Key takeaways
- The Quality Measures (QM) sub-rating is based on 7 clinical indicators — falls, pressure injuries, weight loss, restrictive practices, and medication use. Lower is better for all seven.
- Four of the seven are risk-adjusted to account for the complexity of each facility’s residents, so a home caring for very frail residents isn’t penalised for naturally higher incident rates. The other three — restrictive practices, polypharmacy and antipsychotic use — are reported exactly as recorded, with no adjustment.
- This is why a 5-star home can have some unadjusted rates above the national average — after adjustment, their outcomes may be better than expected for their population.
The 7 quality indicators
The Quality Measures sub-rating is built from seven clinical indicators, each tracking a specific health and safety outcome. For all seven, a lower rate is better:
| # | Indicator | What it measures | Why it matters |
|---|---|---|---|
| 1 | Pressure injuries | % of residents with new or worsening pressure injuries (bed sores) | Indicates whether residents are being repositioned regularly and skin integrity is monitored |
| 2 | Restrictive practices | % of residents subject to physical or chemical restraint | High rates may indicate staffing shortages or an over-reliance on restraint instead of person-centred care |
| 3 | Unplanned weight loss | % of residents with significant unplanned weight loss | A key indicator of nutrition quality, meal assistance, and clinical monitoring |
| 4 | Falls | % of residents who experienced any fall | Reflects fall prevention strategies, mobility support, and environmental safety |
| 5 | Falls with major injury | % of residents whose fall resulted in fracture, head injury, or hospitalisation | More serious than the falls rate — indicates both prevention and response quality |
| 6 | Polypharmacy | % of residents prescribed nine or more regular medications | High medication loads increase adverse drug event risk. Good facilities actively review and reduce medications |
| 7 | Antipsychotic medication | % of residents prescribed antipsychotic drugs (excluding diagnosed psychotic conditions) | Antipsychotics are sometimes used to manage behavioural symptoms of dementia instead of non-drug approaches — a significant concern |
A real home from our data. A plain-language read on how its safety measures compare to the typical home.
On falls with major injury, this home sits fewer than most homes. The other measures track the typical home.
Risk-adjustment explained
This is the most important and least understood part of the star rating system.
- Risk-adjusted: pressure injuries, unplanned weight loss, falls, major injury from a fall
- Reported as-is: restrictive practices, polypharmacy, antipsychotic medication
Everything below describes how adjustment works for the first four. For the other three there is no adjustment, no expected rate, and no resident-mix explanation for a high number — what you see is what the home reported.
Different aged care homes look after very different populations. Some specialise in high-acuity dementia care, where residents are frail, cognitively impaired, and at high risk of falls. Others care for more independent residents who need less intensive support.
If we compared raw quality indicator rates without adjusting for this, facilities caring for the most vulnerable residents would always look worse— even if they were providing excellent care. That would create a perverse incentive to avoid admitting high-needs residents.
Risk-adjustment solves this by asking: “Given the mix of residents at this facility, what rate of falls (or pressure injuries, etc.) would we expect? And how does the actual rate compare?”
What factors are adjusted for
The government’s risk-adjustment model accounts for several resident characteristics:
- Acuity — the overall complexity of care needs, measured through the AN-ACC classification
- Age — older residents have higher baseline risks for most indicators
- Cognitive impairment — residents with dementia or significant cognitive decline have higher falls and behaviour risks
- Mobility — residents with limited mobility have higher pressure injury risk but potentially lower falls risk
- Comorbidities — multiple health conditions increase risk across several indicators
The adjustment produces an expected rate for each indicator at each facility. The star rating is then based on how the actual rate compares to the expected rate, not to a flat national average.
How scores become stars
The journey from raw indicator data to a star rating involves several steps:
- Data collection: Each facility reports quality indicator data quarterly to the Department of Health and Aged Care.
- Risk-adjustment: Each indicator rate is adjusted for the facility’s resident case-mix, producing a risk-adjusted performance score.
- Composite score: The seven risk-adjusted indicator scores are combined into a single composite Quality Measures score. The exact weighting applied to each indicator is determined by the methodology, with more serious outcomes (falls with major injury, pressure injuries) carrying greater weight than less severe indicators.
- Star threshold bands: The composite score is mapped to a 1–5 star rating using threshold bands. These bands are set nationally and determine what composite score earns 1, 2, 3, 4, or 5 stars.
- Contribution to overall rating: The QM sub-rating is then weighted at 15% in the overall star rating calculation, alongside Residents’ Experience (33%), Compliance (30%), and Staffing (22%). Quality Measures is the lightest of the four inputs — worth half as much as compliance.
Worked example
Consider two facilities with different resident populations:
| Metric | Facility A (high acuity) | Facility B (lower acuity) |
|---|---|---|
| Residents with advanced dementia | 65% | 20% |
| Average AN-ACC classification | High | Moderate |
| Actual falls rate | 42% | 28% |
| Expected falls rate (risk-adjusted) | 48% | 25% |
| Performance | Better than expected (42% vs 48%) | Worse than expected (28% vs 25%) |
- Residents with advanced dementia
- 65%
- Average AN-ACC classification
- High
- Actual falls rate
- 42%
- Expected falls rate (risk-adjusted)
- 48%
- Performance
- Better than expected (42% vs 48%)
- Residents with advanced dementia
- 20%
- Average AN-ACC classification
- Moderate
- Actual falls rate
- 28%
- Expected falls rate (risk-adjusted)
- 25%
- Performance
- Worse than expected (28% vs 25%)
In this example, Facility A has a higher raw falls rate (42% vs 28%) but scores better on the risk-adjusted measure. Given their very high-acuity population, a 48% falls rate would be expected — achieving 42% means they’re doing better than average for their resident mix.
Facility B, despite a lower raw rate, is actually underperforming. For their relatively healthy resident population, a 25% falls rate would be expected — their 28% suggests room for improvement in fall prevention.
Unadjusted vs adjusted rates
On our provider profiles, the Quality Measures detail section shows unadjusted (raw) rates compared to national averages. The government’s QM star rating, however, uses risk-adjusted scores.
This can create apparent contradictions:
- A facility may show above-average falls rates on our comparison chart, yet hold a 4 or 5-star QM sub-rating. This means their resident population is very high-risk, and after adjustment, their outcomes are actually good relative to what would be expected.
- Conversely, a facility may show below-average rates on raw indicators but only score 3 stars on QM. This means their population is relatively low-risk, and after adjustment, their performance is only average.
What this means for families
Understanding QM methodology helps you make better decisions:
- Don’t panic at above-average raw rates in high-acuity facilities. Check the star sub-rating — if it’s 4 or 5 stars, the facility is performing well for its population.
- Don’t be reassured by low raw rates alone. A facility caring for mostly independent residents should have low falls and pressure injury rates. Check whether their risk-adjusted performance (reflected in the star rating) is genuinely good.
- Look at trends, not just snapshots. One quarter’s data can be noisy. Our provider profiles show quality measures over multiple quarters. A consistent trend is more meaningful than a single data point.
- Pay attention to the most serious indicators. Falls with major injury, pressure injuries, and antipsychotic use are the most consequential for daily quality of life. Weight these more heavily in your own assessment.
- Combine QM data with everything else. Quality measures are one sub-rating out of four. Use them alongside residents’ experience, staffing data, food spend, and — most importantly — your own observations during a tour.