Ombudsman Act 1976 This legislation sets out the Ombudsman’s role, responsibilities and powers, which include: investigating complaints about the administrative actions of Australian Government officials and agencies, and reviewing statutory compliance by agencies developing policies and principles for accountability. to the Accountability Public Governance, Performance and Accountability Act 2013 This legislation provides a framework for the proper management of public money and public property. Refer to the Accountability Public Service Act 1999 This legislation sets out the values which public servants need to uphold and a code of conduct for public service employees, as well as external processes through which public servants can be held accountable. Refer to the Accountability Policy on preventing and managing unreasonable conduct from external parties This outlines how the National Aged Care Regulatory Programme, including the Scheme, will manage unreasonable conduct from external parties. It is expected that complainants will treat Scheme officers fairly and respectfully; this expectation. Scheme’s notice of collection The Scheme’s outlines what the Scheme may collect, use and disclose. Accountability Scheme’s Service Commitment The Scheme’s describes the level of service that complainants and service providers can expect from the Scheme during a resolution process. Accountability
Residential aged care services, including permanent care and respite care Home Care Packages delivered on a Consumer Directed Care basis Flexible Care where a person is receiving ‘residential care’ or ‘home care’; this includes services provided through Transition Care, Innovative Care or Multi-purpose services (MPS) Commonwealth Home Support Programme (CHSP) National Aboriginal and Torres Strait Islander Flexible Aged Care Programme (NATSIFACP) This includes the care recipient might: have a current approval from an Aged Care Assessment Team for residential care services but is not in an Australian Government subsidised residential care place be a continuing care recipient who is provided residential care under the fees and payment provisions of the Aged Care (Transitional Provisions) Act 1997 not be named or identifiable no longer be receiving services from the service provider to which the information relates, or be deceased. Note: On 1 July 2015, CHSP consolidated a number of entry-level programmes; refer to Chapter 10. The CHSP does not apply to HACC services in Western Australia or Victoria. Determining that the information relates to a responsibility of an approved provider as defined in Chapter 4 of the Act or the Aged Care Principles or a Comprehensive Agreement. Responsibilities of approved providers include: quality of care provided to care recipients (this includes specified care and services) user rights for the people for whom the care is provided (this includes the Charter of Rights and Responsibilities in both residential and home care), and accountability for the care that is provided and the basic suitability of their key personnel (this includes obligations in respect to compulsory reporting and recordkeeping). Responsibilities of Australian Government subsidised aged care programmes under a Comprehensive Grant Agreement are outlined in Chapter 10 of these Guidelines. They generally relate to the same responsibilities outlined above. How to confirm in-scope information Officers are able to confirm the information has been classified correctly as in-scope by referring to the information held on the department’s official information management systems. These have a current list of all service providers, the residential, home care or flexible services they are approved to provide and, residential and Home Care Package services, a list of past and present care recipients of each service.
Out-of-scope enquiries – essential information to collect Officers should collect and record sufficient information for an out-of-scope enquiry to demonstrate: why the information is and the action taken to assist or refer the person or the information to an organisation that may be able to deal with the information or enquiry. For example, a caller phoned regarding an aged care retirement village in ‘Sunnyville’. A check of the retirement village’s name against the list of service providers and their services confirmed the retirement village is not operated by a service provider and is therefore not within the scope of the Scheme. The caller is referred to the Department of Fair Trading which has responsibility for retirement villages. Activity 4: Providing information Determining the of information to provide During the initial contact with the person officers should ensure sufficient information is provided to enable the person to understand the Scheme‘s processes and make informed decisions as to how to resolve their complaint or enquiry. This will vary depending on the classification of the information (see Activity 2: Classifying information). Note: Where a person is becoming distressed, angry or too confused to understand all of the necessary information in one discussion, officers should use their judgment about the level of information they provide and consider whether it may be necessary to follow up with the person at a more suitable time by phone or in writing via a letter or an email. Important! If an officer is unsure as to how much information to provide, the advice of a manager should be sought. Complaints - essential information to provide Where appropriate, officers should advise the complainant during the initial contact of the following information: The role and objectives of the Scheme. Information on the Scheme’s process for managing complaints. What the complainant can expect of the Scheme and what the Scheme expects of the complainant. What issues the Scheme can and cannot deal with; for example, the Scheme cannot comment on industrial matters or decide who should make financial, legal or health decisions on behalf of a care recipient. What outcomes can and cannot be achieved through the Scheme’s processes; for example, the Scheme cannot direct who a service provider employs but can ensure that staff are appropriately skilled and qualified. The right of the complainant to lodge a complaint confidentially or anonymously and the impact on the Scheme’s capacity to resolve the complaint.
Detailed Assessment Phase This chapter sets out the key activities to be undertaken by officers during the detailed assessment phase, the second of the four phases of the complaints management process. Intake Detailed Assessment Phase Resolution Phase Outcome Phase Chapter contents Section Overview of the detailed assessment phase 5.1 Working with more detailed information 5.2 Purpose of the risk assessment and resolution plan (RARP) 5.3 Complaints management principles relevant to the detailed assessment phase 5.4 Key activities in the detailed assessment phase Activity 1: Collecting and assessing relevant information 5.5 Determining the level of information to collect to inform the RARP 5.6 Assessing a service provider’s complaints history 5.7 Assessing a service provider’s accreditation or quality reporting history 5.8 Engaging with the service provider 5.9 Engaging with care recipients or nominated representative 5.10 Engaging with other persons and/or organisations Activity 2: Risk assessment and resolution planning 5.11 Using the risk assessment and resolution plan (RARP) to progress the complaint 5.12 Who completes the of the risk assessment and resolution plan (RARP)? 5.13 When should the risk assessment and resolution plan (RARP) be updated? 5.14 What is a risk element? 5.15 How to complete the risk assessment 5.16 How to determine an appropriate resolution plan 5.17 Determining an appropriate resolution approach to recommend 5.18 issues might be suitable for the different resolution approaches? 5.19 Determining the complaint priority and when to commence the resolution approach Activity 3: Supporting early resolution 5.20 Supporting complaint resolution 5.21 Which complaints are suitable for early resolution?
be conscious that care recipients with a cognitive impairment might still be able to express their views and engage in the resolution process, and be aware that, if it is not appropriate to engage with the care recipient, and there is a nominated representative or guardian for the care recipient, the nominated representative or guardian must be contacted. Note: The care recipient’s nominated representative is the person nominated to the provider for this purpose under the Act. Important! If an officer believes exceptional circumstance exist or is unsure as to whether to contact a care recipient and/or their nominated representative, they should first consult with their manager. Engaging with persons and/or organisations At times during the detailed assessment phase it may be necessary to engage with other persons and/or organisations. When engaging with others, officers must ensure they comply with the Act and the Scheme’s privacy and confidentiality requirements in relation to the use and disclosure of protected information. Important! If an officer is unsure as to whether to contact others, they should first consult with their manager. Activity 2: Risk assessment and resolution planning Using the risk assessment and resolution plan (RARP) to progress the complaint The RARP is designed to assist officers in considering the common risk elements related to each raised in a complaint and to assess the risks, along with other information collected, to decide whether: no further action should be taken on the issue(s) further support should be provided to facilitate an early resolution of the issue(s) within the detailed assessment phase the issue(s) should be progressed to the resolution phase, and/or the issue(s) should be referred to another organisation. The risk rating in the RARP also assists managers in determining: an appropriate resolution approach the priority of the complaint and timeframe in which to respond to the complaint, and the level of oversight the manager should maintain. Who completes the of the risk assessment and resolution plan (RARP)? The RARP is drafted by officers undertaking the detailed assessment in consultation with a manager. Both officers and managers play a role in completing the RARP:
6.23 Teleconferencing to facilitate conciliation 6.24 Speaking separately to the parties to facilitate conciliation Resolution approach - Service provider resolution 6.25 What does service provider resolution involve and what is the potential outcome? 6.26 What types of issues may be suitable for service provider resolution? 6.27 Planning service provider resolution 6.28 Confirming the engagement of all parties 6.29 Referring the issues to the service provider for resolution 6.30 Assessing the service provider’s resolution outcome 6.31 What happens when new information is received during service provider resolution? Resolution approach - Mediation 6.32 What does mediation involve and what is the potential outcome? 6.33 What of issues may be suitable for initiated mediation? Resolution approach - Investigation 6.34 What does investigation involve and what is the potential outcome? 6.35 What types of issues may be suitable for investigation? 6.36 Role of the officer in meeting the principles of good investigation 6.37 Planning an investigation – using the aged care investigation matrix Activity 4: Collecting information 6.38 Collecting information – sources and types 6.39 Considerations about information the Scheme might receive 6.40 Can officers take photographs or record interviews? Activity 5: Undertaking a site visit or on-site meeting 6.41 What does an announced or unannounced site visit involve? 6.42 In what circumstances will a site visit to a residential service or service provider’s office be conducted? 6.43 When would an onsite meeting be conducted? 6.44 Powers of an authorised officer undertaking a site visit under the Aged Care Act 1997 6.45 interview 6.46 Exit interview 6.47 When will a site to a private home be conducted? 6.48 Planning for a site visit to a private home Activity 6: Assessing collected information 6.49 Analysing collected information 6.50 Making findings and conclusions in relation to a burden of proof Activity 7: Referrals to other areas or organisations 6.51 When can the Scheme make a referral to another area or organisation?
Outcome Phase This chapter sets out the key activities to be undertaken by officers during the outcome phase, the fourth and final phase of the complaints management process. Intake Phase Detailed Assessment Phase Resolution Outcome Phase Chapter contents Section Topic Overview of the outcome phase 7.1 Who can make a decision to end the complaint resolution process 7.2 Complaints management principles relevant to the outcome phase 7.3 Manager role at the outcome phase 7.4 Delegate’s role in the outcome phase 7.5 The available decisions to end the complaint resolution process in the outcome Decision to end - the issue has been resolved 7.6 When the Scheme use the decision to end as the issue has been resolved? Decision to end - the service provider has addressed the issue 7.7 When would the Scheme use the decision to end as the service provider has addressed the issue to the satisfaction of the Scheme? Decision to end - the Scheme has issued directions 7.8 When would the Scheme use the decision to end through issuing directions to a service provider? 7.9 What information is included in directions? 7.10 Determining timeframes for directions to be met 7.11 Are directions enforceable? Decision to end - compliance action has been taken 7.12 When would the Scheme use the decision to end as the department has taken compliance action? Decision to end - the complainant has withdrawn from the process 7.13 When the Scheme use the decision to end as the complainant has withdrawn from the process? Decision to end - the issue is better dealt with by another organisation 7.14 When would the Scheme use the decision to end as the issue is better dealt with by another organisation? 7.15 Will the Scheme seek feedback from the referral organisation? Decision to end - continuation of the resolution process is not warranted 7.16 When would the Scheme use the decision to end as continuation of the resolution process is not warranted? 7.17 Circumstances giving rise to the complaint not determined 7.18 Information not in good faith
Complaints Management for Aged Care Programmes under Grant Agreements This chapter provides information on the regulatory framework and complaints management process for aged care programmes subsidised under Comprehensive Grant Agreements. The complaints management process includes an initial phase of service provider local level management prior to the intake, detailed assessment, resolution and outcome phases. Local level management Intake Phase Detailed Assessment Resolution Outcome Phase Chapter contents Section Topic Aged care programmes under a Comprehensive Grant Agreement that are within the Scheme's jurisdiction 10.1 The Commonwealth Home Support Programme 10.2 The National Aboriginal and Torres Strait Islander Flexible Care Programme 10.3 Understanding the regulatory framework for aged care programmes under a Comprehensive Grant Agreement Figure 5. The Complaints and Compliance Administrative Regulatory Framework Service Provider Comprehensive Agreement requirements and the impact on the Scheme 10.4 Administrative responsibilities of service providers under a Comprehensive Grant Agreement 10.5 The CHSP Programme Manual 10.6 The NATSIFACP Guidelines 10.7 Complaints mechanisms and service provider requirements Complaints Management Process for aged care services under Comprehensive Grant Agreements 10.8 The Scheme's complaints management process for aged care services subsidised under Comprehensive Grant Agreements Figure 6. Complaint management process flow chart for complaints related to service providers under Comprehensive Grant Agreements 10.9 Complaints management principles relevant to handling complaints related to service providers under Comprehensive Grant Agreements 10.10 Powers of officers under the Comprehensive Grant Agreement 10.11 Sub-contractor requirements to participate in the Scheme's complaint management process 10.12 Delegates and administrative authority the Comprehensive Grant Agreement 10.13 How the Scheme manages confidential and personal information during complaint handling Local level management phase 10.14 Service provider complaint handling – local level management
of whether to ask the complainant to raise their concerns with the service provider for local level management or whether to handle it as an in-scope complaint. The following information is additional to that provided in Chapter 4 Intake Phase and outlines specific processes relevant to CHSP and NATSIFACP complaint management during the intake phase. What is in-scope information relevant to aged care services under a Comprehensive Grant Agreement? Officers assess whether the information is in-scope by: Determining that the information relates to the responsibilities of a service provider providing services to a person receiving: CHSP services and support. A list of CHSP services and support is found in the CHSP Programme Manual 2015. NATSIFACP services. CHSP Comprehensive Grant Agreements may include special conditions for service delivery to a small number of people in ‘non-target groups’. For example, HACC services for people who are NOT older Australians, or HACC services for older Australian clients living in cross border areas of Victoria or Western Australia. To determine that the information relates to CHSP service delivery, officers should collect information on the service provider name and contact details, the client’s age group, and whether the client/carer identifies as an Aboriginal and/or Torres Strait Islander. Note: Older Australians are defined as people who are 65 years or more of age or people who identify as Aboriginal and Torres Strait Islanders who are 50 years or more of age. Determining that the information relates to a responsibility of a service provider as defined in the Comprehensive Grant Agreement. Responsibilities of service providers include: the quality of services provided to care recipients/clients (as funded through the Programme) user rights for people to whom the care is provided (as applied through the Charter of Rights and Responsibilities for Residential care or Home care), and accountability for the care that is provided and the basic suitability of their personnel to deliver the funded services. In-scope information related to service providers under a Comprehensive Grant Agreement may be classified as: Enquiry Service provider management Complaint Programme referral Out-of-scope information