Oct 15, 2019

“The level of staffing in residential aged care in Australia is substandard”

I have read with interest late last week the very freshly released Royal Commission research paper into aged care staffing requirements, and the shortfall in funding needed to raise the staffing mix and levels to appropriately care for the average residential aged care service consumer. The following excerpt from the recommendations paints a picture of what residents, families, advocates, and indeed some providers have been saying for some time – the level of service provision (staffing) in residential aged care in Australia is substandard. My conclusion is that because that level of provision is so strongly associated with the operating funding mechanism, the funding mechanism for care is equally substandard:

“More than half (57.6%) of Australian residents receive care in aged care homes that have unacceptable levels of staffing (1 and 2 stars).

“To bring staffing levels up to 3 stars would require an increase of 37.3% more staff hours in those facilities. This translates into an additional 20% in total care staff hours across Australia.

“We have not limited our analysis to determining the additional resources required to bring facilities up to an acceptable level. We have also provided an indication of the additional resource requirements that are required to deliver staffing levels consistent with good practice and best practice care.

“For all residents to receive at least 4 stars (what we consider good practice) requires an overall increase of 37.2% in total care staffing while 5 stars (best practice) care would require an overall increase of 49.4% in total care staffing.”

As you are probably well aware, I am the CEO of Braemar Presbyterian Care (Braemar). To put our services into perspective, since I joined Braemar in March 2017 we have been increasing hours per resident per day to a level that is close to the current national average as recorded by the StewartBrown benchmarking service reporting. And, as far as is reasonable, we have been improving our subsidy income to match the staffing. But that recurrent income is not enough.  

aged care funding cartoon

According to this research paper, prepared for the Royal Commission into Aged Care Quality and Safety, less than 3 star level of staffing is unacceptable, while a 4 star staffing is good practice, and 5 star staffing is best practice. Yet 57.6% of residents receive less than 3 star (unacceptable) staffing and only 1.4% receive best practice staffing.

How is this translated into the care of our elders? The difficulty lies with the recurrent care funding mechanism. The daily combined revenue available for payment of salaries and care related goods and services is about $270 per day maximum. There are very few residents at a maximum level of subsidy, but even for those most frail people, who could alternatively be residing in a hospital, the funding mix could not be more different.

That $270 per day in an aged care facility is a long way short of the $850 to $1,050 per day for accommodation only in a hospital, that is, no active health intervention happening. Therefore, the number of staff available to care, and the skill mix (professional qualifications or otherwise), are both much more limited in an aged care service than in a hospital. The Commonwealth funds aged care, and (largely) the States fund hospital care (through Commonwealth Medicare arrangements).  Sadly, the two are incompatible, and our elderly citizens miss out. 

Could there be a better funding mechanism?  Do we need to pay more privately for the care of family members?  I am certain the answer to both questions is yes, but over the years the inclination from Government has only been to minimise its funding commitment.

I have undertaken my own research into this vexed problem of finding an appropriate staff ratio and mix, and, along with other recommendations, estimated the overall cost of achieving that staff mix.

How closely does likely cost extrapolated from this most recent Royal Commission research paper compare?  Allow me to share the following:

i. Additional cost Staff Mix calculation by Wayne Belcher in May 2018 – $4.72 billion per annum

ii. Allow $40 full on cost per hour on average for all carer staff, whatever classification

iii. Allow for 181,000 residents in residential aged care in Australia at any one time (180,923 permanent residents in care at 30 June 2018)

iv. 3 Star staff increase (59 minutes per day, 57.6% of all 181,000 residents) – $1.497 billion per annum

v. 4 Star staff increase (3 Star increase plus 51 minutes per resident – $3.743 billion per annum (all residents))

vi. 5 Star staff increase (4 Star increase plus 21 minutes per resident – $4.668 billion per annum (all residents))

This next question is… How can we provide anything less than best practice for the care and accommodation for our elderly vulnerable and frail elderly? We have to work out how we are going to fund the delivery of this staffing and care.  

Now!

I am excited to see these research outcomes. But, why have we waited until a Royal Commission to eke out and confirm these earlier findings?

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  1. I am not sure that it is ok to say “…because that level of provision is so strongly associated with the operating funding mechanism, the funding mechanism for care is equally substandard…”

    It might be true, but we need some more information.

    Some Aged Care Providers are profitable [or produce a surplus if not for profit].

    Is the substandard care only from those providers who make a profit ?

    Is the substandard care only from those providers who make a loss ?

    I would like to know which providers provide good quality care with the current government funding and how they do it. We need much more transparency. An industry that totally depends on Government subsidies for survival should be 100% transparent.

    From my own families experience [5 in aged care over a period of 20 years] and my employment for 7 years assisting family carers deal with Aged Care issues, I can say that some providers did a wonderful job and were sustainable businesses, while others were bloody awful and constantly complained about lack of funding.

    My observation is that poorly trained management, prioritising financial targets instead of care outcomes, insufficient delegation of decisions about care and routine financial issues, an over reliance on casual staff, a failure to include families in the care team with honesty and support, and a failure to value, train and care for good staff are all major contributors to financial outcomes.

  2. I am in a position where I have my mother in care in a beautiful care facility in Bowral nsw and my son is studying to be a clinical psychologist at a university in Sydney.
    The care facility although wonderful is understaffed and my son and all other students always have trouble obtaining experience, which they have to source themselves in the mental health field.
    I was thinking it would be a great idea for the psychology students to do blocks of unpaid supervised work experience in the aged care facilities to get hours of experience as teachers do while studying for their teaching degree. Surely this would help staff shortages in aged care and help gain valuable experience for the psychology students.
    I have emailed the minister for aged care but have had no response.

    1. Unless there are minimum ratios in aged care things will never change. My place of employment cut staff hours when there are 6 to 8 beds empty. You would think they would give us a break and allow us to spend more quality time with the residents but money is loud and clear here. Empty beds mean not enough cash flow. They are begging staff now to do double shifts as the staff that had their shifts cut are either leaving or are too exhausted to come to work due to the shortages and work load.

  3. I live in a Hammond care Nursing home, in a cottage for younger-onset Dementia, The staff are really good, we have a central kitchen and the staff cook the food, I hear now and then that the pay is not that good, I think that is why some Nursing homes are understaffed, I spent 2 weeks in an older nursing home on respite, i saw first hand that they did not rotate the people who were bed-bound, the food was so awful

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