Quality indicator expansion hits a roadblock, rollout delayed

The next phase of the quality indicator program is right around the corner with April 1, the key date for the three new staffing quality indicators, looming. 

However, a report detailing the findings from last year’s pilot for the staffing indicators reveals that just five of the nine quality indicators (QIs) trialled will be implemented. So what does that mean for the remaining four that fall under the broader categories of enrolled nurses (ENs), allied health professionals and lifestyle officers? 

Key points

• New staffing quality indicators are planned for implementation as part of the National Aged Care Mandatory Quality Indicator Program (QI Program)
• A six-week pilot conducted in 2024 demonstrated the ‘importance, acceptability, feasibility and usability of four quality indicators
• The final assessment ticked off two staffing QIs linked to ENs, plus the care minute QIs for allied health and lifestyle officers
• A QI calculating the percentage of recommended allied health services received was deemed suitable for near-term implementation and appears to be on track for the April 1 reporting date
• Four other QIs linked to allied health and lifestyle officer services will require further research and evaluation

Mixed views on new indicators

Almost six years after it began, the QI Program is expanding to 14 QIs in 2025, with multiple data points (also called QIs) for each overarching indicator. 

The staffing indicators have been designed and developed in consultation with industry stakeholders. Most participants view the new QIs as a positive step towards improving the recognition, value, and employment of ENs, allied health professions and lifestyle officers within the sector. 

However, feedback also reflected mixed feelings toward creating new and separate indicators for each staffing group. Some have labelled them ‘blunt’ instruments for measuring quality of care. 

Data collection is another point of contention with the QIs linked to care minutes providing no additional administrative burden. However, potential QIs that report on the percentage of care recipients who attended a service/received care are likely to challenge providers with manual processes or insufficient technologies. 

While the department states the new QIs are planned for implementation by July 2025, those with notable data collection challenges will be delayed. Their implementation date is TBC. 

Two EN QIs approved for implementation

The two EN QIs have passed with flying colours, although the findings highlight how far the average EN contribution has fallen in aged care. Two EN QIs providers will report on are: 

• EN care minutes per resident per day
• Proportion of EN care minutes to total care minutes (RNs, ENs and PCWs)

Provider feedback highlighted the importance of ENs in delivering quality care. They also said there is value in having visible care minutes data for all care staff to understand a service’s staffing and skill mix.

Others said the EN QIs are useful snapshots that leverage data already being collected, ensuring no additional administrative burden. Many said specific reporting on the proportion of EN care minutes has the potential to provide valuable insights into the full scope of EN care delivery. 

The only negative was arguably the pilot’s findings that revealed 13 EN minutes per resident per day was the median, lower than the international standards of 25-56 minutes. This equalled 7% of the total care minutes time. Government-operated services recorded above-average results.

Additional research for allied health QIs

Three allied health QIs were proposed for the pilot, with a fourth being included and tested during post-pilot analysis: 

• Allied health care minutes per resident per day
• Percentage of care recipients who received at least one instance of care from an allied health professional
• Percentage of care recipients assessed as requiring allied health services who received at least one service instance
• New: Percentage of recommended allied health services received

Like the EN QIs, current data collection methods proved beneficial for total allied health care minutes reporting and calculating the percentage of recommended allied health services received. Both QIs will be implemented from April 1.

Concerns were raised about using a single measure of allied health minutes and the need to distinguish between direct and indirect care minutes. 

Fears over an increased administrative burden were common as data was not readily available to calculate percentages of services/care received.

“Only one-third of the pilot participants reported having a reliable, automated process to report QI 4 [percentage who received care from an allied health professional] and QI 5 [percentage who received at least one allied health service]. Some participants reported that relevant data for QI 5 is captured in clinical notes, so reporting requires manual auditing of care recipient records,” the report explained.

“This led to inconsistencies in pilot data due to varying practices in collection and categorisation of allied health services. Some sites benefited from data collection software, while others struggled without standardised documentation.”

Overall, the median allied health care minutes per resident per day was four minutes, far lower than international standards of 22-24 minutes. Nine out of ten residents received at least one instance of allied health care during the pilot.

The Department made several recommendations to improve the allied health QIs, including improving data collection templates, developing minimum standards for allied health assessments and offering more on-site support for providers. offering more on-site support for providers. 

Lifestyle officer QIs require further evaluation

Three lifestyle officer QIs were piloted with only the care minutes QI deemed suitable for immediate implementation: 

• Lifestyle officer care minutes per resident per day
• Percentage of care recipients who attended at least one lifestyle officer service
• Percentage of care recipients with lifestyle recommendation in their care plan who attended at least one service delivered by a lifestyle officer

Pilot participants were worried about the extra administrative burden as there are significant concerns regarding data collection, standardisation and reporting on lifestyle activities. 

Participants highlighted challenges with assessing needs as there is no consistent framework for the discipline. Monitoring attendance to evaluate the effectiveness of lifestyle programs is another hurdle due to stretched resources. Using volunteers and allied health assistants to deliver lifestyle activities further complicates data collection.

Pilot participants averaged seven lifestyle officer minutes per resident per day with 12.5% of providers reporting zero minutes. The median proportion of care recipients that attended at least one lifestyle officer service across the 69-pilot residential aged care services was 89%. 

The data shows valuable insights into what services are being delivered, including excursions, cooking classes, exercise sessions and games. However, more work is required to implement QIs calculating percentages of care recipients who attend lifestyle services and are recommended to attend services. 

Both need standardised definitions, stronger parameters and better data collection and analysis. Further research and evaluation are required to determine their suitability for broader implementation. 

Timeline clarification

Recent department communications confirm that the EN, allied health and lifestyle officer QIs will be introduced from April 1, the start of the reporting period. The QIs linked directly to care minutes have been approved. The others require additional work with no indication of when this will occur. 

Click here to read the full report. The department has also shared additional information including an updated QI Program manual and QI Program resources.