Ombudsman warning: Star ratings could mislead older people

The Commonwealth Ombudsman has warned the Department of Health and Aged Care that the current star ratings system could actually mislead older people, citing the fact that non-compliance rarely influences a star rating as a cause for concern.

Penny McKay, the Acting Commonwealth Ombudsman, also flagged how complex it can be for older people to find and interpret star ratings.

The star ratings system was introduced to give older people more information about prospective residential aged care service providers. There is an overall star rating plus four sub-categories with all information based on data reported by providers. Star ratings are reviewed and updated periodically with all ratings published on MyAgedCare. 

Ms McKay acknowledged that the star ratings system is helpful for older people and that it is a crucial recommendation from the Royal Commission into Aged Care Quality and Safety. However, she still shared her concerns over its development and maintenance. 

“While I understand the view that the current system of star ratings is an advance on not having any information publicly available at all, I am concerned the current star ratings system is not sufficiently meaningful to help people make decisions about their aged care – and may in fact mislead or misinform people,” she said in a Government submission related to the Aged Care Bill.

“I understand that non-compliance by a provider only impacts the provider’s star rating if the ACQSC issues a formal compliance regulatory notice. This means that the ACQSC may find a provider is not meeting the required standards, but its star ratings do not change. 

“The non-compliance may also be extensive and over an extended period, but again unless a formal regulatory notice is issued the general public will not be informed through the ratings system that the provider is in fact non-compliant.”

There have been plenty of vocal critics in the sector regarding the lack of influence non-compliance has on a facility’s star ratings. A report released earlier this year found little correlation between the overall Rating and actual performance of a facility. 

In total, it found that just 11% of facilities listed on the Non-Compliance Register between November 2022 and December 2023 received a star rating below three out of five.

The Commonwealth Ombudsman followed up with the Department of Health and Aged Care regarding data collection and analysis. Although the Department provided reassurance that data checks are in place, there was no clarity about what those checks are.

“Transparency about how the data is validated or verified would provide further assurance to the community about the reliability of the star ratings,” Ms McKay said

“The department has advised my Office that the proposed legislative changes, particularly the establishment of the Secretary of the Department as ‘System Governor’ (clauses 7 and 339) will strengthen its ability to undertake assurance checks on data used for star ratings.”

Additional concerns over MyAgedCare and the need “to navigate multiple websites to locate and interpret somewhat technical information” also highlighted how aged care participants can be let down by a system intended to help.

“Given the importance of transparency and clear information about the aged care system, as reflected in clause 25 of the Bill and the intent of the Royal Commission’s recommendation regarding star ratings, I suggest the Committee consider the current efficacy of star ratings and the proposed role of the ‘System Governor’,” Ms McKay concluded.

Elsewhere, she touched on the need to create and provide more accessible guidance for whistleblowers: “Guidance should help potential whistleblowers understand which system they can report under and the implications of choosing one regime over another”. 

Ms McKay also called for an accompanying legal definition for an ‘emergency’ where restrictive practices are concerned. 

“I note clause 18(3) of the Bill states the rules governing the use of restrictive practices do not apply if they are ‘necessary in an emergency’. Without an accompanying legal definition, the interpretation of what constitutes an ‘emergency’ may be subjective. I propose that an ‘emergency’ should be clearly defined, including a timeframe for cessation (when there is no immediate risk to the person or others), ” she said.

“Furthermore, even during an emergency, providers must still seek to ensure the least restrictive form of a restrictive practice is being applied, it is applied for the shortest period possible, and only after exploring and applying all evidence-based, personcentred, and proactive strategies.” 

The Commonwealth Ombudsman urged for the documentation of the use of restrictive practices in an emergency to be regulated with a detailed report provided.