Oct 23, 2018

Should Aged Care Residents Have Access to a Registered Nurse 24 hours a Day?

A House of Representatives committee inquiry has called for sweeping changes to the current aged care sector.

The report has been tabled in Federal Parliament and looks to address questions on a number of the hot topic issues that aged care workers, residents and families want answers to, in preparation for the upcoming Royal Commission into Aged Care Quality and Safety.

Parliamentary inquiry chair and Liberal MP Trent Zimmerman, told the lower house that the committee supported the thrust of ongoing reforms, but “There is more that can be done to improve our aged care system.”

While there has been objection to the idea of mandatory staffing ratios from a number of aged care facilities and peak bodies within the sector. The committee inquiry recommends that all nursing homes should have a minimum of one registered nurse on duty at all times.

Which will come as welcome news to residents and families with a loved currently being cared for.

Surprisingly, a recent HelloCare poll indicated that almost 40% of our aged-care-centric audience was actually unaware that there was not a mandated minimum staff ratio in place.

Which would suggest that this percentage might be even greater if the question was posed to a larger audience of varied ages and backgrounds.

The committee has also flagged potential changes to work practices within facilities, asking for the use of restrictive practices in order to subdue residents to only be permitted as a last resort.

Vision of abuse from within Australian aged care facilities has been some of the most horrendous and confronting footage that the public has ever had to deal with. Although hard to watch, it’s a sad necessity in order to bring the plight of our countries most vulnerable to light.

With this in mind, the inquiry is looking to bolster the ability of volunteers to report potential abuse, and advocates the reporting of all assaults on residents regardless of an offenders mental capacity.

“Investigative reporting has highlighted other serious examples of mistreatment and this inquiry has received submissions from residents and family members often outlining what can only be described as harrowing experiences,” said Mr Zimmerman.

“This is simply not acceptable in a nation like Australia.’’

The inquiry has called for mandatory reporting of all assaults on residents, including assaults that are committed by residents with cognitive impairment who were previously exempt from reporting.

This focus on incident reporting also filters it’s way down to volunteers, calling for specific guidelines to be put in place with policies that aged care volunteers can follow in the event that they witness or suspect that a resident is being abused or neglected.

The committee has also recommended changes to the Medicare Benefits Schedule which would help to ensure that aged care residents also had access to medical care from visiting doctors.

Giving volunteers the ability to potentially voice their concerns for residents and improving resident access to visiting doctors will add another dimension of transparency regarding the inner workings of aged care facilities.

Mr Zimmerman referenced the notorious Oakden scandal, where residents of a South Australian aged care Mental Health Service were assaulted, over-medicated and neglected,as an example of the depths that a facility can sink to.

“While perhaps the worst example, Oakden cannot be seen as an isolated event,’’ Mr Zimmerman said in the report.

This types of straight forward recommendations will be a breath of fresh air when compared to the highly complicated and convoluted explanations from aged care providers and peak bodies regarding the same issue.

And Australia is hoping that the Royal Commission feels the same way.

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  1. a lot of what will fix the system will have to be monitored, RN’s on 24/7 a must but then today I heard of a night RN (Agency) who didn’t want to do meds she asked the care staff to do it, she was to tired, care staff were having to do most of her work because she didn’t want to do it, and of cause they are answerable to the RN. I advised reporting her to management they need to know the people they thought were qualified are not doing their job, it will be the same all through the system, you can just put people in positions and then not check on them. As for Volunteers reporting YES definitely, I have volunteer for several years and yes I reported anything untoward, mind you very little was done about it, or the staff were backed, “oh dear the staff are so busy” No excuse, the resident comes first, center and last. this royal commission is going to be over loaded with situations that have been going on for years and staff ,visitors , families, Volunteers were all to scared to report.

  2. Given the complex needs of many residents in aged care facilities, skilled nurses need to be on duty 24/7. At least 1 RN and and EEN’s, the number depending on facility size.

    I do not support Carers administering Medications unless they have had sufficient training. I have worked with a number of competent Medication trained carers.

    In large facilities 1 RN is not always sufficient and each shift can be different bringing different needs. I could work a shift that runs very smooth, with nil falls, nil clinical episodes, nil family concerns and nil staff concerns where I can manage the shift smoothly.

    However I have worked shifts where I have had falls, gastro outbreak with 1/2 the residents isolated, family wanting to talk with the RN, Doctor needing RN to be present during round which may be in various units, staff ringing in sick needing to be replaced and mountains of paper work.

    I worked it one r facility where I had to administer 50 meds (as well as tablets there were eye drops, nebulisers, inhalers, creams for at least 20 residents) on my own as well as manage a palliative care resident etc
    I know if you added up the hours in total the facility would be claiming for Medication administration for ACFI funding, it would be indicate more than i staff would be needed for the 50 residents.

    In some facilities RN’s/physios and carers also have massages (back,knee etc) to complete for some residents as part of pain management which is part of the ACFI funding.

    My priority is always Resident safety and well being , happy family and happy staff.

    I have worked in Aged Care for 35 years and while many things have improved, I believe the workload has increased to the point of staff burnout where staff are rotating across various facilities looking for the dream job that offers a balance.

    You know the good facilities as they rarely advertise for staff are happy and stay long term.

    I welcome the Royal Commission in that it may ensure transparency, give residents and their representatives faith in the system and also mandate staff ratios and appropriate skill mix

  3. When there are many sections in an Aged Care facility it is ridiculous to say that one RN is sufficient in this instance. An RN should be in every section or level of an Aged Care facilities.
    The aged care facilities that want to stop a minimum resident to staff ratio have a very poor attitude.
    Even kindergarten facilities are required to have a staff to child ratio.
    Many aged people cannot more about and it is imperative that there is sufficient minimum staff to person ratio that applies across the board in all areas of a facility

  4. University qualified Registered Nurses on-site during the night, could prevent a resident from being transferred to an Emergency Department via ambulance.

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