From 1 April 2023, as part of updates to the National Aged Care Mandatory Quality Indicator Program, all Commonwealth-subsidised residential aged care services in Australia will need to report on six new quality indicators:

1. Activities of daily living
2. Incontinence care
3. Hospitalisation
4. Workforce
5. Consumer experience
6. Quality of life.

(ACQSC 2023)

Providers will need to report on these new quality indicators in addition to the existing quality indicators, which are:

• Pressure injuries
• Physical restraint
• Unplanned weight loss
• Falls and major injury
• Medication management including polypharmacy and antipsychotics.

(ACQSC 2023)

This article provides a brief overview of these new obligations.

What is the National Aged Care Mandatory Quality Indicator Program?

The National Aged Care Mandatory Quality Indicator Program (QI Program), which was introduced on 1 July 2019, requires Commonwealth-subsidised residential aged care services to collect data and report on specific areas of care that older adults have identified as being most important to them (My Aged Care 2022).

Providers must report their performance across each of these quality indicators every three months in order to measure the quality and safety of their services and facilitate continuous improvement (My Aged Care 2022).

This data is made available publically to help older adults and their families assess the quality of different services and make decisions about their care (DoH 2023).

Starting from December 2022, the provider’s performance across these quality indicators will also be used to help calculate the service’s overall Star Rating (My Aged Care 2022).

New Quality Indicators

Activities of Daily Living

The term activities of daily living (ADLs) refers to an individual’s ability to perform basic life skills integral to independence and quality of life. These include eating, ambulating, toileting, dressing and personal hygiene.

This quality indicator requires each resident to be assessed for ADLs using the Barthel Index of Activities of Daily Living. This assessment should take place around roughly the same time every quarter.

All residents must be assessed every quarter, except for:

• Residents receiving end-of-life care
• Residents who were absent for the entire quarter
• Residents who did not have an ADL score recorded last quarter.

(DoH 2022)

Note: The Department of Health and Aged Care has acknowledged that some providers will not have ADL data from the previous quarter using the Barthel Index of Activities of Daily Living due to this quality indicator not being required until 1 April. These providers may exclude all residents from this quality indicator but should undertake further assessments according to the DoH’s direction. For further information, refer to: https://www.agedcareessentials.com.au/news/new-aged-care-quality-indicators-commence-1-april-2023-how-to-prepare-part-2 (Bryan 2023).

What Data Needs to be Collected?

• The number of residents assessed for ADL function, except for those excluded (see criteria above)
• The number of residents excluded because they are receiving end-of-life care
• The number of residents excluded because they were absent for the entire quarter
• The number of residents excluded because they did not undergo an ADL assessment in the previous quarter - this needs to include comments explaining why this data was not taken
• The number of residents with a total ADL score of zero in the last quarter
• The number of residents who have experienced a decline in ADLs (a decrease of one or more points from their total score last quarter).

(DoH 2022)

Incontinence Care

Incontinence refers to loss of control over the bladder and/or bowels. Under the QI Program, a resident is considered to be incontinent if they:

• Experience bladder incontinence more than once per day, and/or bowel incontinence more than once per week, or
• Require a urinary catheter to pass urine.

This quality indicator requires each resident to be assessed for incontinence at roughly the same time every quarter. Those who are deemed to have incontinence must then be assessed for incontinence associated dermatitis (IAD) using the Ghent Global IAD Categorisation Tool.

The Ghent Global IAD Categorisation Tool sorts IAD into one of four sub-categories:

• 1A: Persistent redness without clinical signs of infection
• 1B: Persistent redness with clinical signs of infection
• 2A: Skin loss without clinical signs of infection
• 2B: Skin loss with clinical signs of infection.

All residents must be assessed every quarter, except for residents who were absent for the entire quarter.

(DoH 2022)

What Data Needs to be Collected?

• The number of residents assessed for incontinence care
• The number of residents excluded because they were absent for the entire quarter
• The number of residents excluded because they were not experiencing incontinence
• The number of residents with incontinence
• The number of residents with incontience who experienced IAD
• The number of residents with incontience who experienced IAD, categorised into each of the four IAD sub-categories.

(DoH 2022)

Hospitalisation

This quality indicator requires providers to report on how many residents presented to the emergency department one or more times during the quarter. This should be assessed by undertaking a review of each resident’s care records for the quarter.

The QI Program defines an emergency department presentation as a resident presenting to an emergency department or urgent care centre in person or virtually.

A hospitalisation is defined as a resident being admitted into a hospital inpatient speciality service for ongoing management. This includes both planned and unplanned admissions, stays of any length and hospitalisations in any location (including hospital in the home).

All residents must be assessed every quarter, except for residents who were absent for the entire quarter.

(DoH 2022)

What Data Needs to be Collected?

• The number of residents assessed for hospitalisation
• The number of residents excluded because they were absent for the entire quarter
• The number of residents who presented to the emergency department one or more times during the quarter
• The number of residents who presented to the emergency department or were hospitalised one or more times during the quarter.

(DoH 2022)

Workforce

This quality indicator requires providers to report on their workforce. This should be assessed by undertaking a review of staff records every quarter.

(DoH 2022)

What Data Needs to be Collected?

For definitions of each staff member type, see the National Aged Care Mandatory Quality Indicator Program (QI Program) Manual 3.0 – Part A.

• The number of staff who worked as service managers for any hours in the previous quarter
• The number of staff who worked as nurse practitioners or registered nurses for any hours in the previous quarter
• The number of staff who worked as enrolled nurses for any hours in the previous quarter
• The number of staff who worked as personal care staff or assistants in nursing for any hours in the previous quarter
• The number of staff employed as service managers at the start of the quarter
• The number of staff employed as nurse practitioners or registered nurses at the start of the quarter
• The number of staff employed as enrolled nurses at the start of the quarter
• The number of staff employed as personal care staff or assistants in nursing at the start of the quarter
• The number of staff employed as service managers who stopped working during the quarter
• The number of staff employed as nurse practitioners or registered nurses who stopped working during the quarter
• The number of staff employed as enrolled nurses who stopped working during the quarter
• The number of staff employed as personal care staff or assistants in nursing who stopped working during the quarter.

Note:

• Employed means the staff member worked for at least 120 hours in the previous quarter.
• Staff who stopped working during the quarter are those who have not worked at the service for a period of at least 60 consecutive days during the current quarter.

(DoH 2022)

Consumer Experience

This quality indicator requires providers measure consumer experience. This should be assessed by giving every resident the opportunity to complete the Quality of Care Experience Aged Care Consumers (QCE-ACC) tool, which asks residents to report on six key areas of the quality of care experience:

1. Respect and dignity
2. Supported decision-making
3. Skills of aged care staff
4. Impact on health and wellbeing
5. Social relationships and community connection
6. Confidence in lodging complaints.

The QCE-ACC should be given to residents at roughly the same time every quarter.

Exclusions include:

• Residents who were absent for the entire quarter
• Residents who chose not to complete the QCE-ACC for the quarter.

(DoH 2022)

What Data Needs to be Collected?

• The number of residents offered the QCE-ACC through self-completion, interviewer facilitated completion or proxy-completion
• The number of residents excluded because they were absent for the entire quarter
• The number of residents excluded because they chose not to complete the QCE-ACC for the quarter
• The number of residents who completed the QCE-ACC through each completion method (self-completion, interviewer facilitated completion and proxy-completion), scored against the following five categories:
  • Excellent: Those who scored between 22 and 24
  • Good: Those who scored between 19 and 21
  • Moderate: Those who scored between 14 and 18
  • Poor: Those who scored between 8 and 13
  • Very poor: Those who scored between 0 and 7.

(DoH 2022)

Quality of Life

Quality of life is an individual’s perception of their position in life. It encompasses their environment, goals, expectations, standards and concerns, and their emotional, physical, material and social wellbeing.

This quality indicator requires providers measure residents’ quality of life. This should be assessed by giving every resident the opportunity to complete the Quality of Life Aged Care Consumers (QOL-ACC) tool, which asks residents to report on six key areas of quality of life:

1. Independence
2. Mobility
3. Pain management
4. Emotional wellbeing
5. Social relationships
6. Leisure activities and hobbies.

The QCE-ACC should be given to residents at roughly the same time every quarter.

Exclusions include:

• Residents who were absent for the entire quarter
• Residents who chose not to complete the QOL-ACC for the quarter.

(DoH 2022)

What Data Needs to be Collected?

• The number of residents offered the QOL-ACC through self-completion, interviewer facilitated completion or proxy-completion
• The number of residents excluded because they were absent for the entire quarter
• The number of residents excluded because they chose not to complete the QOL-ACC for the quarter
• The number of residents who completed the QCE-ACC through each completion method (self-completion, interviewer facilitated completion and proxy-completion), scored against the following five categories:
  • Excellent: Those who scored between 22 and 24
  • Good: Those who scored between 19 and 21
  • Moderate: Those who scored between 14 and 18
  • Poor: Those who scored between 8 and 13
  • Very poor: Those who scored between 0 and 7.

(DoH 2022)

How to Report Data

Quality indicator data must be submitted through the My Aged Care service and support portal.

The Department of Health and Aged Care has made QI Program data recording templates available to assist in calculating and summarising data for each quality indicator.