The star rating system of aged care homes was introduced in December 2022 to help older people and their families compare the quality and safety of services and providers.
Developed as a recommendation of the royal commission, the system has repeatedly come under scrutiny. Experts and unions have questioned why so few homes are rated substandard, given the commission found one in three residents experience neglect, abuse or poor care; and how homes on the non-compliance register manage ratings of three stars and above.
The government in August said the greater levels of transparency were driving improvements across the sector, with increasing numbers of four- and five-star homes and fewer one- and two-star homes.
Nearly two years on, the ratings’ ability to deliver on a promise of informed decision-making for older people is now being independently evaluated. As it stands, do the ratings help people choose the right aged care facility? And what other resources might be useful in making a decision?
Are the ratings helpful?Prof Tracy Comans, the director of the National Ageing Research Institute, says the main criticism is how compliance calculations have been conflated with overall star ratings.
Comans emphasises compliance is only one component of the star ratings. Homes receive an overall rating between one and five stars based on performance across four key areas: residents’ experience, staffing (care time with staff), quality measures (data on health issues such as injuries, unexpected weight loss and medication management) and compliance with government standards.
The residents’ experience rating, based on a face-to-face survey of at least 10% of residents carried out by independent experts, is weighted most heavily (33%) in the overall rating, followed by compliance (30%), staffing (22%) and quality measures (15%).
Comans advises people to look beyond a home’s overall rating. “Drill into each of those four components and look for yourself because you may value different aspects differently to how the overall weighting works,” she says.
Prof Joseph Ibrahim, from La Trobe University’s centre for evidence-based aged care, and a practising specialist in geriatric medicine, says he is sceptical of any rating system in health and aged care. It tends to be “too blunt and generic” when people have very specific needs, he says.
Dr Kaele Stokes, the executive director of advocacy and research at Dementia Australia, says the star ratings are an important component of building transparency in the sector. But, she says, as the vast majority of services sit in the middle bracket, it requires families to have further conversations with services to determine if it’s the right place for themselves or a loved one.
Does non-compliance to government standards affect a service’s star rating?Peter Edwards, the executive director of the Aged Care Quality and Safety Commission’s compliance management group, acknowledges “there may be some confusion about how identified non-compliance impacts a service’s star rating”.
When homes don’t meet the ACQSC’s quality standards, they are listed on its non-compliance register, but those breaches don’t affect a service’s star rating. The rating is only affected when the commission uses its formal powers to require a service to take corrective action.
Edwards says the reason for that approach is “to create an environment where providers are incentivised to actively engage with us and demonstrate that they are willing to take necessary action to self-correct as soon as possible when things go wrong”.
Rodney Jilek, an adjunct professor at the University of Canberra, who also runs his own aged care consultancy firm, found hundreds of homes on the non-compliance register receiving ratings between three and five stars.
Comans emphasises many of these non-compliance breaches will be unrelated to clinical care, and instead related to an organisational governance issue, such as a policy being out of date.
Craig Gear, the chief executive of the Older Persons Advocacy Network, says the system needs to evolve “to give greater understanding when it’s something that’s serious in non-compliance versus something that might be more procedural”.
What other resources or actions can help in choosing an aged care facility?Stokes encourages people to talk about their end-of-life and advanced age care plan early so there can be more input of their wishes, and to avoid the situation many families find themselves – looking for an aged care home at a time of crisis when they can no longer able to care for their loved one.
Ibrahim emphasises the star rating’s care time measures don’t detail what kind of quality the care was or whether the care was kind – only how much time was spent. Ibrahim recommends visiting the aged care home, ask to sit and have a meal there, talk to residents, families and staff. “See for yourself whether it’s clean or smells, how friendly the staff are, and the range of things to do.”
For individuals or families affected by dementia, Stokes recommends asking management if staff are educated in dementia. The NSW Nurses and Midwives’ Association together with other doctors and experts in aged care have developed a series of leaflets called 10 Questions to Ask to help families ask the right questions on a range of issues in residential aged care.
For more information beyond the ratings, Gear says people can read a home’s latest accreditation report and look at its finances, which are also listed on the My Aged Care website. Gear says seeing what money is being spent on food and nutrition “gives a good picture”.
People can check if a home is listed on the non-compliance register and ask a home why the breach occurred, what they are doing in response and whether they see any continuing risks of recurrence, Gear says.
Dementia Australia and OPAN have hotlines staffed by advocates who can help people with their choices.
Under Labor’s proposed new aged care act, Gear says his understanding is that the star ratings will be updated with the act’s enhanced quality standards. Currently accreditation is pass/fail, meaning homes that only just meet the standards are rated the same as those which have the highest performance. The new system will allow for gradation to better reflect homes that are exceeding standards, he said.
If you are having issues or concerns with your aged care, call OPAN on 1800 700 600. The National Dementia Helpline is also available on 1800 100 500.