Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697645327517.pdf (Australia)
Inquiry into the effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse and poor practices, and ensuring proper clinical and medical care standards are maintained and practised Submission of the NSW Mental Health Commission November 2018 TRIM Ref:TD18/7616 Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 96 Executive summary The Mental Health Commission of NSW is an independent statutory agency responsible for monitoring, reviewing and improving the mental health and wellbeing of the people in NSW.
We work with government agencies and the community to secure better mental health and wellbeing for everyone, to prevent mental illness, and to ensure the availability of appropriate supports in or close to home when people are unwell or at risk of becoming unwell.

The Commission promotes policies and practices that recognise the autonomy of people who experience mental health issues and support their recovery, emphasising their personal and social needs and preferences as well as broader health concerns.
We are guided in all of our work by the lived experience of people with mental health issues.

The Commission provided an initial submission to this inquiry in 2017 (Submission #5), consisting of a cover letter outlining key concerns, a copy of the policy document Living Well in Later Life, and related Statement of Principles.
A large focus of this submission was the need for services to offer a recovery-focussed approach and to embed participation of people living in residential aged care facilities with mental health issues.

This second submission raises additional queries related to the scope of the Aged Care Quality Assessment and Accreditation Framework (the Framework) and concerns regarding emerging issues for people with mental health issues who are likely to be impacted by the Framework.
These areas include: care co-ordination challenges for those with an NDIS package • • quality and adequacy of services • • data and quality improvement regulation of RACFs Should you wish to discuss any of the issues raised in this submission in more detail please contact Ms Katrina Davis, Executive Officer, Recovery and participation All people in Australian society, including the elderly, should be offered the opportunity to live with positive mental health.
Everyone should be offered the opportunity to live well, in their community and on their own terms.

Recovery – including the hope that things will get better – is as essential later in life as it is at any age, and we must support people to seek help earlier when they experience distress.

We must accept that mental distress is not an inevitable part of aging.
Above all we need to respect older people and include them, in our communities and in decisions both about their own lives and about how we can do better in providing appropriate services.

They should be key participants in the decisions that affect them – from individual care planning to decisions about their residential environment and choices such as activity, infrastructure and menu planning.
nswmentalhealthcommission.com.au | Twitter: @MHCNSW | Facebook: mhcnsw | YouTube: NSWMHCommission Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 96 Mental Health Commission of NSW Scope of the Framework The Commission seeks clarity on the scope of the Framework focused on in the Inquiry.
The MHC has interpreted the Framework to apply to: Residential aged care facilities o Community based aged care services o All people receiving care from aged care services including people under 65 years o Care co-ordination challenges for those with an NDIS package Due to new arrangements under NDIS, there is likely to be increasing numbers of people receiving NDIS packages who are supported over the long term by aged care services.
The Framework should ensure that decisions about care for these NDIS recipients are well supported and coordinated, despite a person’s care being supported by a range of funding mechanisms.

Continuity of care and appropriateness of care should be achieved though strong communication, information sharing and coordinated care planning arrangements between providers, the person receiving services and their families and carers.
The Framework should ensure an obligation to have an interface between those making decisions about a person’s care.

Quality and adequacy of services The Commission was encouraged to see that the last Australian Federal Budget announced funding for improved access to psychological services for people in aged care settings funded through PHNs: $82.5 million in new mental health services for people with a diagnosed mental disorder living in residential aged care facilities.
The Commission understands that this is a capped rather than demand-based funding approach.

The Framework should ensure people who need access to these services receive them at the level of intensity required and that the services are of a high quality.
Regulation of RACFs Over half (52%) of people living in residential aged care facilities (RACFs) experience symptoms of depression.1 Given the large proportion of aged care residents with mental health issues, it is important that the Framework pays particular attention to the needs of this group.

In particular, the Framework should contain a specific standard regarding the mental health of Australians in contact with aged care services.
In developing such a standard, Australia could follow the UK, which has applied a specific quality standard to the area of aged care.

NICE Guideline Quality Standard 50 covers the mental wellbeing of people aged 65 and over receiving care in care homes (including residential and nursing accommodation, day care and respite care).
It focuses on support for people to improve their mental wellbeing so that they can stay as well and independent as possible and describes high-quality care in priority areas for improvement.

The Framework should ensure high quality care is provided to those engaged with aged care services even when the care is provided by external providers or contractors.

The clinical governance model 1 Australian Institute of Health and Welfare 2013.
Depression in residential aged care 2008 – 2012, aged care statistical series no 39 [Internet].

Canberra.
[cited 2016 August 13] Available from: http://www.aihw.gov.au/publication-detail/?id=60129544869 Inquiry into the effectiveness of the Aged Care Quality Assessment and accreditation framework 3 TRIM Ref TD18/7616 Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 96 Mental Health Commission of NSW applied by health services which vests accountability in the residential service provider for the quality of services delivered to residents by contractors should be considered.
This approach is reflected in the National Safety and Quality Health Service Standards (2nd edition)2: 1.6.a) “Clinical leaders support clinicians to… Understand and perform their delegated safety and quality roles and responsibilities”, and 1.19.b) “The health service organisation provides orientation to the organisation that describes roles and responsibilities for safety and quality for… Clinicians, and any other employed, contracted, locum, agency, student or volunteer members of the organisation”.
Mental health services provide assistance for people with or without dementia who have significant psychology distress and/or mental illness.

In the presence of dementia, this may also include behavioural and psychological symptoms of dementia (BPSD).

Clarity regarding roles and responsibilities of service providers is an essential starting point.
In NSW, the emerging partnership models between mental health and RACFs have a governance system that considers the role of mental health clinicians to sit under the governance of community mental health teams and the other aspects of care to be regulated/overseen and governed by the RACF provider.

This is intended to ensure that the mechanisms for overseeing quality of care are consistent with those of services provided to the rest of the community.
The level of regulation in inpatient mental health settings involves more oversight regarding some aspects of care such as seclusion and restraint and application of consent mechanisms such as the NSW Mental Health Act.

This reflects the greater severity of problems people are likely to have in relation to their mental health.

Regulation should be related to the level of acuity and RACFs would not require identical levels of regulation to acute mental health services on this basis.
The Commission is concerned about any misuse of restrictive practices in residential aged care, but there are appropriate standards recommending the minimisation of restrictive practices in RACFs.

These include the Decision-Making Tool: Handbook - Supporting a Restraint Free Environment in Residential Aged Care.

Data and quality improvement It is important that improvements to the lives of people living in aged care facilities are monitored and evaluated.
The Mental Health Commission submits that data and information collected through the assessment, accreditation and monitoring process should be used to drive service improvement and where possible, publically reported to assist broader planning and advocacy for people in contact with aged care services.

It is hard to comment on the level of restrictive practice in RACFs due to lack of public reporting of on this.
Mental health services have moved to public reporting of seclusion and restraint (physical and mechanical).

This should be considered.

2 https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality- Health-Service-Standards-second-edition.pdf.
Inquiry into the effectiveness of the Aged Care Quality Assessment and accreditation framework 4 TRIM Ref TD18/7616 Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 96 Mental Health Commission of NSW Inquiry into the effectiveness of the Aged Care Quality Assessment and accreditation framework 5 TRIM Ref TD18/7616 Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 96