One of the most significant factors in providing quality residential aged care is to ensure that there is sufficient skilled staff on hand to provide that care.
It seems extraordinary to us that neither the government to date, nor the recent Productivity Commission's Inquiry Caring for Older Australians Draft Report does not recommend a mandated safe staff/resident ratio (and skills).
Many people who contact Aged Care Crisis (ACC) are shocked to learn that there are no mandated minimum staff/resident ratios in aged-care homes across Australia. The Aged Care Act 1997 has little to say about staffing. In fact, only two lines are allocated to this, the most vital aspect of care provision: that there must be "an adequate number of appropriately trained staff".
As a direct consequence of this lack of required standards in staffing, managers who are under pressure to meet their profit targets, do so by reducing staff - placing vulnerable residents at risk.
Nurses and carers frequently report that they are not able to care for residents properly, given the conditions and time restraints imposed on them. It is clear that providers of aged care generally strive to operate with the fewest staff possible.
Incredibly, ACC has also found that in some cases, no staff were rostered on for considerable lengths of time:
"... There are no staff rostered for duty at the home between the hours of 8pm to 6:30 am, and therefore residents are not being supervised at this time. As a result, recurring incidents of residents absconding, wandering and falling have occurred ..."
Source: extract from Accreditation Report (Pg 11, 1.6 Human resource management)
We have mandated staffing levels in childcare centres, kindergartens, schools and hospitals. They, too, cater for people with different levels of need in different locations, but still manage to set a safe, minimum staff to client ratio.
This lack of mandated minimum staff/resident ratios has seen the exodus of experienced nurses from aged-care homes - particularly private-for-profit homes. Those staff who remain find that they can no longer meet their responsibilities to residents in the available time and resident care is compromised.
Most settings which care for vulnerable individuals, for example hospitals and child care centres, operate within a mandated staff/person ratio. It is intolerable that frail, older people do not have this protection.
It wasn't always like this: Prior to the introduction of the Aged Care Act 1997, a fixed percentage of funding received by owners of aged-care homes was dedicated to care - including the salaries of nursing staff. Funding could not be diverted to non-care staff, to capital maintenance or to profit. This requirement was removed under the Aged Care Act 1997
- Aged care deregulation by stealth (The Australian, 8 March, 2000)
- Nurses in the Aged Care System (Dr Wynne) – re: Deregulation
Compared to: Other countries, for example, if you were residing in New Jersey, nursing home owners are required by law to report information on the number of staff involved in direct patient care, and required by law to publicly post information that details direct resident care staffing levels within their facilities.
They are also required to report daily staffing levels via a web-based system to the Department of health. The law also requires that the Department makes this information available to the public on a quarterly basis.
Being an informed consumer (not really): Armed with this and other information publicly available, family members and residents are better equpped to make informed decisions about the care of their loved ones. There are no such levels of transparency or accountability to allow anyone to do similar here in Australia.
October 2015: The ANMF Federal Executive has determined to fund completion of the National Aged Care Staffing and Skills Mix Project to its original scope. They are seeking as much feedback as they can possibly gather – from aged care staff, residents, friends and family and any other interested stakeholders.
Missing: doctors and geriatricians in aged-care homes
Aged-care residents, particularly those in high care, need ready access to a doctor – perhaps more than any other members of society - yet there is a shortage of doctors who regularly visit aged-care homes.
Ideally there should be a team of doctors with an interest in aged care working under the supervision of a geriatrician. They should be responsible for the care received and supervise and intercede when problems occur. Furthermore, visiting clinicians need a suitable, private area to examine and treat patients.
ACC notes that the Australian Medical Association has also been vocal about these deficiencies and therefore adds a further voice to stress the importance of this issue.
While providing evidence at a recent coroner's inquest, one concerned clinician, Dr Tideman, made the point, that the support for nursing home patients by general practitioners in South Australia is simply not adequate.
Dr Tideman expressed the view that:
… It's deplorable, in my view; absolutely deplorable that we are not in this State able to provide good general practitioner services that don't rely on locum services to our residential aged care. And therefore the acute setting – the acute hospitals, like my hospital – then becomes the first line for sick elderly patients who do not need to be in a hospital and, in fact, care can be compromised by them coming into a hospital… Dr Tideman
Poor access to Allied Health Services
For many older persons, a small functional gain can mean a significant improvement in quality of life. Greater access to services such as physiotherapy, speech pathology, dietary advice, music therapy and occupational therapy must occur if we are serious about providing high level, holistic care.
Correspondents to our website regularly report the rapid deterioration of their family member's functionality after they are admitted to an aged-care facility. Hard-pressed care staff, for example, are generally unable to spend the time assisting with mobility. Many residents, who are able to walk on entry to a facility, soon lose this ability. Physiotherapy services, for example, not only focus on mobility but provide oversight and support to less trained staff.
Adequately trained staff
In every hospital coronary care or intensive care unit, staff specially trained in that area, ensure that high standards of care are maintained. The same principle should apply in aged care. More specialty trained staff are urgently needed within the sector. To be effective, this commitment to training must encompass continuing education and ongoing professional development.
ACC is dismayed to see the continuing reduction in the numbers of registered nurses who work in aged-care homes. More and more homes now rely on having a registered nurse on call rather than on site. This is despite the fact that the level of care needed by residents is higher than ever before.
It is also of considerable concern that the sector now relies, to a large extent, on the employment of inexperienced carers, some of whom have poor English language skills and who are unable to communicate effectively with residents. ACC believes that all those employed to care for frail vulnerable people should be able to fully understand the training they are given and the instructions from supervisors. They must also be able to read and understand case notes and care plans and accurately write these themselves, when required.
Parity with the acute sector
ACC draws attention to the lack of salary parity between those nurses who work in aged care and those within the acute sector. It is well known that, on average, aged-care nurses receive 20 percent less pay than their colleagues in acute care. This inequity is one of the prime reasons for the current staff shortages in aged care and the reliance on agency and casual staff - with detrimental effects on the quality of care received by residents. People at the end of life require skilled and consistent care - not piecemeal and makeshift staffing arrangements.
Poor clinical care
The ongoing reduction in the numbers of registered nurses has had a significant impact on the quality of care being provided in aged-care homes. This is one reason why residents must be placed in hospital when they require treatment for even minor complaints. ACC receives much feedback from carers about the increased responsibilities that they are given and for which they may have no, or insufficient, training.
