With a flurry of review and ratings sites recently launched or in development, aged care is now firmly a sector at the mercy of consumer opinion. While greater information is welcome, these sites raise issues around transparency and verification, and for providers the question of how to respond. Ruth Callaghan reports.
Your hotel bathroom was dirty? Your meal arrived cold? That shop assistant was a little rude? Many of us think nothing of dashing out a review on things we do and buy, with websites rating everything from cafes to colleges.
You check Urbanspoon before you book a table and read Tripadvisor before you choose your hotel — so should aged care be any different?
While the sector has largely remained outside this consumer-driven system, that is changing, with a flurry of review and ratings sites launched or in development.
Price and quality are not the same
It is a trend that has accelerated with the listing of facility prices on the My Aged Care website, which — while increasing transparency around cost — says nothing about the care those funds will buy.
“Price is only one part of a value equation,” says Rachel Lane, who leads the Aged Care Gurus network of financial advisors. “Just as you won’t pay $100 to eat at McDonalds but you might pay $100 to eat at Vue De Monde, people want to know that the price they are paying represents a certain level of quality and that’s not unreasonable. That’s where rating systems are good as they help inform that judgment, as if you just look at a facility on price alone it won’t tell you quality or value.”
The source of the advice matters
Lane says her clients frequently ask for advice on choosing a facility, and are referred to placement agencies or told about emerging sites that might help. But she believes caution is needed in how facilities are rated.
“Public sites that don’t measure whether the person making a review is in a position to make a proper judgement are quite dangerous,” she tells Australian Ageing Agenda.
“A rating system done by someone who is an industry expert who has the necessary background knowledge and can walk into a facility and form a really good judgement — well that’s why we use placement consultants.
“As financial advisors we walk into a facility and notice the same thing a client would: are the furnishings pretty, does the food smell good, are the staff happy. But you aren’t there for pretty curtains. You are there for really good care,” says Lane.
Ratings sites are one option
There are different approaches being taken to assess quality, including applying to aged care the same kind of ratings used by hotels.
Ansell Strategic’s Cam Ansell has co-founded AgedCareRatings.com.au with Ben Hannemann and Dana Sawyer from Millennium Aged Care Placement Consultants.
The new site provides self-reported and accredited ratings using a detailed tool that measures categories including physical form, catering, staff culture and activities.
Each category has numerous indicators, so the rating of the building might include whether it is old or modern, home-like or institutional, is accessible, has functional common areas or offers a welcoming ambiance.
Ansell says the decision to make the self-rating tool free was driven in part to reassure the sector. “One of the areas of resistance was that people who had older homes get nervous because they don’t want to advertise that they have a 2 or 2.5-star home and even providers of modern homes might only want to rate those that are new and not any older ones,” he tells AAA.
“We have made the self-rating free and it takes about 30 to 45 minutes to do. It then gives you a self-rating number that might give you 4 or 4.5 circles, which is the self-rating measure as it is with hotels. If you want to have an assessor come out, they will then use your self-rating and verify it. That then results in a star rating and there’s opportunity for consultation.”
The developers have worked with larger providers in test sites to see if the measures back up what Ansell calls his “gut rating” of how a facility feels when walking in.
“We have tweaked the tool enough now that even in those cases where we have adjusted down the self-appraisal, the provider has been pretty happy with the outcome,” he says.
Ansell says he is personally uncomfortable with comment-based rating sites but understands the rise in their popularity. The goal of AgedCareRatings was to offer an independent, professional voice, he says.
“I find [review sites] are usually populated with extremes of views: they have either had a great experience at the restaurant or a terrible experience,” he says. “I expect there will be more of those sorts of ratings as consumers get a greater say in services but this is an opportunity to get some more objective measures.”
Review sites are coming, like it or not
The Federal Government has signaled that it welcomes consumer-led reviews of aged care, with Assistant Minister for Social Services Mitch Fifield telling the Committee for Economic Development of Australia in late 2014 that he foresaw My Aged Care becoming a “Tripadvisor for aged care services”.
In the meantime, non-government sites have sought to enter the same space.
AgedCareReviews.com.au promises an online community and searchable review site, although there appear to be only a few reviews so far.
The National Roads and Motorists’ Association (NRMA) is looking to launch a review and rating site for retirement villages, in-home care and residential accommodation attached to its newly released Living Well Navigator tool.
While the group won’t comment publicly about the service, providers have been told that they can pay a fee of $2900-$3900 in return for an ‘OWL rating’ and a further fee to upload photographs or feature higher on the list. Consumer reviews are part of the planned package, with NRMA members able to post reviews and comments that will be moderated after posting.
Similar measures have been put in place by AgedCareReportCard.com.au, which is another site that describes itself as consumer-driven but inclusive of industry.
Launched in October by registered nurse Lauren Todorovic, the site was prompted by her experience fielding queries from families needing to find an aged care facility.
“There was just nothing out there that captured people’s experiences in a centralised platform,” Todorovic says. “Families want to know what the care is like and the service being delivered. They can look at a facility but right now there is nothing out there utilising consumer experiences to share them with others before they enter aged care.”
The site has more than 150 report cards already, many positive but some critical of facilities. One site in Victoria scores 2.1 out of five (one out of five for management responsiveness), with the two-word review saying only “overall poor.”
Providers should question poor reviews
Todorovic understands that criticism of facilities may be difficult for providers but insists her site has positive goals. “The initial idea of being transparent is confronting for some providers but we are coming at this from a positive angle,” she says.
“It is not a complaints website. It is about sharing people’s experiences so that as more and more people use it, we generate improvements in the industry because we are listening to what people who use the services are wanting.”
The site’s reviews are monitored and facilities can follow up on reviews they believe are unfair.
“We have risk strategies in place so that when people leave a review they need to leave a minimal amount of information and we have designed the back end so we do some monitoring as well. Any individual concerns or complaints — anything personalised — needs to be taken to the facility.”
Families today, residents tomorrow
Todorovic believes that while family members are driving reviews now, this will change as the number of technologically savvy older people increases — and this might force providers to engage.
COTA Australia chief executive Ian Yates says there is a lot of interest among its constituency in the development of rating sites, although he also cautions the need for transparency and verification.
“We are seeing diversity in the approaches and that’s inevitable but will evolve over time,” he says. “There’s not at the moment a rating site on the degree of choice and control that residents and customers of home care experience and we know that is an important consideration.”
Yates says there is a growing expectation among older people to be able to access information online.
“Yes there are older people who don’t go online, just as there are younger people who don’t, but the vast bulk of those people’s families do and they want to shop around,” he says.
“Putting prices for the residential context online has been an important development but getting feedback from people within the facilities is something that they will take quite seriously.”
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