Australia’s aged care sector is facing the consequences of a long-term data vacuum. Recommendations across numerous inquiries, including the 2021 findings in the Royal Commission into Aged Care Quality and Safety, note the complete lack of development of the quality data required to provide clear, concise, person-centred information that can be utilised to meet the needs of Australia’s rapidly aging population. This blog aims to highlight that although there is currently a marked absence of useable data within the Australian aged care sector, the collection of quality data, and the sophisticated use of it, has shown numerable benefits internationally and in Australian testcases, providing hope and possibilities for the future of aged care.
Australian population over 65 is set to become 21%, or
more than 5 million people by 2024, before rising to over 25% by the mid 2030s 2.
Australia is on the cusp of an ageing population crisis. In 1900, 4% of the Australian population was over 65 and by 2010 it was around 14%1 . But with the 5.2 million Baby Boomers poised to retire and move towards aged care services. In addition to the increase of over 65s, the proportion of more complex medical needs has increased by almost eight times3 and the number of people using in-home care has tripled4 over the last 10 years. This is leading to a substantial complexity in the current structure and funding of the Australian aged care system.
As of 30 June 2020, over 1.3 million people accessed aged care services5 , at an annual cost of $21.5 billion6 . However, Baby Boomers not only encompass the largest cohort in history that will require aged care, they are also known as a generation that drive radical cultural change as they descend on history. As the first of the increasingly tech savvy generations to retire, Baby Boomers won’t only have greater health complexities, they will demand personalised, lifestyle-focussed aged care experiences7 , with studies reporting that 76% of them will expect to stay in their own homes and only 1% are willing to enter the residential aged care system in its current format8 .
There is a general consensus that Australia has fallen 5-10 years behind the rest of the world in the creation and use of mature, interoperable aged care data systems
Setting aside the shifting demands of those on the verge of entering the aged care system, the burgeoning numbers alone present a real risk to the care of the elderly and the already groaning structures that support them. In its 2020 report into the aged care system, the Grattan Institute recommended an additional $7 billion would be required to improve the current system annually, which is an increased federal budget spend of 35%9 . However, they also warned that access to appropriate levels of funding is only the beginning of a long road to better support the over 65 population in the years to come.
The remainder of the long road is described in detail in the Royal Commission into Aged Care Quality and Safety10 . Throughout the extensive 5-volume report, filled with 148 recommendations, the Commissioners repeatedly observes the lack of useable, relevant and accessible data, at one point noting:
The Australian Department of Health should have access to comprehensive data to assess the performance and impact of services provided to older people. It does not. There is a lack of data collection, poor interoperability between databases and an absence of data analysis. As a result, as we have indicated, no one is in a position to evaluate the performance of the whole of the system over the long term against appropriately defined goals”11
There is a general consensus that Australia has fallen 5-10 years behind the rest of the world in the creation and use of mature, interoperable aged care data systems 12,13, and expert witnesses during the Royal Commission stated that Australia is currently going backwards in its approach to data 14. The Royal Commission’s study into international care systems found that one of the consistent qualities of the best performing aged care systems were those with a long-term focus on standardised quality care indicators and well governed data processes. This allowed policy makers and providers to make care decisions based on information on the ground in real time 15.
The lack of useable data in Australia presents a huge risk to aged care services, not only to those in government seeking to access an objective appraisal of quality within a system that spans all levels of government, healthcare and private enterprise; but also to providers who are currently unable to assess the success of any quality improvement strategies or programs; and families who are making aged care choices with a lack of basic information and transparency 16.
As we note in our paper ‘5 Good Data Governance Principles’, an organisation that succeeds in becoming mature in its data management is able to trust their data, and the subsequent analysis of that data 17. Indeed, one of the few systematic reviews into data in an Australian aged care context concluded that “Despite the limited number of studies, electronic systems were positively reported to improve data quality, efficiency, information access and communication processes in the aged care setting. [This represents] an argument for a national approach to information management in aged care to address multiple stakeholder information needs and more effectively support client care” 18.
A mature data environment within the aged care sector, with a ‘collect once, use many times’ mindset would have multiple benefits for government, providers and consumers 19.
|Support||Support in making effective strategic decisions||Ability to support assessment and care planning decisions||Clarity of their own care needs, providing comfort and agency in discussions with the multiple areas of care||Access to care plan for the consumer, ensuring all assessment and care planning is available throughout the consumer’s care|
|Planning and Monitoring||Ability to access the requirements of consumers in real time to plan funding accordingly||Planning for numbers and specific requirements of consumer needs||Ability to monitor their own care plan, allowing real time access to their progress and progression through the system||Ability to plan for numbers and requirements of consumers needs|
|Transparency and Decision Making||Quality accountability through quality indicators and other measures||Quality improvement and planning||Transparency of choice in programs and providers||Decreased discovery load of each consumer’s care plans, referrals and discharge information with single point access to required information|
It will take a substantial focus and effort of stakeholders in the aged care sector, supported by the IT Sector, to develop and maintain the quality of data required to turn the Australian aged care sector into the person-centred, care driven industry that it can be.
Repeated studies by BizData and others have shown that a sustainable and successful implementation of data systems leading to trustworthy data requires, “establishing an operating model, having a clear-decision making process for investment in data, understanding the importance of context to data utility, effectively monitoring and acting on data quality issues as well as centrally managing business rules are at the core of establishing, enforcing, and maturing a unified data-centric culture” 20,21,22. Ongoing input and support will be needed from groups such as, “aged care operators, aged care consumer representatives, the government (through agencies such as ADHA and AIHW), IT vendors, software developers, researchers, clinicians, informaticians, clinical modellers, industry leaders, and bodies representing aged care operators and IT vendors” 23 . Testcases for the use of data in Australian aged care settings have proven unequivocally beneficial and supportive in developing a person-centred care system.
- A point of care digital system for documentation and care planning at a residential care facility in Canberra provided a 20% saving of nurses’ time by preventing duplications and providing a single point of access to patient information 24.
- The implementation of an electronic medication management system at two Australian teaching hospitals found that prescribing errors reduced by more than 50%, as well as producing a significant reduction in the gravity of the medication errors that did occur 25, with one of the paper authors concluding that “no other intervention has ever produced such improvements in medication safety; one of the most intransigent barriers to safer, better-quality healthcare” 26.
Quality data provides useable intelligence, insight and revelation. Perhaps most tellingly it illuminates. It is the beacon with which Australia’s aged care system can begin to navigate.
Throughout this blog, we have focussed a lens on the possibilities offered by mature, well-supported data environments that can begin to solidify a foundation for the future of aged care offered in Australia. We hope that we have shown that although there are currently significant gaps in standardising the collection and use of data, there is an increasing understanding that quality data is important and necessary for a system moving ever closer to person-centred care. With a rapidly aging, increasingly demanding population; and under the spectre of the 42nd, and most critical, report about the Australian aged care sector since the 1980s 27, it is time for policy makers across government, departments and providers to act now .
As has been shown in other countries and other areas of health, the opportunities offered by the collection and management of quality data are wide-ranging and far-reaching. A data-driven care system to be proud of beckons.
1. Hal Swerissen. Health and Ageing in 2025: the ‘boomers’go grey. Worner Research Lecture 2005
3.Gibson, D. (2020). Who uses residential aged care now, how has it changed and what does it mean for the future? Australian Health Review, 44(6), 820. doi:10.1071/ah20040
4.AIHW. (2021, April 27). People using aged care. Retrieved from https://www.gen-agedcaredata.gov.au//Topics/People-using-aged-care
6. Australian Government Productivity Commission. (2021, January 20). 14 Aged care services. Retrieved from https://www.pc.gov.au/research/ongoing/report-on-government-services/2021/community-services/aged-care-services
7. Sivathas, S., & Lanfranconi, S. (2020, January 22). Baby boomers' demands will transform aged care. Retrieved from https://home.kpmg/au/en/home/insights/2020/01/20-predictions-for-the-next-20-years/baby-boomers-demands-transform-aged-care.html
8. RSL LifeCare. (2020, November 30). Baby Boomers: Aged Care Research. Retrieved from https://rsllifecare.org.au/latest-news/media-and-pr/baby-boomers/
9.Duckett, S., Stobart, A., and Swerissen, H. (2020). Reforming aged care: a practical plan for a rights-based system. Grattan Institute
10. Pagone, T., QC, & Briggs, L., QC. (2021). Final Report of the Royal Commission into Aged Care Quality and Safety (Australia).
11. Royal Commission into Aged Care Quality and Safety, Transcript, Final Hearing Day 1, Peter Rozen, 22 October 2020 at P9684-5
12. Intersystems. (2020). FHIR and the future of interoperability in Australian healthcare. Retrieved from https://6degreesmedia.com.au/wp-content/uploads/2020/07/Intersystems-2.pdf
13. The Weekly Source. (2019, December). "We don't have a clue": Australia five to 10 years behind other countries on collecting data in residential care, geriatric medicine experts tell Commission. Retrieved from https://www.theweeklysource.com.au/we-dont-have-a-clue-australia-five-to-10-years-behind-other-countries-on-collecting-data-in-residential-care-geriatric-medicine-experts-tell-commission/
14. Royal Commission into Aged Care Quality and Safety, Transcript, Canberra Day 72, Professor Leon Flicker, 12 December 2019 at P7512
15. Dyer, S. M., Valeri, M., Arora, N., Ross, T., Winsall, M., Tilden, D., Crotty, M. (2019). Research Paper 02 - Review of International Systems of Long-term Care of Older People (Australia). Adelaide, SA: Royal Commission into Aged Care Quality and Safety
16. Pagone, T., QC, & Briggs, L., QC. (2021). Final Report of the Royal Commission into Aged Care Quality and Safety (Vol. 3B) (Australia). pp. 578-585
17. Rayman, N. (2020, January). 5 Good Data Governance Principles. Retrieved from https://www.bizdata.com.au/blogpost.php?p=5-principles-for-good-data-governance
18.Davis, J., Morgans, A. and Burgess, S. (2017) ‘Information management in the Australian aged care setting: An integrative review’, Health Information Management Journal, 46(1), pp. 3–14. doi: 10.1177/1833358316639434.
19.Dendere, R., M. Hargrave, J. Ferris, K. Ebrill, I. Frean and L. Gray. (2021). A compelling case for the development and adoption of data standards and interoperability in the Australian aged care sector – White Paper. The University of Queensland, Brisbane, Australia
20.Rayman, N. (2020). 5 Good Data Governance Principles. Retrieved from https://www.bizdata.com.au/blogpost.php?p=5-principles-for-good-data-governance
21.Mcdonald, T., & Russell, F. (2012). Impact of technology-based care and management systems on aged care outcomes in Australia. Nursing & Health Sciences, 14(1), 87-94. doi:10.1111/j.1442-2018.2011.00668.x
22. Yu, P., Zhang, Y., Gong, Y., & Zhang, J. (2013). Unintended adverse consequences of introducing electronic health records in residential aged care homes. International Journal of Medical Informatics, 82(9), 772-788. doi:10.1016/j.ijmedinf.2013.05.008
23. Dendere, R., M. Hargrave, J. Ferris, K. Ebrill, I. Frean and L. Gray. (2021). A compelling case for the development and adoption of data standards and interoperability in the Australian aged care sector – White Paper. The University of Queensland, Brisbane, Australia
24. Bail, K., Merrick, E., Gibson,D., Strickland, K., Smith, B., Hind, A., Vann, B., Jojo, N., Paterson, C., Redley, B. (2021). Evaluation of ACE in residential aged care: The impact of a digital point-of-care system on residents and staff. University of Canberra
25.Westbrook, J. I., Reckmann, M., Li, L., Runciman, W. B., Burke, R., Lo, C. et al. (2012). Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study. PLoS Medicine, 9(1). doi:10.1371/journal.pmed.1001164
26. Armstrong, D. R. (2019, July). Harnessing the power of informatics to improve aged care. Retrieved from https://www.croakey.org/harnessing-the-power-of-informatics-to-improve-aged-care/
27. Royal Commission into Aged Care Quality and Safety. Background Paper 8; A History of Aged Care Reviews. Appendix: Non exhaustive list of major reviews and inquiries into aged care. p. 52