The prevalence of and variation in indicators of the quality and safety of long term aged care in Australia, 2019: a cross-sectional population-based study

Objectives: To examine the prevalence of and variation in indicators of the quality and safety of care provided to older Australians who received subsidised long term care during 2019, by type of care (residential aged care or home care packages).

Study design: Cross-sectional population-based study; analysis of linked data from the Registry of Senior Australians (ROSA) National Historical Cohort (National Aged Care Data Clearinghouse, National Death Index, Medicare Benefits Schedule, Pharmaceutical Benefits Scheme databases; South Australian, New South Wales, Victorian, and Queensland hospital admissions and emergency department [ED] presentations databases).

Setting, participants: All people in the ROSA National Historical Cohort who received residential or home-based aged care during the 2019 calendar year.

Main outcome measures: Risk-adjusted prevalence estimates (with 95% confidence intervals, CIs) for quality and safety indicators of care (twelve for residential care, fifteen for home care packages); proportions by indicator of outlier residential facilities and home care services (outside 95% CI for mean value) as a measure of variation in quality of care.

Results: In 2019, 244 754 people received residential aged care in 2746 facilities; 149 104 people received home care packages through 2407 home care services. For residential aged care, indicator prevalence and variation were highest for antibiotic use (prevalence: 64.5% [95% CI, 64.3–64.7%]; 13.9% of facilities beyond upper 95% CI bound), high sedative load (prevalence: 45.2%, [95% CI, 45.0–45.4%]; 12.4% beyond upper 95% CI bound), and ED presentations (prevalence: 37.8% [95% CI, 37.6–38.0%]; 19.3% beyond upper 95% CI bound). For home care services, indicator prevalence and variation were highest for waiting time longer than six months (prevalence: 81.8% [95% CI, 81.4–82.1%]; 17.5% of services beyond upper 95% CI bound), ED presentations (prevalence: 43.2% [95% CI, 43.0–43.5%]; 14.7% beyond upper 95% CI bound), chronic disease management plans (prevalence: 43.2% [95% CI, 42.9–43.5%]; 12.9% below lower 95% CI bound), and home medicines reviews (prevalence: 3.2% [95% CI, 3.1–3.3%]; 28.9% below lower 95% CI bound). The proportions of home care recipients were larger than for facility residents for hospitalisations with delirium/dementia (home care, 10.5% [95% CI, 10.1–10.9%]; residents, 4.3% [95% CI, 4.2–4.4%]), weight loss/malnutrition (home care, 5.5% [95% CI, 5.3–5.6%]; residents, 2.5% [95% CI, 2.4–2.6%]), or medication-related events (home care, 4.6% [95% CI, 4.5–4.7%]; residents, 2.4% [95% CI, 2.3–2.5%]).

Conclusions: The marked national variations by residential or home aged care provider in antibiotic use, ED presentations, high sedative load, longer waiting times for home care services, home medicines reviews, and chronic disease management plans suggest these areas could benefit from targeted quality improvement strategies.