Response to Sydney Morning Herald article Aged care residents reveal which centres are the worst to live in (8 Jan 2020):  Aged care residents are happier in smaller regional centres and not-for-profits than they are in city-based, for-profit operations.

Dr Richard Baldwin (UTS) et al examined all sanctions between 1999 and 2012. They found that for-profit owned facilities were more than twice as likely to be sanctioned as those owned by nonprofits confirming similar findings in 2010. They challenged government policy in their several articles. 

Baldwin has published articles calling for evidence based policy. He pointed out that the "most researched structural factor is ownership as it is a predictor of other factors that may influence quality such as staffing levels, organisational culture and financial performance. - - - - - - - - most research studies using large samples have reported that residents in not-for-profit facilities enjoy better quality of care and have better outcomes than those in for-profit facilities. - - - The evidence on indicators of financial performance tends to favour the for-profit sector". 

In another paper he writes that the Australian government "appears to be indifferent to other structural factors”. He said:   “... Neither the previous, nor the current, Australian Government has indicated a preference on the future mix of service providers, the growth of large providers, or the size of facilities. This suggests that policy makers, even in the light of the available evidence, have enabled these trends to continue through their silence, or are at least comfortable with the direction in which the industry is headed...” 

He also called for “wider community debate on the future shape of the residential aged care industry in Australia”. 

Our analysis in 2008 revealed that when facilities in the same locations were compared, for-profit owned facilities were failing between 2 to 4 times more often than non-profit.  Even after a UTS study (Baldwin et al) revealed that for-profit owned facilities were more than twice as likely to be sanctioned, the Agency responded by reporting that there was no difference in accreditation. When challenged on their analysis via phone, email and online, they refused to respond.

Politicians and the Agency have consistently claimed that there was no difference in performance of for-profit and NFP, but regional and remote providers performed more poorly.  Agency figures showed little difference in failures between for-profit and non-profit providers had poorer performance in rural and remote areas.  They also showed that facilities in rural and remote areas failed more often than those in metropolitan areas.  But for-profits rarely if ever, operate in rural and remote areas.  For them to perform equally well in metropolitan areas, where like could be compared with like, non-profits must be performing significantly better than for profits. 

As Baldwin and others have indicated, this sort of analysis is vitally important for making policy. It is doubly so when it shows that the policy is flawed and produces worse outcomes.