Star Ratings system fails to properly report red flags: Report finds

A report released by the Aged Care Consulting & Advisory Services, Australasia, has found serious inaccuracies in the aged care Star Ratings system with a significant number of aged care facilities receiving positive Star Ratings despite being non-compliant, suggesting there is little correlation between the overall Rating and actual performance of a facility. 

Key points

• In total, 501 residential aged care facilities were listed on the Non-Compliance Register between November 2022 and December 2023
• A significant proportion of non-compliant homes were self-rated at three (300 facilities), four (81) or five (68) stars for Quality Measures despite non-compliance with minimum basic standards considered unacceptable
• Multiple facilities appeared up to five times on the register, while one dozen providers featured ten or more times
• Between December 1, 2022, and June 30, 2023, the Compliance rating for 20.50% of facilities on the Non-Compliance Register did not meet the requirements of key guidelines, increasing to 42.76% for the timeframe between July 1 and December 12, 2023

The findings are concerning for the report’s lead author, Adjunct Professor Dr Rodney Jilek, who told hello leaders the unacceptable rate of error reflects poorly on providers doing the right thing.

“The objective of the report is not to bash providers. We undertook the review because of the absence of dissenting discussion around the star rating system in the face of what we believe is an unacceptable rate of error by the Department of Health & Aged Care and the Aged Care Commission,” explained Dr Jilek. 

“From a provider’s perspective, the rate of error and the apparent unwillingness of the regulators to identify poor performers should be seen as a slight upon every home that manages to maintain full compliance.”

“If I was managing a fully compliant service and was rated the same as, or in many instances, lower than those found on the non-compliance register I would be deeply offended. The system is a disincentive to aim beyond basic minimum standards.”

Under the aged care Star Ratings system, the Compliance rating is based on regulatory decisions by the Aged Care Quality and Safety Commission. It makes up 30% of the Overall Star Rating in a reflection of its importance.

However, aged care facilities that have shown consistent non-compliance with accreditation standards achieved pass marks in the Star Ratings system when they supposedly should not have.

“St Elizabeth Home in Sydney’s west has been non-compliant with the accreditation standards since April 2020. Despite repeated interventions by the Commission including the imposition of sanctions and the requirement to engage external advisors, the facility has been unable to address the noncompliance and it remains non-compliant three and a half years later,” read the Report.

“Despite this, it is fully accredited until August 2024 and has been awarded a 3-star overall rating with a 4-star compliance rating.”

Another highlighted provider in NSW received three stars despite failing seven of the eight Aged Care Quality Standards in 2020 and 2022.

“Given the Compliance Rating accounts for 30% of the overall star rating, it is reasonable to deduce that many, if not all of these services have all been incorrectly rated,” said the Report.

“The star rating system as it stands is in our opinion, grossly ineffective as a comparison tool and ignoring the obvious data integrity issues, the reliance on self-reported, largely unvetted data makes the ratings invalid,” added Dr Jilek.

Incorrect ratings would be another blow to the Government after previous instances of inaccuracies appeared, including the use of outdated data when the Star Ratings system launched. The lack of correlation between the Overall Star Rating and sub-categories such as the Compliance and Quality Measures ratings also suggests the system requires work.

With ongoing issues with the Star Ratings system, Dr Jilek said further investigations are required as the discrepancy in ratings may be a deliberate attempt to mislead and there is no evidence the system has achieved its stated objectives of being clear, transparent or effectively driving improvement.

“As the system stands, it cannot be relied upon as an accurate reflection of quality in aged care and any star rating should be viewed with a great deal of scepticism and caution,” added Dr Jilek.