Home care reporting lags on international scale

Australia has no quality reporting for home care and needs to immediately establish an independent regulatory system based on overseas models, a research paper says.

The paper by the South Australian Health and Medical Research Institute, was released by the aged care royal commission this week.

It identifies indicators that are currently used to measure aged care in Europe, North America and New Zealand across home and residential care, and examines how Australia compares.

The paper says like other countries, Australia’s federal government provides home care packages dependent on level of need, to provide aged and health care services to help people to remain at home and offer choice and flexibility in the support and care they receive.

However, unlike Australia, other countries that provide home care such as Canada, Netherlands and Sweden have quality and safety indicators, while New Zealand is in the process of implementing them.

Author Associate Professor Gillian Caughey, a principal research fellow at the Registry of Senior Australians (ROSA), said the work highlighted the lack of any kind of quality and safety outcome reporting for home care in Australia.

“With the increasing utilisation and demand for home care packages to support older people to remain at home in the community, routine monitoring of home care quality and safety is essential,” she told Community Care Review.

Key measures that are commonly examined overseas include changes in cognition, mood, functional abilities and pain, as well as hospitalisations, falls, incontinence and medication use.

The survey found 50 quality and safety indicators for home care internationally, compared to none in Australia.

Associate Professor Caughey says compared to indicators in countries like Canada, Netherlands and Sweden, Australia is on the lower end of performance for medication-related quality of care .

However, in comparison to other countries relating to fractures or hospitalisations, including ED presentations, Australia is comparable to that of Canada.

“There are a range of quality and safety indicators that can be routinely monitored in Australia for both home care and residential aged care, using existing data sources and having these embedded as part of overall routine monitoring of aged care would be optimal for Australia,” she said.

Overseas examples

Canada uses 16 clinical quality indicators to measure care for all people who get publicly funded aged care services in home and community settings, the paper found.

Among them is daily activity, mood, cognition, falls, pain, weightloss and caregiver distress.

While Canada reports on home care indicators separately, Sweden and the Netherlands embed home care in their overall aged carequality and safety indicators.

Sweden uses indicators including trust in the service, risk prevention, social activities, food and meals, use of psychoactive drugs and continuity of care.

The Netherlands has 20 indicators including care plans, decision making, home cleaning, shared decision-making and daytime activities. It also measures competence, consistency and reliability of care givers.

Policy implications

Associate Professor Caughey says the research has multiple policy implications.

“It is imperative that Australia establish increased monitoring of aged care quality and safety indicators using currently available data to include a range of indicators that places no extra burden to aged care providers.

“An independent regulatory body that oversees the monitoring of quality and safety for both home care and residential aged care be established to improve transparency and accountability of the system.  

“Quality of life data collection needs to also be embedded within data collection in aged care and included within the outcome monitoring system also,” she said.

Comment on the story below. Follow Community Care Review on Facebook, Twitter and LinkedIn and sign up to our newsletter.