The Royal Commission into Aged Care Quality and Safety recommended a rating system for residential aged careIN December 2022, star ratings for aged care homes were introduced. The system has been controversial.
The star rating system is intended to offer a straightforward way to compare the quality of aged care homes. This information is found by searching for a provider on the My Aged Care website, which then gives detailed information on each facility’s star rating.
However, there are criticisms that the system might be misleading to those who take it at face value and that it does not go far enough to separate the good, the bad and the ugly. Others argue that unfair pressure is being put on aged care providers that are struggling with staffing.
What is the star rating system?
There are four areas, which all receive a star rating.
The key areas that are measured to determine a facility’s star rating are:
- Residents’ experience:
An independent third-party group attends the aged care facility and interviews a small number of residents, who are randomly selected. The survey has 12 questions. Providers can decline to participate, but they will automatically be given a one-star rating in this category – which would have a big impact on their overall rating as residents’ experiences makes up a third of the final score. Surveys are conducted yearly. - Compliance:
The Aged Care Quality and Safety Commission visits the aged care home to check for compliance with government regulations and standards, and can direct the provider to fix issues if needed. Facilities that seriously breach regulations can be forced to stop accepting new residents, limit their fees or even repay fees. A five-star rating means that the facility has not been given a formal warning (or ‘notice of breach’) in at least 3 years. Compliance makes up 30% of the star rating. - Staffing:
Residential aged care providers must report on how much care each resident receives daily, which should be averaged out at 200 minutes. This includes help with daily tasks and personal care, making appointments and treatment planning, as well as at least 40 minutes of clinical care delivered by a Registered Nurse. This score is updated every 3 months and makes up 20% of the star rating. To get top marks, facilities have to exceed targets. - Quality measures:
Providers must report on pressure injuries, restrictive practices, unplanned weight loss, falls and major injuries, and medication management. This data is compared to a national average to determine how an aged care home measures up, and to identify opportunities for quality improvement across the sector. This determines 15% of the overall star rating.
What’s the issue?
Unfortunately, the star rating system might suggest that a facility is better than it is. The Australian Government describes high quality care on the My Aged Care website as “meeting regulatory and health care requirements and providing enough staff”. One might argue that these indicators really represent the base line of care that should be provided rather than signalling a top-tier aged care facility.
Indeed, based on these measures it seems ghastly to think of what a one-star facility might look like.
For example, to receive a five-star rating in ‘quality measures’, an aged care home must be reporting less falls and major injuries than other facilities. This does not mean that there are no preventable falls occurring, just that everyone else is doing a worse job (or a better job with reporting).
Meanwhile, the Australian Government is being lambasted by providers for imposing strict operating requirements that are impacting the profitability of aged care facilities, which are facing staffing shortages and administrative burdens as they struggle to catch up to new regulations.
This is a particular issue in rural areas where it is difficult to hire and retain skilled staff. Many facilities have been given special dispensation to operate without adequate staff, as the alternative is to leave the area without residential aged care. No one wants to move hours away from their family and community.
All-in-all, things are still a mess and there isn’t too much a star system can do to fix that. Realistically, what’s really needed is greater investment into the sector. The debate about where this money will come from continues.
Future directions
A recent survey suggests that most of us would prefer to stay at home as long as possible, with the support of home care services. At least 1 in 5 said that they would not consider moving into an aged care facility under any circumstances.
It is clear that there is a long way to go to improve the quality of residential aged care in Australia. Despite flaws in the system, aged care star ratings are providing a motivation for aged care providers to pick up their game, and a framework for quality improvement. In future we would like to see providers display this information on their website and in a prominent place onsite, in a similar manner to food hygiene ratings.
Other ways to find the right care
Despite its flaws, the star rating system has the potential support people to make informed decisions about aged care. Whilst the ratings on their own can only provide a small insight into the care provided at a facility, it is one piece of the puzzle.
If you are trying to make a decision about aged care or are supporting someone else in this process, it might help to try to arrange respite care for a short period of time at a potential aged care home.
It is also a good idea to search the Aged Care Quality and Safety Commission’s register that lists breaches of quality standards. Some breaches might be more important to you than others, and unless formal directions are made these incidents might not impact star ratings at all.
Making the decision to move into residential aged care is difficult for many reasons. Whilst the rating system is flawed, it is one step towards a transparent and high-quality aged care system. The rest will take time.
Related articles
- Home Care Packages: What you can and can’t get
- Home Care merger: Delayed to the never-never
- Home Care waiting times: Getting better or worse?
- Will we have RN24/7 registered nurses in nursing homes?
Helpful links:
- My Aged Care is the Australian Government’s Aged Care portal. You can find them online or call 1800 200 422 for information on what aged care supports are available and how to access them.
- Centrelink has a face-to-face My Aged Care service. You can find out more here or call 1800 227 475 and ask to make an appointment with an Aged Care Specialist Officer.
- The Older Persons Advocacy Network (OPAN) can help if you are having problems with a service provider, don’t know what services you might be able to get, or need help understanding your rights. You can find their website here or call them on 1800 700 600.
- If you would like to make a complaint about an aged care service, including the assessment team or My Aged Care, you can contact the Aged Care Quality and Disability Commission online or at 1800 951 822.
- If you have concerns about elder abuse and you are in NSW you can reach the NSW Elder Abuse Hotline at 1800 628 221. Otherwise, you can call 1800 353 374 to reach the national ELDERHelp line.
You can find other helpful numbers here.
IN December 2022, star ratings for aged care homes were introduced. The system has been controversial.
The star rating system is intended to offer a straightforward way to compare the quality of aged care homes. This information is found by searching for a provider on the My Aged Care website, which then gives detailed information on each facility’s star rating.
However, there are criticisms that the system might be misleading to those who take it at face value and that it does not go far enough to separate the good, the bad and the ugly. Others argue that unfair pressure is being put on aged care providers that are struggling with staffing.
What is the star rating system?
There are four areas, which all receive a star rating.
The key areas that are measured to determine a facility’s star rating are:
- Residents’ experience:
An independent third-party group attends the aged care facility and interviews a small number of residents, who are randomly selected. The survey has 12 questions. Providers can decline to participate, but they will automatically be given a one-star rating in this category – which would have a big impact on their overall rating as residents’ experiences makes up a third of the final score. Surveys are conducted yearly. - Compliance:
The Aged Care Quality and Safety Commission visits the aged care home to check for compliance with government regulations and standards, and can direct the provider to fix issues if needed. Facilities that seriously breach regulations can be forced to stop accepting new residents, limit their fees or even repay fees. A five-star rating means that the facility has not been given a formal warning (or ‘notice of breach’) in at least 3 years. Compliance makes up 30% of the star rating. - Staffing:
Residential aged care providers must report on how much care each resident receives daily, which should be averaged out at 200 minutes. This includes help with daily tasks and personal care, making appointments and treatment planning, as well as at least 40 minutes of clinical care delivered by a Registered Nurse. This score is updated every 3 months and makes up 20% of the star rating. To get top marks, facilities have to exceed targets. - Quality measures:
Providers must report on pressure injuries, restrictive practices, unplanned weight loss, falls and major injuries, and medication management. This data is compared to a national average to determine how an aged care home measures up, and to identify opportunities for quality improvement across the sector. This determines 15% of the overall star rating.
What’s the issue?
Unfortunately, the star rating system might suggest that a facility is better than it is. The Australian Government describes high quality care on the My Aged Care website as “meeting regulatory and health care requirements and providing enough staff”. One might argue that these indicators really represent the base line of care that should be provided rather than signalling a top-tier aged care facility.
Indeed, based on these measures it seems ghastly to think of what a one-star facility might look like.
For example, to receive a five-star rating in ‘quality measures’, an aged care home must be reporting less falls and major injuries than other facilities. This does not mean that there are no preventable falls occurring, just that everyone else is doing a worse job (or a better job with reporting).
Meanwhile, the Australian Government is being lambasted by providers for imposing strict operating requirements that are impacting the profitability of aged care facilities, which are facing staffing shortages and administrative burdens as they struggle to catch up to new regulations.
This is a particular issue in rural areas where it is difficult to hire and retain skilled staff. Many facilities have been given special dispensation to operate without adequate staff, as the alternative is to leave the area without residential aged care. No one wants to move hours away from their family and community.
All-in-all, things are still a mess and there isn’t too much a star system can do to fix that. Realistically, what’s really needed is greater investment into the sector. The debate about where this money will come from continues.
Future directions
A recent survey suggests that most of us would prefer to stay at home as long as possible, with the support of home care services. At least 1 in 5 said that they would not consider moving into an aged care facility under any circumstances.
It is clear that there is a long way to go to improve the quality of residential aged care in Australia. Despite flaws in the system, aged care star ratings are providing a motivation for aged care providers to pick up their game, and a framework for quality improvement. In future we would like to see providers display this information on their website and in a prominent place onsite, in a similar manner to food hygiene ratings.
Other ways to find the right care
Despite its flaws, the star rating system has the potential support people to make informed decisions about aged care. Whilst the ratings on their own can only provide a small insight into the care provided at a facility, it is one piece of the puzzle.
If you are trying to make a decision about aged care or are supporting someone else in this process, it might help to try to arrange respite care for a short period of time at a potential aged care home.
It is also a good idea to search the Aged Care Quality and Safety Commission’s register that lists breaches of quality standards. Some breaches might be more important to you than others, and unless formal directions are made these incidents might not impact star ratings at all.
Making the decision to move into residential aged care is difficult for many reasons. Whilst the rating system is flawed, it is one step towards a transparent and high-quality aged care system. The rest will take time.
Related articles
- Home Care Packages: What you can and can’t get
- Home Care merger: Delayed to the never-never
- Home Care waiting times: Getting better or worse?
- Will we have RN24/7 registered nurses in nursing homes?
Helpful links:
- My Aged Care is the Australian Government’s Aged Care portal. You can find them online or call 1800 200 422 for information on what aged care supports are available and how to access them.
- Centrelink has a face-to-face My Aged Care service. You can find out more here or call 1800 227 475 and ask to make an appointment with an Aged Care Specialist Officer.
- The Older Persons Advocacy Network (OPAN) can help if you are having problems with a service provider, don’t know what services you might be able to get, or need help understanding your rights. You can find their website here or call them on 1800 700 600.
- If you would like to make a complaint about an aged care service, including the assessment team or My Aged Care, you can contact the Aged Care Quality and Disability Commission online or at 1800 951 822.
- If you have concerns about elder abuse and you are in NSW you can reach the NSW Elder Abuse Hotline at 1800 628 221. Otherwise, you can call 1800 353 374 to reach the national ELDERHelp line.
You can find other helpful numbers here.
