The aged care royal commission has used its legal authority to provide the most complete picture yet of quality in Australian nursing homes with the new data proving beyond doubt that government-run facilities are safest.
In two research papers, released late on Sunday, the Office of the Aged Care Quality and Safety Royal Commission analysed more than 50 program indicators — including those that measured clinical care, resident feedback, workforce data and serious assaults or restraint — to build a compelling case for more qualified nursing support and care hours.
“This is the most detailed profile of quality in residential aged care that has been published in Australia,” the inquiry said in a media statement.
“The datasets were acquired under the legal authority of the Royal Commission and have not been available to researchers before.”
Its headline figures are revealing.
Across 20 clinical care indicators, government-run nursing homes achieved the best result in 17. Not-for-profit homes, such as those run by charities and religious organisations, came out on top in two while private, for-profit providers managed just a single best outcome.
These outcomes in clinical care represent only those considered statistically significant. A further 14 datapoints were measured where the results were statistically significant in other categories. Government services performed best in every single one.
Despite these clear wins, the use of antipsychotics were most common in government services where on average one in every 4.1 residents had been dispensed these sedatives in the 2016-17 financial year. In not-for-profits, which outperformed in the category, this rate was one in 4.5. Similarly, chronic opioid usage was heaviest in state-run facilities with one in every three residents classified as “chronic users.” The rate was lowest in private facilities at one in 3.8.
Results for residents experiencing a “high sedative load” — often misused to control unpredictable behaviour or to reduce the demand for staff time — were fairly even split across all three service types. One in every 2.1 residents were in this category for both government and private providers while one in every 2.2 residents.
Beyond these key measures, the differences between nursing home provider types become quite stark.
Take hospitalisation and emergency department presentations of long-term residents suffering delirium or diagnosed with dementia, for example. In the 2016-17 financial year, just one in every 116.3 residents in government services were attended hospital for delirium and/or dementia. In non-profit homes, however, the presentation rate was one in 36.2 and higher again in the private sector where it was one in 33.3.
Once a nursing home resident is returned to their facility from hospital, the risk of readmission is high. The aged care royal commission has found it is most likely in the non-profit and private sector where one in every 4.8 and one in every 5.1 residents respectively were sent back to hospital emergency departments within 30 days of being released from hospital.
In government homes, the rate was lowest at one in every 6.6 residents.
For short-term residents, government homes outperformed private and non-profits by a factor of two on the same emergency readmission criteria.
The results were similar again for longterm residents taken to hospital for one or more falls in 2016-17: government homes fared better than the other two provider types with half the rate of admissions.
State facilities also performed substantially better than private and non-profit homes on the prevalence of pressure injuries resulting in emergency department presentation with just one in every 61.7 residents in this category. It was much more frequent in non-profit homes — one in every 33.1 residents — and private homes — one in every 27.2 — on average.
In more recent data, from the first quarter of the 2019-20 financial year, government homes again performed better on the total rate of pressure sores identified in the facility.
Alarmingly, there were almost four times the rate of emergency department presentations for weight loss or malnutrition in private and non-profit nursing homes as there were in government homes, according to this research.
In 2018-19, some 13 per cent of government-run facilities failed to meet national accreditation standards while 16 and 18 per cent of non-profit and private for-profit providers were caught.
For the same year, serious risk notices — where the regulator believes noncompliance places or has placed a resident’s health, safety or wellbeing in jeopardy — were issued to 4 per cent of government homes, 5 per cent of non-profit facilities and 7 per cent of privately operated homes.
A likely explanation for the litany of measures on which government homes outperformed other provider types in the sector is on staffing. The results in the royal commission study are significant.
In 2018-19 a total of 119 nursing staff minutes were spent on each resident in each facility every day, more than three times the 39 minutes in each of the private and non-profit sector.
Low paid, poorly trained personal care workers, in contrast, spent as much as 130 minutes on average with each resident per day in non-profit homes. Here, still, government homes managed 114 minutes for each resident each day.
Taken together, the number of direct care staffing minutes spent on each resident was 229 in government homes, a full 45 minutes longer than both the other provider types.
When the researchers take into account all staff working in catering, cleaning, laundry, maintenance, administration, quality and education together with direct care staff, the gap is even greater. State-run nursing homes clocked 303 minutes per resident per day in this category, ahead of just 238 minutes in non-profit homes and 244 minutes in private facilities.
Confirming prior research from the University of Queensland commissioned for the inquiry, the new research also shows a clear correlation with the size of a nursing home.
Small facilities with fewer than 30 residential places showed the best average results for 24 indicators.
The research, conducted within the office of the aged care royal commission, is for the “information of the commissioners and the public.”
“It also demonstrates the value of making data publicly available at facility level to inform the community about aged care services, support consumer choice, encourage continuous improvement, and foster research and innovation,” the commission said.
Rick Morton is the author of the bestselling One Hundred Years of Dirt. He has been a journalist for 15 years with a particular focus on social policy and national affairs. Rick is the senior reporter for The Saturday Paper.
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