Jun 03, 2020

60% Of Australian Nursing Homes Are Understaffed


New research published in the Medical Journal of Australia reveals that close to 60 per cent of Australian aged care residents are living in facilities with ‘unacceptable’ staffing levels when compared to international staffing benchmarks. 

The Royal Commission’s Interim Report highlighted evidence showing that aged care workers often experience excessive work demands and that these pressures had a negative impact on their ability to deliver person-centred care.

Researchers found the five-star rating system used in the US to be the most relevant international system for judging care in Australia, and the following MJA research was requested by the Royal Commission to better inform them as to how Australian staffing levels compare to aged care homes overseas.

The research found that the majority of Australian aged care homes would be classified as either one or two-star rated homes due to low staffing numbers and that any facilities that are rated below three-stars are should be deemed as having inadequate staffing levels for aged care homes in Australia.

The research shows that aged care residents in Australia receive on average 188 minutes of care per day. This care is comprised of 36 minutes by registered nurses, 8 minutes by allied health professionals (mostly physiotherapists), and 144 minutes by personal care assistants.

It was also noted that anecdotally, registered nurses, and allied health professionals are required to spend a disproportionate amount of time on paperwork for funding purposes, leaving even less time to spend on care.

Using the five-star metrics, a little over a quarter (27.0%) are in RACFs that have three stars, 14.1% of residents are in RACFs with four stars, and 1.3% are in RACFs with five stars, which are considered best practice from an international standpoint.

Staffing levels in Australian nursing homes rate poorly when compared to staffing levels in the US where the majority of aged care residents live in homes that are rated three-stars or above.

Australia also fails to meet the standards of countries like Germany and Canada despite staffing legislation in both Queensland and Victoria.

Statistically, bringing all Australian aged care homes up to adequate staffing levels would require an average staffing increase of 37.3% in those RACFs currently rated one or two stars, which would result in an overall increase of 20% in total care staffing across Australia.

The needs of aged care residents have increased in recent decades, as residential aged care is now primarily home to people who are too vulnerable to live independently in their own homes.

This new report also provided a significant snapshot of the frailty of Australian aged care residents as only 15% of the 5,000 residents who were independently assessed were deemed independently mobile.

The other 85% of residents either required mobility assistance or were not mobile at all.

Communication issues and mental health problems are rife in Australian aged care homes including agitation which is the most prevalent problem (43%), followed by depression (35%) and irritability (35%).

There has been more than enough research done over the last two decades that clearly indicate the lack of staffing in aged care has resulted in poor outcomes for older Australians and their increasingly complex needs.

Despite this clear evidence, both the Australian Government and provider-focused peak bodies have done everything in their power to avoid legislation that would enforce a minimum standard of staff ratios and skill mix.

Older Australians deserve a model of care that fulfills both their social and clinical needs.

Achieving this will require a government that is willing to make a significant financial investment and a level of transparency that requires providers to disclose how they are using their funding to ensure that people are taking precedent over profits.


Photo Credit – iStock – Willowpix

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  1. This study has to be questioned, particularly in the light of the Covid-19 pandemic. Staffing in Australian aged care facilities is based on the needs of each resident and aged care facilities staff to cover the current and changing care needs of the community, with increasing numbers of high care residents and shorter stays. The majority of providers staff their homes well to meet these care needs and add other resources as required.

    The study seems not to reflect this reality and a different conclusion would have been reached if the researchers had reviewed actual rostering and care mix of facilities and actually visited homes and talked to staff.

    The Royal Commission in Australia has put a lot of faith in the USA’s system of star ratings without examining this properly. The USA system was never going to be suitable to consider as the standards and regulations are far lower than in Australia where we have the benefits of a strongly regulated system, regular monitoring by the Quality Commission and department and high standards of infection control.

    The current Covid-19 crisis has stripped the USA bare with 35% of deaths being residents and staff in aged care homes. For a variety of reasons – including the US’s privatised healthcare system, pre-existing problems with infection-control in America’s care homes, a lack of federal leadership on the pandemic and the varying rate of spread of the virus across other states residents of nursing homes have accounted for a staggering proportion of Covid-19 deaths in the US, where more than 100,000 people have died. Privately compiled data shows that such deaths now account for more than half of all fatalities in 14 states, according to the Kaiser Family Foundation. But only 33 states report nursing home-related deaths, so the true extent of the problem across the state remains unknown.

    The Commission and others who seek to comment on staffing in aged care facilities should heed the USA situation. Staff in Australian aged care homes have done an exceptional job to care for residents during the pandemic and the low case numbers and deaths are testament to their great work.

    Yes, we can we would welcome more resources but the current system is better than our critics say.

  2. Only 60% I would think it is more I have worked in a lot of facilities and getting staff and keeping staff is hard. I have worked up to 13 days straight and five of them double shifts as there was not staff. Even now in the last 2 months, we have lost 5 staff, not though the coivd19 but retirement age and also trainees who did not realise how hard the work was. Looking after up to 20 residents by yourself is unfair for the resident and the worker.
    Maybe fingers crossed ratios will come in

  3. I have a relative who is high care in Arcare – she cannot do anything for herself but if she calls the bell to get someone to take her to the toilet it sees to take 1.5 hrs which is terrible. I have seen her at 10.30am and she still has not been dressed. There are no staff around half the time. The premises are beautiful but that’s no good if there is no-one to care for the residents. I am extremely disappointed in the staff levels – I feel there should always be carers around just to make sure that everyone is OK. That high care residents should be checked on at least once an hour. This is certainly not the case.

  4. You would agree there is understaffing and overworked staff if you worked on an age care facility. Even a short visit will tell you that.

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