What predicts consumer experience in residential aged care? An analysis of consumer experience report data

Objectives This study explored whether consumer experience report (CER) data from residential aged care services (RACSs) could be combined into a general factor and determined whether poor experience in RACSs could be predicted by known resident or home characteristics or sampling procedures. Methods CER data collected by structured interviews in 2018 and early 2019 were analysed using structural equation modelling and linear regression analysis. Results Data were available from 17194 interviews undertaken at 1159 RACSs. The 10 CER items loaded onto two independent factors. Bifactorial modelling indicated that items could be combined into a general factor. Controlling for state or territory, consumer experience was best predicted by home size: those in large facilities reported poorer experience than those in smaller facilities. Other significant negative predictors with small effect sizes included not being independently mobile, being male and not being randomly selected. Dementia did not predict total CER score. Conclusions The results of this study support the inclusion of people with dementia and exclusion of volunteer participants from published CERs. Further research is needed to explore why a relatively poor consumer experience is reported by people in larger homes, men and those with mobility issues. What is known about the topic? Poor experience in aged care is a persistent concern for government, individuals and aged care services. The recent Royal Commission into Aged Care Quality and Safety has identified systemic failure. Although many organisational features and processes have previously been identified as important in determining the quality of care, few studies have explored the characteristics that predict the consumer experience of residents in aged care. What does this paper add? This paper provides empirical evidence that several variables influence consumer experience in aged care, including facility size and resident sex and mobility. There is evidence that smaller facilities provide care that is perceived better by residents, and that men and people with mobility issues have worse experiences in aged care. There is a lack of clarity as to what other influences, such as facility ethos, facility location and staffing levels, may contribute to resident experience. Such clarity is important, because Australian aged care is currently facing comprehensive scrutiny, and governments are looking to ensure the safety and quality of aged care services. What are the implications for practitioners? Identifying and addressing inequities in aged care services and mitigating risks must be a priority in Australia to ensure aged care services provide safe and high-quality care. The results of this study challenge current funding structures that encourage the development of larger aged care homes, and instead suggest that better funding for smaller-sized facilities may be able to improve the experience of residents in aged care. The results also suggest that facilities and governments should attend to the experiences of specific groups, such as men and people with mobility issues.