After 21 years of opacity about staffing and care, the aged-care community and workforce needs and deserves guaranteed clarity.
MP Rebekha Sharkie has recently introduced a Bill (which has now progressed to an Inquiry) requiring every aged care home to disclose and publish quarterly staff/resident ratios, providing some much-needed transparency to aged care.
The aged-care sector has opposed this on the basis that staffing and care are 'too complex'. This is an argument for collecting and studying data, not for hiding it. Australia has endured 21 years of opacity about staffing and care. Both the community and the workforce have had enough. We need sunlight.
Accurate data is essential for debating policy and for a market to work. In 2003, the sector promised parliament it would collect data about the care provided in aged-care facilities but soon reneged on this promise. Regulators later sanctioned this.
The importance of staffing data
In the absence of legislation specifying required staffing levels or skills, MP Rebekha Sharkie’s Staffing Disclosure Bill (and Inquiry taking submissions until 4 Oct) is important and should be strongly supported.
When we have accurate staffing data we can perform the research needed to refine our staffing guidelines and keep the public informed. Sector claims of "unreasonable additional administrative costs and red tape" are baseless and a furphy.
It should be noted that staffing data is already being collected and reported to the sector on a regular basis by financial institutions. The Quality Agency has been collecting this information for around 10 years. It promised the sector that this information would not be made public.
When it comes to the collection and reporting of financial data or development of benchmarks based on them, no one complains that it is 'problematic or 'burdensome. This data is conveniently trotted out prior to, and during inquiry appearances, coronial inquests, industry talkfests or when asking governments for more money. Financially based staffing benchmarks have even been used by non-profit organisations as justification for reducing staffing across nursing homes.
Unlike Australia, the US government openly acknowledges that staffing levels and skills are "the most critical determinants of care". It also recognises the significance of employee turnover and tenure as “a vital component of quality care for nursing home residents”.
Recommended minimum safe staffing levels have been established to ensure that residents are not harmed. These are based on careful research and expert opinion. Extensive staffing and care data has been available in the USA for nearly 20 years. In Australia, there has been a 21-year battle to keep this sort of information away from those who need to know it.
Staffing levels, particularly the number of trained nurses, have fallen to unsafe levels in many homes in Australia over the last 21 years. In comparison, US residents receive twice as much care from trained nurses and more than a third more nursing care overall. This makes it impossible for our system to be world class or to be providing the care our residents need.
Dr Kidd, who has provided care to residents in nursing homes since the 1990s, spoke for the AMA at the House of Reps Inquiry on 11th May. He said "It’s definitely worse now than it was 20 years ago”.
Average direct care nursing levels are about 2.9 hours per resident day (hprd) with care by trained nurses providing only a fraction of that. This falls a long way behind what was expected in the late 1980s and early 1990s, and well below the 4.1 (hprd) minimum recommended in the USA.
Reporting staffing ratios by professional qualification for those who care directly for residents is straightforward and not complicated. Reporting in this way will allow us to draw on a vast pool of international research when making policy. This Inquiry is a critical first step in achieving this.
We need data about care too
The CEO of Alzheimer’s Australia in 2015 indicated that quality of care was one of the biggest gaping holes in aged care because we don’t have “a single measure of quality” and without accurate data about care you cannot have choices.
The aged-care sector argues against fixed ratios on the basis that staffing varies with the frailty of residents. That too is an argument for collecting accurate data about resident frailty and care outcomes. Such data tells us whether staffing is adequate. It allows us to develop reliable guidelines for variation in frailty and then check that they are being followed when failures in care occur.
Providers and government regulators have avoided collecting and publishing outcomes data to date. This opacity and secrecy is one reason why regulation has failed citizens so often. After 21 years of opacity and years of pressure there are plans to collect some data and release it, but the lack of enthusiasm is revealed by the delays in doing so.
It took nearly four years for a complex process to develop just three indicators. It needed the assistance of a large and expensive accounting firm. To entice them providers were promised that the results would not be published.
The lack of enthusiasm is apparent from the small number, one-tenth of homes in Australia, that participated in the voluntary pilot for the National Aged Care Quality Indicator Programme. Only 18 per cent of those were for-profit showing which group has most to fear from transparency.
In contrast the Victorian Government, which is responsible for approximately 170 aged-care homes, has been collecting data on five clinical care indicators since 2006 - pressure injuries, restraint use, falls, unplanned weight loss and the use of nine or more medications.
Conclusion
The absence of data has made it impossible to formulate policies that are based on evidence rather than wishful thinking. It has been impossible to make informed choice and has exposed many vulnerable citizens to the risk of exploitation by profit-focused operators. Staffing skills and numbers have fallen to dangerous levels and people are being harmed.
After 21 years of the same policy, this proposed Bill would, if successful, be a major turning point. The public should place strong pressure on their representatives to ensure that it is supported and passed. They should then maintain the pressure to ensure the next step is the collection of accurate and verifiable data about care.
