Recent Productivity Commission findings suggest the aged care sector has much work to do before it can realistically claim to be providing acceptable quality care, according to health and aged care policy analyst Charles Maskell-Knight.
Almost 30 percent of audited homes did not have an adequate workforce to deliver save, respectful, and quality care, he reports.
Charles Maskell-Knight writes:
The aged care sector used the release of the aged care star ratings last December to claim that 90 percent of aged care homes were delivering acceptable quality care, as they had received three or more stars.
In an article on this site several weeks ago I argued that the aged care ratings system deserved only one star as it “needs significant improvement”.
Under the system a home can receive three stars for compliance, even though the regulator has required it to develop a plan to ensure it complied with the standards, and it can receive three stars for staffing, even though it has failed to meet the targets for minutes of care time.
The Productivity Commission has now released the section of its Report on Government Services dealing with aged care.
The data on the results of reaccreditation site audits by the regulator suggests that significantly fewer than 90 percent of the homes audited are meeting the quality standards.
In 2021-22 the regulator carried out re-accreditation site audits at 710 homes – just over a quarter of all homes – and measured performance against the eight quality standards:
- Consumer dignity and choice
- Ongoing assessment and planning with consumers
- Personal care and clinical care
- Services and support for daily living
- Organisation’s service environment
- Feedback and complaints
- Human resources
- Organisational governance.
The highest proportion of homes meeting an individual standard was observed for Standard 5 Organisation’s service environment, where 88.5 percent of homes met the standard.
At the other end of the scale, only 61.5 percent of homes met Standard 3 Personal care and clinical care, 67.6 per cent met Standard 8 Organisational governance, and 70.1 per cent met Standard 7 Human resources.
All the standards are expressed as both a consumer outcome and an organisational statement.
For Personal care and clinical care these are respectively:
(1) I get personal care, clinical care, or both personal care and clinical care, that is safe and right for me.
(2) The organisation delivers safe and effective personal care, clinical care, or both personal care and clinical care, in accordance with the consumer’s needs, goals and preferences to optimise health and well-being.
The results indicate that almost 40 percent of the audited homes were not delivering safe and effective personal and clinical care.
For Human resources the standard is expressed as:
(1) I get quality care and services when I need them from people who are knowledgeable, capable and caring.
(2) The organisation has a workforce that is sufficient, and is skilled and qualified to provide safe, respectful and quality care and services.
The results suggest that almost 30 percent of audited homes did not have an adequate workforce to deliver save, respectful, and quality care.
While it is true that these results are drawn from only a quarter of homes, there is no reason to believe that the unsatisfactory results cannot be extrapolated across other homes.
Management in the homes being audited would have known that their accreditation period was expiring, and would have expected a reaccreditation visit. Human nature being what it is, they would have done their best to ensure that they were complying with the standards before the auditors arrived.
The fact they failed in such large numbers suggests that poor quality continues to be endemic across the sector, despite the results derived from the star ratings system.
If anybody seriously believes that 90 percent of homes are delivering an acceptable quality of care, I have a bridge to sell them.
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20.
See Croakey’s archive of articles on aged care