Aged care needs overhaul

The Lamp September10 cover

In their initial submissions to the Governments Productivity Commission Inquiry 2010 Caring for Older Australians, the ANF and QACAG have recommended an overhaul of the aged care sector, including more funding for nurses.

‘Inadequate staffing levels, inappropriate skill mix,’ reports ANF

The ANF has highlighted the concerns of its members about the current delivery of aged care services in residential settings. ‘Inadequate staffing levels, inappropriate skill mix, excessive workloads, declining standards of care, and excessive documentation, are frequently reported,’ it said.

‘These concerns, combined with the differences in wages between the aged care and acute sectors, have all contributed to difficulties recruiting and retaining qualified nursing staff to work in aged care.

‘Long-term reform in the aged care sector will not succeed without the provision of a robust, highly educated and skilled nursing workforce, transparency and accountability of funding, additional funding for wages and attractive career paths in aged care.’

ANF Recommendations

  • The Australian Government fund the ANF to develop minimum standards that provide for staffing levels and skill mix in aged care settings.
  • There is recognition of the professional skills of Assistants in Nursing, (however titled) through a national licensing system regulated by the Nursing and Midwifery Board of Australia (NMBA).
  • There is a mandated/legislated Federal requirement for 24-hour Registered Nurse cover for all high-care residents in aged care facilities, inclusive of those low-care facilities with ageing in place.
  • The Australian Government fund the development of a workload management tool for use in residential aged care to be linked to the existing Aged Care Funding Instrument (ACFI).
  • The ACFI funding model be reviewed by the Australian Government to enable the incorporation of Nurse Practitioners in aged care.
  • The current regional and rural undergraduate and post-graduate scholarships, funded by the Australian Government for nurses working in aged care, be extended to include urban areas.
  • A mechanism be developed by the Australian Government to monitor the use of funds by Residential Aged Care Facilities (RACF) to develop and implement Graduate Nurse Programs in aged care.
  • In line with the recommendation above, there is an acquittal system implemented to ensure the money made available for the graduate nurse programs is directed to wages and educational support for graduates.
  • The Australian Government determines a benchmark of the cost of care in aged and community care.
  • The Australian Government close the wages gap between nurses and Assistants in Nursing, (however titled), working in aged care and their public hospital counterparts.
  • That dedicated funding is made available by the Australian Government to close the wages gap, and that provision of the funding is conditional on the achievement and maintenance of wage parity.
  • The Australian Government legislates for the introduction of annual reporting on the way aged care providers spend their funding, particularly on care activities and staff.
  • The funding arrangements for accommodation and care components of aged care services be accounted for separately, using the ACFI model.
  • The aged care standards agency is required to use professional guidelines as benchmarks during accreditation.
  • A national education program be developed by the Aged Care Standards and Accreditation Agency (ACSAA) to ensure consistent application of national benchmarks of its Accreditation Standards and Quality Care Principles to enable alignment of all processes, with the end result being the assurance of high-quality care to our frail elderly citizens.
  • That compulsory benchmarks are federally legislated by the Australian Government in relation to occupational health and safety in residential and community aged care.
  • That an independent Aged Care Complaints Commission be established with an Aged Care Complaints Commissioner appointed who will report directly to the Federal Minister for Ageing.

QACAG submission to Productivity Commission

In its submission to the Productivity Commission, Quality Aged Care Action Group (QACAG) features several comments from its members, many of whom are current or former aged care nurses.

QACAG also makes recommendations around good models of care, staff ratios and skill mix, staff recruitment and retention, licensing of AiNs, and the establishment of an Aged Care Complaints Commission and Aged Care Commissioner.

QACAQ Recommendations

  • Development of programs and systems to assist residents and families to better understand the sector, to more easily find the best facility for their needs and to make the transition easier from home to nursing home.
  • Good models of care to be properly examined and benchmarked.
  • Identify how to connect ‘success’ with good care and ensure financial viability is intrinsically connected with good care ie. values or care driven, consumer satisfaction driven, not solely profit driven.
  • Consider a combination of regulation and incentive in regards to care models.
  • Ensure accreditation processes are improved to measure what actually occurs, not what is documented to occur.
  • A formula for mandatory staffing numbers and skill mix, and a system tying a set proportion of funding to staffing.
  • Protection of the current requirements in NSW for an RN to be on duty at all times in a nursing home.
  • A minimum requirement that an RN be on duty in any residential facility where there are high-care residents, as a minimum part of a staffing formula.
  • Workforce strategies to combine the aim of attracting newly graduating staff and younger staff into aged care, while valuing older, experienced staff to balance a mix of age and experience.
  • The proposal submitted by the ANF on licensing of AiNs and care staff to be adopted.
  • Ongoing input and representation from older people, consumer groups and carers be built in to all phases of the aged care reform process.

What QACAG members said

‘As the number of nurses employed in aged care decreases, so does the appeal for nurses making this their career choice. The erosion of nursing positions de-professionalises and devalues the work, and ultimately this devalues the care of older people.’

(DoN, QACAG President)

‘A main issue for me is the funding tool, it needs to be simplified to reduce paperwork, to increase the quality of care and guarantee adequate staffing levels.’

(RN, QACAG Metro)

‘A colleague told me that the facility has 113 beds and with ageing in place, and 93 of these residents have now been assessed with high care needs. Recently the staffing mix has been changed to remove the RN position off the night duty roster, and to have a CSE (care service employee) as Team Leader (ie. not a nurse) and just have an RN on call.’

(RN,QACAG Metro)

‘I have seen so much change over 30 years, and the biggest change by far is less staff per shift, and more residents with more complexity to look after.’

(RN, QACAG Metro)