The arrival of a ‘Trip Advisor’-type website for rest homes has the sector squirming. AgedAdvisor.nz allows anyone to rate and review aged care facilities and retirement villages, which has left some providers feeling anxious. JUDE BARBACK looks at the issues providers face in the push for more transparency and accountability.

“Often the residents are left in the living room to sleep/wait for death to happen, in their chairs, with very few activities being instigated or seemingly encouraged.”

So reads a scathing review of an Auckland rest home on Aged Advisor (agedadvisor.nz), a new website that rates aged care facilities and retirement villages. The reviewer (name withheld) has awarded the rest home two stars. They are “not sure” whether they would recommend it to others.

Others are more positive.

“Great food and lovely homely atmosphere! Staff are very attentive and caring,” states the review of a Tauranga rest home – the reviewer (again, name withheld) awarding it the maximum five stars.

It is not hard to understand why some aged care providers are sceptical of a service that allows Joe Public to openly comment on their facility and its operation, but it’s also easy to see why such a site would appeal to the general public. The real question is: will such a site help to bring transparency to the sector and, in doing so, help keep operators accountable to high standards?

Aged Advisor founder and general manager Nigel Matthews believes it will.

“We know that places make changes when the people speak. We wanted to give everyone a voice. One of our goals is to highlight the best, and give those not so good an opportunity to deliver what they promised.”

What is Aged Advisor?

Aged Advisor is a bit like the travel site TripAdvisor, but for rest homes and retirement villages. It encourages residents and visitors to rate aspects of care and operation out of five, and to comment on the pros, cons and whether they would recommend the facility to others.

Nigel Matthews says it was only a matter of time before a comparison site emerged to help people select an aged care or retirement facility, which he describes as “a far more important decision than where one should go to for dinner”.

Matthews, who is also the founder of LifeFriends, a volunteer-based visitation programme, says the idea for Aged Advisor came from a frustration with how something was not working as well as it should be.

“After assisting parents move for a third time in two years due to changes in health, it became clear that retirement homes and aged care facilities varied greatly in environment, activities, workplace culture and management approaches. Although there was audit information available on each of the facilities, this primarily covered health systems and processes – there was nowhere that you could go to compare facilities or read reviews from people who were either residents or friends and family that visited.”

And so Aged Advisor was born. The intention was to create a site for people to share their experiences – good or bad – so that others can make informed decisions on where they or their loved ones can plan to spend the next stage of their lives. There are plans to extend it to a range of other age-related services, including home and community support services.

Independence the key

In some ways, it is surprising there hasn’t been such a site until now in New Zealand. Aged care facilities in New Zealand are operating at high occupancy levels. Extensions and new facilities are being built in order to keep up with demand as the number of older adults rapidly increases. Yet, until now no site has existed to review and compare these facilities. ElderNet is developing its own feedback and review section on its site; it is currently in test phase.

Both the United Kingdom and United States have comparison sites. The UK site has several thousand comments; however, the review component appears very limited and the sites do not seem to be fully independent of government or health care funding. Matthews believes maintaining independence is important, and as such this is a key feature of Aged Advisor.

Public keen, providers not so sure

The general public appears keen for more information on aged care facilities. People outside of the aged care sector told INsite they would be interested in reading people’s reviews and ratings of rest homes and retirement villages.

“I’d keep in mind that it is just their opinion, but I’d still be interested to read what people have written about a home, particularly if I was looking into a rest home for my dad,” said Waikato dairy farmer, Alan Charles.

“It would be good to see what people have to say about rest homes, although there would need to be at least several reviews for it to have any credence,” said Neil Morris of Te Puke.

While Aged Advisor is essentially meeting a public need, Matthews is also keen to get buy-in from aged care providers and retirement village operators. They have contacted each facility or facilities’ head offices, advising them of the new website and the need for them to ‘opt in’ if they would like to receive immediate emailed notification of the reviews about their facility when posted.

Facilities also have the opportunity to ‘upgrade at their discretion’, which allows them to add photos, video, contact details, a website link, and also the ability to reply to any comments or reviews from users. Matthews says aged care facilities can currently upgrade their listing from $29–$49 per month and retirement villages from $59–$99 per month, depending on size. The costs for upgrading are based on the number of beds.

Some providers have expressed concerns over the site.

Fran Pucilowski, manager of WesleyCare in Papanui, Christchurch, says perhaps consumers will find the site useful, although she is not convinced it is something the sector particularly needs. She says she had never used TripAdvisor or other such sites to publicly review services.

“If I didn’t like the hotel I stayed at, I simply wouldn’t go there again. And if I wasn’t happy with the care provided at my mother’s rest home, I’d remove her. You let the cares speak for themselves, really.”

Pucilowski said a bad review could be really damaging, especially when they’re all trying so hard to do a good job.

Robyn Molony, manager of Holly Lea retirement village in Christchurch, agreed it would have a “hugely damaging effect” if a negative review appeared.

Matthews says that in the event a comment is posted that the facility disagrees with, or it falls outside of Aged Advisor’s review policy, the facility owner, or anyone else logged in, may report the comment for moderation. That comment is then immediately removed from view until it has been moderated.

“If the facility has upgraded, then they can also reply to the comment, which we see as an excellent opportunity of showing how responsive and open a facility is in dealing with people’s comments and suggestions.”

Matthews says the organisations that do a fantastic job shouldn’t be nervous about the introduction of Aged Advisor.

“Just like the restaurant review sites, people become familiar with comments given and can see through certain one-off comments where the majority share a different perspective.

“No one wants a bad review – and just like TradeMe has shown with their feedback, people go out of their way to be nice and helpful to ensure great feedback. We do hope that Aged Advisor helps raise the quality of care given to such an important generation.”

Even so, some providers have voiced concerns over whether the site was the best way to communicate a resident’s or family member’s dissatisfaction with a service.

“There are formal, approved processes people can take if they aren’t happy with something,” says Molony.

Matthews says they certainly encourage users to follow the approved complaint process outlined by the facility.

“However, we also understand how intimidating a formal complaints process can be, and for many the idea of having to lay a formal complaint carries with it the fear of retribution or being branded the ‘difficult’ one. If a situation has to get to the formalised stage just to be heard, then there is clearly room for improvement on the facility’s behalf,” says Matthews.

Molony is also sceptical about the validity of the reviews, saying it would be easy for people to skew the ratings.

“What’s to stop a facility getting all of its staff to give it excellent reviews?” she questioned.

The New Zealand Aged Care Association even encouraged providers to take this approach. In its In Touch newsletter, the association urged providers to encourage residents, staff and family members to write positive reviews about their facility.

“You should consider this an essential part of your marketing plan. This site is effectively just a physical manifestation of word-of-mouth promotion that takes place within any community.”

The push for transparency

In spite of some reluctance from aged care providers, there is no denying the public has been hankering after more transparency from the sector for some time.

It was this push for more public accountability that prompted the Ministry of Health’s decision to post full rest home audits online.

Following a positive six-month trial of publishing the full audit reports online, the Ministry decided to continue with the practice. During the trial period, over 200 people per week visited the full audit reports site, with around 80 of those downloading a copy of a full audit report. In the two years prior to the trial, the Ministry confirmed they received just 12 requests under the Official Information Act for full audit reports.

The Ministry has worked with key stakeholder groups, including Age Concern, Grey Power, the New Zealand Aged Care Association, and Consumer NZ, to further improve the audit reports, making them more streamlined and reader-friendly, while still retaining the full content.

Many rest home operators were initially a little fearful of the decision to publish full audit reports online.

Routine audit inspections look at approximately 247 criteria within the 57 health and disability standards, with which facilities are expected to comply. The average number of failings across the industry apparently sits at around 15 (out of 247) and there is a tendency for the public and the media to focus on the 15 things they are doing wrong rather than the 232 things they are doing right.

Even when these routine audits are complemented with an internal auditing process, it is still not feasible for most rest homes to address the individual care for each resident in these audits.

Unannounced inspections are more useful, but these generally occur only when a complaint has been raised.

Making full audit reports publicly available could be considered a lightweight approach in comparison to that taken by other countries.

The United States, for example, applies a five-star rating system to its rest home audits. The audits operate on an unannounced, spot-check basis with full transparency and heavy financial penalties for facilities that don’t meet the standards. Rest homes are given a rating of one to five stars based on state-conducted health inspections, nursing and physical therapy staffing, and quality of medical care. The ratings are then posted on Nursing Home Compare, a website run by the federal Centers for Medicare & Medicaid Services.

Compliance and customer satisfaction not the same thing

Audit reports tell only half the story though. Audits are a measure of a facility’s compliance, and are not necessarily a reflection of customer satisfaction levels.

Most rest homes and villages will routinely conduct some sort of customer feedback survey and report the results back to residents and families. However, there has never been any move to make this sort of information public.

In an opinion piece for INsite, Consumer editor David Naulls said the individual experiences of residents and their families need to be heeded by the sector.

“We continue to hear from people who tell us their relative – often their mother or father – has been in a home where there have been failings in care. We also hear from people who have experienced good care and are full of praise for the home. Unfortunately, there are more of the former than the latter. More than the bare statistics, it’s these experiences – good and bad – that the aged care industry needs to listen to and learn from.”

Perhaps this is where a site like Aged Advisor might add value – as a forum for examples of good and bad care to be heard. A review might tally with what an audit report says, or it might give a different picture. It is up to users to weigh up the reliability of the information at their disposal, make their own impressions of a facility or village, and draw their own conclusions.

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