Residential aged care providers will soon be required to meet six new Mandatory Quality Indicators (QIs). Although providers will not have to report on the new QIs until July 2023, they will have to start collecting the new QI data from 1 April 2023.

Your Data Collection Process Must Follow the Manual

It takes a lot of work to collect data. Many providers are probably hoping to improve efficiencies by mining existing sources, such as incident reports, to find the data they need to address the new QIs.

If this is something you are hoping to do, then you need to stop and read paragraph 5.0 from the National Aged Care QI Manual (our emphasis):

Pursuant to section 26(a) of the Accountability Principles, approved providers must make measurements or other assessments that are relevant to indicating the quality of residential care, exactly as described in this Manual. Information from existing data sets (e.g. incident reporting systems) must not be used where information has been collected differently to what is described in this Manual.

Your data for the new QIs will not be valid unless you collect it “exactly as described” in the Manual. So, what exactly does the Manual say? In this article, we explain.

This is the third article in our series on the new QIs. For background and general information on the new QIs see:

• New Aged Care Quality Indicators Commence 1 April 2023: How to Prepare
• New Aged Care Quality Indicators Commence 1 April 2023: How to Prepare – Part 2

Privacy Requirements

The Manual states that, when gathering data on any of the QIs, providers must ensure that residents’ privacy is protected and data “does not contain any personal information about any of the care recipients”.

In practice this means that when you record your data you should remove names and any identifying details. You could do this, for example, by referring to “Resident 1” rather than “Joanne Smith”. Your aim is to create a situation where a person reading the data cannot tell which specific residents are being referred to.

New QI 1: Activities of Daily Living (ADL)

The ADL QI requires providers to report on the percentage of care recipients whose ADL function has declined.

How to Collect ADL Data

Complete a single assessment for each care recipient around the same time every quarter and compare it to their ADL assessment total score in the previous quarter to determine decline.

According to the Manual, to make a valid ADL assessment you must use the Barthel Index of Activities of Daily Living (ADL assessment) tool. The Barthel Index is a clinical rating scale containing 10 activities of daily living items, looking at personal or self care and mobility, with lower scores indicating increased disability. The items cover bowel and bladder continence, personal care, toileting, feeding, transfers, mobility, dressing, going up and down stairs and bathing.

You can find a copy of the Barthel Index tool in Appendix A of the Manual. You must use the tool exactly as it appears in this Appendix. In practice, this will probably mean printing a copy for each resident and filling in the boxes by hand when you make your assessment.

Who Can Collect ADL Data?

The Manual does not stipulate which member of staff should use the Barthel Index tool and conduct the ADL assessment. Providers should consider who is qualified and competent to conduct such assessments at their facility.

New QI 2: Incontinence Care

The incontinence QI requires providers to report on the percentage of care recipients with incontinence associated dermatitis.

How to Collect Incontinence Care Data

Conduct a single assessment for each care recipient, around the same time every quarter as part of routine care.

According to the Manual, to make a valid assessment for this QI you must use the Ghent Global IAD Categorisation Tool (GLOBIAD). The GLOBIAD categorises incontinence associated dermatitis (IAD) severity based on visual inspection of the affected skin areas.

You can find a copy of the GLOBIAD in Appendix B of the Manual. You must use the tool exactly as it appears in this Appendix. In practice, this will probably mean taking a printed or electronic copy of the GLOBIAD with you when you inspect a resident, using the GLOBIAD as a reference and taking notes on your categorisations.

Who Can Collect Incontinence Care Data?

The Manual states:

“An IAD assessment should be conducted by staff who understand the Ghent Global IAD Categorisation Tool and have the necessary skills and experience to do so accurately and safely. It may be appropriate for a personal care worker to observe for signs of redness or skin loss during routine personal care and if identified, escalate to appropriately trained staff for further assessment. Approved providers must consult with a suitably qualified health practitioner if there is uncertainty about the presence or severity of IAD.”

New QI 3: Hospitalisations

The hospitalisations QI requires providers to report on the percentage of care recipients who presented to hospital.

How to Collect Hospitalisations Data

Conduct a single review of the care records for each care recipient for the entire quarter.

The Manual does not provide any other substantial guidance on how to collect this data. This suggests that providers are free to use their existing care records as the data source.

Who Can Collect Hospitalisations Data?

The Manual provides no substantial guidance on this point. It will be a matter for you.

New QI 4: Workforce

The workforce QI requires providers to report on the percentage of staff turnover.

How to Collect Workforce Data

Conduct a single review of staff records. The collection date must take place in the 21 days after the end of the current quarter, so that you can review records for the entire quarter. So, for the first round of reporting, the collection date must be between 1 July and 21 July 2023, inclusive.

The Manual does not provide any other substantial guidance on how to collect this data. However, we asked the Aged Care Quality and Safety Commission to clarify, and they forwarded us this advice from the Department of Health and Aged Care: “Worked hours are collected and reported by providers as part of the Quarterly Financial Report (QFR). If time recording functions are not available in accounting systems, providers should use service level rostering records instead.”

Who Can Collect Workforce Data?

The Manual provides no substantial guidance on this point. It will be a matter for you. Consider taking advantage of the systems and delegations that you already use to collect workforce data for other purposes (e.g., QFR).

New QI 5: Consumer Experience

The consumer experience QI requires providers to report on the percentage of care recipients who report good or excellent experience of the service.

How to Collect Consumer Experience Data

Offer a consumer experience assessment to each care recipient for completion, around the same time every quarter.

According to the Manual, to make a valid consumer experience assessment you must use the Quality of Care Experience Aged Care Consumers (QCE-ACC) tool. The QCE-ACC is comprised of six questions focused on key attributes of the quality of care experience — respect and dignity, supported decision-making, skills of aged care staff, impact on health and wellbeing, social relationships and community connection, and confidence in lodging complaints.

You can find a copy of the QCE-ACC in Appendix C of the Manual. You must use the tool exactly as it appears in this Appendix. In practice, this will probably mean printing a copy for each resident. The form can then be filled out in the most appropriate of three ways:

• Self-completion: a care recipient independently completes the QCE-ACC Self-Complete Version. The Manual recommends that “the QCE-ACC is self-completed by all care recipients with capacity”.
• Interviewer facilitated completion: used when a care recipient requires additional support (e.g. support with reading the questions or writing responses) to facilitate completion. The interviewer “must not influence scoring by the care recipient and must use the QCE-ACC Interviewer Facilitated Version”.
• Proxy-completion: used when a care recipient is unable to answer on their own behalf (e.g. because of moderate or severe cognitive impairment). The QCE-ACC Proxy Version should be used by a person who knows the care recipient well and sees them regularly (e.g. informal carer, relative). “It is only appropriate for a care worker or other employee at the service to act as proxy for the care recipient if a proxy with a more suitable relationship to the care recipient is unavailable.”

The Manual says that “Anonymous collection of QCE-ACC assessments is preferred and should be supported to the extent possible.”

Who Can Collect Consumer Experience Data?

Other than the rules regarding proxy-completion (see the paragraph immediately above), the Manual provides no substantial guidance on this point. It will be a matter for you.

New QI 6: Quality of Life

The quality of life QI requires providers to report on the percentage of care recipients who report good or excellent quality of life.

How to Collect Quality of Life Data

Offer a quality of life assessment to each care recipient for completion, around the same time every quarter.

According to the Manual, to make a valid quality of life assessment you must use the Quality of Life Aged Care Consumers (QOL-ACC) tool. The QOL-ACC is comprised of six questions focused on six key attributes of quality of life — independence, mobility, pain management, emotional wellbeing, social relationships, and leisure activities/hobbies.

You can find a copy of the QOL-ACC in Appendix D of the Manual. You must use the tool exactly as it appears in this Appendix. In practice, this will probably mean printing a copy for each resident. The form can then be filled out in the most appropriate of three ways:

• Self-completion: a care recipient independently completes the QOL-ACC Self-Complete Version. The Manual recommends that “the QCE-ACC is self-completed by all care recipients with capacity”.
• Interviewer facilitated completion: used when a care recipient requires additional support (e.g., support with reading the questions or writing responses) to facilitate completion. The interviewer “must not influence scoring by the care recipient and must use the QOL-ACC Interviewer Facilitated Version”.
• Proxy-completion: used when a care recipient is unable to answer on their own behalf (e.g., because of moderate or severe cognitive impairment). The QOL-ACC Proxy Version should be used by a person who knows the care recipient well and sees them regularly (e.g. informal carer, relative). “It is only appropriate for a care worker or other employee at the service to act as proxy for the care recipient if a proxy with a more suitable relationship to the care recipient is unavailable.”

The Manual says that “Anonymous collection of QOL-ACC assessments is preferred and should be supported to the extent possible.”

Who Can Collect Quality of Life Data?

Other than the recommendations regarding proxy-completion (see the paragraph immediately above), the Manual provides no substantial guidance on this point. It will be a matter for you.

Further Resources

• Department of Health and Aged Care: National Aged Care Mandatory Quality Indicator Program Manual
• Department of Health and Aged Care: QI Program interactive modules
• Aged Care Quality and Safety Commission: National Aged Care Mandatory Quality Indicator Program