In New Zealand, aged residential care (ARC) providers deliver a range of services for older people – rest home, hospital, dementia and psychogeriatric care. The Ministry of Health is responsible for ensuring that ARC facilities operate in accordance with the Health and Disability Services (Safety) Act 2001 and administers an audit system to determine if services meet the appropriate standards.
Following audits, rest homes are certified for set periods of time, usually between one and four years, depending on the standard attained. At least one unannounced “spot” audit is performed around the middle of a rest home’s certification period. This is to check that progress has been made on areas for improvement, identified earlier, and that standards have been maintained. Rest homes are also audited when they change ownership or add a new service (e.g. adding hospital-level care).
Rest home audits are undertaken by agencies designated by the Ministry. The reports are reviewed by the rest home and then sent to the Ministry of Health and the district health board (DHB) which set up the home’s contract. The Ministry decides the period of certification, taking into account feedback from the DHB.
Auditors collect information on how well a rest home is meeting the standards by observing it in action; interviewing rest home staff, residents and family members; and looking at documentation of systems, policies, procedures and records.
Auckland University of Technology was contracted by the Ministry of Health to evaluate whether recent changes to auditing processes have resulted in improved outcomes for ARC residents. The focus of the research was on the quality of care and the satisfaction of the residents and their families. Reports from this research can be found at http://www.health.govt.nz/publication/improving-outcomes-age-residential-care
The focus was on changes to the audit process since 2009. The ones most relevant to the project are –
• Introduction of an integrated audit approach with DHBs
• Introduction of unannounced audits
• The publication of online summary and full audit reports
• Changes to the system to handle serious complaints about the care and safety of residents.
Views from voluntary organisations
Part of my input into the research was to seek the views of stakeholders from the voluntary sector. I conducted interviews with staff and volunteers from Age Concern, Grey Power and Presbyterian Support. In this blog I look at their views on changes to the audit process and in the second on ARC in general and how it could be improved, using findings from the research.
Integration with DHBs
Most of the interviewees have a positive view of the integrated approach, bringing the Ministry of Health auditing processes closer to those of DHBs and avoiding duplication. They considered that involvement of DHBs, especially outside the big cities, allows a more localised approach. But the quality of the interactions ultimately depends on personal relationships.
This change was considered beneficial and helpful by all the interviewees – it keeps rest homes “on their toes” and up to date, especially in maintaining their quality systems. But there were some reservations and questions about how truly unannounced the audits actually are.
Familiarity with and use of published (on-line) audit reports
Voluntary sector people had mixed responses on this. They may look at reports when a particular situation arises, such as investigating a complaint. “I just pick out the parts I am interested in.” Several said they refer families to the reports when they are looking for residential care. The summaries appear to be more useful than the full reports, which are often seen as too complicated and needing too much time to digest. Some interviewees commented that the reports need to be more resident focussed – “they do not tell you how well people are cared for on a daily basis.” The recommendation was for families to visit rest homes in person.
Public awareness and use of published audit reports
The impression gleaned from the interviews was that very little use is made of the published audit reports by the public and their availability is not widely known.
The general view among the voluntary sector interviewees was that the reports can be helpful, but there was no strong endorsement of their usefulness. They are able to indicate inadequacies – where standards are not being met. “Red flags indicate problems” said one respondent.
Experience of complaints and how they are handled
Rest home audits include scrutiny of complaints registers, and complaints can trigger a “spot” audit. Age Concern staff, especially those involved with elder abuse prevention, can act as advocates for residents and their families when complaints arise and can provide training for staff to help remedy problems. In terms of change, the impression is that generally people are becoming more aware and better informed about the complaints process. Complaints are taken more seriously by the rest homes and there is more accountability and cooperation. Most complaints are settled internally, but DHBs and the Health and Disability Commission can be involved.