Aged care residents are only receiving appropriate care half the time, and even less often for common conditions including depression, infections and wound care, according to a world-first Australian study.
Research led by the Australian Institute of Health Innovation at Macquarie University, published on Tuesday in the international journal BMC Medicine, found management of depression had the lowest rate of care being given in line with guidelines despite more than half of all permanent aged care residents experiencing depression symptoms.
Prof Peter Hibbert, the lead author, said while previous studies had evaluated a single condition such as dementia or nutrition among aged care residents, this study was the first of its kind to evaluate the adherence to evidence-based care across multiple conditions and processes of care using a standardised method.
The researchers developed a set of 236 quality care indicators for 14 common conditions and processes of care based on more than 5,600 recommendations extracted from clinical practice guidelines from Australia and around the world.
Aged care nurses then reviewed the care records of 294 residents across 27,585 incidences of needing care between March and May 2021 from 25 different South Australian aged care facilities against the indicators established by the researchers.
The study found there was considerable variation, with an 81% rate of adherence for continence care at the highest end but only 12% adherence for depression at the lowest.
The research found that only 1% of residents who had been receiving antidepressants were monitored on a monthly basis for side-effects, as recommended by the guidelines.
Researchers found that on average, residents received care in line with guidelines 53.2% of the time, and less than 50% of the time for wound care, infections, medications, end of life care, depression and sleep.
Hibbert said: “We think [the study] points to those conditions where they are ripe for quality improvement projects.
“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.”
Data for the study was collected around the time the royal commission into aged care reported its findings in 2021, and Hibbert said the study provided a benchmark against which the impact of policy changes could be measured.
The researchers acknowledged limitations of only aged care facilities in one state being able to be recruited due to the restrictions of the Covid-19 pandemic, but said the profile of the South Australian facilities and the residents was similar to those of the whole Australian not-for-profit long-term care sector.
The researchers acknowledged that other limitations of the study meant the reported adherence rates may still underestimate the true extent of compliance with care standards.
Because private aged care facilities could not be recruited, they were removed from the sampling frame, but evidence points to private facilities likely having lower adherence to care standards, the researchers said.
Because researchers also relied on gathering data from aged care homes who agreed to share their care records with researchers, they acknowledged that homes open to this scrutiny could be more likely to be providing better care – a problem known as “self selection bias” which has been acknowledged in similar studies.
Dr Madhan Balasubramanian, a senior lecturer in health and aged care management at Flinders University, said the study “reveals some serious concerns about the quality of care provided to long-term care residents in Australia”.
“The authors rightly point out that this research is the first of its kind in Australia to systematically assess compliance with clinical practice guidelines for multiple conditions in long term care facilities.”
Balasubramanian said the findings from the study should be interpreted with some caution because the small sample size affected precision to some extent, as well as the underrepresentation of rural and remote areas and private facilities.
The authors said one of the most significant reasons behind the low adherence to clinical practice guidelines in long-term care facilities was the shortage of healthcare workers in aged care and lack of proper health workforce planning.
They advocated the need for innovative approaches, including the use of multidisciplinary teams, integrated care provision, structured communication and handovers, involving residents in co-design and establishing local clinical pathways that are evidence-based.
