This is a submission to the Royal Commission into Aged Care Quality and Safety. To
identify the causes of any systemic failures, and to recommend actions in response, the
Commission will need analyses of all the relevant data available.
We have analysed the last 10 years of notices of non-compliance, and the last 16 years of
sanctions. We also analysed a sample of 300 Consumer Experience Reports, available
since June 2017, and some recent data on complaints, expenses and staff.
Numbers 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.
For-profit providers had had non-compliance risks about 1.70 times those of not-for-profit
providers, sanction risks about 2.78 times, satisfaction scores about 0.98 times, and
complaint numbers about 1.77 times. They may have similar staff expenses per resident.
The Commission should be able to form a view whether the data reflect real differences in
quality, or inconsistent decision-making. Evidence from senior decision-makers may help.
As Carnell and Paterson noted in 2017, there are no reliable comparable data on aged care
quality. Consumer experience reports may partly fill this gap. We show that 20% samples
give very unreliable results, and recommend 80% sampling.
Better quality control needs to come from better quality measures. The Commission should
seek advice from health care professional bodies about measures which can be quickly
implemented, at reasonable cost.
Financial data on each aged care provider would help analyse links between quality failures
and staffing expenditures. Under section 86(1) of the Aged Care Act 1997, the Department
of Health refuses to disclose these data, but has discretion to do so under 86(3).