“You’ve got to be joking”: Aged care staff doubt royal commission’s care recommendations can be met

Nurse patient glasses

The recommendation from the final report of the Royal Commission into Aged Care Quality and Safety means providers will have to employ enough nurses, enrolled nurses and personal care workers for at least 3.3 hours of care per resident per day.

However, members of HelloCare’s Aged Care Worker Support Group found the idea impossible, after sharing the image below. 

“Tell ’em they’re dreaming,” one wrote. 

Many others said the idea was laughable, and shared their experiences of working in short-staffed homes.

Meanwhile, Annie Butler, Federal Secretary of the Australian Nursing and Midwifery Federation, asks where enough qualified staff will come from?

The recommendations

The royal commission recommended that by 1 July 2022, a “minimum staff time standard” should be introduced to require providers to employ RNs, enrolled nurses, and PCWs for at least 200 minutes per resident per day, with at least 40 minutes of that time provided by a registered nurse.

The minimum staff time standard should also require at least one RN on site for every aged care home for each morning and afternoon shift, for a minimum of 16 hours per day.

By 1 July 2024, the minimum staff time standard should increase to at least 215 minutes of care per resident per day, with at least 44 minutes of that time provided by an RN.

By mid 2024, the standard should require at least one RN on site at all times.

The current situation

According to research done by the royal commission, direct care staff – which includes care management, nurses, personal care workers, allied health and lifestyle staff – in non-government aged care homes worked on average 184 minutes per resident per day in 2018-19. 

Direct care staff in government-run aged care homes worked 229 minutes per resident per day, a reflection of the fact that government-run homes often have staff ratios.

Nurses in non-government homes on average worked 39 minutes per resident per day, while in government homes they worked 119 minutes per resident per day – a massive difference.

PCWs in not-for-profit homes worked 130 minutes per resident per day, while PCWs in for profit homes worked 123 minutes per resident per day. 

Interestingly, in government homes, PCWs only worked 114 minutes per resident per day.

But a high number of PCWs is not necessarily an indication of high-quality care, the report’s authors noted.

“A high number of PCWs are not necessarily a good result if it is accompanied by reduced nursing staff, as this suggests duties normally performed by nurses are being shifted to less trained personal care workers,” they wrote.

In other words, government-run homes employ plenty of nurses, so they don’t need to employ so many PCWs.

Where will staff come from?

Australian Nursing and Midwifery Federation Federal Secretary Annie Butler said the recommendation is “a step in the right direction”.

The commissioners have acknowledged “the importance of the right numbers of the right types of staff in guaranteeing safe, dignified care for every older Australian,” Butler said.

The commissioners “see the clear link between more staff, safety of care, a safe work environment, and attraction and retention of workers

Inadequate staffing levels are linked to worse outcomes for staff, including burnout, lower retention and high turnover, Butler said.

She called on the government to address staff shortages in order to fill the gaps in the aged care workforce.

“This government and many previous governments have done nothing to address shortages of RNs and qualified carers working in aged care,” Butler said.

“The Morrison government must act now.

“Every day the government delays taking action to address dangerous understaffing, is another sad day that vulnerable residents will continue to suffer,” she said.

It’s achievable – mostly

Sean Rooney, CEO of aged care peak body, Leading Age Services Australia, told HelloCare the feedback LASA has received from its members is that Phase 1 of the recommendation of 200 minutes of care per resident per day “should be able to be achieved” by the 1 July 2022 deadline.

However, he said achieving the second increase “may present a bigger challenge” for members due to the additional costs and the lack of available staff. 

“The recruitment of the additional staff needed will depend on the availability of additional funding to pay for more hours and higher rates of pay. 

“Many members are experiencing difficulty in attracting and retaining enough staff to meet their current rosters,” he added. 

Additional government funding is needed if providers are to increase their workforce, Rooney said.

“Major recruitment efforts need to take place over a period of time, and providers cannot be expected to suddenly hire a large number of new staff as the clock strikes midnight on 1 July.”

“Equally, some providers already have the required level of staffing and they should not be expected to continue incurring significant losses for showing leadership.

“Comprehensive workforce planning and development is a critical prerequisite for many of the Royal Commission recommendations and must be addressed as part of the upcoming Federal Budget announcements,” Rooney said.

Attract nurses back to aged care

Lori-Anne Sharp, Assistant Federal Secretary of the ANMF, told HelloCare it is “critical” that “a minimum level of safe staffing” be mandated “as a matter of urgency, to protect residents in nursing homes from suffering any longer”.

She said now that the government has the royal commission’s recommendations, there are “no more excuses” for continued inaction. 

Workforce coordination, planning and training will be required to meet staffing needs, including looking at ways to attract nurses back into the aged care sector.

Safe working environments, minimum legislated staffing levels and appropriate remuneration are needed, Sharp said.

“Elderly residents in private aged care deserve to have access to safe staffing levels, so their basic needs can be met and that they receive the care and respect they deserve.

“We must aim to have a world class system, our elderly deserve nothing less.”

What do you think about the royal commission’s proposed staffing timeline? Tell us in the comments below.

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