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When you're deciding which nursing home will best care for your vulnerable elderly parent or grandparent, you'd probably like to avoid the ones with a high rate of pressure sores or malnutrition.
You'd probably prefer a nursing home with enough nurses and properly trained carers who won't physically restrain your grandma with straps or rely on dangerous anti-psychotics to keep grandad sedated.
In other words, you want to look beyond the glossy brochures full of smiling staff who boast the facility has a perfect federal accreditation score. Right?
But you can't.
Because if you ask for rates of pressures sores or infections, you'll likely be told there isn't any data. At least not any you're able to access.
What can you find out?
If you want to find out the number of times each year that nursing home staff administer the wrong drugs or physically restrain residents, it's likely no-one will tell you.
Instead you'll be assured the aged care facility has all the appropriate processes in place to ensure your loved one is given the best 24/7 care and medical support.
And most of them will point to a near perfect federal accreditation score.
That's because, despite a litany of scandals, less than 1 per cent of nursing homes had their accreditation revoked or varied last year.
In fact, 98 per cent of Australian facilities have met all required outcomes to achieve accreditation — including South Australia's Oakden facility which was exposed last year for systemic neglect and mistreatment of elderly dementia residents.
"It is rare to find a failure of care during an accreditation audit," according to a Nous Group management consulting report commissioned by the Australian Aged Care Quality Agency in the wake of the Oakden scandal.
But we came across a Victorian Government resource manual for state aged care managers that presents a different picture.
It provides a national estimate of the extent of some dangerous medical conditions for those in residential care:
- Pressure sores: "Up to 42 per cent"
- Malnutrition: "Ranges from 40-70 per cent"
- Use of physical restraint: "Between 12-49 per cent"
- Falls: "Up to 50 per cent … will fall every year"
- More than nine medications: "Ranged from 13-75 per cent"
So why do homes score so highly in accreditation?
Because the system seems to largely measure processes, not actual clinical outcomes, as another government-commissioned review stated last year.
"All too often, the review heard about accreditation … that was focused on processes rather than outcomes and appeared to be a 'tick-the-box' exercise," the Review of National Aged Care Quality Regulatory Processes concluded.
An example of that is malnutrition.
The Victorian Government manual puts the rate of malnutrition in Australian nursing homes at up to 70 per cent of residents.
But the federal regulator identified less than 2 per cent of nursing homes as having failed nutrition and hydration standards between 2012-2017, according to figures supplied to Senate Estimates last year.
How can that be?
Mark Brandon, the former CEO of the then Aged Care Standards & Accreditation Agency, explained it this way in 2010: "We do not measure nutrition levels. We look at standards which we expect will stop malnutrition actually happening."
In other words, the agency checks that a facility has processes for ordering, cooking and then distributing food.
It doesn't measure whether residents are adequately nourished.
Process, not outcome.
Similarly, the Victorian Government’s manual estimates the incidence of pressure sores at 42 per cent of all residents.
But the federal regulator identified less than 2 per cent of nursing homes as having failed accreditation standards around skin care.
"The absence of reliable, comparable information about care quality in residential aged care is a striking feature of the current system," last year's regulatory review concluded.
"There is currently little meaningful quality information available to the public, and Australia is falling behind other countries in this area."
You would think the Federal Government, which tipped $12 billion into residential aged care last year, would want to know whether Australia's nursing homes have high or low rates of key clinical indicators like malnutrition or pressure sores, both of which can be fatal.
So, we asked what the rates are
Before we give you the Federal Health Department's response, the good news is that the Government has launched a voluntary program for nursing home providers to collect the data, as well as the incidence of physical restraint.
The plan is to publish the results on the My Aged Care website, so the public can compare nursing homes.
The bad news is that less than 9 per cent of aged care services are participating — just 230 out of 2,677 nursing homes.
Which is why a Health Department spokesperson told us: "The data is not yet at a stage it would be suitable as a basis for publicly reporting on the performance of services.
"The request for a national average prevalence rate for pressure injuries, unplanned weight loss [as a potential measure of malnutrition] and the use of physical restraint is therefore not yet available."
Last year's aged care regulatory review concluded participation should be mandatory, and that the number of clinical outcomes measured should be increased.
(The US compulsorily measures 13 clinical outcomes, including pressures sores, the use of catheters and the incidence of pain.)
There is some good news
There's clear evidence that collecting such data can dramatically improve outcomes for nursing home residents.
We know that because the Victorian Government, which runs 178 nursing homes, has been collecting data on five clinical care indicators since 2006: pressure injuries, the use of restraint, falls, unplanned weight loss and the use of nine or more medications.
Its figures, released for the first time to the ABC, show that over 12 years the rate of pressure ulcers dropped by 75 per cent; the rate of severe pressure injuries by 85 per cent; and physical restraint use plunged by 91 per cent.
Other indicators — falls and unplanned weight loss — have seen little change while the use of nine or more medications has increased.
The Victorian Department of Health believes this could partly be explained by the increase in the levels of dementia, frailty, and chronic illness among aged care residents. Federal Aged Care Minister Ken Wyatt recently instigated unannounced accreditation visits as well as a wide-ranging restructure of aged care agencies that he believes will, "intensify risk management and streamline regulation, compliance and complaints handling".
The Minister is now considering whether to expand the clinical care data program and make it mandatory although he pointed out in a statement: "The provision of care to prevent pressure sores and ensure adequate, healthy and nutritious diets are fundamental components of … quality standards, that are strongly enforced.
But for now, despite innumerable reports, reviews, and promises by successive federal governments, consumers are still waiting for the clinical care data that would give them a clearer guide about how to choose the safest nursing home for their loved one.