A new approach to aged care clinical governance and staffing issues

The ongoing debate over setting minimal staffing ratios has taken a new and positive turn. I support the notion, that there should be a review of staffing in aged care, however to do that properly we also need to move away from the current ACFI assessment based model of funding that is unproductive and not cost effective. Introducing minimal staffing levels will be just that… minimal and any legislation around it will give poor providers some where else to hide. Staffing ratios must be linked to skill levels and must be flexible to change with the changing needs of the residents. In the link below, Rebekha Sharkie ( Central Alliance candidate for Mayo) sets out a balanced and well considered alternative through legislation that will require operators to publish all rostered hours for their resident population. This will provide a far more accurate assessment of the actual care and resources provided to residents.


Is this a Game Changer for future development. What will happen to current Balance sheets if licensing moves to consumers

I have long held the view that residential care needs to move to deregulation.  A system that allows providers to develop business cases to support new development that is non reliant on the annual lottery of ACAR.   One of the barriers has been that current providers hold the value of bed places on their balance sheets. ( Even though there was no cost to them in obtaining the licenses, there is a value at the point of sale. ) So if we move to a deregulated system, where the is no ACAR ( as is now the case for Home care), where does that leave the industry.

The extract below is taken from budget commentary and are not my personal views.  However the context of the these views need to be discussed

The government has backed the Tune Review recommendation to put residential aged care places in the hands of consumers, the 2018-19 Federal Budget shows.

The Government will provide $300,000 to explore allocating residential care places to consumers rather than providers, according to the Budget handed down by Treasurer Scott Morrison last night.

The government said it provided in-principle support to putting residential places in the hands of consumers, which is a key feature of the Aged Care Roadmap and a recommendation of the 2017 Legislated Review of Aged Care led by David Tune.

The analysis will assess the potential impacts on consumers, providers, the financial sector and any changes to the system that may be required. It will also pay special attention to how the change would impact rural and remote areas that have limited choice and competition, according to the announcement.

The government announced the aged care budget would grow by $5 billion over the next five years, which is in line with recent trends of around an additional $1 billion of aged care expenditure annually.

Among measures announced in the budget package are 13,500 residential places, 775 Short-Term Restorative Care places and $60 million in capital funding for new residential places in the 2018-19 Aged Care Approvals Round.

The new residential aged care places combine targets for 2018-19 and 2019-20 according to the budget papers, which show 7,300 fewer residential places in 2020-21 than what was tabled in last year’s budget.

This year’s budget estimates 204,700 aged care places at the end of this financial year, which falls short of the 209,700 target in last year’s budget papers.

The new residential care targets for 2018-19 are 210,100 (down from 216,900) and 217,000 for 2019-20 (down from 224,600).

As part of measures to minimise its risk in guaranteeing refundable accommodations deposits, the government said it would go ahead and introduce a compulsory retrospective levy on residential services, where defaults exceeded $3 million in any financial year.

The Tune Review and the Aged Care Financing Authority both recommended that providers should pay toward the Accommodation Payment Guarantee Scheme.

The measures, which will cost $4.8 million over two years, also include developing strong prudential standards for bonds held by providers and raising government’s capability to better reduce the likelihood of a claim and protect the growing pool of refundable payments, currently around $23 billion.

Mental health, palliative care, remote

Responding to the long-standing concerns around a lack of access for residents to psychological care, the budget provides $82.5 million over four years for mental health services for aged care residents, along with $20 million over four years to trial nurse-led mental health services for people aged over 75 experiencing social isolation and loneliness.

The budget also contained $32.8 million over four years for a trial to improve palliative care for aged care residents but that initiative is contingent on state and territory governments matching the funding.

The government will also provide capital grants to the value of $40 million over five years for aged care facilities in regional, rural and remote communities.

Elsewhere in remote aged care services, the government will provide $105.7 million over four years, including $32 million from within the existing resources, to support the National Aboriginal and Torres Strait Islander Flexible Aged Care Program for residential and home aged care services in remote Indigenous communities.


Could Oakden Happen Again – Aged Care Industry Needs to Recognize Indicators of Non -Compliance and Risk

The shameful events that occurred at the Oakden nursing home rightly sent shock waves throughout the community.

But we are fooling ourselves if we think such appalling mistreatment of our most vulnerable isn’t happening today – or will continue to do so in the future.

The severe compliance outcomes of the Oakden aged care service – and the severity of the issues identified – not only shocked the community, but also the industry, quality and compliance agencies and governments across the country.

It exposed the risks that occur (including to human life) when the gap between governance and compliance – the pure lack of skills and knowledge at all levels of management from the board room to the ward room – goes unchecked.

Oakden is not an isolated case in failing compliance outcomes.

There have been – and will continue to be – facilities that fail to meet compliance outcomes to a far greater degree unless we recognize the failings of the accreditation monitoring system.

Currently across Australia there are 32 facilities with notices of non-compliance and five facilities issued with sanctions– this clearly demonstrates my point!

In SA, there are 11 facilities listed as non-compliant.

I have long believed that the process of compliance monitoring does not come close to identifying the risks to a client’s health and wellbeing, nor the quality of skills and knowledge of the staff who care for our elderly at governance level in sufficient numbers to meet their purpose.

Having worked in the industry for more than 40 years, I can state unequivocally that it is the failure of those private owners, Boards, CEOs and executive managers who fail to understand and question the standards of care being delivered in their name,  and the lack of governance systems in place to provide the answers, that are to blame for predicaments like which occurred at Oaken.

All too often we see the wrong people with the wrong skill sets undertaking roles that they are not trained to undertake.

It is time to set higher levels of training requirements for our care workers – Certificate 3 is not good enough, nor are the academic levels that we accept for our carers.


It is time to have more robust examination of the skills and actual clinical outcomes achieved by our registered and enrolled nurses.

Failure to do so will again be at the peril of the most vulnerable in our community.



ACMA operates as an independent nurse advisory service specializing in compliance

 Peter Vincent is a 40 year veteran of the aged care sector and in Principal Consultant of Aged Care Management Australia.  Contact 0403 949 006




Prevention is more cost effective than the cure

Aged Care Management Australia ( ACMA ) has been engaged by a NSW based provider to assist with managing compliance. ACMA director and principal consultant Peter Vincent says his group was recently approached to provide support in maintaining compliance and mentoring facility staff.

“Following the initial contact, 4 days ago, we will have staff on site from Monday morning. This is one of our key services to clients in preventing issues of concern from escalating to formal non-compliance and sanction. We have a 100 % success rate in dealing with these types of scenario Peter said”

In these instances, the use of a recognized nurse advisory service in a preventative mode is far more beneficial and cost effective than waiting until issues escalate sanction. ACMA provide highly experienced clinical staff including nurse educators to work with facility and organizational staff to remedy issues of clinical and operational governance and ensure compliance is maintained and sustainable.

For further details contact us via our web site


ACMA Successfully gains Approved Provider status for new Home care provider in SA

ACMA has maintained its 100% success rate in developing and submitting applications for new providers. Our latest client in South Australia has gained approval to deliver home care and flexible care, with the application process proceeding without requests for additional information from the Department.

Our success comes from understanding the business model of the applicant, working with them to develop solid business and financial modelling, staffing structures and complete infrastructure services such as operating policies, procedures, resident and staff contracts.



Aged Care Management Australia Appointed to the national ‘Aboriginal and Torres Strait Islander Aged Care Service Development Assistance Panel’

Director and Principal Consultant Peter Vincent has confirmed that Aged Care Management Australia (ACMA) and their partners Hodgkison Architects and Henson Lloyd Chartered Accountants have been appointed to the national ‘Aboriginal and Torres Strait Islander Aged Care Service Development Assistance Panel’ for the next 3 years.

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