An ‘unacceptable level of staffing’ in aged  care homes 

Australia ranks poorly for aged care staffing in international comparisons.

More than half of all Australian aged care residents are in homes with staffing levels that would be rated one or two stars in the United States’ five-star rating system, according to new research.

The Australian Health Services Research Institute at the University of Wollongong compiled the report for the Royal Commission into Aged Care. The study analyses staffing of Australian residential aged care homes compared to standards in other countries.

In the US system, each aged care home is rated on a five-star scale. Three stars is the sector average, one to two stars is below average, and four to five stars is above average. The US star ratings are based on the amount of nurse and personal carer time per resident, adjusted for differences in residents’ care needs so that homes can be compared against one another.

When the US system was applied to Australian data, the report found that 57.6 per cent of all Australian aged care residents are in homes with staffing that would only rate one or two stars in the US’s five-star rating system.

Among Australian aged care residents, 27 per cent are in three-star homes, while 14.1 per cent receive four stars and just 1.3 per cent are in homes with five stars.

Raising the standard so that all Australian aged care homes are rated at least three stars would require an average increase of 37.3 per cent in total care staffing in the homes currently rated one or two stars. This would require an increase of 20 per cent in total residential aged care staffing across Australia.

The researchers point out that the US model does not address allied health staffing levels.

The study did make comparisons with other jurisdictions that do include allied health staffing levels such as the Canadian province of British Columbia.

Only two per cent of Australian residents are in homes that currently meet the 22 minutes of allied health services per day recommended in the British Columbia system. The current Australian average is eight minutes of allied health care per day. Achieving the level recommended in British Columbia would require 
a 175 per cent increase in allied health staffing.

The researchers concluded that the American Nursing Home Compare system was “the best that is currently available internationally”.

“Aged care homes that have a rating of one or two stars have an unacceptable level of staffing. Those with three stars have an acceptable level, those with four stars have a good level and those with five stars have best practice levels of staffing,” the researchers concluded.

“The minimum amount of staff time per resident day for acceptable care is thus 30 minutes of RN time and 215 minutes of total care time (RNs and other care workers).”

Nurses and doctors stand together for aged care

Older Australians cannot wait for the conclusion of the Royal Commission into Aged Care for more funding and reforms say the Australian Medical Association (AMA) and the Australian Nursing and Midwifery Federation (ANMF).

The two organisations have jointly called on the federal government to “make immediate and effective improvement to aged care, especially with ensuring a safe and quality skills mix of medical, nursing and care staff”.

This can be done, they say, by providing:

  • a general funding increase
  • mandatory minimum staff-to-resident ratios, including ensuring sufficient skilled nurses in residential aged care facilities
  • increased GP aged care Medicare rebates for patients to facilitate enhanced medical practitioner care of aged care residents and
  • expanded home care investment to allow more older people to stay longer in their own homes and relieve pressure on residential aged care services.

AMA President, Dr Tony Bartone, said: “Standards of care for our elderly should not be compromised through restriction of resources or the budget bottom line.

“Ignoring the health and care needs of older Australians will lead to an increase in avoidable hospitalisations and excessive costs to the health system.

“The aged care system urgently needs a safe and quality skills mix of medical, nursing, and care staff. The increased presence of doctors as part of the care team is vital.” 

ANMF Federal Secretary, Annie Butler, said: “Underpinning so many of the problems that are being exposed across the aged care sector is systemic, chronic understaffing, leading to unacceptable instances of neglect, abuse, and too many preventable deaths.

“We can’t wait for the Morrison government to act on recommendations of the Royal Commission to stop the suffering of our elderly; we simply cannot allow the government to continue to sit idly on the sidelines and watch the extent of this suffering unfold.”

Read the report

The report can be downloaded from the Royal Commission into Aged Care’s website: