Bottom of the barrel: Some high-star rated nursing homes not what they seem

Comparative data compiled exclusively for the Newcastle Herald reveals the region's average aged care facility rating falls below both the state and national averages.

The Central Coast region is ranked 69 out of 73 aged care planning regions nationwide, federal government data bases show.

The average rating for Central Coast homes falls behind the national average by 6.4 per cent, while homes in the Newcastle local government area fall behind by 5.5 per cent. Overall, the Hunter aged care planning region is ranked 34^th.

Among the deficits identified across the four sub-categories, the Central Coast achieved an average of fewer than three out of five stars for staffing shortages.

At two Central Coast homes more than half the residents were prescribed nine or more medications, 73 and 51 per cent of residents at Catholic Healthcare Our Lady of Loreto Gardens and Southern Cross Care Reynolds Court Residential Aged Care respectively, compared with the national average of 35 per cent.

Four Central Coast homes achieved one out of five stars for quality measures overall, which cover issues such as pressure injuries, fall risks, unplanned weightloss and use of restrictive practices (Vietnam Veterans Keith Payne VC Hostel, Killarney Court Aged Care Facility, Lake Haven Court Aged Care Facility, and Adelene Nursing Home at Wyoming).

Four Hunter homes also scored one out of five stars for quality measures, being Amaroo Aged Care Facility at Charlestown, The Whiddon Group, Belmont; Uniting Elizabeth Gates and Alroy House at Singleton, and Uniting Narla Belmont North.

At three separate Hunter homes more than 75 per cent of residents were subject to restrictive practices, which can be environmental or chemical - all residents of Cooranbong's Avondale House, 88 per cent at Woodlands Lodge, Wallsend, which is five times the national average of 17 per cent, and 76 per cent at Alton Lodge, also at Cooranbong.

The star ratings system, however, does not tell the whole story and the situation is likely a lot worse, critics say.

Of the 20 nursing homes in the Hunter and Central Coast deemed non-compliant by the Aged Care Quality and Safety Commission in the past 12 months, recording failures across three or more of eight quality standards, seven score three (acceptable) and four (good) out of five stars on the My Aged Care website.

Some standards are arguably more critical to residents than others, such as Standard 3 Personal and Clinical Care, not met by 10 of the 20 services named.

Aged care industry stalwart and whistleblower Rodney Jilek, managing director of Aged Care Consulting and Advisory Services Australia, says it is not unusual for compliance scores to contradict Department of Health and Aged Care advice, making it a "useless" reference point.

"The guidelines are so clear about the compliance ratings," he said. "Basically, to get a five star compliance rating you need to have no non-compliance for three years. For a four star rating you need to have no non-compliance for 12 months. Therefore, anyone on the non-compliance register can't have a four or five star rating - not possible."

Part of the problem is that most of the information on which the star ratings are based is self-reported, Dr Jilek says.

The star rating system, which came into effect in December, 2022, is based on four sub-categories: residents' experience (which accounts for 33 per cent of the overall rating), staffing (22 per cent), quality measures (15 per cent), and compliance (30 per cent).

The resident experience component was "completely useless", Dr Jilek said, as it relied on an annual survey of about 10 per cent of residents who could be 'cherry picked'.

"The whole methodology is flawed because the provider has certain - if not complete control," Dr Jilek said.

Dr Jilek also dismisses the quality measures and the staffing elements of the ratings system.

"They are all completely unvetted, provider-supplied data," he said. "There's no checks and balances to say that the data is correct. There's no validation process."

Only the compliance component of the star rating is subject to scrutiny. It is measured against a provider's performance according to government regulations and standards submitted to the department by the Aged Care Quality and Safety Commission.

The commission conducts site audits, interviewing staff, residents, and family members, as well as making observations and inspecting systems and documentation.

The watchdog also publishes audit reports, highlighting issues at individual facilities, however, they contain very little detail compared with the site audit reports on which they are based, and are sent to service providers only.

Dr Jilek says the publicly-available reports are heavily redacted, "sanitised" versions of the originals.

That fact was highlighted in the case of the sanction imposed on Taree's Anglican Care Storm Village in January, 2023. The official report referenced 'gaps' in the management of pressure injuries, and pain "not recognised and responded to appropriately".

Comparatively, for example, the site audit report described a resident crying in pain for weeks leading up to her death, going at least 40 days without pain medication.

An investigation revealed her dressings had not been changed in more than a week. Another resident was described as being in significant pain since October, 2022, which at the time of the January audit was "still currently not being effectively monitored or managed".

Anglican Care Storm Village is still named on the commission's non-compliance register across three standards, including personal and clinical care.