Government-run aged care facilities outperform not-for-profit and for-profits on most quality and safety measures, new analysis has shown.
The latest research paper from the Royal Commission into Aged Care Quality and Safety looks at how aged care facilities from each sector performed on a variety indicators, such as staffing, healthcare and patient wellbeing.
It found government-run facilities showed the best average results for 31 of 44 indicators.
Government-run facilities were found to have more direct care staff minutes per resident per day - an average of 229 minutes compared with 184 minutes for not-for-profits and for-profits.
They also had more nursing minutes per resident per day - 119 minutes compared with 39 minutes a day in not-for-profits and for-profits.
The data for direct care staff minutes may be understated, as many providers contract allied health services and they may not all record the allied health contract hours.
However government-run homes performed better than not-for-profits and for-profits on a range of other measures too.
There were fewer pressure injuries at government-run homes - on average 7.21 injuries per 100 residents assessed. In not-for-profits, the rate of pressure sores reported was 8.44 per 100 residents, and 8.23 per 100 residents in for-profit facilities.
There were also fewer residents who experienced significant unplanned weight loss in government-run facilities - one in every 15.6 patients compared to one in 11.8 residents in not-for-profits and one in 11.1 in for-profits.
A greater proportion of not-for-profits and for-profits were found to have issues during unannounced site visits from the Aged Care Quality and Safety Commission as well.
Seven per cent of visits to for-profit facilities in 2018-19 resulted in serious risk decisions, compared with 5 per cent of not-for-profit visits and 4 per cent of government-run facility visits.
Eighteen per cent of for-profit facilities also failed to comply with applicable standards during the unannounced visits, compared with 16 per cent of not-for-profits and 13 per cent of government-run facilities.
Not-for-profits did outperform government-run facilities and for-profits when it came to having fewer suspected or alleged assaults reported. Not-for-profits had on average 2.62 notifications per 100 occupied beds compared to 2.95 for government-run facilities and 3.06 in for-profits.
Not-for-profit facilities also dispensed less anti-psychotic medication. On average one in every 4.5 residents in not-for-profit homes were being given anti-psychotic medication, compared with one in every 4.1 residents in government facilities and one in every 4.3 residents in for-profits.
The only indicator where for-profits performed best was having fewer residents using opioids routinely.
One in every 3.8 residents in for-profit run facilities were chronic opioid users, compared to one in 3.4 in not-for-profits and one in three in government-run facilities.
The data comes as the royal commission probes the models of care in Australia's aged care system.
More than half (57 per cent) of aged care facilities in Australia are run by not-for-profits, while 34 per cent are operated by for-profit organisations. Just 9 per cent of aged care homes are run by government organisations.
Reforms introduced in 1997 transformed the system into a free-market model, amid concerns over the dominance of institutional care, a lack of choice and unequal distribution of services by geographical area.
However the changes were also accompanied a lighter-touch accreditation approach and the relaxation of previous regulatory requirements.
In its interim report, titled "Neglect", the aged care royal commission noted the aged care system lacked the features of an ideal market.
Aged care was a need, not a want, consumers lacked the right information to make an informed choice, and decisions were often made at short notice and in times of heightened emotion.
The aged care sector was also not a free market as the number of places were constrained through government policy.
The royal commission foreshadowed it would be looking at alternative models of delivering care in future months.
It is set to make a final report by February 26, 2021.