Residents’ Experience Surveys
(Formerly Consumer Experience Interviews)
Thursday, 9 March 2023
Assistant Secretary, Choice and Transparency Branch, Department of Health and Aged Care
Senior Director, IQVIA Solutions
Dr Lisa Fodero PhD
Chief People Officer, Access Care Network Australia (ACNA)
[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Residents’ Experience Surveys’, ‘(Formerly Consumer Experience Interviews)’, ‘agedcareengagement.health.gov.au’]
[The visuals during this webinar are of each speaker presenting in turn via video, with reference to the content of a PowerPoint presentation being played on screen]
Hello everybody. Thank you for joining us today. My name’s Josh Maldon and I’m the Assistant Secretary of the Choice and Transparency Branch in the Ageing and Aged Care Group here at the Department of Health and Aged Care.
Before we start the webinar today I’d like to acknowledge the traditional custodians of the Ngunnawal Ngambri lands that I’m speaking to you from today and also pay my respects to Elders past and present. And I also want to acknowledge the traditional custodians of the vast lands from which each of you are joining with us today.
So I again wanted to give you all a big thanks for making the time available to have a conversation with us today and find out about what’s happening with 2023 in the resident experience surveys and also how we’re including the feedback of residents in measuring the quality of residential services. If you have questions – and we’re absolutely encouraging questions – please pop them into Slido which you can see there on the right hand side on the right panel there.
So before we go over what we’re going to cover I did want to introduce the other speakers for our session, the representatives from our independent third party consortium who are undertaking the resident experience surveys. I’ve had a range of experience working with contractors while working in aged care and this team has been nothing short of impressive for us on multiple fronts. Their professionalism, their responsiveness and their commitment to surveying as many senior Australians as possible has been absolutely again nothing short of impressive. I’m really glad to be working with them for the second year of surveys.
So we have Leighton Howard who’s the Senior Director at IQVIA. We also have Lisa Fodero who’s the partner at HealthConsult. We also have Rebecca Woods who’s the Executive Director at Access Care Network Australia. So we will hear more from both Leighton, Lisa and Rebecca about their roles in the resident experience surveys a little later on.
So just in terms of an overview in today’s session we’ll reiterate the purpose of the resident experience surveys, talk a little bit about their background and discuss the impact the surveys have on a home’s star rating including how the survey results translate into a resident’s experience rating. We’ll then provide a bit of an overview of how we went in terms of both resident and service survey participation in 2022. Following that we’ll cover off on some early sector insights from the 2022 interviews and also step through some of the findings that we’ve had in the evaluation of the program.
We’ll talk about changes we’ve made to the survey this year and we’ll also talk about the 2023 process in some detail including how the surveys will be scheduled, how residents are selected for participation and also how they’re supported to participate and again give you some insight into the survey team’s training. At the end we’ll have the question and answer session and so please again I encourage you to submit those. We have had some pre-submitted which we’ll cover and again try to cover as many as we can.
[Visual of slide with text saying ‘Section 1’, ‘Background’]
Lovely. So in terms of background just to reorientate you prior to the Royal Commission consumer experience interviews were something that were previously undertaken and published by the Aged Care Quality and Safety Commission during its intense review of aged care. The Royal Commission emphasised the value of these and publishing results and how we could use that to help drive a philosophical shift to place the consumer voice at the centre of the system. So in response to that the Australian Government committed to interviewing at least ten percent of residents in Australian Government funded residential aged care to offer them the opportunity to share feedback on their lived experience. Government also committed to publishing the results of the interviews as part of the star ratings for aged care services.
So based on feedback and insights from stakeholders the Department decided to engage a third party to undertake the interviews. What we’d heard is that sometimes older Australians don’t feel comfortable providing honest feedback either to the aged care provider or the regulator in case there are negative consequences as a result of this. So IQVIA in consortia with HealthConsult and ACNA were successful in their bid and undertook the interviews in 2022. Those interviews were completed in November last year and the results were first published on My Aged Care as part of the new star ratings in December ’22 where you can see that resident experience surveys contribute 33% to the overall rating. Building on the success of this and their experience we extended their contract to complete the interviews for 2023.
So if we move through to the next slide. So the star ratings just to give you a bit of background – the star ratings support older Australians and their representatives to easily compare services and make informed choices based on an overall rating and four sub-categories. As I said resident experience is a 33% weighting, compliance is 30%, staffing minutes is 22% and quality indicators is 15%. The algorithm used to determine the resident experience rating on the screen now matches real world expectations of what one, two, three and four and five star implies. That algorithm was developed after extensive consultation with industry experts, researchers and bodies including the University of Queensland and the Australian Institute of Health and Welfare.
Throughout the process of development we sought the views of the sector and older Australians through 24 focus groups, we had written submissions, a series of monthly sessions with a consumer reference group and sector reference group for quality as well as input from the Council of Elders and the National Aged Care Advisory Council. What we did originally was model historic datasets, so the results of the interviews undertaken by the Aged Care Quality and Safety Commission, and we compared those against the results of the ’22 residential experience data.
From that we could see residents were marking harder which to us confirmed the proposition that we’d heard many times which is that residents don’t always feel comfortable in providing honest feedback unless it’s independent of the provider and the regulator. So we selected the approach which was recommended by the Australian Institute of Health and Welfare and what it does is propose a rules based approach with cut offs aligning with the meanings of star ratings for example three an average, five as great. This approach had the impact of making scoring easier for providers rather than the methodology which had been previously proposed based on historic datasets.
[Visual of slide with text saying ‘Section 2’, ‘2022 Consumer Experience Interviews’, ‘Findings and Results’]
So in the 2022 round of interviews participation was obviously voluntary. We always require consent for surveys. And it’s worth noting that following the surveys all information collected remains anonymous, it’s kept strictly confidential and it is stored securely. Resident identity is not revealed in any review or report which may be published. In total 70,655 residents were invited to participate and out of that we had 38,258 or 54% residents who chose to participate. We had 15,540 or 22% residents who chose not to participate. Where the resident declines to participate the ACNA team thanks the resident and doesn’t ask questions as to why they don’t wish to continue. We had 16,857 or 24% of those residents were unavailable on the day of the visit. And where there’s residents unavailable on the day of visit it’s usually because there may be infectious outbreaks, they’re in hospital or possibly away doing other things.
We had a total of 815 or 2% of participants who actually commenced the survey but didn’t complete all 12 questions. So quite a minor cohort there. We had 37,443 or 98% of those complete all 12 questions who started. That’s over 20% of all residents in Australian Government residential aged care. Of the residents that did participate we had 17,549 or 55% who identified as belonging to a special needs group as defined per the Aged Care Act, 269 or 0.7% used an interpreter, and we had 4,555 or 12% of interviews conducted with residential proxies.
So in the 2022 round of surveys we had 2,646 residential aged care homes participate and then of course on the 19th of December we had the launch of star ratings. And what did star ratings show us in relation to the results? So we had 50 services or 0.8% services at five stars. And what did star ratings show us in relation to the results? So we had 50 services or 0.8% services at five stars and that’s where they’d scored between 45 and 48. 756 services or 37.5% services were at four stars and again that’s where they had a score between 41 and 45. The majority, 1,527 services or 53.4% services were at a three star and that’s with a score of between 36 and less than 41. 241 services or 7.4% at two star, a score between 30 and less than 36, and five services at less than 1% at one star scoring between 12 and less than 30.
We had nine services which received a resident experience star rating but they didn’t get a breakdown of their score against each question and the reason we did that was to protect residents’ privacy. These were smaller services so where interviews were completed with less than five residents but above more than 50% of the target. Five percent services were excluded due to a low sample size. So these were services with interviews completed with less than five residents and there was less than 50% of the required sample target. And that was based on advice that we’d had from the Australian Institute of Health and Welfare from published guidance around the risks of publication where those statistical points are less than five. Five services declined to participate in the surveys and therefore received a one star for the resident experience star rating.
So with that overview I’d now like to hand over to Leighton Howard from IQVIA. Leighton take it away.
Thanks very much Josh. Good afternoon everybody and thanks for your kind words. On behalf of the consortium I think it’s fair to say that we are incredibly proud to be working on this foundational project to help understand the experiences of older Australians living in residential aged care homes.
I’m going to give you a little bit of an overview of the consortium for those of you who are not familiar with the various components. As Josh mentioned there are three parties involved in the consortium. Firstly IQVIA is the lead party and IQVIA is a recognised leader in human data science, clinical services, predictive analytics and healthcare technology. And we’re responsible for the technology solution, for all of the communications that goes out to the aged care homes and the residents themselves. We’re responsible for optimising the scheduling of the aged care facilities and managing the overall project as well as securing the information that we collect. We’ve also been challenged with preparing a sector report based on some deep analyses of the outcomes of the surveys that we conduct.
We also have HealthConsult who’s a professional advisory firm who has a track record of delivering very high quality consulting services to health, aged care and disability sector clients. For the large part they will stay behind the scenes as far as you’re concerned but they’re a very important component of the overall program and they are responsible for the study design, stakeholder engagement to understand how we should be conducting the study, ethics approval, biostatistics, and they’ve also been charged, which we’ll talk a little bit more about later, to do a proxy versus resident response analysis. HealthConsult also act as the independent evaluators of the program and they may reach out to individual aged care homes to do some case studies so you may hear from them directly in that regard.
And then last but not least we have ACNA who is the largest not for profit supplier of assessment coordination and case management services in Australia and they are very much at the coalface. They are responsible for scheduling, reaching out to all of the facilities to provide a time when the interviewers will be conducting the surveys and also for the comprehensive training and recruitment of interviewers that will be interacting with the aged care homes and the residents therein.
If we could maybe just move onto the next slide please.
Now the Department as I mentioned has commissioned IQVIA to undertake an analysis at a sector level based on all of the data that was collected across the 14 questions in 2022. So I’m going to share with you some very early insights noting that the full report will be available on the Department’s website once it’s completed the final review process.
The early insights include such things as residents in medium to large residential aged care homes responded to all of the questions more negatively than those in smaller aged care services.
When we go on to analyse further negative and positive responses what we find is that most positive responses related to the care environment. And when we say the care environment we’ve categorised questions into certain categories and the care environment questions involve those such as ‘Do you feel safe here’, ‘Do you feel at home here’, ‘Do you get the care you need’, ‘Do staff treat you with respect’, ‘Are staff kind and caring?’
What we also noted is that more negative responses related to the organisational aspects of care provision and those questions involved ‘Do you like the food here’, ‘Do the staff know what they’re doing’, ‘Is the place well run’, ‘Do staff follow up when you raise things with them’, ‘Do staff explain things to you?’
Further remoteness of the home, the organisation type, the size of the organisation remained the largest single contributing factor to the proportion of positive responses. And this trend was most significant in the organisational aspects of care provision questions indicating that there are improvement opportunities for these services to enhance the resident experience in relation to staffing, staff communication and food.
So with that little preview we’ll move on to the next slide thank you. What we also did at a very high level was have a look at the responses from proxies or representatives of the residents versus the residents themselves. Now I should preface this by saying that there is a lot more analysis to be done on this data and so this is just a very high level preliminary finding just to whet your appetite for this particular subject which I know is close to everyone’s heart. What we found ultimately was that there was no significant difference between the number of positive responses received by proxies versus residents across the entire dataset. However what we did notice was that proxies responded 14% less positively than residents to the autonomy related questions. However with the staff communication questions proxies’ responses were 6% to 8% more positive indicating differences in the experience of staff communication between residents and their family members.
Again these are only preliminary findings and further insights will be made available once the detailed studies have been completed. And with that I’m going to hand over to my colleague from HealthConsult Lisa Fodero.
Dr Lisa Fodero:
Thanks Leighton. So as Josh and Leighton have mentioned HealthConsult were engaged to do the independent evaluation of the round one of consumer experience interviews. We designed a mixed method approach. So it involved the data that was gathered through the interview process but we also surveyed the residential aged care homes after they’d had the visits to get an understanding of their experience with the interview process and the interviewers.
What we found was that about 30% of the services completed that survey and we found that 93% of them found that the scheduling process was efficient and they appreciated the fact that the Government had invested money in an independent evaluation to gather their feedback on the process. We found that 92% had confidence and trust in the interviewers and felt that the interviewers treated the residents with dignity and respect. The aged care staff valued the interviews as a way for both management and Government to better understand the views and experiences of their residents and they expressed that while they were keen to address residents’ feedback and make improvements it was often difficult due to some of the workforce challenges they experienced.
Also as part of the mixed method evaluation approach we interviewed all the interviewers and they reported that the residents that participated and the proxies were well informed about the consumer experience interviews and they were well supported by the residential homes in being aware of the process that was being undertaken. Next slide.
So the evaluation really was focused about gathering insights and feedback from both residents, staff and the interviewers about possible areas for improvement and as part of that design we visited eight residential aged care homes in Queensland, New South Wales, Victoria and South Australia within two weeks of having the interviewers on site. The key feedback that we got from the residents that were interviewed was that 80% of them who participated in the evaluation recall participating in the interviews themselves, 84% agreed that the Government should ask for feedback routinely, 77% believed that their residential aged care home would act on the findings of the surveys and 94% found that the questions were clear, easy to understand and very satisfied with the process. 75% appreciated that Government had asked for their feedback and thought that the star ratings system would be a useful source of information.
The main feedback we got from residents was around question 12 and that question asked ‘Do you feel at home here?’ Most reported that this could be an emotional question for some older Australians who were struggling about being placed in an aged care home and so the evaluation recommended that this question be modified. Overall residents were positive about the experience and most were happy and comfortable to participate. The main concerns they had related to the lack of staff in the homes and the high staff turnover rates which were impacting the quality of care they were receiving. And back to you Josh.
[Visual of slide with text saying ‘Section 3’, ‘2023 Residents’ Experience Surveys’, ‘Changes implemented and next round’]
Thanks Lisa and thanks also Leighton for that. It’s great to hear about the positive results of the evaluation and it sounds like we do have a really solid platform to continue building on which is great. And also I do look forward to better understanding the insights that we have now on proxies and sharing those with the sector.
In terms of the changes that we’ve made for this year so we have aligned terminology. So we did have the consumer experience interview name that we were using. We’ve renamed that to resident experience surveys and the reason we did that is we wanted to better align the terminology across the information that’s published under star ratings. And the language under star ratings did go through extensive testing with senior Australians.
So we’ve also refined the methodology for small services and services with a higher cohort of First Nations people because we want to improve participation and representation. We’re still finalising the approach but what we’re doing is trialling with three services potential supported interviews with a local Elder and also the option of having a small group interview.
So from the HealthConsult evaluation and from stakeholder engagements more broadly we did hear that residents can find question 12 ‘Do you feel at home here’ triggering as Lisa said. It can be emotional. Some people were struggling with the fact that they were placed into an aged care home. It’s 24/7 care which is communal living. It’s not the same as being in your actual home. So based on that feedback we have changed the question to ‘How likely are you to recommend this residential aged care home to someone?’ That question will still have the four response options, so never, some of the time, most of the time and always.
So also we’ve had improvements in communications and engagement with residential aged care homes and their residents. All services will have the materials they need to promote the surveys and to advise family and friends that they’re occurring as well. We’ve also introduced a refined randomisation sampling method to improve efficiency in the way that this year’s survey will be conducted and to minimise any impact on residents. So what this means is homes will no longer need to provide data files prior to the scheduled visit. Instead the survey support team will approach residents at random inviting them to participate in the survey. Survey support team will have a list of residents. They’ll know which residents are in the special needs groups to make sure that we do have that proportion of people as part of the cohort we do want to interview.
Scheduled survey visits will be done at least four weeks in advance and that’s to make sure that homes have sufficient time to inform residents and families. Improvements to scheduling and surveying to ensure staff and residents have a clear understanding of the residents’ experience survey and how their feedback can be used to improve the quality of care have also been incorporated. The residents’ experience report, we’ll be looking to issue that to the participating aged care homes six weeks after the interviews are finalised. We’re conscious that people want to have that as early as possible, seek to understand that result and engage in conversations with residents about plans for continuous improvement in that space.
So resident experience surveys. We’ve got the surveys that are being conducted at this stage between February, so it’s started, and they’re going to track through to October 2023. So we’ve already commenced. We’ve had 4,000 interviews already undertaken in around 300 homes and where homes didn’t have an interview in 2022 we have prioritised those first. Again aged care homes do receive a one star rating for the resident experience rating if they decline to participate and it has a significant impact on the overall rating at 33%.
Services will still be able to reschedule their survey for example for genuine reasons such as infectious outbreaks and the like. There will be some limited exemptions as well. So for example if you haven’t been operating for 12 months under current owners then you’re not required to participate in the year.
Leighton I might hand over to you for some further detail on the process.
[Visual of slide with text saying ‘Section 5’, ’20-23 Residents’ Experience Survey process’]
Thank you Josh. Happy to take everybody through the process that we’re going to be following for 2023 and give you a little bit more information about the programs and the timeframes.
So firstly as for 2022 the surveys will be conducted across all aged care homes in Australia that receive Government funding. There is a minimum of 10% of residents in each aged care home which excludes those in respite care that will be surveyed however that is subject to minimum participation limits which I’ll talk about in a moment. With the smaller aged care homes obviously 10% doesn’t provide statistical significance or anonymity for such a small number of residents and so in those aged care homes the number of residents that are surveyed will be increased to protect both anonymity and to ensure statistical significance. So overall across all residents receiving Government funded residential aged care we will be surveying approximately 20%.
Now in terms of representation we’ll be using both Government provided and resident collected data to ensure that the Special Needs Group as defined in the Act are represented. And we’re trying to over-represent those special needs groups to the extent that we’re looking for 40% participation by residents belonging to one or more of those groups.
Now due to the importance of the residential experience surveys as an input into star ratings we’re expecting support from close to 100% of Government funded homes. Participation is again voluntary and by participation residential aged care homes are able to update their rating showing the residents that they are committed to making improvements in their homes. But I should reiterate the Department’s message that the impact of non-participation is a resident experience rating of one star.
If we could move on to the next slide please we’re going to talk about the scheduling and visit process very briefly. It’s changed slightly from 2022. Could I have the next slide please?
Great. Thank you. So as I mentioned there’s been a slight change in the process from last year to improve the efficiency of the process and also reduce the burden both on the aged care homes and on the residents themselves. So initial communications have gone out to homes and providers including launch communications and also all of the supporting materials for display and distribution within aged care homes. And following that contact with the facilities via email and telephone will occur from our colleagues at ACNA to schedule a date for the interviewers to come and complete the surveys on site. There will then be reminder calls and emails sent out along with some communication around expected protocols, etcetera, etcetera, and then we will be conducting the surveys face to face on the day.
Once the interviews have been completed both with the residents on site and also with any proxies that have been nominated who are required for the residents we will confirm that we’ve completed the interviews with the aged care home and then within six weeks we’ll be providing an updated residents’ experience report. Shortly after that you will receive a survey which we’d very much appreciate you completing as part of the evaluation process so that we can understand your experience of us collecting the residents’ experience from you.
At the end of the year in December we will provide a report to all providers who have five or more aged care homes in the group so that you can more easily benchmark each of the facilities sitting under that particular umbrella.
And so I’d like to hand over to Lisa who’s going to talk you through a little bit more detail about that resident sample size.
Dr Lisa Fodero:
Thanks Leighton. So in terms of the sample size so this is consistent with the methodology that was used in round one. So the size of the residential aged care homes have been partitioned into seven different groups with the largest and based on the number of residents that live in the homes with the largest home being defined as 150 residents or greater and the smallest homes having 11 residents or less. Based on which of the seven categories a home falls into then there is an agreed number of minimum surveys that will be conducted. At the lower end in those smaller homes of less than 11 residents all residents will be invited to participate in the survey so you’re looking at 100% representation in those homes. Up to the mid-point, sort of the 40-59 size homes where we know about 22% of residential aged care homes are that size, a minimum of 13 will be done so you’re looking at a proportion in between sort of the 100% and the 10% and then when you get up to the larger homes of 150 that’s when the 10% minimum sample size kicks in. So overall you’re looking at between 100% to 10% in the total population and was consistent with the interview done in round one. It was a 20% sample size completed. And so the aim for round two would be to keep it at an overall sample size of 20% noting that there will be a slightly different sample size on the basis of the size of the residential aged care homes.
And in terms of the randomisation approach there were some learnings from the first consumer experience interviews and that was that the randomisation approach which was an offsite randomisation approach was quite burdensome to both the homes and the residents and so some changes have been made here. But consistent with the first round of consumer experience interviews is we’ve designed a randomisation approach that involves two stratum. So we have information on residents in terms of whether they belong to a special needs group or not. We know that we don’t have full coverage of those in the data but that’s why as Leighton mentioned we’re using both I suppose data informed and client informed identification of special needs groups.
By using the initial data we’re then randomising to two different strata. We’ve got a strata that we call the special needs group and the other one called the non-special needs group strata. We’re aiming to get 40% of that minimum number in each home in the special needs strata. We’re aiming for over-representation in the special needs cohort. I’ve facilitated many discussions with special needs groups and peaks and consumers and we know that majority of residents in homes are actually belonging to the special needs group. But I’m happy to say that this is the first study that’s actually had a sample size for round one that included 55% that identified as belonging to a special needs population.
So once they’re stratified into the two groups the change in round two is that we’re doing an onsite randomisation approach and what that means is that this will ensure that residential aged care homes don’t need to provide data before. There are pre-determined lists that they need to inform. Once interviewers get onsite they have the two stratum in their dataset and then they’re given an approach by which each wing is randomly allocated room numbers and then they go visit those residents in each of those rooms until the minimum number in each of the strata are met. If for some reason in a particular home they can’t achieve 60% in the non-special needs stratum they then complete more of the interviews or surveys with those belonging to the special needs stratum. So overall 40% of residents who belong to the special needs groups and 60% in the remaining population.
And now I’ll hand over to Rebecca.
Thanks so much Lisa. So I’m just going to talk about the survey process. I think the most important thing to highlight here is that when our survey team members come to a resident they are there to have a conversation and build rapport to give them comfort before they start. And so when they start the conversation we’re introducing ourselves, the purpose of the survey and we’re referencing the participant information statement.
The team member then looks to seek consent with the resident to participate in the survey and if that participant is unwilling or unable to provide consent, so unable to engage in that conversation and confirm that they can give consent the interview doesn’t proceed. So we will thank the resident for their time and then move on to the next resident.
So consent is determined in a range of ways. For example the interviewers first engage in a conversation as I mentioned before, that conversational approach. Where the resident doesn’t open up to a conversation, does not respond or indicates that they have no interest at that point in time then consent is not obtained and so the interview simply does not commence. Similarly if the resident cannot consent in a meaningful way then the interview doesn’t commence. For a survey to be considered complete the 12 questions need to be answered.
So if we move on to the next slide that really talks to that the residents can withdraw consent at any time during the interview. Where there’s evidence that a participant does not have the capacity to undertake the interview in whole, for example the participants are unable to respond, even if we can revisit questions or we move into a conversation and come back to a question or they can’t effectively engage in the answer then again we don’t continue and we can finalise that interview. Sorry. We can terminate the interview.
The survey approach is adapted to support the residents that are living with cognitive impairment for example. We have things like the visual scale with the black smiley faces on the white paper so that they can clearly be seen and understood in regards to the ratings, the four different ratings that are the response. And one of the important things, that if a resident can’t continue the survey or can’t consent we can then move to connect with their representative. So as you can see by the diagram on the screen we start by seeking the voice of the resident first and then we can connect with their representative and a proxy survey process is undertaken where that resident’s unable to consent.
So let’s move on to the workforce. So our survey team in 2023 are all returning from the 2022 team so that is a lot of experience and a lot of interviews that were conducted. Our core workforce of 17 people in our survey team across Australia, well they conducted 37,000 plus interviews so carrying that experience forward, we’ve refreshed with a start to the year with a big collective training experience and dual interviews, so that we can make sure that we’re calibrating that experience, refreshing it and moving it forward into 2023.
We’ve also completed quality checks on site already to start the year. Big collaboration between team members but also with senior management and our clinical director overseeing that interview process at the start of the year onsite with our survey team. And we completed that on the 3rd of February so we’re already there in homes conducting those interviews.
So I believe that I’m passing that back over to Josh now.
[Visual of slide with text saying ‘Section 5’, ‘Next Steps’]
You certainly are. Thank you so much for that Bec. So in terms of next steps IQVIA sent out their communication packs to all residential aged care homes. They’ve already commenced scheduling and undertaking surveys which is fabulous. If you do want more information about the resident experience surveys and the process please visit IQVIA’s website. So it’s up there. It’s at residentexperiencesurveys.com.au. And what we might do now is head into the question and answer session.
[Visual of slide with text saying ‘Questions?’, ‘agedcareengagement.health.gov.au’, ‘9 March 2023’]
So I’m just looking now and we have had some questions come through on Slido so we’ll start to go through those. The first one we’ve got is:
Q: Will the Commission continue to ask these questions also at site visits?
So the answer to that is no, they’re not actually undertaking the consumer experience surveys. We do have that running through a separate program. But having said that the Commission will still continue to interview around 10% of consumers as part of their regulatory monitoring processes through accreditation and the like.
We have another question on:
Q: Will the quality of life and consumer experience QIs eventually replace the resident experience survey?
Really good question to ask. So that’s absolutely an option that we’ll be providing to Government which would require a Government decision if we were take that forward. From my perspective it makes sense. We are going to have residential aged care services undertaking those tools and so to have alignment with what we do from a third party independent interview space makes total sense to me. But stay tuned for that at some stage in the future. We’ll be having conversations with Government.
Okay. We’ve got another one.
Q: Is the aim for 10% of residents or 20%? Would be keen for this proportion to be high as possible for greater statistical robustness.
Love the comment. Love the concept. Agree with you. And as Lisa said we’re absolutely aiming for 20%. We do no less than 10% at particular services. The more we can do to engage older Australians in this space the better. And as part of that beyond the program that’s why we’re also looking at other options for example through the consumer experience and quality of life tools that we’re rolling out through the quality indicator program.
We did have a question here which Lisa I might head this one to you because I think you provided a really good explanation on it. And that’s:
Q: Will interviewers be seeking representation amongst participants including across different communities, wings, gender, ethnicity, mobility, age and the like?
Dr Lisa Fodero:
Thanks Josh. Yeah. So as I mentioned the randomisation approach does take into account two stratum. There is the special needs stratum so the special needs groups are accounted for which is included I think in the question about ethnicity but other special needs groups as well. Also wings. So with the onsite randomisation process each wing is included so no wing will be missed, so to ensure that the different resident populations are included in the sample. So was that all the question?
Yes Lisa. That was perfect. Well spoken. So Bec I might shoot the next question over to you. So this is one around – and it was one of the ones we had which was pre-submitted. The question is:
Q: How are we supporting people with dementia to meaningfully participate in the process?
Thanks so much for that question Josh. And it’s something that comes up a lot. I think the most important thing is that our team, all of us at ACNA but our team specifically are trained to be inclusive and to ensure that even if someone is living with dementia that we believe their voice is important and their voice needs to be heard. So we give everyone the opportunity to be surveyed for lack of a better word but we do approach everyone. So we approach them, we start a conversation, we introduce ourselves and see if they connect. So the assumption is that someone is able to connect and undertake this survey. We don’t exclude people. And then through the way that we conduct that interview we’re working with the person and their capacity to answer but then of course if they do not have the capacity to answer and make that decision then we don’t push through or continue that interview. We revert to a representative. But at all times we assume that every single person should be included in those interviews.
Thank you for that Bec. So in a really similar vein one of the questions we’ve had is:
Q: Why are you including older people with cognitive impairment such as people with dementia?
And I guess that’s absolutely at the heart of the program. It’s something that the Royal Commission highlighted is that any presumption of an older person’s cognitive capacity can lead them to be excluded from conversations about their care. We’ve got a really firm position going into this that people with cognitive impairment should not be excluded from having their voices heard particularly again when more than half of older people residing in an aged care home can be living with dementia. So dementia advocates really strongly encourage that older people with cognitive impairment need to have a voice and that they do get the opportunity to provide feedback. We’ve assessed the results from the 2022 interviews and we identified that the aggregated average difference between a resident with and without assessed cognitive impairment in their results is less than 1%. So the concerns held by some providers that the inclusion of these residents in the surveys may disadvantage their results is something that we are not seeing in the data.
Q: Are transition care program clients living in aged care still excluded from the resident experience survey program given the updated legislation?
Yes at this particular point in time it is still strictly limited to those residing in residential aged care.
Just scrolling through. See if we’ve got many others.
Q: How do you interview CALD residents when language is an issue?
Really good question. So when IQVIA and the team do the scheduling piece they actually do ask the question whether or not people do require additional support with the survey whether that’s a support person, a proxy of sorts or alternatively where a translator may be required. And translators are absolutely a part of the process where required.
I think we’ve answered most of these.
Q: When will the new star ratings be updated with the resident experience survey results?
Great question. And again some people certainly weren’t happy that they had interviews undertaken early last year and because we didn’t have the star ratings system were unable to publish it until December. We do want to do those more frequently this time round. So I’m working with our IT colleagues to make sure that more frequent updates are possible and the target date that we’ve set is that following June we’ll be able to update these. So if you have your interviews set in one quarter, by the following quarter refresh it will be updated. But again I do need confirmation from my IT colleagues on that. But good question.
I think the only other question that we’ve had, and it was one of the pre-loaded ones, is:
Q: What is the relationship between the consumer experience and quality and the residents’ experience survey?
So those QIs. Again we are introducing those new quality indicators as part of the National Aged Care mandatory Quality Indicator Program from 1 April. But the new consumer experience quality indicators requires providers to report quarterly on the percentage of people who report good or excellent experience of a service using the quality of care experience aged care consumers assessment tool. This assessment tool is different to the residents’ experience surveys which obviously use the 12 questions and we report through the star ratings. And again we are looking at options to explore alignment with those particular programs. Any decision will be obviously for Government. We’ll absolutely communicate it to you in advance to the sector through our regular channels.
Another question come in.
Q: How is the star rating affected if the provider agrees to the survey taking place but not sufficient residents agree to participate?
So again that’s something that we spoke about earlier in the actual presentation, that where we don’t have the numbers that actually that part of the component doesn’t feed in. And so what you’ll end up with a star rating is the components that you do have but you won’t have an overall star rating to make sure that you’re not unfairly impacted.
I think all the questions have stopped flowing through.
So look we might look to wrap that up then. Great questions. Appreciate the engagement. I want to give you a big thanks for making the time. If there’s questions that come through after the fact happy to look at those and of course we’ll publish those responses to those. We’re happy to get back within about two weeks if we can see key themes, key questions coming in, those sorts of things.
Again just make you really aware that from April those new quality indicators are coming into play through expansion of the QI program. Another thing that I just did want to flag in relation to the star ratings system is that over the next few weeks we’ll be starting to look at recalculating star ratings for the new quarterly update. To make sure that you do get your star ratings I really encourage you to find out who in your organisation is a My Aged Care org admin user and make sure their contact details are up to date in the system or get your details in the system to make sure you can get timely access to that star rating.
If you want to hear more information on this particular program please join us again for a webinar on 28th of March at 2:00pm. You can register to attend by visiting the webinars for the aged care sector page on the Department’s website. We do have a link there on the slide. And again just want to do a shoutout for the second aged care sector pulse survey which is currently open for responses. Absolutely always keen to hear from you. It gives us really important insights into how you’re going with adopting recent reforms and also your awareness, preparedness and additional support that you might require for upcoming ones. The survey only takes less than ten minutes. We do that quarterly to make sure that we can track progress and adapt as appropriate over time. And again that link is there on the slide.
There’s also a post-webinar survey at the end. Again if you’ve got the time please we appreciate your feedback because it helps us improve the delivery of content to you guys in these webinars going forward. Again a big thanks. Hope it’s been informative. Look forward to connecting with you all soon. Thanks everyone.
[Closing visual of slide with text saying ‘Next Steps’, ‘Aged Care Sector Pulse Survey’, ‘The Aged Care Sector Pulse Survey is currently open’, ‘The survey is available here: www.agedcareengagement.health.gov.au/get-involved/’, ‘New residential aged care quality indicators launch 1 April 2023’, ‘To help providers prepare, we are hosting a QI Program Webinar. Please register at: www.health.gov.au/resources/webinars’]
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