Aged Care Staffing Levels and Skills Mix Project

A new national report reveals how the current inadequate level of staffing in Australian nursing homes is failing to ensure the provision of safe, quality aged care – resulting in all-too frequent ‘missed care’ episodes for elderly, vulnerable nursing home residents.

The Australian Nursing and Midwifery Federation (ANMF) has released the report of its National Aged Care Staffing and Skills Mix Project, undertaken in conjunction with the ANMF South Australian Branch, the Flinders University Research Team and the University of South Australia. The project is the first of its kind in Australia and demonstrates the urgent need for a staffing methodology that considers both staffing levels (the right number) and skills mix (the right qualification) for residential aged care.

Download or read the whole report here.

The key findings are:

  • Residents should receive an average 4 hours and 18 minutes of care per day – compared to the 2.84 hours which is currently being provided;
  • A skills mix of Registered Nurses (RN) 30%, Enrolled Nurses (EN) 20% and Assistant in Nursing/Personal Care Worker (AIN/PCA) 50% is the minimum skills mix to ensure safe residential care;

The ANMF has provided the report to the Senate Inquiry into the aged care workforce with the hope the Committee will use the evidence to make significant recommendations to legislate minimum staffing levels and skills mix in residential care.

Recommendations from the Committee are due in April 2017.

Precis of results

This is the second stage of a two-part study that has collected evidence relating to the need for a staffing methodology that considers both staffing levels and skills mix for Residential Aged Care.

Data collection for the second stage of the study involved three methods:

– Verification of six typical resident profiles that were developed in Stage One of the project. These profiles are based on a methodology for staffing aged care which determined the percentage of nursing and personal care (skills mix) time needed for each resident profile, based on the interventions to be completed over a 24-hour period and the time taken to complete those interventions inclusive of time for indirect and environmental tasks. These resident profiles were presented in seven national focus groups across the country to determine the validity of the interventions and timings.

– Administration and analysis of a MISSCARE survey modified for use with staff in Residential Aged Care. This survey collected information from 3206 participants about the interventions they believed were being missed and the reasons these interventions were missed.

– A third evaluative component was a Delphi survey undertaken with 102 invited experts (residential site managers) about changes to the resident profile in Residential Aged Care and the associated impact on staffing and skills mix. It also sought agreement on the principles, but not timings, underpinning the methodology used in the focus groups.

Evidence supporting the staffing methodology:

The MISSCARE survey found that all nursing services and personal care interventions were missed at least some of the time.

Only 8.2% of respondents to the MISSCARE survey indicated that staffing was always adequate. Inadequate staff numbers was the most commonly identified reason for missed care.

The types and frequencies of missed care were consistent across 24 hours, ie. staff shift did not influence the frequency or types of missed care in Residential Aged Care.

Factors that were reported as adding to the time needed to deliver care were administrative load; communication needs of residents and their families; inadequate skills mix; size of facility and access to resources and working with special needs groups (people with dementia, CALD background and people receiving palliative care).

Evidence supporting the need for a staffing methodology: impact of skills mix

Participants in the Focus groups and Delphi survey indicated that Residential Aged Care Facilities are admitting a greater volume of residents with more complex needs who have shorter lengths of stay than previously.

Participants in the Focus groups associated an inadequate skills mix comprising a low ratio of Registered Nurses to Assistants in Nursing with poor reporting and delayed management of emerging resident health issues.

Participants in the Focus groups stated that the administrative load undertaken by Registered Nurses limited their ability to provide direct nursing care.

Findings from the MISSCARE survey show that RNs identify more missed care related to Activities of Daily Living and complex health care than Enrolled Nurses and Personal Care Workers.

Recommendations on the basis of findings:

1. That a staffing methodology be adopted for Residential Aged Care Facilities.
2. That a methodology for staffing Residential Aged Care Facilities needs to incorporate the time taken for both direct and indirect nursing and personal care tasks and assessment of residents; it also needs to reflect the level of care required by residents.
3. That the average of 4.30 Resident and Personal Care Hours Per Day or 4 hours and 18 minutes of care per day, with a skills mix requirement of Registered Nurse
30%, Enrolled Nurse 20% and Assistant in Nursing/PCW 50% is the evidence-based minimum care requirement and skills mix to ensure safe residential and restorative care.