Special report by Grace Frost

The Federal Government’s assessment of aged care quality and safety has found nearly four out of five aged care homes in the Mitchell Shire, Macedon Ranges and City of Whittlesea fail to provide a ‘good’ quality of care for residents.

The ratings of more than 2500 government-funded aged care homes across the country received a score between one and five stars based on four key areas of performance – compliance, quality measures, residents’ experience and staffing.

The statistics were first published online in December, after the Royal Commission into Aged Care Quality and Safety recommended star ratings based on measurable information be published.

A one-star rating was given if significant improvement was needed, two stars if improvement was needed, three stars if the service was acceptable, four stars if it was good and five stars if it was excellent.

Of the 24 aged care homes assessed in the municipalities across the region, none received an overall five-star rating.

Nineteen homes were given three stars overall, an ‘acceptable’ ranking, while five were given four stars.

The region’s aged care homes performed poorest in quality measures and staffing, receiving an average of 2.5 stars and 2.3 stars respectively.

Mitchell Shire received the poorest quality measures rating in the region, averaging 1.2 stars across its five aged care homes.

However, Mitchell Shire aged care homes achieved the highest ranking with regard to staffing compared to the broader region, but still failed to meet an ‘acceptable’ ranking, averaging 2.8 stars.

Aged care homes in the City of Whittlesea were ranked worst in the region for residents’ experience, averaging 2.9 stars across 15 facilities.

Macedon Ranges-based aged care homes saw the highest overall average at 3.25 stars between four homes, the only region to receive an ‘acceptable’ rating or higher for compliance, quality and residents’ experience.

The national data showed more than 1600 homes fell short of the three-star minimum acceptable ranking.

Analysis by The Age in December showed almost one in 10 aged care facilities were ranked poorly for residents’ experience, 17 per cent ranked poorly for quality of care and seven per cent failed to meet the acceptable threshold for compliance measures.

Staff shortages, mostly caused by staff being burnt out from the pandemic, have been telling in the ratings.

TABLE: Star ratings for the district’s aged care homes

Staffing a key issue

More than 70 per cent of aged care homes across the Mitchell, Macedon and City of Whittlesea municipalities failed to meet an ‘acceptable’ time of care provided by nursing and personal care staff.

The government requires all residents to achieve about 200 minutes of care by either a registered nurse, enrolled nurse or personal care worker each day, and about 40 minutes of care from a registered nurse, with times varying slightly between homes.

Two homes in the district, Caladenia Nursing Home and Seymour District Nursing Home, achieved a perfect five-star rating in regard to staffing.

Kilmore District Health interim chief executive Jennifer Gilham said Caladenia Nursing Home was ‘proud’ to have received the top rating.

“Like all public sector aged care facilities, we staff our facilities in line with the Safe Patient Care Act, according to required ratios, and we have a registered nurse on site 24 hours per day,” she said.

However, nearly 30 per cent of aged care homes in the region only received one star, and 42 per cent two stars – some falling below target times by as much as 51 minutes.

The Oaks Nursing Home in Gisborne was one of seven homes in the district to receive a one-star rating for its staffing.

A Benetas spokesperson said the team at Gisborne Oaks was working hard to overcome workforce shortages, as was the broader aged care sector.

“We have a range of programs to try and attract new workers, such as targeted traineeships and our new graduate nursing program,” they said.

“Our main focus is providing the best level of care for our residents. As part of that commitment, we ensure that we develop rosters that meet the individual care needs of our residents.”

Quality

More than 40 per cent of homes across the region required improvement or significant improvement of the quality and safety of care provided at the home.

The quality measures rating, which contributed to 15 per cent of the overall rating, ranked the prevalence of pressure injuries, physical restraint, unplanned weight loss, falls and major injury, and medication management, and compared each home with the national average.

All homes in the Mitchell Shire, one in the Macedon Ranges and four from the City of Whittlesea required improvement for quality of care.

Caladenia Nursing Home Kilmore was one of five homes to receive just one star for its quality measures.

Fifty-four per cent of residents at the home were physically restrained, 32 per cent above national average, and 17 per cent of residents were prescribed antipsychotic medications without a diagnosis of psychosis, seven per cent above national average.

Ms Gilham said Kilmore District Health worked closely with its stakeholders to ensure safe and quality care and continued improvement to its services.

Though some of its practices, aimed to provide additional assistance for aged care residents, have resulted in a low quality measures score.

Physical restraint includes mechanical restraints – devices that stop, restrict or reduce a person’s movement – which for Caladenia Nursing Home includes their use of key-pad entry to secure places.

“We strive for excellence in the delivery of care to all patients, including our residents at our aged care facilities, Caladenia Nursing Home and Dianella Hostel,” Ms Gilham said.

“Our patients’ safety is our priority and our practices reflect our commitment to that.

“These practices include the use of key-pads to secure doors to ensure residents who require additional assistance, such as dementia sufferers, always have a staff member supporting them when they leave the facility.

“Some residents of our facilities are prescribed medications by their treating GP to manage their conditions. This is done in consultation with the resident and if required, their next of kin.”

Residents report varying experiences

Nearly four in five aged care homes failed to achieve a ‘good’ four-star rating for residents’ experience, based on a 12-question survey given to residents by an independent team.

Residents at Epping Meadows Care Community, which was one of two homes in the region to receive two stars for residents’ experience, were unsatisfied across a variety of areas.

Thirty six per cent said staff knew what they were doing only ‘some of the time’, and 43 per cent reported they ‘never’ or only ‘some of the time’ had a say in their daily activities.

Though 57 per cent of residents said they liked the food served ‘most’ or ‘all of the time’, 14 per cent of residents reported they ‘never’ liked it.

Epping Meadows Care Community spokesperson said the home was always looking at improving its services and had taken feedback onboard from residents.

“We have actively been doing food focus groups and taking feedback onboard from our residents. As part of this process, we have hired a new chef with extensive experience in the care sector,” they said.

“We are confident our team members are well trained and conscientious.

“Nevertheless, a relatively small proportion of residents had an alternative perception about their capabilities. As a result, we have increased our face-to-face training and online learning.”

The spokesperson said the home also hosted monthly resident and relative meetings where residents chose activities for the following month, of which some preferred to not be involved.

The Oaks Nursing Home, Gisborne, was one of the highest rated homes for resident experience, with 93 per cent of residents agreeing they ‘always’ received the care they needed and staff ‘always’ treated them with respect.

A Benetas spokesperson said the team at Gisborne Oaks ensured they were doing their best to keep residents safe and happy.

“While we are currently below current government staffing targets, our resident scores show we are still able to deliver high quality care,” they said.

Compliance

Aged care homes in the district rated best for ‘compliance’ – their adherence to government regulations and standards – averaging 4.5 stars.

Compliance contributed to 30 per cent of the overall rating.

To receive four stars, a home must have had no compliance issues for one year.

Whittlesea Lodge received three stars in its March rating, updated from only two stars after it received a non-compliance notice for the second time since April 2021.

Whittlesea Lodge facility manager Kaye Simpson said the home was pleased to report that every issue had been rectified, and the work of staff and management of Whittlesea Lodge had been acknowledged by the Aged Care Quality and Safety Commission, ACQSC.

“We are proud of our staff, especially of their passion and dedication in delivering the highest quality of care for our residents to enable them to live their best lives,” she said.

“Continuous improvement is a normal part of the work we do and we at Whittlesea Lodge will endeavour to maintain those high standards into the future to the satisfaction of our residents and their loved ones.”

Federal Government focus on reform

A STAR rating system forms just one part of the Federal Government’s aged care reforms.

From July 1, older people in residential aged care will have access to a registered nurse 24 hours, seven days a week.

Mandatory average care times for residents will be further increased to 215 minutes from October 1, 2024.

The government will also deliver a pay rise of at least 15 per cent for aged care workers on the minimum award, starting this year.

March 1 marked two years since the Royal Commission into Aged Care Quality and Safety’s final report was tabled in Parliament.

In a statement earlier this month, Aged Care Minister Anika Wells said the report was a damning assessment of an aged care system in crisis.

Ms Wells said creating the star rating system increased choice, accountability and transparency.

She also pointed to other government achievements in aged care, such as implementing the inaugural code of conduct for providers and workers to protect older people; capping home-care charges and exit fees to stop the rorting; appointing an interim inspector general to be an independent champion for the sector; and enhancing safeguards for restrictive practices.

“I have visited more than 20 aged care homes since being sworn in as minister, talking with residents and workers about how our reforms are impacting their daily lives,” she said.

“I have witnessed exceptional care being delivered, have seen problems that still need to be addressed and issues that clearly need improvement.

“This is just the start of our reform mission.

“What we are working on right now is bedding in our current reforms while addressing more royal commission recommendations.

“We are drilling into ways to boost the numbers of aged care workers, helping aged care providers recruit and train thousands of personal care workers to care for older people at home or in residential facilities, reforming in-home aged care and working on the National Dementia Action Plan.”

Ms Wells said she was determined to make people ‘the beating heart of a strengthened aged care system’ that replaced fear with trust.

“Older people helped build this country. The very least we can provide them is quality care,” she said.

“We have critical reforms to tackle over the next 12 months and are working hard to ensure they not only address current issues but set the sector up for long term success.”

Member for McEwen Rob Mitchell said the government was committed to reforming the aged care system, and had already directly addressed 37 recommendations of the Royal Commission into Aged Care Quality and Safety.

“We have implemented major changes to reform the aged care system, including the capping of home care package admin fees, supported a meaningful pay rise for aged care workers, legislated 24/7 nurses in aged care homes from July 2023 [and] legislated more care minutes in aged care homes from Oct 2023,” he said.