Older people and their representatives are more likely than their provider counterparts to want the compliance rating impacted across all of a providers’ aged care homes if one has significant failures or systemic non-compliance – but it is still the majority view of both cohorts.
Stakeholders and consumers also largely agreed on the other proposed design changes across the independent evaluation and consultation undertaken to ensure the star ratings system launched in 2022 is fit-for-purpose, but providers were more likely to raise concerns about the potential impact of changes.
The evaluation was undertaken by professional services firm KPMG on behalf of the Department of Health and Aged Care to ensure the star ratings are an effective tool in helping older people compare aged care homes and encouraging providers to deliver quality services.
It comes three months after another department-commissioned evaluation highlighting the need to improve transparency and choice was released, more than a year since an independent analysis exposed contradictions in the ratings, and after a number of system glitches along the way.
Public consultation from April to August 2024 on planned design changes aimed to understand the views of stakeholders, including older people and their representatives, providers, workforce organisations, peak bodies, advocacy organisations and advisory bodies.
The consultation focused on:
- changes to the compliance rating
- changes to the staffing rating
- design considerations
It engaged 271 individuals across 29 written submissions, 162 online survey responses, 74 consultation participants – with 42 attending the 12 virtual sessions and 32 attending 10 face-to-face sessions. Two virtual workshops with six participants were also held to test and validate findings.
The online survey included 15 questions but not all were mandatory, so survey data has been presented as a proportion of the total number of responses received KPMG noted in the summary report.
Compliance rating
The questions related to compliance rating covered four key topics:
- inclusion of provider-level impacts in the compliance rating
- display of the exceeding grade while a formal regulatory notice applies to a provider or aged care home
- timeframes for returning to a previous compliance rating after the resolution of non-compliance
- impact of regulatory notices issued by the system governor on compliance ratings.
According to KPMG’s findings, 72 per cent of older people and their representatives and 64 per cent of all providers agreed or strongly agreed that the compliance rating of all the providers’ aged care homes should be impacted in the case of them being issued with formal regulatory notice for significant failures or systemic patterns of non-compliance.
Some providers did express that home level factors can have greater influence than provider-level on the delivery of quality care, and outlined their belief that there should be clearer definitions around major and minor non-conformance, and that they should impact the rating differently.
Some older people and their representatives also suggested a timeline to improve the traceability of provider compliance ratings.
Stakeholders were also asked about providers or aged care homes displaying the exceeding grade while a formal regulatory notice is in place, with mixed results.
For survey participants, 58 per cent indicated they either disagreed or strongly disagreed that a previously awarded exceeding grade should be displayed if that home or provider has been issued a formal regulatory notice. However, the remaining 32 per cent of survey participants agreed or strongly agreed.
Meanwhile 67 per cent of survey participants agreed or strongly agreed that the display of the exceeding grade and a formal regulatory notice at the same time may make it hard for older people and their representatives to compare aged care homes, preventing the star ratings system to fulfill its purpose as a tool to promote clarity and transparency.
During the consultation activities it also became clear there were some older people and their representatives that firmly believed an aged care home should not maintain an exceeding grade if they have been issued a regulatory notice. Others believed the type of regulatory notice should be a factor in deciding whether it needs to be displayed or not.
In terms of the timeframe in which a compliance rating should return following a resolved non-compliance, many stakeholders found the one-to-three-year timeline too long. More favour was given to the time delay being dependent on the severity and type of non-compliance, but 54 per cent of all survey participants agreed or strongly agreed that an aged care home should be limited to a three-star rating for one year following a resolved formal regulatory notice.
Older people and their representatives were more likely to agree or strongly agree – 60 per cent – while 65 per cent of providers disagreed or strongly disagreed, indicating a point of clear division between the groups that was not seen in the other sections.
Stakeholders strongly agreed that any regulatory notices issued by the system governor should be published alongside the compliance rating, with both providers and older people believing it will enhance transparency.
There was also a majority agreement amongst stakeholders that regulatory notices issued by the system governor should impact the compliance rating in the same way as those issued by the commission, with 75 per cent indicating they agree or strongly agree.
Staffing rating
In relation to staffing rating the questions covered two 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.
There was consensus among providers and older people and their representatives – 75 per cent – that the staff rating should be capped at a maximum of two stars for aged care homes not meeting both of their care minute targets. Both groups did recognise however that higher care minutes do not always correlate to higher quality care, and staff qualifications and experience are also crucial and should be incorporated.
Stakeholders also strongly emphasised the effectiveness of the staff rating being dependent on the accuracy and reliability of the data being reported by providers. They indicated a need for safeguards to ensure data reported is accurate and reliable, especially if self-reported.
Stakeholders also agreed that there is a necessity for a degree of tolerance towards rural and remote area providers where workforce shortages can impact direct care minutes at no fault of the provider.
Workforce organisations looked at the staff rating from a wider perspective, noting it is also reflective of the working conditions and can play a role in staff retention and attraction, with lower staff ratings potentially exacerbating workforce shortages even further.
There were strong and consistent views relating to the 24/7 nurse requirement being incorporated into the staff rating, with 87 per cent of survey respondents in agreement or strong agreement.
Stakeholders also largely agreed that aged care homes should be capped at two stars if the 24/7 RN requirement was not met. Some older people and their representatives even suggested failure to meet the requirement should result in a zero-star rating, while providers emphasised the need for tolerance and consideration – particularly for rural and remote homes.
Design considerations
Questions relating to the design considerations covered:
- inclusion of half star ratings
- inclusion of environmental restraint alongside restrictive practices and the quality measures rating.
Only half of all stakeholders agreed to the introduction of half star ratings to the overall star rating (51 per cent) while almost two in five did not support the inclusion (38 per cent). Drilling down, almost three-quarters of providers surveyed supported this change (64 per cent) compared to only half of older people and their representatives (52 per cent). And face-to-face and virtual consultation participants indicated this approval more strongly than survey participants.
Concerns relating to the half star rating included:
- concerns that it would make it more confusing for older people and their representatives
- could overwhelm people with too much detail.
There was consensus regarding the display of information relating to a provider’s use of environmental restraint too, with 82 per cent of survey respondents agreeing that providing as much information as possible would be beneficial to both potential clients and workers.
However, some providers did raise the concern 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 complete summary report on the design changes for star ratings can be read here.
More information on the star ratings consultation and evaluation can be found here.
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