Aged care star ratings: a guide to reform
The way we rate aged care homes is changing. NSA’s contribution to a watershed report gives a voice to older Australians.
Key Points
- NSA participated in a review of the star ratings given to aged care facilities.
- The current system fails to adequately reflect compliance failures.
- The 24/7 registered nurse requirement is crucial to resident safety.
Star ratings are published on the My Aged Care website to help older people and other community members understand and compare the quality of care at residential aged care homes.
The ratings also inform care providers about their service performance and, hopefully, drive quality improvement. Each aged care home is assigned an Overall Star Rating as well as ratings against four sub-categories:
- Residents’ experience.
- Compliance.
- Staffing.
- Quality measures.
The introduction of a new Aged Care Act sparked a Health Department – KPMG review of the existing star rating system.
Public consultation focused on:
Changes to the compliance rating.
Changes to the staffing rating.
Design considerations.
National Seniors Australia (NSA) participated in the consultation, lodging a submission with recommendations that we believe would improve the rating system.
We believe that star ratings are just one tool to give people confidence they will receive safe, high-quality services that adapt to their changing needs, ensuring their safety and security.
Star ratings do not replace regulatory oversight; an aged care home should be providing adequate quality of care to be considered by prospective residents, their family, or carers.
The star rating system should distil complex information about the performance of aged care homes in a way that is intelligible to older people and their families. To do so, it must be easy to navigate and straightforward. Ultimately, ratings should encourage aged care homes to continuously improve the delivery of services to residents.
The final report was recently published, and its key findings include:
Compliance rating
The KPMG consultation asked a series of questions about possible changes to the Compliance rating. These included whether the star ratings should:
- include provider-level impacts in the calculation of the Compliance rating.
- display the exceeding grade while a formal regulatory notice applies to a provider or aged care home.
NSA told the review that the current ratings system is failing to adequately reflect compliance failures wants all such breaches and failures to be easily visible on the MyAgedCare website.
A majority of community members and providers agreed that a new star ratings system should show all failures by a home in complying with regulatory requirements.
Some providers wanted clearer definitions around major and minor breaches, and that they should impact the rating differently.
Staffing rating
Staff rating questions covered several key topics:
Capping the staffing rating where an aged care home does not meet its care minute targets.
Inclusion of the 24/7 registered nurse requirement in the staffing rating.
NSA strongly supports both these changes.
Providers that fail to meet staffing targets should be limited to just two stars. This would clearly inform consumers about this important performance indicator. It emphasises the importance of meeting care minute targets and acts as a compelling incentive to maintain adequate staffing levels.
The mandated care minutes imposed by regulation is compulsory for an important reason: older Australians need access to an appropriately qualified health professional when they need it, not when it is convenient for the provider.
The 24/7 registered nurse requirement is crucial to resident safety and failure to meet it should be clearly reflected in the star ratings
Providers cautioned for a degree of tolerance towards rural and remote homes where workforce shortages can impact direct care minutes at no fault of the provider.
Design considerations:
The consultation considered several possible changes to the star ratings system:
Inclusion of half star ratings.
Inclusion of environmental restraint alongside restrictive practices and the quality measures rating.
NSA submitted that while half stars would be a welcome improvement, consumers would be more accurately informed by rating made up of decimal stars (for instance: 1.2, 3.5, 4.9). This is the system used by Amazon and Google Maps, and many other mainstream comparison sites.
The final report from KPMG reported strong agreement for half-stars, which we hope will be a step towards a more nuanced decimal approach in the future.
There was agreement about displaying information about a provider’s use of environmental restraint. Some 82% of survey respondents agreed providing as much information as possible would be beneficial to both potential clients and workers. Environmental restraint is any practice or intervention that restricts a care recipient’s free access to all parts of their environment (including items and activities) for the purpose of influencing their behaviour.
Some providers were concerned that negative connotations surrounding high use of environmental restraint could lead to providers being selective about who they would accept into their facilities, accepting only low-risk clients.
Providers working in memory support units or specialising in dementia care could also be adversely impacted if information on environmental restraint is displayed without further context on the application of environmental restraint.
The full report is available at: Design Changes for Star Ratings for Residential Aged Care – Consultation Findings Summary Report. The NSA submission is available here.
Related reading: Australian Ageing Agenda
