Quality indicator fail: “Awful” survey tool overshadows the home care QI pilot 

As the Department of Health and Aged Care moves into the next stage of quality indicator development for in-home aged care services, red flags have been raised regarding a key assessment tool currently being used in residential care settings. 

Multiple participants in the home care QI Pilot webinar highlighted that two quality assessment tools designed by the Caring Future Institute – which is part of Flinders University – are “awful” and fail to “produce quality data for providers”. 

It’s not the first time issues have been raised with similar concerns revealed during the trial run of quality indicators for residential aged care. 

Key points

• HealthConsult is running a 12-week pilot from early October to test seven proposed quality indicators for home care services
• Eligible home care service providers would join residential aged care providers in having to submit Quality Indicator (QI) Program data four times a year once approved and implemented alongside Support at Home
• The pilot will see most data collected through two validated quality assessment tools produced by Flinders University/Caring Future Institute: the Quality of Life-Aged Care Consumers (QOL-ACC) and the Quality of Care Experience – Aged Care Consumers (QCE-ACC)

The current state of play

The Federal Government announced plans to expand the National Aged Care Mandatory Quality Indicator Program into home care in 2021. 

Progress paused when the development of Support at Home began as it wanted to align the introduction of quality indicators with the new home care system. New quality indicators for home care will likely be ready for implementation on July 1, 2026.

Speaking in the webinar, titled Piloting Quality Indicators for the future Support at Home Program, Victoria Angel, Director – Quality Indicator Section, Department of Health and Aged Care, said the program would deliver benefits such as:

• Enabling older people, their families, friends and representatives to find information about the quality of aged care services when making choices about their care
• Providing greater transparency for participants to make informed decisions
• Helping service providers to measure, monitor, compare and improve the quality of their services
• Helping Government and policymakers to make policy decisions and consider system-wide issues based on evidence of the quality of care delivered by providers

HealthConsult, who will manage the quality indicator pilot, worked with the Registry of Senior Australians (ROSA) to identify the most appropriate quality indicators for in-home aged care. 

Consultation with over 400 individuals and a range of organisations helped them elevate the consumer experience, quality of life and service delivery/care planning as the most important indicators. 

The seven quality indicators will be organised under three domains for the pilot: Consumer experience (quality of care experience, participant overall rating, willingness to recommend), Quality of Life and Service Delivery/Care Planning (participant involvement in care planning, missed visits, review of care plan). 

Approximately 150 service providers have been recruited for a 12-week pilot. Following this critical phase, data will be analysed and assessed to determine which indicators are the most “relevant, usable and feasible”. A final recommendation will be presented to the Department of Health and Aged Care in late February. 

Survey tool disagreements

At the centre of the controversy are the survey tools providers will use to collect data. The QOL-ACC and QCE-ACC tools will become part of a new 14-question survey. 

The two surveys from the Caring Futures Institute will be used for five of the seven quality indicators while a Net Promoter Score captures a client’s willingness to recommend a service to a friend or a colleague, and two additional questions result in an overall rating and separate rating for their involvement in care planning.

However, while the two aged care consumer surveys are designed specifically for these situations, representatives from aged care providers have shared their honest thoughts.

“The consensus from everyone was very strong that the Flinders surveys are, I’m not going to mince words, awful and not useful at all. I personally am a little bit apprehensive about trialling those surveys knowing that people are already struggling with them in the residential setting,” shared one manager.

When asked what those problems were she responded, “How long do you have? It’s a lot of reasons and a lot of client-based reasons. There were a few home care providers on that webinar that said those surveys in particular for home care clients they find it quite distressing and that’s certainly what we’ve seen in residential.”

Another aged care representative said, “People are over-surveyed. They’ve had enough and it doesn’t produce quality data for providers. I’m really concerned that we may be repeating the same all over again unless the questions are completely different. I would only want to do it [the pilot] if they’re completely different.”

Ms Fodero responded by saying the surveys produced by Flinders University are just one tool being used to collect data and that the pilot will offer an opportunity to see what the best survey method is. 

“The purpose of the pilot is to look at the three different quality indicators and see whether they all correlate. If they do then it provides justification and evidence why you wouldn’t need to use a six-question survey… We are aware of the burden on providers and that is part of the pilot design,” she added.

A representative from the Caring Futures Institute told Hello Leaders that the surveys have been “developed from the ground up with older Australians received aged care services and aged care providers”. The intention is for older people to complete the survey themselves, but if that’s not possible, for a family member to complete a proxy version or for it to be conducted interview-style. 

Professor Julie Ratcliffe has previously explained how the person-centred tools focus on the key indicators that are most important to older people and their families rather than the clinical outcomes providers used to prioritise.

Despite the best intentions of the Caring Futures Institute, feedback from several webinars suggests there is consensus on the ground that their tools are not having the desired impact from a resident and provider perspective. 

The home care pilot needs to be mindful of past and present feedback as it appears some concerns from residential aged care providers have fallen on deaf ears as the same tools continue to be used with no changes. Given the importance of quality indicators in aged care, mistakes cannot be repeated.