A pilot of quality indicators for home and community care remains on hold until further notice, as new research shows Australia is lagging compared to other countries.
PWC launched a project last September to identify, assess and pilot evidence-based quality indicators across five areas and examine assessment tools for a consumer experience and quality of life.
While the pilot in residential aged care went ahead, the government says the pilot for in-home was postponed to “support greater alignment with” the new Support at Home Program” which was due to begin this month.
“Further information on timeframes will be made available in the coming weeks,” PWC says on its website.
It comes as new research highlighted that Australia is lagging behind other countries in implementing QIs in home and community-based aged care.
An early view of the report by researchers form Macquarie University was published in the Australian Journal on Ageing online this month.
“Australia has lagged behind some other countries like the US and NZ who have used home care quality indicators for a while,” Dr Mikaela Jorgensen, Adjunct Fellow at Macquarie University told Community Care Review.
The researchers assessed 37 peer-reviewed articles from a range of countries including the US, UK and Canada and identified three routinely used home care quality indicator sets.
The QIs measured aspects of home care quality including daily activities, falls, caregiver distress and hospital admissions.
However, the review also found gaps in the QI sets, which the researchers say should be considered by policymakers, researchers, and other stakeholders when developing and applying quality indicators in an Australian setting.
Dr Jorgensen says many of the quality indicators the research team looked at didn’t have strong scientific evidence to back their use, and none measured quality at a system level, such as home care waiting times.
“Just over half of the international indicators could potentially be calculated from existing Australian datasets, such as hospital data, but this would miss some aspects of home care quality that older Australians say are important, like quality of life,” she said.
The report says more than three quarters of Australians using aged care services access support via HCP or CHSP, and demand for these services is significant.
It says that standardised, evidence-based measures of quality of care can help governments and providers drive improvements in care and enable consumers to make informed choices.
Australian residential aged care services have been required to report quarterly as part of the National Aged Care Mandatory Quality Indicator Program since 2019, but, there has as yet been no formal implementation of quality indicators for home- and community-based aged care services.
A set of home care quality indicators was piloted in 2016 for the Australian Department of Health and the then Aged Care Quality and Safety Agency – but they weren’t taken up and details on how the specific tools were selected and appraised in the pilot aren’t publicly available.
In response to the aged care royal commission, the federal government announced last year that it would expand the national aged care mandatory quality indicator program to home care and engaged a consortium consisting of PWC, the Centre for Health Services Research at the University of Queensland and the Registry of Senior Australians.
The government announced in February the pilot had been postponed.
Unique QIs needed for home care sector
Dr Jorgensen says it’s important to have quality indicators that are unique to home and community-based aged care.
“Core goals such as maintaining independence, setting, funding model and service delivery can differ markedly from residential aged care,” she says.
“The lack of quality indicators also means it’s hard to measure the impact of ongoing policy changes in the home care sector – are things getting better or worse? “
Dr Jorgensen says it’s important that QIs that are relevant to and designed to improve the standard of home care are included in the new support at home program.
“As the system changes over time, home care indicators should be revisited to check they are still relevant to older Australians and the system, and actually being used to improve home care,” she says.
It’s important to consider the views of those at the centre of home care provision in any QI design, adds the report’s lead author Dr Hui Yuan Foong.
“Incorporating consumer voices is central to ensuring that quality measurement actually improves the lives of those for whom the system is designed,” Dr Foong told Community Care Review.