Government-run providers best performers: new royal commission research

The Royal Commission into Aged Care Quality and Safety has today released the most detailed look into the quality of residential aged care homes published in Australia.

Using data acquired under the legal authority of the commission, and not previously available to researchers, they present over 50 quality indicators about residential aged care – including how results are distributed across facilities.

The indicators cover topics such as clinical outcomes, compliance, complaints, reporting of assaults and missing residents, consumer experience, and workforce levels.

On average government-run facilities showed the best average results for 31 of the quality and safety indicators, but only make up nine per cent of the organisations in Australia.

Around 57 per cent of aged care facilities in Australia are operated by not-for-profit organisations and 34 per cent are operated by for-profit organisations.

The data also shows that not-for-profit aged care-run homes had better average results than profitmaking providers on 25 indicators.

Who cares best?

Many of the quality indicators showed close results and minimal difference in outcomes across the three types of providers.

However, some of the more serious categories showed stark differences. In 2016/17 the data shows that government-run facilities delivered the best results for the ‘falls’ category.

On average 1 in every 15 residents of a government facility attended hospital for a fall, compared to one in 8.2 in not-for-profit and one in 8.6 in for-profit.

Similarly, on average one in every 30.6 residents of government facilities attended hospital for a fracture compared to one in 19, and one in 19.1, for not-for-profit and for-profit homes respectively.

Another area of disparity concerns ‘medication-related events’.

One in every 303 residents in a government run facility ends up in hospital for a ‘medication-related events’, while that figure jumps to one in 175.4 in not-for-profit and one in 232 for residents in profit making homes.

Government homes come out on top again in relation to pressure injuries.  One in 61.7 people living in a government facility end up in hospital with a pressure-related injury, compared to around one in 33.1 in not-for-profit homes and one in 27.2 in for-profit homes.

This trend continues for the indicator concerning hospitalisations for ‘weight loss or malnutrition’.

Who cares longest?

The data from 2018/19 shows that, on average, government-run homes performed best when it comes to ‘nursing minutes’.

In government run facilities nurses (including RNs, ENs and licensed nurses) spend on average 119 minutes per resident per day.

This figure dwarfs the minutes put up by not-for profit and for-profit facilities, which both stand at 39 minutes per resident per day on average.

For PCAs, not-for-profit providers narrowly performed best with 130 minutes per resident per day, compared to for-profit providers and government run facilities – 123 minutes and 114 minutes respectively.

Overall government run facilities provide 303 minutes of total staffing (which includes: in catering, cleaning, laundry, maintenance, administration, quality and education in addition to direct care) per resident per day. Not-for-profit provide 238 minutes and for-profit 244 minutes per day.

Complaints and non-compliance

The data shows that there were fewer resident complaints to the Aged Care Quality and Safety Commission (ACSQC) from government-run facilities. The same goes for the number of individual issues raised to the ACSQC as part of the complaint.  

Residents of government-run facilities raised on average 4.98 issues per 100 occupied beds, compared to 7.29 issues in not-for-profit homes and 10.24 in for-profit homes.

In 2018-2019, unannounced site visits by the ACSQC were conducted on 195 Government-run facilities and 26 (13 per cent) were found to be non-compliant. Seven (4 per cent) of these homes were non-compliant and then resulted in serious risk decisions.

The ACSQC made 1309 visits to not-for-profit facilities and 215 (16 per cent) were non-compliant. Sixty-two (5 per cent) of which resulted in serious risk decisions.

And 837 for-profit facilities had unannounced visits, 153 (18 per cent) of which were non-compliant. Fifty-five (7 per cent) of those visits resulted in serious risk decisions.

Small is best

The research also found that small facilities (homes with a maximum of 30 people) had the best average scores across 24 indicators.

Homes this size are rare, making up just 11 per cent of homes Australia-wide. Most homes in Australia have between 61-100 places or 100 and above places, 32 and 31 per cent respectively, while 26 per cent of homes have between 31 and 60 places.

Overall, government-run facilities showed the best average results for 31 indicators, compared to 2 indicators for not-for-profit facilities and 1 indicator for not-for-profit facilities.

The research was conducted by the Office of the Royal Commission into Aged Care Quality and all of the findings are presented in Research Paper 15 – Residential Care Quality Indicator Profile are available on the Royal Commission’s website.

The commission intends to hand down its final report on 26 February 2021.

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