Authors: Dr Rachel Milte1, Dr Jyoti Khadka1, Prof Julie Ratcliffe1

  1. Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia


According to the Australian Institute of Health and Welfare, over 1 million Australians access aged care nationally. The Australian Government spends over $23 billion a year on aged care, with over half of that funding allocated to the provision of residential care. However, the quality of care provided in the system was called into question recently during a series of scandals leading to the Royal Commission into Aged Care Quality and Safety. Researchers at the Caring Futures Institute, Flinders University, have led a five-year program of research to develop and validate new quality of life and quality of care experience instruments for application in aged care. The Quality of Life-Aged Care Consumers (QOL-ACC) and Quality of Care Experience-Aged Care Consumers (QCE-ACC) instruments will be administered regularly, allowing sector wide monitoring of quality of life and quality of care experience for aged care residents. Additionally, assessing quality of life and quality of care experience as part of a suite of new quality indicators will enable detailed assessment of the relationships between person-centred indicators of care quality and other clinical or structurally focused quality indicators.

For more information on the QOL-ACC and the QCE-ACC visit:

Furthermore, the Royal Commissions’ Final Report acknowledged that the quality and safety of aged care was unlikely to improve without routine measurement and reporting of key quality indicators. Traditionally quality assessment in aged care has focused on structural or clinical indicators of care quality and has not incorporated detailed assessment of the quality of care received from the perspective of consumers (older people and family carers). To address this, the Royal Commission recommended ‘comprehensive quality of life assessment’ be implemented sector wide, alongside more traditional indicators of care quality, such as rates of pressure injury, falls, and sedative loads.

In response to these recommendations a landmark policy reform with the new mandated National Quality Indicators Program for residential care commencing in April 2023 includes routine monitoring and reporting of quality of life and quality of care experience for the first time in the history of Australia’s aged care sector.

The QOL-ACC instrument has been developed for economic evaluation as well as quality assessment and includes an associated preference-based scoring algorithm based upon the quality-of-life preferences of almost one thousand aged care consumers which allows the incorporation of the QOL-ACC as a measure of benefit into a cost-utility analysis framework. An Australian general population preference-based scoring algorithm for the QOL-ACC is also available. In comparison with health care settings, economic evaluation evidence is scant in aged care settings, both in Australia and internationally. The development and validation of the QOL-ACC provides the opportunity to facilitate economic evaluation in the sector, providing quality-of-life benefits of new models of care and service innovations relative to the costs of implementation.

The work was funded through the Australian Research Council linkage grant scheme and the Royal Commission into Aged Care Quality and Safety. Flinders University researchers worked in partnership with older people and family carers, aged care service providers and researchers from the Australian National University, University of Sydney, the National Ageing Research Institute and Monash University.