Aug 19, 2020

Public “shocked” by staffing gaps in aged care. It took a pandemic for them to notice

Media reports slamming aged care facilities for having only one nurse on duty for more than 100 residents ignore an important fact: this is not unusual in aged care.

In fact, it’s the norm.

It has been well established by the Royal Commission into Aged Care Quality and Safety, and several inquiries before it, that the aged care sector is understaffed and does not have the appropriate skill mix in place to meet the increasingly complex needs of residents. 

And yet there has been little progress in this area. The problem remains. 

Staff ratios are the answer: ANMF

Australian Nursing and Midwifery Federation secretary, Lori-Anne Sharp, told HelloCare, “The public are shocked, and disappointed, and traumatised by what they are seeing” in aged care during COVID-19.

With the problems associated with staff shortages being compounded and magnified during COVID-19 outbreaks in aged care facilities, could now be the time to address the thorny issue of staff numbers and skill mixes?

“Absolutely” said Ms Sharp. The ANMF has been advocating for staff ratios for a decade now, and she said the government must act now to prepare the aged care workforce for potential infection outbreaks.

The ANMF is calling on the government to mandate staffing numbers, skill mixes, and minimum nursing/care hours.

Vague guidance is open to interpretation

It’s up to aged care providers how many staff they employ in their homes, because aged care laws and quality standards only require “sufficient” and “appropriate” staffing.

The Aged Care Quality and Safety Standards, which set the baseline for the quality of aged care services, does not stipulate how many staff should be employed in an aged care facility, or what qualifications they need.

For Standard 7, aged care organisations are tested against the statement, “The organisation has a workforce that is sufficient, and is skilled and qualified to provide safe, respectful and quality care and services.”

The Aged Care Act is similarly vague, requiring “only appropriate staffing to meet the nursing and personal care needs” of the resident.

It’s not hard to imagine that interpretation of these requirements could create a tension for providers. 

On the one hand there’s no doubt they want to deliver the best care for their residents, but there is also the pressure to return a profit to shareholders, or just to make ends meet in the cash-strapped sector.

RNs declining as a proportion of aged care workforce

With providers with complete discretion over who they employ, it’s no surprise the number of highly skilled registered nurses employed as a proportion of total staff in aged care has declined over the years.

Registered nurses made up 21 per cent of the direct care aged care workforce in 2003, but only made up 14.6 per cent of the workforce in 2016. The percentage is likely to have declined even further since then.

When only one or two RNs must care for more than 100 residents, the pressures on them are immense. It’s impossible really; it’s no wonder RNs are leaving the sector in droves.

Compounding the problem, inexplicably, throughout the COVID-19 pandemic, the ANMF has reported that 64 per cent of its members that took part in a survey said their aged care facility had staff cuts and hours of care during the pandemic.

The role of the RN

Registered nurses play a crucial role in aged care homes, and the public is right to be shocked by how few there are employed to care for elderly residents. 

RNs assess the residents on admission and develop nursing care plans for each resident. They are also then responsible for ensuring the care plan is followed and matches the assessed needs of the resident. RNs are responsible for the management of medication administration, pain management, continence management and wound care, and they delegate nursing care to other staff.

RNs are also highly trained in infection control, an issue that is, of course, crucial during COVID-19.

Professor Deborah Parker told the Royal Commission, that clinical tasks are often performed by less skilled, unregulated staff these days.  

“Due to the low number of registered nurses that work in aged care facilities, supervision of clinical tasks for personal care workers may not be being carried out by registered nurses but instead by other unregulated workers,” she said.

COVID-19 has revealed the consequences when there are too few clinical staff with infection control training on the ground. The public is right to be shocked by the fact that a single nurse can be responsible for more than 100 residents. Sometimes that nurse isn’t even on site. 

With the public’s attention firmly on the sector, perhaps now, finally, the government will find the will to act on this issue.

Image: Kiwis, iStock.

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  1. “One RN to one hundred residents the norm” is an inflammatory comment and inaccurate.
    I support nurse ratios if they are funded but clearly the federal government has failed its duty of care to provide adequate funding for the provision of services to the elderly.

    It is however not as simple as a 1-5ratio or such. What confuses the issue, and it was done deliberately is that the Federal government has lumped all facets of care under the “Aged care” banner.

    In a village setting one experienced nurse on site is easily managed with the only need being an unlikely fall or such.
    In a high care setting there are vast differences between residents ailments but the the one over riding reality is The Standards applied by the department of health. They are mostly experienced people with medical backgrounds and their job is, and they do it well, is to ensure that appropriate care is delivered to all residents.
    As an example, a couple of years ago we had a resident with the normal ailments plus diabetes. The blood sugars are tested three times a day. The team went through our documentation and found over an eight month period that on two occasions the residents chart was unsigned for the test, they accepted that the test was most likely done but the staff simply forgot the signature required.
    This is the extent of the depth and lengths of scrutiny that homes already live under and this constant nonsense that would suggest that elderly are locked up, malnourished and mistreated is just so insulting to the industry.

    Unfortunately the media is able to print half the facts, unfortunately the aged care associations are not strong in defending facilities from misinformation and unfortunately a lot of facilities are reluctant to speak up in fear of reprisals.

  2. The whole Corona virus fiasco in aged care has been brought about by aged care homes being underfunded under resourced undertrained understaffed. I Think there is a need to review the way homes are managed across the board.

    The federal Government should take care of funding and capital works. as they do now however local and state government should be assessing the care and delivery of services as they should do as health is a state responsibility. States have neglected their role in Aged care for too long saying it is a Federal Government responsibility They should be involved deeply. A complete rethink of who owns and operates these facilities and ensuring adequate resources and funding needs to be rethought with a root and branch reform Scrap the current system and allow the changes needed to be put in place to really meet the residents needs.

  3. Very few responsible aged care operators would run 1 nurse to 100 residents.

    The reality is the industry is grossly underfunded with the Stewart Brown industry averages showing in excess of 60% of aged care companies are operating at a cash loss – do not blame the operators blame the government and families who are not prepared to pay sufficient for aged care to allow operators of sites to run their sites with the staffing they would like to.

  4. And with all due respect to ANMF they may want to consider what the staffing of public hospitals now look like. You can visit any public hospital in Sydney and observe numbers of staff providing clinical care and support who are not registered nurses, but assistants in nursing. It can reasonably be assumed that this situation has arisen because there are not the numbers of RNs to staff a public hospital. If they cannot attract and retain sufficient numbers of RNs it would seem a pointless exercise to criticize aged care for suffering the same issue. Perhaps the better question would be to ask why are people not attracted to becoming registered nurses?

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