2012: How does Australia stack up?

A quick review and comparison of other western world counterparts in countries like the United States, Ireland, and the UK for example, all seem to be far more open and transparent with the way they collect and publish aged care data. In all instances, open publishing of all reports, including unannounced inspections, complaints reports, the CQC places emphasis and focuses it's reports on consumer input: "What people who use the service experienced and told us".

In all instances (in other countries other than Australia), all reports are made publicly available (including unannounced inspections), as well as the complaints information made at the facility level, the date the complaint was rectified, this also included the non-compliance information and/or regulatory activities and reports.

If you were to reside in New Jersey, for example, nursing home owners are required by law to report information on the number of staff involved in direct patient care, and required by law to publicly post information that details direct resident care staffing levels within their facilities.

The table at the end of the article illustrates the absence of useful information for consumers of aged care services in Australia.

Country comparison of information available for aged care consumers:

The information in almost all instances in all other countries in the table below, publish all information at all times, eg, they make all information available, at all times, unlike Australian authorities.

Description	Ireland	UK	US	AU
Date of visit
Facility name and address
Description of premises accommodation/bulding structure, and general layout of facility; no. bedrooms, building age, single or multi-storey; car parking facilities, etc.
Facility and ownership type : Private, public, NFP, etc.
Date facility was first established (or initial date of certification – MC)
Facility: Manager/key person's name in charge
Facility: Registered provider
Facility ownership (owned, rented)
Management/staff reporting structure				*
Staffing information: staff designation and number of staff on duty on day of inspection
Inspection times (start/completion)
Inspection type: Announced				*
Inspection type: Unannounced
Inspection type: Complaints
Number of inspections and visits to facility by Authority
Closing visit meeting with provider
Chronology of previous inspections/visits including dates and inspection type (Registration, Schedules, Follow-up, Announced, Unannounced)
Provider's response to inspection report - responding to non-compliance and what actions were or were not taken to fully comply with Authority
Provider's comments
*Complaints information (substantiated) published against facility
*Complaints information recorded for each facility and published, including date and nature of complaint and when the complaint was rectified
Resident's comments and feedback about the facility
Dependency level of current residents (eg, high, low, medium, etc)
Number of vacancies on date of inspection
Resident mix: number of male / female residents

Notes about the table data:

• *Announced (or "known and prepared" visits performed on aged care homes in Australia are the only reports published. (see additional notes above on Transparency)
• *The Accreditation Agency have recently decided to collect staffing information at the time of accreditation, but have determined this information will not be made publicly available.
• *Complaints information is managed by the "Aged Care Complaints Scheme" - which is embedded within the same department that funds, sets policies and approvals of aged care providers, the Department of Health and Ageing. None of the substantiated complaints information against facilities in Australia is ever released.
• Standard procedure for The Agency is to simply add additional pages outlining whether the standards were met or not. There is no actual information or summary that indicates a clear outline of timeline of dates of what was actually done to fix any problems, or importantly, the provider's response (or "submission") to The Agency.

Australia: ACSAA and DOHA

Information on aged care homes is confusingly spread between a number of websites. This may be due to the fractured setup of regulation of nursing homes in Australia. It has never worked effectively in the past, and is unlikely to in the future under the current regime.

Whilst the Aged Care Standards and Accreditation Agency's (ACSAA) (an industry friendly initiative that also works with educating the very industry it "checks" on) performs audits on homes, with only a small proportion of reports are published on their site at any time. These audits are cyclical and dependent on continued registration of the facility. The agency is also FOI exempt.

The Department of Health and Ageing has a multi-faceted role which includes the funding and regulation of aged care, providing policy advice to government as well as applying sanctions to those aged-care homes which are not compliant with standards. The (fourth) "Aged Care Complaints Scheme" like it's predecessors, is embedded within DoHA. There is another "arm" of this structure, and that is the Aged Care Commissioner for Complaints - their role is to review decisions (by request and only in a tight nominated timeframe) made by the "Aged Care Complaints Scheme" - but DoHA can reject the Commissioner's recommendations. Therefore, the Commissioner's powers are illusionary.

Transparency: Desperately seeking information

For example, of the over 8,000 visits and reports made to a little under 3,000 nursing homes by the Aged Care Standards and Accreditation Agency (The Agency) and by the Department of Health and Ageing (incl. the Complaints Scheme embedded within DOHA) in the 2010-2011 year, only the 500 accreditation reports are publicly available.

The vast majority (476) of these accreditation visits were done 3 yearly at the request of the nursing home, at a convenient time, after the homes may have spent months preparing.

Such reports tell us that the management of the aged-care home knows what it is supposed to do but gives no information about what happens on the other 1,093 days of the cycle.

Research shows that residents will enter and exit a facility without ever taking part in an accreditation audit. In other words, the quality of care they receive will not be assessed while they are alive to benefit from any improvement made as a result of the assessment. They are of little value to a community, anxious about those who lack motivation to provide quality care.

The current limited system of late release and early removal of adverse reports from the Aged Care Standards and Accreditation Agency website is unsatisfactory. Consumers are entitled to disclosure of all past, as well as present, reports. Information needs to be presented in a digestible format. As already stated, frail older people are one of the most vulnerable groups in society and their protection should outweigh all other considerations.

The aged care home finder and compliance/sanctions information are dual-listed on the Aged Care Australia government website, as well as the Department of Health and Ageing website. Either of these websites in addition to the ACSAA website need to be checked for what little information (or none) is published.

Perfect scores... imperfect past?

Nothing illustrates this more than the fact that a home can retain a perfect score by the Agency, but shockingly, have a history of substantiated complaints, breaches and assaults - and some or all of this information is not made publicly available.

Many people who contact Aged Care Crisis are shocked to learn that it is still possible for a home to breach its responsibilities as an approved provider under the Aged Care Act, have serious complaints substantiated against it - including assaults - and yet still manage a perfect accreditation score ... and avoid any public scrutiny whatsoever.

The coonundrum lies within the fractured structure of oversight of nursing homes - The Agency check and report on standards, and the DoHA regulate the complaints and breaches - and the bulk of DoHA's information against facilities is never published.

For example, the 393 "Notices of Required Actions" (NRA's) that were issued by the DoHA's Complaints Scheme in the financial year 2010-2011, none of the offenders are named. NRA's have now been demoted to a less severe sounding label - now referring to them as "Directions". In all other countries (see table below), all of the complaints information and what the provider did to fix the problem, would all be published and available - all of that information is published in one central repository, along with all other reports and complaints information.

United Kingdom: Care Quality Commission

The Care Quality Commission in the UK is the organisation that checks hospitals, care homes and care services that are meeting government standards.

• The CQC website publishes all of their inspection reports – with substantial focus of the CQC reporting based on "What people who use the service experienced and told us" recorded in all of their reports, as well as the inspector's independent assessment notes.
• The website is targeted specifically for consumers wanting to make informed decisions for placement of loved ones in care homes in UK. The website also provides information such as a snapshot of the ownership or company structure and other services run by the same provider or company. They also publish the person or management responsible at the facility level (and company level).
• Depending on the type of report (all are published), it also details the improvement actions and concerns about the facility (equivalent to the NRA's – Notices of Required Actions issued to Australian aged care providers).
• If a "Review" of a service is performed – what triggered the review is documented in the report, as well as how the review was carried out, including "What people who use the service experienced and told us" (eg, complaint, result of spot check, etc). These reports also detail the compliance actions and what the provider has been asked to fix.

Example: Monks Haven Residential Home (web landing page); Monks Haven Residential Home (Review of compliance) report

Ireland: Health Information and Quality Authority

The Health Information and Quality Authority in Ireland are an independent authority that oversee health and social care services. Similar to the CQC website, they too appear to publish current and historical information.

• Management structure including directors, nominated representative (equivalent to "approved provider"), Matron/person in charge as well - who is responsible for the supervision of staff, as well as documenting staff on duty on day of inspection. (The Aged Care Standards and the Accreditation Agency have started collecting this information - only at audit times, but have reassured providers that this information will not be published!)
• As comprehensive and transparent as the CQC, all reports including unannounced inspection reports are made publicly available.
• The report states the organisational type (private, public, etc.), the registered provider as well as the person in charge.
• They also record the time/s when the inspections were performed, and for how long. The management structure is also published in the report – including staff on duty on day of inspection.
• The reports also detail ALL of the date and types of visits to date (unannounced, follow-up, schedules, etc.).
• The reports also include the provider's response to the inspection report.
  Provider's responses to the Accreditation Agency or DOHA are called "submissions" and are protected from FOI and never published here in Australia!

Examples: Avondale Nursing home Inspection Report: Unannounced (6 July 2011); Balinamore House Nursing Home

United States: Medicare

In comparison, Medicare is the official body in the U.S. has a nursing home compare tool, which publishes formatted listing type of recorded data supplied by nursing homes on a regular basis.

• The reports are not as "wordy" as the CQC or the HIQA, but they do store a lot of details regarding not only the facility, but on the residents health or care level status as well.
• Medicare includes ownership type, whether it is part of a multi home chain, nursing home staffing, complaints information, all historical reports, as well as regional "averages" of staffing.
• They have a star rating system that includes benchmarking the quality measures and staffing within a region, including care time per resident by staff type.
• They also publish information transparently about complaints, how many residents affected by the complaint, the level of seriousness, date of the complaint/investigation and the date of correction.
• Interestingly, a "deficiency" can be recorded against the facility for NOT publishing information, for example, of staffing levels at the home! (this could explain the absence of data on the australia.gov.au website!)
• Nursing homes are also required to publish aspects of residents' health, physical functioning, mental status and general well being. (eg, prevalence of residents who have severe pain, bedsores, limited mobility, losing too much weight, flu vaccination, etc.).
• The homes are also required to publish building types - including what fire safety provisions they have, ie, sprinklers or not.
• A penalty system may be recorded against the facility as well for a variety of reasons.
• A Special Focus Facility (SFF) is one with a recent history of persistent poor quality of care, as indicated by the findings of inspection teams. Based on inspection findings for the most recent three-year period, the Centers for Medicare & Medicaid Services (CMS) selects a group of nursing homes with the worst repeated inspections as SFFs. The equivalent here in Australia would be the register of the Homes of Concern list (established in 2008 by DOHA) – (which strangely coincided with the height of the global financial crisis).
• In order to achieve true accountability it is essential that all information about publicly-funded aged-care homes is available to those families seeking care for loved ones and to those researching the sector. A case in point is the Medicare.gov website where you have the option of downloading the data that is used by the Nursing Home Compare tool onto your computer - in a database format! This function is primarily used by health policy researchers and the media.

Related link: Use the search facility - the links were too long to provide here:

Brooklyn United Methodist Church Home, 1485 Dumont Avenue, Brooklyn, Ny 11208
on the Medicare.gov website (official U.S. Government site for Medicare) Nursing Home Compare
Centers for Medicare & Medicaid Services (CMS)