Star Ratings in Long-Term Care Facilities in Australia: Facility Characteristics Associated with High Ratings and Changes in Ratings Over Time

Objectives: A Star Rating system (1 to 5 stars) of long-term care facilities in Australia is based on 4 sub-categories: compliance, quality measures, residents' experience, and staffing. The objectives were to examine associations between facility characteristics and the odds of receiving a 4- or 5-star rating, and changes in ratings between the earliest reporting period (October-December 2022) to the most recent (April-June 2023).

Design: Cross-sectional, ecological study, with an additional longitudinal component.

Setting: Long-term care facilities in Australia.

Methods: Associations between facility characteristics and the odds of receiving a 4- or 5-star rating were examined using a multiple logistic regression model. Average changes in overall star rating and each sub-category weighted by fractional contribution to overall star rating were estimated.

Results: Of 2476 facilities, 53.7% received a 4- or 5-star rating, 44.1% a 3-star rating, and 2.1% a 1- or 2-star rating in the April-June 2023 reporting period. Facility characteristics associated with higher odds of 4- or 5-star ratings included small (≤60 residents) and medium-size (61-100 residents) (odds ratios, 3.16; 95% CI, 2.51-3.98 and 1.72; 95% CI, 1.38-2.13, respectively), and Queensland location compared with New South Wales (2.42; 95% CI, 1.87-3.14). Facilities in socioeconomically disadvantaged areas (0.45; 95% CI, 0.33-0.62) and for-profit (0.12; 95% CI, 0.07-0.22) or not-for-profit facilities (0.16; 95% CI, 0.09-0.29) compared with government-operated were associated with lower odds of 4- or 5-star ratings. Between the 2 reporting periods, 25.1% of facilities' star ratings increased and 10.2% decreased (average change 0.156). Residents' experience, compliance, and staffing had the largest weighted average sub-category rating changes (0.051, 0.042, and 0.042, respectively).

Conclusions: Smaller size, government ownership, and location in socioeconomically advantaged areas were associated with higher odds of 4- or 5-star ratings in long-term care facilities. Average star ratings increased over time but increases and decreases in overall and sub-category ratings were observed.