One of the Government’s key aged care reforms is one step closer with the Federal Department of Health tendering for a contractor to undertake Consumer Experience Interviews (CEIs).
Introduced in 2017 by the former regulator, the Australian Aged Care Quality Agency (AACQA) to capture the consumer experience of quality of care, Consumer Experience Reports recorded the experiences of at least 10% of residents during aged care audits, gathering data on issues such as food and safety.
But they were abandoned in December 2019 ahead of the creation of the new regulator, the Aged Care Quality and Safety Commission (ACQSC).
Now the Department is on the hunt for a contractor (or consortia) to restart the program, with the interviews to be conducted across all aged care homes starting from January 2022 ahead of new star ratings for residential care by December 2022.
2,000 interviews a month
The tender states that the contractor will be required to interview 18,500 residents – 10% of residents – either face-to-face or online over nine months between January and October 2022.
That’s around 2,000 interviews a month – which would require at least 10 full-time people to conduct.
This initial consumer experience reporting will feed into the star ratings for residential care by the end of the year after they were recommended by the Royal Commission to help consumers compare the performance of providers.
But do the Consumer Experience Reports (CERs) offer a true picture of ‘quality’ – and will the ratings work?
Royal Commission recommended 20% sample
Like the previous program, CEI participants – or their family representatives – will be selected at random to take part, with the successful tendered required to include a representative sample from special needs group such as people from diverse backgrounds.
In a 80-bed facility, that is just eight residents – or their family members – whose experience may be positive or negative.
The Royal Commission had recommended at least 20% of residents be interviewed to provide a more accurate picture.
No timeframe for ratings rollover
The tender also doesn’t reveal whether new CEIs will be conducted in 2023 – does the star rating then stay in place for one or even two years?
“Specifications of the Star Ratings, including the frequency of Consumer Experience data refresh, are currently being defined by the Department, with assistance from a University of Queensland led consortium with the Aged Care Industry IT Council and PricewaterhouseCoopers (the Consortium),” a DoH spokesperson told us.
“The Consortium’s work will include a process of research, consultation, concept design and user testing, due to conclude in early 2022.”
Overseas experience of star ratings mixed
There is also a question mark over star ratings as a system to judge ‘quality’.
Star ratings were recommended in the 2017 Carnell Paterson report which pointed towards England’s Care Quality Commission (CQC) system.
Established in 2004, it has had a bumpy road. The rating system was re-introduced in 2014 and now rates each home against five questions: is it safe, is it effective, is it responsive, it is caring and is it well led? This results in four ratings: outstanding, good, requires improvement, or inadequate – which could be seen as simplistic.
US ratings systems blamed for COVID-19 deaths
The US experience has also been mixed.
The US Government website’s Nursing Home Compare has been the subject of controversy since its Five-Star Quality Rating System was introduced in 2008.
In 2018, providers were accused of ‘gaming the system’ after a study found that higher-rated facilities had higher rates of preventable hospitalisations because they were ‘cherry-picking’ higher-acuity residents.
During the first COVID-19 wave last year, a New York Times investigation found the star rating systems contributed to the high number of deaths among aged care residents because much of the data supplied to authorities was inaccurate with results being tweaked to make homes appear cleaner and safer.
There is no doubt that consumers and families need a better way to compare homes.
But a star rating system is just one piece of the ‘quality’ puzzle.