Smaller is better in aged-care delivery

More top-quality aged care is being delivered in state government-run and smaller nursing homes of 30 beds or fewer than larger private ones, a new study finds.

The report calculates that bringing all nursing homes in Australia up to a high standard on current quality measures would cost an extra $621m a year.

More top-quality aged care is being delivered in state government-run and smaller nursing homes of 30 beds or fewer than larger private ones, a new study finds.

The report calculates that bringing all nursing homes in Australia up to a high standard on current quality measures would cost an extra $621m a year, but that sum rises to $3.2bn a year if they were all to operate under the “small sized home model” that dominates higher quality measures, it said.

The report, prepared for the aged-care royal commission by University of Queensland researcher Tracy Comans, found only one in 20 nursing homes with 60-120 beds was in the highest quality category, and one in 50 with more than 120 beds.

However, 41 per cent of homes with 15 or fewer beds and 26 per cent of homes with 16-30 beds were considered top quality.

The highest quality level, based on measures such as meeting ­accreditation standards, lower use of high-risk medicines, fewer complaints and higher customer experience ratings, comprised 11 per cent of all nursing homes.

A greater proportion of ­government-run homes were also in this category — 24 per cent of all state-run nursing homes — compared with 13 per cent of not-for-profit homes and 4 per cent of for-profit facilities.

Associate Professor Comans said private nursing homes, whether for-profit or not-for-profit, were funded through the federal government and therefore constrained in their ability to provide greater levels of care to that level of funding.

“They are spending what they get, so if we are going to improve quality, we have to increase the funding,” she said. “State governments have more flexibility in their own budgets to put more into residential care homes, and states such as Queensland and Victoria have mandated staffing levels.”

Royal commissioners Tony Pagone and Lynelle Briggs said the UQ research suggested that higher funding was needed for residential aged care if it were to meet basic standards, and even more would be required for reform to achieve high-quality care in Australia.

 

“Australians expect that all are entitled to the best quality level of care in aged-care homes. Additional funding will be needed to enable providers to meet those expectations consistently,” they said.

The Morrison government has been under pressure on the quality of aged care since publication of the royal commission’s interim report in October, in which it gave a scathing assessment of the ­sector’s treatment of older Australians.

A recent hearing on the government’s response to the COVID pandemic in aged care has drawn further criticism, and led to days of intense questioning of Scott ­Morrison in question time. Professor Comans said it was critical extra funding to the aged-care sector in the future was targeted at quality improvement. “It is very important not to just hand out money willy-nilly and expect quality to improve. We need to provide incentives … for instance to incentivise providers to reach higher than minimum quality standards rather than require them to get to that initial bar.”

The report also considered the flow-on economic impacts of more spending on quality, including reduced need for hospitalis­ations, less spending on high-risk medicines and a reduction in work­place injuries and accidents in aged-care homes.