Consumer experience reports should be done more often and by more residents if they are to be useful, says actuary Richard Cumpston.

In his submission to the Royal Commission into Aged Care Quality and Safety, actuary Richard Cumpston said there are “issues of concern” with the data from consumer experience reports that could stem from providers finding workarounds to boost results.

“Rising satisfaction levels since 2017 may reflect better quality of life, but they may also reflect providers finding ways to artificially improve responses,” he wrote. 

“Providers may be improving staffing levels before reaccreditation reviews are due, or may be making critical residents unavailable,” Dr Cumpston wrote. 

“About 77 per cent of persons interviewed are mobile, even though only a minority of all residents are mobile, and mobile residents generally report much higher satisfaction levels,” he observed.

“Statistical uncertainties”

In an email to HelloCare, Dr Cumpston said because only low numbers of residents are taking part in the consumer experience reports there are “large statistical uncertainties”, making them “almost useless” for the purpose for which they were created.  

“Reports are only obtained about once every three years from nursing homes, often making them too out-of-date to help prospective residents,” he wrote.

80% of consumers should be interviewed every year

Dr Cumpston’s actuarial business, Australian Projections, recommends that consumer experience reports be obtained annually from every nursing home, and that “at least” 80 per cent of residents be interviewed.  

“The extra cost of these interviews would be very small in relation to the total expenditure by residents and the government on residential care,” he noted.

Useful data, and to tap into consumer voices

Kate Carnell and Ron Paterson in their 2017 review of aged care, in the wake of the Oakden scandal, noted the poor availability of data in the sector.

“The absence of reliable, comparable information about care quality in residential aged care is a striking feature of the current system,” they said in their report.

In their submission to the Royal Commission into Aged Care Quality and Safety, Richard Cumpston and Kasia Bail said their analyses confirm “there are currently no reliable data about care quality”.

Going back as far as 2011, the Productivity Commission recommended the introduction of quality measures to help prospective residents and their families choose nursing homes.  

In May 2017, the Australian Aged Care Quality Agency introduced consumer experience reports, for which 10 per cent of residents at each facility are asked 10 set questions at the time of assessments.  

The questions include, ‘Do staff treat you with respect?’, ‘Do you like the food here?’, and ‘Is this place well run?’.  

“We need to do more to hear from the people”: Paterson

In his hearing at the royal commission, Professor Paterson said more needs to be done to obtain data on how the residents are experiencing their care.

“We need to do much more, to be hearing from the people who are living there, from their family and also from the workers in that facility. 

“We need to be really creative about how we get their voices and… capturing that all year round,” Professor Paterson said.

Consumer experience data difficult to obtain

In their submission to the royal commission, Dr Cumpston and Ms Kasia noted that the data that is available on consumer experience is difficult to access.

“While the results are available on MyAgedCare, it is laborious to find services for which consumer experience reports have been prepared, and to download the results,” they wrote.

For their purposes, the researchers obtained consumer experience report data from the Australian Aged Care Quality Agency under a Freedom of Information request.

There are a number of online platforms available, such as CarePage, which provide aged care reviews and consumer feedback, including customer satisfaction data. These platforms can be helpful for the general public when choosing an aged care facility for their loved one.

Sanctions declined due to changes in government policy

Dr Cumpston’s submission to the royal commission also noted that the number of notices of non-compliance dropped sharply after 2009, and rose sharply after 2016. Sanctions gradually declined from 2003 to 2016, then rose sharply.  

“We think these changes reflect major changes in the decision-making of Commonwealth government agencies, rather than real changes in quality.

“Non-compliance and sanction rates have varied strongly between the states, suggesting different approaches by branch administrators,” he wrote.

Technology could be used to access more data

Dr Cumpston, who started Australian Projections to make predictions about Australian households, and who has a particular interest in aged care because of its social importance, believes that more data could be easily obtained to help aged care providers.

“We think that quality of care measurements should be made automatically and transmitted to the quality agency,” he said.

“For example, weight and activity measurements could be made by mattress sensors. Falls could be measured by wrist sensors. The use of physical restraints could be electronically monitored. Data on prescriptions should be transmitted to the quality agency, allowing analysis of chemical restraints and inappropriate prescriptions.”

Greater financial clarity would shed light on quality failures

In his submission to the royal commission, Dr Cumpston notes that having more financial data about each aged care provider could help “analyse links between quality failures and staffing expenditures”.  

He said the government does have the power to obtain such data.

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