• Number of care recipients assessed for ADL function [this should be all care recipients minus those excluded as per the next dot points].
• Number of care recipients excluded because they were receiving end-of-life care.
• Number of care recipients excluded because they were absent from the service for the entire quarter.
• Number of care recipients excluded because they did not have an ADL assessment total score recorded for the previous quarter.
• Number of care recipients with an ADL assessment total score of zero in the previous quarter.
• Number of care recipients who experienced a decline in ADL assessment total score of one or more points.

[For the first round of reporting in July 2023, many of these requirements could be problematic due to providers’ lack of data from the previous quarter. See clarification below.]

How to collect this 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. [See clarification below.]

What if we have no data from the previous quarter? A clarification from the Department of Health and Aged Care:

As you can see from the points above, when you report on this data you will have to compare your ADL data from the current quarter (1 Apr-30 Jun) with your ADL data from the previous quarter (1 Jan-31 March). But you may not have any ADL data from the previous quarter, because you weren’t required to collect it back then. So what should you do?

We asked the Aged Care Quality and Safety Commission to clarify this point and they forwarded us a response from the Department of Health and Aged Care.

In summary, the Department says that you won’t be in trouble if you have no ADL data from the previous quarter. To get the ADL data you must use the Barthel Index of Activities of Daily Living, and the Department recognises that not all providers will use the Barthel Index during the 1 Jan-31 March quarter.

If you don’t use the Barthel Index during 1 Jan-31 March, that’s no problem. In your report you will be able to say that you have no data for the quarter (technically you will have to say that you have “excluded all consumers” from your ADL data count for the quarter). You must add a comment explaining this, e.g., “we have excluded all consumers from the count because we did not use the Barthel Index tool in the previous quarter, so we have no ADL data from the previous quarter to use for comparison”.

Note: if you do use the Barthel Index tool in the previous quarter, you will be required to make a full report on your ADL data in the 1-21 July reporting period.

Here is the full response:

“Providers must conduct an ADL assessment for each care recipient every quarter, by completing all questions in the Barthel Index of Activities of Daily Living assessment tool (see Appendix A of the Manual – Part A). Exclusions for the ADL quality indicator include care recipients who did not have an ADL assessment total score recorded for the previous quarter and comments providing explanation as to why the recording is absent.

“While some services already use the Barthel Index of Activities of Daily Living and will be able to report on previous quarter results, it is likely some services will not have used this tool previously, and therefore will not have an ADL assessment total score collected for their residents in the first quarter of reporting (April – June 2023).

“These care recipients would meet the exclusion criteria and must be reported in the corresponding exclusion field, with comments providing explanation as to why recording is absent (i.e., comparative data is not available to determine ADL decline as this is the first reporting period).”

Other Points to Note

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

• Incontinence care

• Number of care recipients assessed for incontinence care [this should be all care recipients minus those excluded as per the next dot points].
• Number of care recipients excluded because they were absent from the service for the entire quarter.
• Number of care recipients excluded from Incontinence Associated Dermatitis (IAD) assessment because they did not have incontinence.
• Number of care recipients with incontinence.
• Number of care recipients with incontinence who experienced IAD.
• Number of care recipients with incontinence who experienced IAD, reported against each of the four IAD 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.

How to collect this data:

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

Providers should consider who is qualified and competent to conduct such assessments at their facility.

The QI 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.”

• Number of care recipients assessed for hospitalisation [this should be all care recipients minus those excluded as per the next dot points].
• Number of care recipients excluded because they were absent from the service for the entire quarter.
• Number of care recipients who had one or more emergency department presentations during the quarter.
• Number of care recipients who had one or more emergency department presentations or hospital admissions during the quarter.

How to collect this data:

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

[For the first round of reporting in July 2023, many of these requirements could be problematic due to providers’ lack of data from the previous quarter. See clarification below.]

How to collect this 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, in order to 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.

What if we have no data from the previous quarter? A clarification from the Department of Health and Aged Care:

As you can see from the points above, when you report on this data you will have to compare your workforce data from the current quarter (1 Apr-30 Jun) with your workforce data from the previous quarter (1 Jan-31 March). But you may not have any workforce data from the previous quarter, because you weren’t required to collect it back then (at least not for the purposes of this QI). So what should you do?

We asked the Aged Care Quality and Safety Commission to clarify this point and they forwarded us a response from the Department of Health and Aged Care. In summary: the Department’s view is that you should have already been collecting workforce data for other purposes. Therefore, unlike the ADL reporting, no exemptions will be granted on the grounds that this is the first time that providers have had to report on this data. You must find some previous quarter workforce data and report on it. Here is the full response:

“The workforce quality indicator requires a single review of staff records for the current and previous quarter to collect quality indicator data to determine the percentage of staff turnover. Providers are required to report the percentage of staff employed (in the outlined roles) who stopped working during the quarter.

“For the purposes of the QI Program, staff are considered employed when they have worked at least 120 hours in the previous quarter. Additional reporting includes all staff (in the outlined roles) who worked any hours during the previous quarter.

“There are no exclusions for the Workforce quality indicator. Providers are required to report on this quality indicator in the first reporting quarter.

“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. The QFR frequently asked questions available on the department website, provides guidance on the reporting requirements under the QFR, including recording internal, contracted and agency staff hours.”

*Other Points to Note

Recently the Department made the following change to the QI Manual without notifying anyone of the fact: “care management staff” was replaced with “services managers” in the places we’ve marked above with an asterisk. The definition of the new term is identical to the definition of the old term and means “staff who manage the operations of a residential aged care service”.

• Number of care recipients offered a consumer experience assessment through self-completion, interviewer-facilitated completion or proxy-completion [this should be all care recipients minus those excluded as per the next dot points].
• Number of care recipients excluded because they were absent from the service for the entire quarter.
• Number of care recipients excluded because they did not choose to complete the Quality of Care Experience Aged Care Consumers (QCE-ACC) for the entire quarter.
• Number of care recipients who reported consumer experience through each completion mode of the QCE-ACC (self-completion, interviewer-facilitated completion, or proxy-completion), scored against the five categories:
  • ‘Excellent’ (care recipients who score between 22–24)
  • ‘Good’ (care recipients who score between 19–21)
  • ‘Moderate’ (care recipients who score between 14–18)
  • ‘Poor’ (care recipients who score between 8–13)
  • ‘Very poor’ (care recipients who score between 0–7).

How to collect this data:

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

• Number of care recipients offered a quality of life assessment through self-completion, interviewer-facilitated completion or proxy-completion [this should be all care recipients minus those excluded as per the next dot points].
• Number of care recipients excluded because they were absent from the service for the entire quarter.
• Number of care recipients excluded because they did not choose to complete the QOL-ACC (Quality of Life Aged Care Consumers) for the entire quarter.
• Number of care recipients who reported quality of life through each completion mode of the QOL-ACC (self-completion, interviewer- facilitated completion or proxy-completion), scored against the five categories:
  • ‘Excellent’ (care recipients who score between 22–24)
  • ‘Good’ (care recipients who score between 19–21)
  • ‘Moderate’ (care recipients who score between 14–18)
  • ‘Poor’ (care recipients who score between 8–13)
  • ‘Very poor’ (care recipients who score between 0–7).

How to collect this data:

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