Aged care system plagued by inconsistency

Australia’s aged care system is struggling to meet the needs of our ageing population.

More than 565 000 people received government‐subsidised long term aged care in Australia during 2022–2023, with 250 273 in residential aged care and 314 971 receiving home care.

Monitoring of the quality and safety of our aged care services is vital for ensuring consistent high quality long term care.

However, a new study, published in the Medical Journal of Australia, has found marked variation in care quality across Australia.

“We found significant variations in quality measures of long term aged care for older people in Australia, particularly with regard to waiting time for home care services, ED [emergency department] presentations, antibiotic use, high sedative load, home medicines reviews, and chronic disease management plans,” the authors wrote.

“We also found differences in quality and variations in quality between residential and home‐based long term care.”

Multiple quality indicators

The researchers used data from the Registry of Senior Australians (ROSA) to analyse care quality indicators for 244 754 people who received subsidised long term care in 2019.

“The ROSA National Historical Cohort integrates deidentified data from national and state‐based aged care, health care, and social welfare datasets for older Australians who were assessed for subsidised aged care eligibility or who received aged care services during 1 January 2002 – 30 June 2020 (with data updates every two years),” the authors explained.

There were 12 quality and safety indicators of care measured for residential care (including antipsychotic use, chronic opioid use, high sedative load, antibiotic use, premature mortality) and 15 for home care packages (including hospitalisations, fractures, medication‐related hospitalisations, emergency department [ED] presentations, pressure injury‐related hospitalisations, weight loss or malnutrition‐related hospitalisation).

Eight of the indicators were monitored in all states, whereas seven were only able to be monitored in four states for which hospital use data was available.

High use of medications

The researchers found a high prevalence of medication-related indicators in aged care facilities, with 21.4% of residents receiving antipsychotic medications, 45.2% having high sedative loads, 64.5% receiving antibiotics, and 26.1% receiving opioid medications for longer periods.

For home care recipients, medication-related indicators also remained stable, despite reductions in opioids, antimicrobial medicines, and antipsychotics in the wider community.

“These changes contrast with our findings, suggesting differences in medication management and health care use between older Australians in general and those receiving residential or home‐based care,” the authors wrote.

Only 3.2% of home care recipients had government‐subsidised home medicines reviews and 43.2% received chronic disease management plans.

“National variation in the use of these services was quite substantial, suggesting that a nationally consistent and systematic approach to promoting them for people with home care packages is needed,” the authors wrote.

Reducing variation in care quality

There was considerable variation in care quality among residential and home care providers.

“The three hospitalisation‐related indicators with the largest proportions of outlier facilities … were ED presentations, and falls‐ and pressure injury‐related hospitalisations,” the authors wrote.

“Among the nationally assessable indicators, variability in the use of antibiotics and antipsychotics, and in high sedative load, is concerning.”

The authors suggest adherence to clinical care standards and clinical practice guidelines could reduce care variation and promote a higher quality of care.

“The marked national variations in antibiotic use, ED presentations, high sedative load, longer waiting times for home care services, home medicines reviews, and chronic disease management plans suggest these areas could benefit from targeted quality improvement strategies,” the authors wrote.

“For antibiotic use, adherence to antimicrobial stewardship guidelines can minimise inappropriate prescribing.

“Variation in high sedative load can be reduced by safe prescribing frameworks and adherence to appropriate psychotropic medicine use guidelines for aged care.”

Emergency department presentations could be reduced with improved multidisciplinary services such as the 24‐hour on‐call services recommended by the Royal Commission into Aged Care Quality and Safety, while the new Support at Home program could improve access to allied health and restorative care in the home.

“Our findings highlight national performance on key quality measures, and we have identified areas of long term aged care that could particularly benefit from targeted quality improvement strategies,” the authors concluded.

Read the research in the Medical Journal of Australia.