Feeling connected the key to regulating aged care

A protrait of a man wearing an orange tie Emeritus Professor Valerie Braithwaite, Expert Advisory Panel member

Public consultation is underway to seek your views on our proposed new model for regulating aged care.

The new model details the fundamental changes to the way we engage and monitor the aged care sector, and the rules and expectations placed on providers delivering care.

Emeritus Professor Valerie Braithwaite has shared her expert knowledge of best practice regulation with us as a member of our Expert Advisory Panel.

My name's Valerie Braithwaite, and I'm a member of the Expert Advisory Panel for the new regulatory model. My presence there comes about through an interest in regulation that's gone on for, I think, 30 years now, and also a passion for aged care and the regulation of aged care. I wrote a book with Toni Makkai and John Braithwaite a number of years ago on this topic. It took ten years. That was a big chunk of our lives, and so I've followed it ever since, and of course I followed the Royal Commission, like so many Australians did.

Regulation, for me, means steering the flow of events. Now you'll think that's very broad, and I think we should think about it in a very broad way because it means that we regulate each other all the time, so parents regulate their children, and then at a certain point in time - and I can vouch for this, children start regulating their parents. That notion of regulating, of steering and influencing each other all the time, means that we all are part of a regulatory community, and that's at the centre of these changes that are being proposed for the aged care sector. Now of course there is a formal regulator. I think we should think of a formal regulator as the referee in the soccer game. The person who will call out when rules are being broken and guide us through solving the problems that arise when rules and laws are broken. If you think of regulation as something that we're all part of, that all our eyes are on the quality of aged care, then relational regulation is about connections. It's saying that we're not going to isolate people and knowledge and information and problem solving. We're all going to get in there and work together to find the solutions that will suit the older Australian who's affected by some breakdown in procedures or in care.

I think we can get better quality of care with relational regulation, and let me use this as an example. I may like a care environment that's very quiet, but you might like a care environment which is full of young people being quite noisy. The only way we know about that, we can't legislate that, the only way we know about that is by having meaningful conversations with people. So it's those meaningful conversations between regulators, providers, staff, working in a facility or delivering care, the client themselves and their families. Everyone needs to be connected in conversations about what high quality means, and when things go wrong, that group of people need to be prepared to come together quite quickly to fix the problem and find a way forward.

It's often thought that relational regulation does mean a softer approach and nothing could be further from the truth. Relational regulation, however, does mean that we treat each other with respect. It's about respectful dialogue, and knowing and being interested in knowing and in solving the problems that we're having. Now, if we can't solve those problems, and let me give you an example: a care planning meeting is the perfect place for everyone to come together to solve a problem, and even difficult problems can be solved in a care planning meeting. But if there is no meeting, if the meeting does not include the resident or the person receiving care, and they're not allowed to attend or they're silenced in some way, then we do need to have a regulatory apparatus that will deal with that, and we do have that. There is no way that we're not going to have capacity for a regulator to do an audit, do an inspection. In fact, very often when there's a serious problem that cannot be solved, the regulator should be in that facility or looking at what's happening on the ground. Boots on the ground is really important in relational regulation, and that's not soft because the regulator has got powers, and in fact more powers than before, under the new proposed model.

Relational regulation I think offers particular benefits for older Australians, for everyone, but particularly older Australians, because being disconnected is one of the problems that older Australians have, and we saw that in the Royal Commission. So it's about connections. It means that the problems that they have, the issues they want to raise, should be heard by someone and most importantly fixed very quickly. An older person doesn't want to have to go to the computer and write down a complaint and send it in and then wait weeks for it to be solved or for someone to come back. Really, the most respectful thing that we can do for our older citizens is to take their concerns seriously and realize that each day is very important to them and fix the problem as soon as we can. And I think we can do that very well with the relational regulation model.

Could I ask everyone to become involved in this conversation? Now, let's not wait. I'd like to invite you all to have your voice heard and do so by going to the aged care engagement hub. There, you will be able to answer a questionnaire if you want, you can put in a submission, and I believe there are going to be workshops as well. And we'd really like you to join in and tell us what you think. How can we ensure that the voices of everyone who is involved, who's in this regulatory community, are heard and respected, and we move towards our shared goal of better care for elderly Australians.

Thank you.

The Panel provides guidance to make sure the new regulatory model will not only address the current issues, but create an environment where the sector works well together to meet the needs of our older people and continually improve the quality of care on offer.

At the heart of this model is what Professor Braithwaite refers to as ‘relational regulation’.

“We regulate each other all the time,” she explains.

“That notion of regulating, of steering and influencing each other all the time, means that we are all part of a regulatory community.”

“If you think of regulation as something that we're all part of, that all our eyes are on the quality of aged care, then relational regulation is about connections.

“We’re all going to get in there and work together to find solutions that will suit older Australians,” she said.

Strong relationships within the sector will encourage open and meaningful conversations between providers, staff, older people and their families, and the aged care Regulator, to identify problems and work together to solve them.

Professor Braithwaite says the Regulator is like a referee in a soccer game - “[they are] the person who will call out when rules are being broken and guide us through solving the problems that arise when rules and laws are broken.”

For this reason, we’re proposing strengthened monitoring and enforcement powers for the Aged Care Quality and Safety Commission (the Regulator) in the new model.

Watch the video of Professor Braithwaite speak about creating quality aged care through connected and respectful conversations.

We encourage you to read A new model for regulating Aged Care, Consultation Paper No.2: Details of the proposed new model.

Visit the Aged Care Engagement Hub Regulatory Model page to read the paper, register for upcoming workshops, and submit your feedback by 23 June 2023.

Let's change aged care, together

Every Australian should feel confident about accessing high quality and safe aged care, when and where they need it.

The changes mean older Australians will have greater choice and control, services that respect and meet their needs, and support to stay independent as they age.

To find out more and help design the changes, visit the Get Involved page or call 1800 318 209.

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