Study reveals quality of Australian aged care services varies widely

A new national study has exposed significant inconsistencies in the quality of aged care services delivered to older Australians, raising concerns about equitable access to high-quality care.

The research, led by the South Australian Health and Medical Research Institute’s Registry of Senior Australians (ROSA) Research Centre and the Caring Futures Institute at Flinders University, analysed data from over 390,000 individuals receiving government-subsidised long-term aged care, both in residential facilities and through home care packages.

Published in the Medical Journal of Australia (MJA), the study assessed a range of quality and safety indicators, including medication use, emergency department presentations, and wait times for services.

“More than 80 per cent of people receiving home care packages waited over six months to access services, with considerable variation nationally in the total time people wait for home care supports,” study co-author and ROSA associate director Professor Gill Caughey said.

“In residential aged care, we saw large differences in rates of antibiotic use, with 14 per cent of facilities prescribing at levels above the national average.

“High sedative load and emergency department presentation rates also ranged considerably.”

The ROSA outcome monitoring system used in the study looked at data from multiple sources, including Medicare, the Pharmaceutical Benefits Scheme (PBS) and state hospitalisation and emergency department (ED) databases. This was used to assess and benchmark aged care performance across Australia and identifying areas for improvement for providers and policymakers.

Apart from wait times, antibiotic and sedative use, and hospital presentations, the study also looked at the levels of antipsychotic and opioid use, premature mortality, chronic disease management, and medication reviews. It also examined the reasons behind instances of hospitalisation (e.g. falls, fractures, pressure injuries, malnutrition and medication related harm).

The study revealed significant discrepancies across aged care providers, suggesting a nationally consistent approach to evidence-based practices, including safe prescribing guidelines, is needed to improve the quality of life and health outcomes for older Australians.

“Adherence to clinical care standards and clinical practice guidelines can promote high quality care and reduce care variation. For antibiotic use, adherence to antimicrobial stewardship guidelines can minimise inappropriate prescribing. Variation in high sedative load can be reduced by safe prescribing frameworks and adherence to appropriate psychotropic medicine use guidelines for aged care,” the research found.

Researchers also found variations in quality between residential and home-based long term care.

“Highlighting these discrepancies matters because it shows what needs to be done to improve quality of life and health outcomes for older Australians,” Professor Caughey said.

“We know older people’s preference is to age in place. To facilitate this, we need a nationally consistent approach to evidence-based practices, including safe prescribing guidelines and reforms to reduce wait times for home care services.

“The aim is to ensure every older person in Australia, regardless of where they live or who provides their care, has access to the same high standard of care.”