Aim: To examine care variation among older Australians accessing long-term care in residential aged care facilities (RACFs) or at home with home care packages.

Methods: A cross-sectional population-based study using the ROSA National Historical Cohort was conducted. All individuals who received long-term care between 01/01/2019-31/12/2019 were included. Twelve quality indicators for residential care and 15 for home care packages were examined. Among these, eight indicators were captured nationally (e.g., antipsychotic use, high sedative load, antibiotic use, chronic disease management plans), while seven indicators (e.g., emergency department [ED] presentations, fractures) were reported in four states (NSW, VIC, QLD, SA). RACF and home care service-level variation in risk-adjusted prevalence/incidence were examined using funnel plots. Percentage of outliers with indicators above or below the 95% confidence interval (CIs) around the indicator mean were reported.

Results: In 2019, 244,754 residents (65.3% women, median age 86 years) received care in 2746 RACFs and 149,104 individuals (64.6% women, median age 83 years) received care at home from 2407 services. Significant variation in care was observed across RACFs and home care services for six high-burden indicators. The highest proportion of out-of-range RACFs with indicators outside the upper 95%CI were ED presentations (19.3%), antibiotic use (13.9%), and exposure to high sedative load (12.6%). In home care services, ED presentations (14.7%), chronic disease management plan (10.1%), and antibiotic use (7.8%) had the highest out-of-range services.

Conclusions: Quality of care varied significantly across aged care providers, particularly in ED presentations, antibiotic use, high sedative load, and chronic disease management plans.