of transparency, and this allows prospective residents to evaluate the value of these services before the decision to enter a particular facility is made. To assist providers in ensuring there is transparency, we provide our clients with tailored collateral to help facility teams communicate effectively with residents and their families.

Understanding Agreements

1.4.2 ‘The provider supports older people to understand information provided to them, including any agreement they will be required to enter into, the terms relating to their rights and responsibilities, the care and services to be provided and the fees and other charges to be paid.’

Understanding flows from both collateral and communication. Well-structured programs contain clear materials on the inclusions and comprehensive provisions regarding the responsibilities of both the provider and the resident. Staff training ensures that the facility can explain the AS program to residents and ensure they understand the package and their obligations. We encourage all providers who offer AS to ensure their collateral and training programs are of the highest standard, as this will ensure you meet the expectations of 1.4.2.

Time to Consider Options

1.4.3 ‘The provider allows older people the time they need to consider and review their options and seek external advice before making decisions.’

One of the advantages of AS programs as part of the conditions of entry is that prospective residents get to consider the complete offer of the facility at the time of decision. We consider this to provide both more time and greater transparency to potential residents than decisions made after admission. Residents must have time to review their options. Our AS packages are designed to be straightforward, affordable, and provide more value than they cost, ensuring residents can make informed decisions.
Changes to Fees and Charges

1.4.4 ‘The provider informs the older person of any changes to previously agreed fees and charges and seeks their informed consent to implement these changes before they are made.’

We understand this is an area where the Quality Commission has concerns. Some providers are of the view that stating the mechanism for changing (increasing fees) in the resident agreement achieves the objective of allowing consumers to make an informed consent. The alternative view is that while a statement in the agreement sets out the mechanism, agreement has to be obtained at the time that the charges are changed.

At a practical level, as opposed to a legal opinion, which we are not providing in this insight, we compare the mechanism for AS with the mechanism for increasing the basic daily fee and the means-tested care fee. In neither of these cases does the resident have a right not to accept the change in these fees, having agreed as a condition of entry that the fees will change in accordance with predetermined criteria. We acknowledge that demonstrating informed consent in this context can be a challenge.

We recommend that AS programs have inbuilt mechanisms to ensure that stated inclusions are available and that residents are evaluated for their ability to benefit from their AS package. With respect to changes in package prices that are consistent with the agreement, these should be discussed well in advance of the proposed operative date, and written agreement to the new fees should be obtained from the resident or their nominee.

Clear Invoices

1.4.6 ‘The provider ensures invoices are timely, accurate, clear and presented in a way the older person understands.’

Most providers use standard software for their resident charges (invoices), and there is generally a presumption that these are clear from the resident’s perspective. Good practice would suggest that early in the resident’s tenure, residents are asked whether they understand the charges and this interaction is recorded. We see this as a gap in training and processes in some organisations we have worked with.

Addressing Overcharges

1.4.7 ‘The provider promptly addresses any overcharging and provides refunds to older people.’

To meet this requirement, we must identify that there has been an overcharge. From the perspective of capacity to benefit and that inclusions are available, this flows directly from 1.4.4 above, and a robust AS program will have embedded triggers and review points in it to ensure that any overcharging because of changes in capacity to benefit or non-availability of included items become known as soon as possible.

At Pride Living, we have developed an audit tool that highlights incorrect charges (over and under) based on rules relating to which residents should be paying for AS and the period when residents should not be charged (leave and hospitalisation). This can be an area that is poorly monitored by providers.

Standard 2: The Organisation
Partnering with Older People

2.1.3 ‘The provider partners with older people in the design, delivery, evaluation and improvement of quality care and services.’

It can be tempting to set and forget the inclusions in your AS program. However, preferences change, and this means that to ensure residents continue to value the additional services you provide. We recommend you review your programs in a structured way, including obtaining resident feedback on the inclusions they value and if there are other inclusions they would value. Our AS ongoing support program identifies issues with inclusions. We recently ran a survey on AS programs and asked respondents to nominate which inclusions were highly valued. Watch out for the publication of our AS white paper in July.

Accountability and Quality System

2.3.6 ‘The provider maintains and implements policies and procedures that are current, regularly reviewed, informed by contemporary, evidence-based practice, and are understood and accessible by workers and relevant parties.’

All AS programs should include structured program management policies and comprehensive support documents. There should be collaboration between corporate services and operational staff on regulatory and policy requirements. As part of our ongoing support program we ensure clients are up-to-date with the latest standards and regulations. The program includes both ongoing reviews and an annual review process that covers both the efficacy of the program and the appropriateness of matters covered by the standards.

We recommend that you have your program independently audited. Our ongoing support program does this for clients who have engaged us to implement their programs. We have a standalone AS audit program for providers who have implemented their programs internally or with the assistance of another service provider.

We can’t overstate the importance of review. We have found numerous cases where providers’ programs don’t comply with the regulations; the most common failures are the inclusion of specified care and services and charging for inclusions that are no longer available.

Feedback and Complaints Management

2.6.1 ‘The provider implements a complaints management system to receive, record, respond to and report on complaints.’
2.6.2 ‘The provider encourages and supports older people, family and carers, workers and others to provide feedback and make complaints.’

There is evidence that residents value the ability to make complaints and, more importantly, know that their complaints will be addressed. This does not mean that they want the complaint to be resolved in their favour. Having a complaints mechanism does not of itself encourage complaints. A robust complaints system will proactively engage residents to provide feedback through accessible channels and treat negative feedback as an opportunity for improvement.

The December quarterly complaints report published by the ACQSC highlights the top 20 areas of complaint, and it is pleasing to see that complaints about AS programs do not feature in this list. Our survey also asked a number of questions about complaints relating to AS programs.

Key Takeaways

In our experience, successful AS programs include the following seven essential elements:

1

Transparency

2

Clarity and simplicity

3

Dedicated and trained customer support teams

4

Equitable value base pricing

5

Independent quality assurance

6

Relevant inclusions

7

Robust and open feedback mechanisms

If you operate an AS program and can give a tick to your program on the above elements, then we expect you would be operating a high-quality, compliant AS program. If you can’t tick off all these elements, then perhaps we should have a chat about your concerns and how you can address them. There is no obligation, and we’re happy to answer any questions you may have.

If you would like to discuss your organisation's needs for Additional Services or on Clinical and Quality Performance, please contact Pride Living on 02 9068 0777 or clientservice@prideliving.com.au

JC Yap
Principal Consultant

AMBIKA MEHTA
Client Relationship Consultant