Ahead of its final hearing, the Royal Commission has released two new research papers designed to shine a light on what life is like for people inside the aged care system – but the research methodology appears limited.

The Royal Commission’s 88-page Research Paper 13 – ‘Inside the system: aged care residents’ perspectives’ and 137-page Research Paper 14 – ‘Inside the system: home and respite care clients’ perspectives’ were both conducted by the National Ageing Research Institute (NARI).

You can download the papers here.

Questions over sample of residential care respondents

There is a question mark over the sample size of the residential care research.

The paper notes that only 391 residents – or where necessary, their representatives – were interviewed from 67 aged care homes between January and Mid-March 2020 before the survey was shut down early due to COVID.

“Consequently, the sample size is not as large as planned and the confidence intervals around the survey estimates are larger, though still reliable,” the researchers write.

For the home care paper, the sample size was larger with 1,223 respondents from 865 interviews with HCP clients across all four levels, 155 interviews with CHSP respite clients, and 203 interviews with residential respite clients.

However, almost half (49.8%) of the respondents were representatives who answered on behalf of a client, which did impact on the responses.

Almost half of home care clients said their care needs were not met

The surveys find only 25% of aged care residents and home care clients feel that their care needs are always met, with 39% in residential care and 32.5% in home care saying their needs are ‘mostly’ met.

33.4% of people in residential care and 44.1% in home care report that their care needs are met ‘sometimes’, ‘rarely’ or ‘never’ – with these figures higher among people using aged care respite services.

Survey respondents also identified a number of concerns with their care. Among aged care residents, the most common concern was unsurprisingly staffing (46.7%), including a lack of staff, call bells not being answered, high rates of staff turnover, inadequate training, and agency staff not knowing the resident or their needs.

Services and fees were the next biggest concern (39.7%) followed by medical and health care (26.3%).

In home care, the top concerns were around finance and administration, including lack of value for money, fee transparency, service coordination and rostering.

Most aged care recipients don’t report concerns about their care, survey shows

The research found just under half of respondents that had concerns hadn’t raised them with anyone – because they did not think anything will change, the concerns were seen as too minor, they did not want to be a nuisance, or they were not sure who to report to.

Consequently, less than 1% of official complaints are raised with the Aged Care Quality and Safety Commission (ACQSC), with over half (56.3%) saying that ‘nothing had changed’.

The other interesting point from the research concerns quality of life – a key issue for the Royal Commissioners.

Many aged care residents still have high life satisfaction

Despite the issues with their services, on average aged care residents still rated their life satisfaction as moderately high, driven by one-third of residents who rated their life satisfaction as very high.

There was still a proportion of residents (16.9%) who said their life satisfaction was low – but the numbers suggest the majority are satisfied.

Where people were unhappy, residents cited feeling constrained by their age, a loss of control, being left out of things and unable to do what they want or lacking a sense of meaning or being able to look forward to each day – all issues associated with residential care.

Home care recorded similar numbers with general life satisfaction averaging 7.2 out of 10 for the HCP clients (decreasing with increasing package level – perhaps a sign of increasing comorbidities and their impact), 6.8 for residential respite and 6.5 for CHSP respite clients.

Representatives had a lower rating of a client’s life satisfaction than the client themselves

These results fell however when the surveys were completed by the client’s representatives rather than the clients themselves – indicating a gap between the clients and their proxies.

The reports conclude that there is still clearly a need for action to improve quality of care for those for whom the system is failing.

In particular, it highlights that more work should be done to improve staffing, financial transparency, complaints resolution and understanding care recipients’ social and emotional needs.

Will we see these issues pinpointed then in the Senior Counsel’s final submissions this week?