How will we know when Australia’s aged care system is fixed?  

Introduction by Croakey: After over a year of consultations and investigations, The Royal Commission into Aged Care Quality and Safety is due to release its interim report tomorrow.

The Commission’s report will add to the commitments already made by the Federal Government in agreeing to 12 out of 14 of the recommendations from the House of Representatives Standing Committee on Health, Aged Care and Sport’s Report on the Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia.

While some stakeholders, such as the Australian Healthcare and Hospitals Association, have called on the Government to go further in addressing the need for new funding models and increased the numbers of registered nurses in aged care facilities, there is support among the sector for the majority of the recommendations on issues, including improved access to GP services, unannounced audits of residential aged care facilities and mandatory reporting of assaults.

These changes, together with those recommended by the Royal Commission, have the potential to radically transform aged care in Australia and address widespread problems with quality, transparency and accountability.

This raises the question asked below by Dr Joyce Siette from the Australian Institute of Health Innovation, How will we know when Australia’s aged care system is fixed?

In answering this important question, she outlines the important role of publicly available quality of life measures as a key indicator for the sector to assist in developing industry standards and to inform consumer choice and decision-making.

Joyce Siette writes:

Improving the quality of care for older people receiving aged care services has become a focus of attention for health and social care providers, both nationally and internationally. It’s now time for Australia to place the measurement and valuation of quality measures from a consumer perspective where it should be – at the forefront of our aged care system.

Our Aged Care Landscape

The current Royal Commission into Aged Care Quality and Safety offers an unique opportunity to answer the core questions facing the sector and to put in place real reforms that can transform aged care into quality care. One of the concerns raised by many witnesses at the Commission was about the quality of aged care and the need for greater transparency.

In order to address this, a revamped set of Aged Care Quality Standards, comprised of eight standards, was applied to all aged care service types as of 1 July 2019. These standards represent a much needed and welcome development towards outcome based and person-centred care. The standards focus primarily on consumer dignity and choice, ongoing assessment and planning, personal care, supports for daily living, the organisation’s environment, opportunity for feedback, human resources and organisational governance.

Previously, the consumer could check the quality of Australian Government-funded aged care providers through publicly available audits but with the new standards they can also now access consumer experience reports. These reports provide information on whether consumers felt respected and safe during their use of aged care services, among others.

However, the public is not provided with all the information they might need. Audits occur every 3 years. Consumer experience reports are currently available for residential aged care only and for a very small number of residents (<15 per home), which is not representative of the quality received.

What should consumers be looking at then?

An increasing number of research studies that test the effectiveness and cost-effectiveness of various interventions in aged care have focused on measuring quality of life as an outcome measure. Quality of life typically encompasses an individual’s psychological, social and physical wellbeing. The purpose of measuring quality of life in these studies is to focus on measures that matter to older adults as well as to facilitate health economic evaluation.

However, measuring quality of life outcomes and the impact of aged care services on quality of life, consistently and systematically, is a challenge for most aged care providers due to the sheer variety of available tools. It is also not routinely undertaken unless a research trial is taking place and even then, is often not sustained beyond the research project.

Despite the latest reforms, a majority of aged care performance measures still has a strong focus on structure and processes. Currently, across both residential and community/home-based aged care, care planning is typically focused on consumer’s clinical needs. Although consumer assessments are targeting a more integrated process and include questions around goal setting for lifestyle and leisure preferences/activities, this is not always linked to quality of life outcomes. There is a further lack of focus on evaluating the impact of services on consumer’s quality of life.

Call for a national roll-out of quality of life quality indicators

Older Australians report quality of life as a central goal for aged care, with 93% agreeing that it should be mandatory for providers to publicly report on quality of life measures. Administering, collecting and linking quality of life measures in current aged care systems is possible. In Australia, there are a number of aged care providers who recognise the need to measure quality of life with their consumers.

Some have started to integrate quality of life measures into their everyday practices, with promising benefits. Our work with a large provider assessing the quality of life of >1,300 clients across four languages has shown that incorporating these measures can lead to an increased awareness of consumers’ needs, better rapport, and more tailored programs that improve their care experience.

What next?

Our first steps are to commence a routine collection across all providers in a systematic way. Then we need to make publicly available quality of life measures a key indicator for the sector to assist in developing industry standards and to inform consumer choice and decision-making.

Other OECD countries (including England, Denmark, Austria, Finland, and the Netherlands) are already measuring quality of life of their recipients – not simply complaints or satisfaction – on a national level. With the Royal Commission’s interim report coming out soon, let’s hope that an emphasis on quantifying meaningful outcomes is made.

• Dr Joyce Siette is a research fellow with the Australian Institute of Health Innovation, Macquarie University, dedicated to improving the quality of life for individuals living in community and residential aged care by understanding what contributes to their sense of wellbeing.