Australian research finds quality of care is below par half the time

The Australian Institute of Health Innovation has unveiled new research regarding the quality of care in residential aged care settings, finding that the majority of common conditions receive treatment that’s below par half the time.

It’s the first study to evaluate adherence to evidence-based care across several common conditions, including continence care, mental health, end-of-life care and infection.

Key points

• Sixteen conditions and/or processes of care were assessed and measured by their adherence to clinical practice guideline recommendations by researchers at the Australian Institute of Health Innovation, Macquarie University
• The results, published in The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records, found that adherence to evidence-based care indicators occurred in 53% of all care encounters
• Continence support had the strongest results at an 81% adherence rate, followed by cognitive impairment (74%) and oral health (65%)
• Depression care performed poorly at just a 12% adherence rate, with medication management (27%) and infection care (35%) also at the bottom of the

Importantly, it’s necessary to note the data collected from the research is from 2021, at a time when the aged care sector was just starting its current reform journey. The findings therefore act more as a benchmark for determining how impactful policy changes and recommendations from the Royal Commission into Aged Care Quality and Safety have been. 

Widespread issues identified

A range of issues were identified in the research, such as the poor management of residents with depression. The research found that only 1% of residents who had been receiving antidepressants for four weeks were monitored every month for side-effects as per the guidelines.

In addition, urinary tract infections were not being managed according to guidelines with limited use of evidence-based treatment combined with an over-reliance on antibiotics.

By highlighting these issues, lead author Professor Peter Hibbert said they want to provide an accurate commentary on the sector, particularly as studies such as this are more common in healthcare settings and not aged care. 

“We are not judging individual aged care providers with these results. This is a commentary on the overall aged care sector which is struggling to provide residents the right care at the right time,” Professor Hibbert said.

“The data for this study was collected around the time that the Royal Commission into Aged Care reported its findings in 2021. The Royal Commission recommended that registered nurses should be onsite 24/7 and that other healthcare staff be more available. These changes are very welcome, however, broader workforce shortages have increased since 2021, which has continued to put pressure on the system.”

Professor Hibbert and his team also discovered varying levels of adherence to evidence-based care at different stages of care with the referral/consultation phase performing the strongest at 65% adherence. 

Treatment (61%) and documentation (56%) followed closely, although there were incredibly poor results for information provision (10%). 

“Being treated according to evidence-based care is a fundamental human right and essential for ensuring people in aged care are safe and experience the best possible quality of life,” Professor Hibbert added.

“Caring for older people in aged care is likely to become more and more challenging as demand increases and resources become more stretched. Understanding where and how evidence-based care is being delivered, or not, is very important to keeping people safe and allocating limited resources.”

Data sets the benchmark

As the research provides an important comparison between the quality of care in 2021 and the present, it offers valuable insights to identify specific conditions and clinical processes where improvement efforts should be targeted.

Key examples include the management of depression where increased monitoring is required for residents receiving long-term medicinal treatments. End-of-life care is also highlighted as less than half (47%) of residents had an individualised care plan that specified how they wanted to die and how they wanted their family to be involved in their final moments.

Rather than painting a negative image of the sector in its conclusion, the research suggests that broader healthcare literature can provide additional guidance for the aged care sector. For example, widespread utilisation of multi-disciplinary teams, structured handovers and communication and stronger clinical pathways can all help enhance care adherence levels.

“The adoption of these strategies should be underpinned by implementation science principles and skilled local clinical governance teams. At a system and facility level, there should be ongoing routine measurement of evidence-based care.”

“Adoption of electronic recording of care can improve both the delivery, via decision support, and efficient measurement of evidence-based care,” the report concluded.