How to check if your mum or dad's nursing home is up to scratch

If you’ve read the headlines about poor standards in Australia’s nursing homes, it’s only natural to be concerned about your own family or friends in residential aged care.

For instance, there was news in recent weeks that 45 of 72 Bupa nursing homes in Australia had failed to meet all health and safety standards, with 22 putting residents at “serious risk”.

Then there are the harrowing stories of neglect and abuse coming from the Royal Commission into Aged Care Quality and Safety, which is due to release an interim report by the end of October.

So, how do you check if your loved one’s nursing home is really up to scratch? How do you interpret audit reports about residents’ health and safety? And how else could you find out if your mum or dad’s nursing home lives up to the promise of its marketing brochures?

Who keeps an eye on nursing home standards?

Every nursing home in Australia receiving government funding is assessed and accredited by the Australian Aged Care Quality and Safety Commission. Assessments are conducted every three years or more often if there are concerns.

Commission staff check if each nursing home meets eight minimum standards. These include whether residents are treated with respect, the nursing home is providing safe and effective clinical care, and staff have adequate qualifications and training to do their jobs.

Commission auditors interview residents, families and staff; observe care; and review the facility’s documentation. Visits can be unannounced to get a better picture of what regular care is like. Auditors then use that information to write a site audit.

It takes about a month after a site audit for the commission to decide on the quality of care. Then there’s up to another month for the audit report to be posted online.

Posting the decision publicly can be delayed further if a nursing home asks for the decision to be reconsidered. We understand this often happens if a home receives a poor report.

What is a bad report?

When a home is judged as not meeting standards, the commission will decide how serious it believes these deficiencies are. In increasing order of seriousness, the report says if a home is:

1. Not meeting standards. Nursing homes can be judged as not meeting one or more of the eight minimum aged care standards. Each standard has three to seven individual requirements. Nursing homes don’t have to meet all the individual requirements to meet the overall standard. The more standards or requirements a nursing home fails to meet, the poorer the care.
2. Serious risk. If a nursing home is given a “serious risk” judgement, the quality of care has placed or may place the safety, health or well-being of a resident at serious risk. An example might be a home not having enough skilled staff, leading to clinical mistakes, such as the wrong medication administered often.
3. Sanctions. Sanctions are imposed on homes when care places an immediate and severe risk to residents’ health, safety or well-being. This might be for multiple organisational problems (such as with clinical care, staffing, wounds not being cared for), leading to multiple poor outcomes (such as assault, avoidable illness, and the dangerous administration of medication). Homes can also be sanctioned if they do not fix continued non-compliance.
4. Revoking accreditation status. If sanctions are imposed and there is no improvement, the commission can revoke a home’s accreditation status. This means a home cannot take new residents or receive government subsidies. Some of these homes reapply for accreditation, others shut down.

Families are notified in writing, and facilities must hold a meeting for residents and families to tell everyone what the problems are and how they will fix them by a certain date.

When a nursing home is sanctioned, it is penalised in several ways, depending on what was poor about the care:

• the home is not allowed to receive Commonwealth subsidies for any new resident for a set time (usually six months) and

• an adviser and/or administrator is appointed to the home to help it comply with its responsibilities and/or

• the home provides specified training to staff within a set time.

A home’s history of non-compliance, serious risk decisions and sanctions are archived online (see below for details). So it might be worth taking a look when choosing a nursing home, as well as checking on an existing one.

How do I find out? Look online

The most up-to-date information on nursing homes not meeting standards (non-compliance) and sanctions is through myagedcare’s non-compliance checker. This allows you to see if an individual home has not met standards, is sanctioned currently or has been in the past. Some archived sanctions on the website go back to 2002.

However, the myagedcare website doesn’t list “serious risk” reports. For those, you have to go to the Aged Care Quality and Safety Commission’s website.

You can also search the commission’s website for audit and consumer experience reports, which provide more detail on the quality of care.

Audit reports can be difficult to understand because their intended audience is aged care professionals, not the general public. Reports before July 2019 are on the 44 old aged care standards. Reports from July 2019 are on the new eight standards.

Consumer experience reports show what residents said about their care. That’s from whether staff followed-up when they raised an issue, to what they thought about the food. These reports are easier to follow.

How do I find out? Other ways

It can be hard for family to know if their expectations for care are reasonable, particularly when feelings of sadness and guilt colour those expectations.

So, it can help to consider the aged care standards when making your own decisions about whether the quality of care is good enough.

You can do this by observing what happens day to day. Do residents wait too long for attention, for instance, to be taken to the toilet? Do staff speak respectfully and kindly to residents? Are meals appetising and healthy? What happens when residents are distressed? Is there high staff turnover?

Does the nurse on duty know the detail of your loved one’s clinical needs, for instance, diet, illnesses or medications? Is the manager responsive when you raise issues?

You can also talk to other families about their experiences of care.

What should I do next?

If you find that your loved one’s home doesn’t meet standards or is sanctioned, here’s what to expect.

The commission gives the home a set period of time (usually three or six months) to improve care. Commission staff keep visiting the home until they are confident the home is meeting standards.

You will probably want to visit regularly and keep an even more careful eye on your mum or dad’s care. Speak to the home or commission about any concerns.

You can ask your home’s management:

• about its plan to improve care
• about staff changes and staff ratios — staff often leave or are asked to leave when there are sanctions and lots of new and agency staff are a challenge to providing quality care
• for regular written updates and meetings including actions taken and the outcomes. This could be data on the home’s use of antipsychotic medications, and how often residents have falls, critical incidents or pressure ulcers.

As a resident or nominated family member, you have a right to information and to complain about your loved one’s aged care.

When should I consider switching to another home?

The issue of whether to move a loved one to a new nursing home is a difficult one. It’s a personal decision involving weighing up the negative impacts you think the care is having with your own energy levels, funds and whether you can find a suitable new home.

Government reforms presume market forces will drive up the quality of aged care. In the meantime, we hope the resources in this article will help you make a more informed decision about your loved one’s care.

This article was first published on The Conversation and is written by Associate Professor Lee-Fay Low from the University of Sydney School of Health Sciences.

Declaration: Lee-Fay Low collaborates with and has received funding from multiple aged care organisations and sat on committees for the Australian Aged Care Quality Agency, the predecessor to the Aged Care Quality and Safety Commission. She is funded by an NHMRC Boosting Dementia Leadership Development Fellowship and has received funding from the NHMRC, Department of Health, NSW Health, Dementia Australia and other research funding organisations.