Mar 09, 2022

Will the new aged care home ratings system mislead the public?

Aged care home ratings system

The Australian government is introducing a residential aged care ratings system to help people make informed choices about their care – but whether this will bring greater transparency to the industry remains to be seen.

The new star ratings for residential aged care will be available from the end of 2022. Aged care homes will be given an overall star rating, as well as a rating against four sub-categories: five quality indicators; service compliance ratings; consumer experience and staff care minutes.

The system is intended to help senior Australians and their families easily compare the quality and safety performance of different providers, so they can make informed decisions about their care.

But will star ratings deliver genuine transparency for aged care consumers and their families?

In the wake of COVID, a worrying picture is emerging from the United States’ beleaguered aged care system. 

In 2008, the US Centers for Medicare & Medicaid Services (CMS) introduced a rating system based on five stars, which promised to make information on resident safety and staffing easier to understand.

Although the ratings system has garnered praise internationally, an investigative report published by The New York Times in February this year found it is failing some of the most vulnerable populations across the country.

The ratings system relies on self-reporting, and in-person audits are rare. 

The report analysed millions of payroll records and the financial statements of more than 10,000 nursing homes, and found much of the information submitted to the CMS is incorrect.

Some nursing homes inflated their staffing levels, such as including employees who were away on vacation. 

Of the 3,500 homes given a five-star rating, over 2,400 were cited for patient abuse or problems with infection control. Some of these homes had serious problems, with residents developing severe bed sores or losing the ability to move.

Star ratings in Australia must be “fit for purpose”

In Australia, the Royal Commission into Aged Care Quality and Safety’s Final Report recommended adopting a system of star ratings based on measurable indicators. 

“It is critical that the public has access to information about the performance of individual services, in a way that is accessible and easy to understand – a system of star ratings enables this,” wrote the Commissioners.

Saviour Buhagiar, Uniting NSW.ACT Director of Ageing, says any proposed ratings system needs to be “fit for purpose, administrable and sufficiently sophisticated to show quality, person-centred care to consumers and their families”.

“Uniting NSW.ACT is in support of any system of transparency that allows older people and their families to make meaningful comparisons of the quality and safety performance of services and providers,” said Mr Buhagiar.

Mr Buhagiar also said any quality indicator adopted by Australia must be provided with education and context, so people can make informed choices about their care.

“Personal choices made by older Australians around how they would like to live their life frequently require providers to consider ways to balance concerns about their duty of care with people’s right to self-determination, and the right to take reasonable risks that maintain dignity and self-esteem,” he said.

“Such choices can impact quality indicators, so it is essential that education and context is provided in order for people to make informed choices based on published information, be it a star ratings system or otherwise.”

The planned star ratings system is being developed with assistance from a University of Queensland-led consortium, including the UQ Centre for Health Services Research (CHSR), the Aged Care Industry Information Technology Council (ACIITC), and PricewaterhouseCoopers (PwC).

Research, consultation, design and testing has been completed, and the system is being refined before launch.


For more information about the new star ratings for residential aged care, visit the Department of Health’s website here.

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