The finer details around the mandatory requirement for aged care homes to deliver 200 minutes of care are still being hammered out, but a recent The Hatchery panel discussion provided an opportunity to take a closer look at what the change will mean for providers and the sector as a whole.
Grant Corderoy, senior partner with aged care accounting consultancy, StewartBrown, said from the data they’ve analysed – which is sourced from surveys of 50% of all aged care homes in Australia – the current average minutes of care being delivered in the sector is 175.8 minutes, a significantly lower figure than the 200 minutes required that will be expected from October 2023.
Of the requirement for registered nurses to spend 40 minutes per resident per day on care, 11% were exceeding that target but 89% were not.
The average time spent on care for those delivering more than 200 minutes of care was 206 minutes, while the average of those delivering below 200 minutes was 168 minutes.
“So, there’s quite a disparity between the two,” said Mr Corderoy.
How will the change be funded?
Resident mix and acuity has a “significant impact” on care minutes, Corderoy said.
He said it was unclear how homes already delivering more than 200 minutes of care will be affected.
“Do they get no more funding? Or do they have reduced funding?” he asked.
Homes will have to employ additional staff or existing staff will have to work more overtime to meet the new requirements, adding costs to operations that in many cases are already struggling to stay afloat.
“Certainly, we know from a quality point of view it needs to be increased and there’s broad agreement with that.”
Time spent on care is “intrinsic to providing quality care”, Corduroy added, and more discussion is needed.
Mark Richardson, assistant secretary, Residential Aged Care Funding and Reform in the Home and Residential Provision of Ageing and Aged Care Group at the Department of Health, said the government has allocated $3.9 billion to achieve the 200 care minutes.
The additional funding will be available from October 2022, allowing for a “one year transition period,” he said.
What’s included in the 200 minutes?
Mr Corderoy said there was an “air of confusion” about what makes up the 200 minutes.
Guidance indicates it will include registered nurses, enrolled nurses and personal care assistants, but it does not include allied health, lifestyle or pastoral care.
Mr Richardson explained that the 200 minutes is case-mix adjusted and an average of 200 minutes per resident per day. It includes the 40 minutes of registered nurse time.
Care minute requirements will be adjusted quarterly, but Mr Richardson said he hopes they will be “reasonably stable”.
Some homes may be able to claim exemptions. For example, homes that cater for homeless older people may be able to claim social workers to be included in their 200 minutes of care.
He said staff’s salaried hours would be counted in the 200 minutes.
“We would take all the hours that that nurse has worked in a facility and put it towards the 200 minutes.”
Low-acuity homes will struggle
James Underwood, an aged care specialist with firm James Underwood Consulting, noted that the 200 minutes of care will be difficult for low-care homes to achieve.
Compared to similar countries, Australia has high rates of people living in residential aged care over the age of 70 because of our lower threshold for entry.
This may ultimately mean that mandated care hours lead more people to stay at home, but providers currently running low-acuity services will have to go through a period of adjustment, Underwood said.
Many services “are really not cut out for a higher frailty, or higher acuity, 220-minute-plus future,” Mr Underwood said.
“So I certainly would look forward to seeing what we are doing to transition our residential aged care service to a more hospital-like type of facility with specified levels of care staff and registered nursing staff.”
Many of Mr Underwood’s clients would “most unlikely” be able to function under a higher-acuity model, he observed.
Homes that rely on more expensive agency staff will also be “more challenged” in achieving the 200 minutes requirement.
Care minutes will feed into star ratings
Mr Richardson said the star-rating system will include care minutes.
Ensuring data integrity
To ensure providers are submitting accurate data, the Department of Health will collect roster data for salary hours and will be able to conduct cross checks.
The aged care regulator will also be provided with additional funding to include care minutes data in its quality audits, Mr Richardson explained.
Providers or aged care homes “should be held to account” on the provision of accurate data, he said.
A sector health check
Ian Yates AM, chief executive of COTA and convener of the panel, asked about new pay rates for aged care staff, which don’t kick in until 12 months after the 200 minutes become mandatory.
Mr Corderoy also said it was “unclear” how the new AN-ACC funding system will account for the increased cost of delivering the mandatory minutes of care.
Mr Richardson explained that shadow AN-ACC assessments are being conducted, but progress has been slower than hoped for due to COVID-19 restrictions.
The Department is still working through the details Mr Richardson said, but it is “keen to engage” with the sector.
Mr Corderoy concluded by saying he hopes the data and the quarterly monitoring will help homes manage their operations better, and improve the sector as a whole.
In that long report I could not find a definition of what the 200 minutes consists of. To a lay person it would mean time actually spent with the resident but I think it means more like writing reports or ?? planning care whatever that means for a resident. My companion has been in care since August and the registered nurse hasn’t noticed that he needed a podiatrist..I had to ask to arrange it and even now don’t know if he’s seen one. He has a colostomy and I have visited and found the colostomy bag put on upside down.
To consider that he gets care when one sees these things, one wonders.
It is most unfortunate that care hours spent with a resident by Wellbeing / Lifestyle staff are not currently going to be included in the 200 minutes. Many residents need antidotes to loneliness and boredom more than they need extra personal care and medication time. The outcome of this move will be to continue to turn our Aged Care Facilities into quasi hospitals instead of making them a great place to live where people can feel at home, happy and with lots to do.