A new star ratings system for aged care, which shines a much-needed light on key areas of quality and staffing levels within every facility, has the potential to build greater public confidence in the sector.
The ratings were a recommendation of the Royal Commission into Aged Care Quality and Safety. They are designed to give future and existing residents and their families a valuable way to compare and monitor different facilities based on four key subcategories:
- Resident experience
- Staffing levels
- Quality measures
The new ratings system will give providers a clearer understanding of how they are performing and the ability to benchmark against other providers using nationally consistent quality measures. They can also see the results of continuous improvement to the service they deliver.
How a provider rates in each of the subcategories will lead to an overall star rating, with:
- 1 star indicating significant improvement needed
- 2 stars indicating improvement needed
- 3 stars indicating an acceptable quality of care
- 4 stars indicating a good quality of care
- 5 stars rating indicating an excellent quality of care.
The ratings will be made public on the My Aged Care website through the ‘find a provider’ tool, allowing anyone researching aged care online to compare and monitor facilities in a transparent and simple way.
First ratings show room for improvement
The first round of ratings was released by the Department of Health in December 2022, with 31% receiving four or five stars, 59% receiving three stars and 10% receiving one or two stars.
New data becomes available each quarter. The 2700 government funded aged care facilities that will form part of the ratings system are given a small window to preview their overall star rating as well as the rating given to each subcategory before it is made public. This also gives them time to lift their game.
According to the department, the information being fed into the algorithms that make up the star ratings is already being collected from the aged care facilities, which means there are no additional reporting burdens on providers.
Key subcategory weightings
Each of the four subcategories has a different weighting within the overall rating.
1. The resident experience rating carries the highest weighting at 33%.
At least 10% of older Australians living in residential aged care will be interviewed face-to-face about their overall experience at their residential aged care home by a third-party vendor each year.
To understand the lived experience of residents, twelve questions are asked, including: ‘Do staff treat you with respect?’, ‘Do you like the food here?’, Do you feel safe here?’, ‘Is this place well run?’, ‘Do you get the care you need?’, ‘Do staff know what they are doing?’ and ‘Are the staff kind and caring?’. Responses can vary from never to always.
2. The compliance rating carries a 30% weighting.
Compliance is the responsibility of the Aged Care Quality and Safety Commission and provides information on the extent to which a residential aged care service is meeting its responsibilities, including the Aged Care Quality Standards.
A compliance rating can change any day depending on the findings of the Commission.
A service that receives a 1 star compliance rating (which would occur if it was sanctioned or found to be punishing anyone who complained to the Commission) will receive an overall 1 star rating regardless of how they perform in other sub-categories.
Services that receive a 2 star compliance rating (if they were issued a compliance notice under the current system) cannot receive an overall star rating higher than two stars regardless of how they perform in other subcategories.
3. The rating for the staffing minutes accounts for 22% of the overall rating.
With no staff ratios in aged care, the focus is on care minutes provided by registered nurses, enrolled nurses and personal care workers.
Care minutes are derived from reporting under the Quarterly Financial Report and Annual Financial report, case-mix adjusted through the Australian National Aged Care Classification and reported quarterly.
A new funding model in place for aged care requires facilities to meet a minimum average care minute target of 200 minutes a day, including 40 minutes registered nurse time, from 1 October 2022. This target will become mandatory from 1 October 2023 and increase to 215 minutes, including 44 registered nurse minutes, from 1 October 2024.
4. The quality rating accounts for 15% of the overall rating.
The quality measures look at five crucial areas of care including pressure injuries, physical restraint, unplanned weight loss, falls and major injury, and medication management.
A positive initial response
The initial public release of the star ratings was met with great interest from residents and their families and providers.
Families with loved ones in care were keen to learn what rating the facility had been given. Some agreed that the rating as accurate. Others were highly critical of the rating received, particularly when the information displayed on the My Aged Care website differed markedly from the Aged Care Quality and Safety Commission.
Providers who received a 4 star rating were understandably pleased and thought it reflected the high staffing levels and quality care they had in place. Those with low ratings were no doubt looking for ways they could immediately lift their rating.
Star ratings will be updated at different times but the overall star rating given to a facility recalculates when new data is available.
Compliance is updated daily resident experience is updated yearly, and the staffing and quality measures are updated every three months.
Time will tell as to whether the ratings have the desired impact of much higher standards and a noticeable difference to the way the elderly are cared for.