What concerns are there around the soon-to-be-released star ratings?

The highly anticipated star ratings for residential aged care will drop in only a few weeks, and while there is now much more information available on how this system will work, many providers are feeling apprehensive of the change.

From December 2022, a rating of between 1 and 5 stars for every residential aged care provider in Australia, will be available on the My Aged Care website.

The ratings are expected to equate to:

• 1 star for a facility operating below standard
• 3 stars for a facility operating at average standard
• 5 stars for a facility operating well above standard

They will include each facility’s:

• Residents’ experiences
• Service compliance
• Care minutes
• Quality indicators reporting

The Federal Government has promised providers will be able to see their ratings before they are made public on the My Aged Care website.

However, this will not give you time to change your rating before it is published and the preview is only designed to be an opportunity for you to prepare for the release of your rating by knowing what it is and notifying the Department of Health and Aged Care of any concerns.

While the Department of Health and Aged Care has said the ratings have been “extensively tested” with consumers and providers, industry experts have concerns for some areas of the system.

This article outlines how the star rating may impact your facility and the issues you may expect to find with the system.

Weighting in the rating

The weighting and composition of each star rating has been confirmed as:

• 33% for residents’ experience – which is informed by annual interviews of an average of 20% of residents in a facility 
• 30% for service compliance audit and assessment data – which is already published in a dot rating on the My Aged Care website
• 22% for the care minutes which are reported through the Quarterly Financial Report every three months and used under the AN-ACC funding model
• 15% for the five existing quality indicators – based on the facility’s information on pressure injuries, physical restraint, unplanned weight loss, falls and medication management

It’s important to note that providers that do not submit a Quarterly Financial Report will not have their star rating published, as the care minutes in particular will not be able to be worked out.

Overall, experts are worried the star ratings may not be as helpful for potential residents and families as the Government hopes they will be.

Principal Consultant at Pride Living, JC Yap, said his research into how the star ratings system in the United States is performing, which has been in place since 2008 and is very similar to Australia’s new system, shows the initial benefits of improving confidence in the sector have given way to a flawed system.

“A facility that shows it’s five star, it may not really be five star because the components that make up the rating are not live, it takes time to refresh,” he said.

“It may not be an accurate representation of that facility at this point in time.”

While the rating does break down different factors in a facility’s care into easy visual cues, the rating may also be irrelevant if the biggest consideration for a family is the location of the facility, for example.

Resident experience

With the residents’ experience carrying the most weighting, the interviews which this section is based on have drawn critique. 

Industry experts believe the sample of interviewed residents is not representative of the actual cohort living in each facility because of the way some residents may have been ruled out of participating in interviews, for example if they have dementia and are ruled out on the basis they may be unable to understand the questions.

There is also the belief that an annual interview will quickly become out of date.

Master of Health Science/Aged Services Management at Aged Care Strategies and Support, Angelika Koplin, said while she is not against the star ratings she believes there are some key issues with them.

“I think one of them is that the consumer reports or surveys are only done once a year, which is a long time in aged care, a lot can change in 12 months,” she said.

“The process [of selecting residents to interview] is supposed to be random but I also wonder how they will have results that make sense if they’re coming from a population that might not have English as a first language… And if that’s actually random sampling because a lot of facilities have multicultural populations, then you have residents with dementia that maybe can’t express themselves as well as they used to.”

If the interviews are not truly representative of the service provided at a facility, this has the potential to not only be a waste of time but also to harm the reputation of a facility that is actually providing quality care.

Service compliance

The main criticism of the service compliance section of the star ratings is that this information is already available on My Aged Care in the form of a dot rating for each facility.

Potential residents and their families can already access the dot rating for each facility to compare the compliance and factor that into their decision, so adding it to the star rating is argued to have little impact on improving transparency and confidence in the sector.

For providers though, this means the compliance section of the star rating should not be a surprise as it is a form of reporting that already exists.

Care minutes

The care minutes rating is taken from the Quarterly Financial Reports (QFRs), updated every three months, compared to the number of care minutes the Government expects a facility to have per resident, per day. This means the ratings will change as the Government increases the target of care minutes and that providers will have to adequately increase care minutes in order to keep a good star rating.

As it only takes into account care minutes delivered by personal carers, registered nurses and enrolled nurses, this section of the star rating has been criticised as having a narrow focus.

It does not include any allied health care or lifestyle activities for example, so does not show what the facility offers in terms of a resident’s overall wellbeing.

Ms Koplin explained that meant there was no input about the hours provided for allied health such as physiotherapists, exercise physiologists and occupational therapists, or social and emotional supports like social workers and pastoral care. 

“Not even lifestyle staff that provide the reason for residents to get up in the morning and ensure they enjoy their day,” she said.

“So while it’s important to know the care that is given and how many care hours there are, this section relates also to the activities they are offered and the support for physical exercise they are given and so on and that’s not reflected in those care minutes at all, and it’s not reflected anywhere else in the star ratings.”

The other criticism of the care minutes is that the quarterly update does not necessarily reflect the actual care minutes a resident might be receiving day to day, as it is not live data.

Quality indicators

The quality indicators, despite being the smallest weighted component of the star ratings, have drawn criticism for the amount of reporting they require.

This regular reporting is only set to become more burdensome in April, when the quality indicators expand from five to 11.

Mr Yap said he hoped the star ratings would have a benefit, because otherwise the reporting in the quality indicators alone would have an impact on the time staff spend reporting without a worthy reason.

“I get it that the Commission wants more accounts for the providers, but then again where this is leading onto is that it’s sad that our nurses are spending more time in front of the computer doing reporting, gathering data, rather than actually spending time with residents,” he said. 

The ratings are expected to go live next month and the Department has confirmed providers will be given a preview “up to two weeks” before the public release.