Older people want compliance ratings to reflect any findings against providers and homes in a timely fashion. They also want caps for non-compliance and care-minute failures.
Older Australians and their representatives have told the Department of Health and Aged Care in no uncertain terms that they want changes to the aged care Star Ratings system – including capping ratings for homes that fail to meet care minute targets.
Star ratings for aged care homes were introduced following the Royal Commission into Aged Care Quality and Safety, which recommended the development and publishing of measurable indicators allowing older people to make meaningful comparisons of the quality and safety performance of providers.
In November 2024 the Commonwealth Ombudsman Iain Anderson was critical of the system, saying the ratings were “not sufficiently meaningful to help people make informed decisions about their aged care”.
A major fault in the system has not included all non-compliance information and could therefore be misleading.
“The [Aged Care Quality and Safety] Commission may issue a formal compliance notice requiring a provider to take action to remediate identified issues,” said Mr Anderson.
“Only when the Commission issues a formal compliance regulatory notice will the non-compliance impact a provider’s compliance and overall star ratings.
“This means that in some instances the Commission may find a provider is not meeting the required standards, potentially for an extended period, but its star rating does not change.”
In response DoHAC commissioned KPMG to undertake public consultations based on the department’s published paper, “Design changes for Star Ratings”. DoHAC has now released the findings from those consultations.
The consultations were held between 25 November and 13 December 2024, and involved 10 face-to-face consultation sessions held across five states, 12 virtual consultation sessions, an online survey, and written submissions.
A total of 271 individuals participated, including 29 written submissions, 162 survey responses, 74 consultation participants and six virtual workshop participants.
Older people and their representatives, as well as providers, generally supported the idea of capping the staffing rating at a maximum of two stars for aged care homes who do not meet both their care minute targets, indicating this would appropriately signal the level of care being provided – 75% of all respondents indicated they agreed or strongly agreed.
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Failing to meet care minute targets should be reflected in the staffing rating to ensure transparency and support decision making, said 80% of older people and their representatives. However, only 35% of providers indicated that they agreed or strongly agreed, although they did believe the capping would emphasise the importance of meeting care-minute targets and would act as a “compelling incentive to ensure transparency and support decision making”.
In terms of the lag between non-compliance and the adjustment of the star rating, 58% of all respondents indicated they disagreed or strongly disagreed that a previously awarded exceeding grade should still be displayed if the aged care home was issued with a formal regulatory notice.
Older people and their representatives had mixed views around displaying an exceeding grade alongside a formal regulatory notice. Some shared concerns that this would be confusing and should not be displayed at the same time.
Others, however, were supportive of displaying both and agreed it would positively impact their ability to compare homes if enough contextual and explanatory information accompanied both.
One suggested change to the system was a delay of one to three years to return to previous compliance rating, once a provider has resolved non-compliance.
Many stakeholders believed that delay was too long and instead favoured an approach commensurate with the type and severity of the non-compliance issue.
“For example, some older people and their representatives and providers stated they believed timeframes should be flexible and applied on a case-by-case basis,” said the report.
Sixty-six percent of all survey respondents agreed or strongly agreed that an aged care home should be able to restore its former compliance rating immediately after resolving non-compliance issues, including 82% of providers.
Fifty-four percent of respondents agreed that a home should be limited to a maximum three-star rating for one year after a regulatory notice was resolved.
“Older people and their representatives also expressed that the differentiation between major and minor non-conformance is important, suggesting minor non-conformance due to compliance activities such as administrative responsibilities are of less concern than major non-compliance that directly relate to the quality of care being delivered,” said the report.
In other staffing findings, 87% of all respondents indicated that they agreed or strongly agreed that the requirement to have a registered nurse available 24/7 be included in the staffing rating calculation.
Among older people and their representatives, 92% of respondents indicated that they agreed or strongly agreed, and 68% of providers indicated that they agreed or strongly agreed.
If that requirement was not met, homes should be capped at a two-star rating.
“Some older people and their representatives suggested that failure to meet this requirement should result in a zero-star rating, highlighting the critical importance of having a registered nurse on site and on duty at all times,” said the authors.
The slight majority (51%) of stakeholders also agreed that half-star ratings should be introduced, and 82% supported the inclusion of the use of environmental restraint and all restrictive practices in the ratings system.
Read the full report here.