Opinion: Star rating system – giving voice to those experiencing the care

Debra Nicholl, CEO, of Elders Rights Advocacy (ERA)

In this guest post, Debra Nicholl, CEO, of Elders Rights Advocacy (ERA) shares views on the recent Star Rating System and the importance of making sure those receiving care are being heard. ERA supports older people, their families and representatives in Victoria to address issues related to Commonwealth-funded aged care services.

One of the 148 recommendations made by the Aged Care Royal Commission was the introduction of a star rating system for residential aged care homes. The first round of ratings has been released and the results were not surprising with 59% of aged care homes across the country receiving 3 stars. Only 1% of homes received the highest rating of 5 stars and only 1 % the lowest rating of 1 star. 9% of homes achieved 2 stars and 30% 4 stars.

Elder Rights Advocacy supports increased transparency and accountability in the aged care sector. Accurate information is empowering and can assist informed decision-making. What older people and their representatives have been telling us for over 30 years is that they need more reliable, easy-to understand information at a time when they are considering care options. This is often a time of extreme stress and uncertainty, a time when older persons’ care needs are changing and increasing so a reliable star rating system could potentially provide some confidence when deciding on which aged care home to choose.

For older people living in regional or remote communities, there is often no choice at all unless they decide to leave their hometown and move away from their known community and established connections. In this case, the star rating system provides no consolation but rather it highlights the need for equitable access to high-quality care regardless of where you live.

This consideration is not limited to regional areas, it also applies in our suburbs where older people want to remain living in their local area close to their established networks. Again, the star rating system does not offer choice to all older people however it does highlight the need for all aged care homes to operate at a 5-star level.

Older people have a right to access safe, quality aged care services regardless of where they live or how much money they have. Homes may look different with some having chandeliers and plush furnishings while others offer vinyl-covered chairs and oyster light fittings, but they should certainly all be providing the same level of quality care that meets the person’s assessed needs. This is not too much to expect.

How data is gathered and from who will make a big difference to each home’s rating. We know that 30% of the data is gathered from the Aged Care Quality and Safety Commission and this data reflects a home’s compliance record. 37% of the data collected comes directly from the service provider who is self-reporting on the critical areas of quality and clinical indicators as well as staffing. These indicators are regularly included in the concerns that are raised with us by older people who live in residential homes. Pressure injuries, medication management and the concerning use of antipsychotics to control behaviour, falls and the resulting injuries, and weight loss influenced by simple things like the quality of food or dentures that are ill-fitting.

Just 33% of the data collected for the star ratings come directly from the resident experience surveys which are completed by just 10% of older people living in the home. For the star rating system to be truly effective in providing a reliable and accurate indication of service quality, the older person’s and their representative’s experience should represent the highest percentage of primary source data.

For all things aged care related the voice of those who are experiencing the care day in, and day out must be the loudest. Their voice is the most authentic and will give others a true indication of what it is like to live in a particular home.


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