Aged care star ratings: Good but can do better

The ratings are available on the My Aged Care website through the ‘find a provider’ tool, allowing anyone researching aged care online to compare and monitor facilities.

Star ratings draw on data from Residents’ Experience Survey results, regulatory decisions of the Aged Care Quality and Safety Commission, Care Minutes and the National Aged Care Mandatory Quality Indicator Program (see Dollars to Care section below).

What users of Star Ratings should be aware of is the residents’ experiences are derived from a survey of at least 10% (and in practice, around 20%) of residents across all aged care homes which is randomly sampled and not influenced by the provider.

Staffing is also self-reported by the provider and unvetted.

The Aged Care Quality and Safety Commission provides the data about compliance, but it turns out there is a difference between non-compliance and a non-compliance decision.

“Non-compliance is defined as the failure of an aged care provider to meet one or more of the regulations and standards as set out in the Aged Care Act 1997, whereas a non-compliance decision is when the Commission uses one of its formal regulatory powers in response to identified non-compliance. A finding of non-compliance in itself does not impact a service’s star rating; rather it is only where the Commission then uses its formal powers to require a service to take corrective action that a service’s star rating will be impacted. 

That makes sense because most of the Commission’s regulatory powers are designed to be used where a provider fails to take seriously their obligations to address identified non-compliance.”

Source: Aged Care Quality and Safety Commission

Dollars to Care

The Dollars to Care data now being displayed on the My Aged Care website gives greater insight into how an aged care home operates, including where it draws its income and the amount it spends on food for residents and workers’ wages.

Using the data that is already being provided by facilities to the Department of Health, the new displays include the total amount spent on food compared to the sector average, along with resident feedback on the food itself.

The results of resident experience surveys and how they relate to key questions such as ‘Do you like the food here?’ are also available.

Care minute totals have been mandated since October 2023. The new data gives a clear picture of a facility’s expenditure on care and nursing per resident per day and a breakdown of care minutes delivered by staff, including registered nurses, enrolled nurses and personal care workers.

As with food, the data will now include results from the resident experience survey used for the star ratings such as, ‘Do you get the care you need?’; ‘Do you think staff know what they are doing?’; ‘Do you feel safe here?’.

Consumers can also see a simple outline of where providers source their income and how much the budget was in surplus or deficit last financial year.

Again, the data is being submitted by the aged care providers themselves.

Ratings still show room for improvement

The first round of star 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. 

A year later, the number of aged care homes with four and five stars increased to 54%.

Aged care homes that received one and two stars – a clear sign that improvement was needed – decreased to 2%. 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 one-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 one-star rating regardless of how they perform in other subcategories.

Services that receive a two-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 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 was mandatory from 1 October 2023 and increases 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, restrictive practices, 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 was 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 four-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.

Regular updates

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.

The public jury is still out on whether the ratings will have the desired impact of much higher standards and a noticeable difference to the way the elderly are cared for.