Melting under any scrutiny, the ratings have now become totally useless to anyone trying to find a place worth dying in.
Is it just me, or is a rating system in which everybody gets a high rating and nobody gets a low rating about as useful as a chocolate teapot?
Back in 2020, when I was trying to help my mother pick an aged care facility for herself, the current Star Rating system didn’t exist. We relied on word of mouth and the help of a private aged care buyer’s advocate who dressed like my dad and charmed his way into winning my mother’s trust.
“Got to keep her moving up the crush any way we can, Catie,” he said as he brushed off his RMs and polished his cattle prod.
A star rating system sounds like a great plan, doesn’t it? Give the punters a methodologically credible way of picking the wheat from the chaff, right? I would have been glad of it back in 2020.
Four stars out of five would have sounded pretty reassuring. Five stars would have been exceptional. One star would probably have sent me looking elsewhere.
Yesterday in Federal Parliament, the Labor member for Banks, Zhi Soon had some good news to deliver:
“More than 80% of aged care homes now have a four or five-star rating,” he told the House.
The latest quarterly data extract puts the figure at 75.9%. Nevertheless, it sounds impressive. But there is another statistic Mr Soon did not mention.
Not one residential aged care home with an overall Star Rating has one or two stars.
Of the 2390 residential aged care services with an overall Star Rating in the August data, 576 are rated three stars, 1659 have four stars and 155 have five.
Not a single one has an overall rating below three stars.
That, in the words of the great Lancastrian stand-up comedian Peter Kay, is mathematical bollocks.
It would be an extraordinary testament to the quality of Australian residential aged care if the individual components underlying those ratings told the same story. But they don’t.
More than 1100 aged care homes have at least one individual performance domain rated either one or two stars.
Among them are 103 homes rated four stars overall despite receiving just one star in at least one area of their performance. Another 33 four-star homes have two separate domains rated one or two stars.
Even four of Australia’s 155 five-star homes have a two-star rating for Quality Measures.
It raises a fairly fundamental question about a system explicitly created to give older Australians greater transparency about the quality of residential aged care:
What does an overall star rating actually tell you?
Look beneath the stars
Star Ratings don’t assess a home on a single measure. Services are rated across four domains: residents’ experience, compliance, staffing and quality measures. Those results feed into the overall rating, but they don’t carry equal weight.
And it is when you look beneath the overall rating that Australia’s seemingly stellar aged care performance becomes considerably more complicated.
In the August data, 774 homes have “staffing” ratings of just one or two stars. Another 596 receive one or two stars for “quality measures”. Thirty-five have a two-star “residents’ experience” rating.
Yet none of those poor individual results has produced an overall rating of one or two stars.
That doesn’t necessarily mean the overall ratings are mathematically or methodologically wrong.
It does mean consumers need to understand that four stars overall does not necessarily mean four-star performance across the home.
A four-star home can have one-star staffing. A four-star home can have one-star quality measures. And a five-star home can have two-star quality measures.
Of the 1659 four-star homes, 557 – that’s one in three – have at least one domain rated one or two stars. More than 100 have a one-star domain.
For a rating system intended to help older Australians compare homes, that’s not a trivial distinction.
Related
What does a four-star rating mean?
COTA Australia CEO Patricia Sparrow says the Star Ratings system was introduced to improve transparency and accountability.
“Older Australians deserve clear, reliable information about the quality of care provided when they’re considering aged care options,” she told HSD.
Ms Sparrow also zeroed in on the unusual distribution of ratings.
“The relatively small number of services receiving one or two stars makes it particularly important that the system is giving an accurate picture of performance across the sector,” she said.
Relatively small? Meaning none, in this case.
“The ratings need to clearly distinguish how services are performing across each of the areas, including where care falls short.”
There is an important argument on the other side.
An overall rating is supposed to synthesise different aspects of performance. One poor result need not logically mean an entire service is poor. And the current system deliberately gives greater weight to some things than others.
Ms Sparrow supports that principle.
“Giving the greatest weight to residents’ experiences and compliance helps ensure the ratings are centred on the older person, the care they receive and whether providers are meeting their obligations,” she said.
She also argues staffing needs to remain clearly visible to consumers.
“Good staffing is fundamental to good care,” she said.
“Being able to easily see how providers are performing on staffing gives older Australians another important piece of information when making such an important decision.”
That is precisely why the individual ratings matter.
The issue isn’t whether a one-star result in one domain should automatically condemn a home to one star overall. It’s whether an older Australian seeing four stars beside a home’s name would reasonably understand that somewhere underneath those four stars could be a one-star category.
A rating needs to discriminate
There is another way of looking at the August figures.
More than three-quarters of rated residential aged care services – 1814 of 2390 – received either four or five stars.
The remaining 576 received three.
In other words, every residential aged care service with a published overall rating sits within the top three positions of a five-point scale.
Perhaps Australian residential aged care really is performing at such a consistently high level that nobody deserves the bottom two ratings.
If so, that’s something worth celebrating.
But after everything the sector has been through – including a royal commission whose interim report was titled “Neglect” and whose final report was titled “Care, Dignity and Respect”, and documented systemic failures in the quality and safety of care – it is also reasonable to ask whether a rating system in which every rated service receives at least three stars is sufficiently discriminating to do the job for which it was created.
Stars aren’t there to make providers feel good – although I don’t for one moment think providers are that easily self-deluded. The ratings are there to tell older Australians something useful.
And if a four-star rating can coexist with a one-star performance on staffing or quality measures, consumers need to know exactly what those four stars mean.
We have asked both the Department of Health, Disability and Ageing, and the federal minister for aged care and seniors, Sam Rae, some very specific questions about those numbers and how star ratings work.
Actually, we asked them three times. Once yesterday morning, once yesterday evening, and a repeat set this morning just for good measure.
Crickets.