The role of sanctions in Australia's residential aged care quality assurance system.

OBJECTIVE To assess the role of sanctions as the highest level of enforcement in Australia's residential aged care quality assurance (QA) system. DESIGN ANALYSIS of secondary data on accreditation activities and outcomes from 1999-2000 to 2007-08, extracted from the Annual Report on the Aged Care Act 1997. SETTING A total of 138 sanctioned homes among all aged care homes in Australia (n = 2830 in 2007-08). MAIN OUTCOME MEASURES Chi-square test of differences between sanctioned and non-sanctioned homes, and z scores to identify variables underlying differences. RESULTS Sanctions are a rare event as more frequent enforcement actions at lower levels of regulatory action mean that a diminishing number of homes are subject to higher levels of action. Relationships between the risk of sanctions and characteristics of homes (state, size, sector and level of care) were evident. Sanctions provide only limited signals on quality to potential users and do not reflect the full scope of the QA process and the range of quality of care found. CONCLUSIONS The effectiveness of sanctions in contributing to quality improvement has to be seen within the wider regulatory framework, which in turn has to be set in the context of other factors driving quality of care. Quality improvement in Australia and elsewhere will depend on further development of QA systems but will also require attention to wider contextual factors that contribute to quality outcomes, including quality of the aged care workforce.