Residents of government-run aged care homes were less likely to end up in hospital, but residents of not-for-profit homes had lower death rates, according to a large Australian study released this month. The findings land as the number of aged care providers keeps shrinking.
The research, published in BMJ Open last week, followed more than 205,000 people over 65 who moved into permanent residential aged care in New South Wales, Victoria and Queensland between 2013 and 2018. It looked at what happened to each person in their first 12 months in care, and whether the type of provider running the home made a difference.
Among the residents in the study, 51.3% lived in not-for-profit homes, 44.4% in for-profit homes and just 4.4% in government-run homes. These figures describe the 2013 to 2018 study group, not the sector today.
The authors cite more recent national figures showing not-for-profit providers operate a little over half of Australia’s homes, for-profit providers about a third, and government providers about 8%.
They also note that mergers and acquisitions have reduced the number of providers from 663 in 2023 to 642 in 2024.
Government-home residents were less likely than those in either of the other two models to have a hospital emergency.
In inner regional areas, their risk of needing to go to the emergency department was 32% lower than for not-for-profit residents and 39% lower than for for-profit residents.
Their risk of an unplanned hospital admission was also lower:
In inner regional areas, government-home residents also spent fewer days in hospital than not-for-profit residents.
On mortality, the results went the other way. Compared with not-for-profit homes, for-profit homes had a 13% higher risk of death within 12 months in metropolitan areas and a 17% higher risk in inner regional areas. Government homes in inner regional areas had a 20% higher risk.
Government and for-profit homes did not differ on mortality.
The authors urge caution with the government figure. Government homes often take people with complex needs, such as multiple health conditions or advanced dementia, whom other providers may turn away. They also tend to be in areas of greater socioeconomic disadvantage.
Residents may simply have been at higher risk when they arrived.
On hospital-related outcomes, the study found few meaningful differences between for-profit and not-for-profit homes.
The authors suggest this may reflect the regulation, quality monitoring, public reporting and workforce governance the two models share.
That gap between government homes and the other two models is why the researchers want ownership changes watched closely, so that resident outcomes are not compromised.
About 80% of the government homes in the study were in Victoria, where government-run homes make up about 20% of facilities, compared with less than 10% in other states.
Victorian law requires government homes to meet nurse-to-resident ratios and report quality indicators in high-risk areas such as pressure injuries, falls and fractures, and polypharmacy.
Those ratios have long set Victorian public homes apart. As HelloCare reported in 2020, Victorian public homes must provide one nurse for every seven residents on morning shifts, one for every eight in the evening and one for every 15 overnight.
At that time, government-owned homes in Victoria and Queensland were the exceptions in a sector with no minimum nurse or carer numbers per shift.
The state’s ageing minister at the time, Luke Donnellan, said “ratios are vital in our public aged care system”.
The study did not test whether these requirements explain its results, and the authors say they did not account for differences in state policy. Staffing levels weren’t measured at all.
The researchers matched residents with similar characteristics to make the comparisons fair, but say some differences may remain unexplained. Residents’ care needs on entry and their personal preferences weren’t captured.
The data also covers the years before the COVID-19 pandemic and recent aged care reforms. It excludes Aboriginal and Torres Strait Islander residents, people with Department of Veterans’ Affairs entitlements and those receiving palliative care.
The government-home sample was small, particularly in metropolitan areas.
For families choosing a home, the lesson isn’t that one model is best. Each ownership type came out ahead on different measures, but the gaps were widest in inner regional areas.
