Better staffing will fix the crisis in aged care
The Australian Nursing and Midwifery Federation (ANMF) is calling for mandatory minimum staffing ratios and skills mix in aged care facilities.
The ANMF said that it does not dispute Minister Ken Wyatt’s recent comments that the government was working hard to ensure older Australians had the best care possible, but it has rejected his claim that increasing staffing levels won’t necessarily solve the problems in aged care.
Increasing staffing levels is precisely what will solve the problem for elderly, vulnerable Australians in nursing homes, according to the ANMF’s A/Federal Secretary, Annie Butler.
“The aged care sector presents complex problems that successive governments have grappled with, unsuccessfully, for years. They’ve conducted myriad reports, reviews and inquiries looking for complex solutions to complex problems rather than going straight to the core of the problem. Chronic understaffing,” Ms Butler said.
“As we see, aged care providers continue to employ fewer and fewer nurses to care for an increasing number of vulnerable residents with increasingly complex medical needs. In a sector which has been systematically decimated with regard to staffing for more than a decade, staffing levels have now reached a critical low.
“From 2003 to 2016 there was a 13% reduction in trained nursing staff working full-time in aged care facilities while there was a 40% increase in the number of residents needing ‘high care’. Recently released research found that in the same period there had been a 400% increase in preventable deaths. ANMF members both in aged care and acute hospitals also know that there are many more preventable incidents occurring in aged care leading to unnecessary transfers to emergency departments and hospital stays.
“These are incidents that could have been prevented if there had been the right numbers of the right staff. This is exactly what could be provided if the sector had laws which mandated minimum staffing ratios.
“Furthermore, we have the evidence: the ANMF’s National Aged Care Staffing and Skills Mix Project (the Project) demonstrates that, on average, elderly residents in aged care receive 2 hours and fifty minutes of care, almost one and a half less hours care than the 4 hours and eighteen minutes they should get every day. The project also demonstrated that this care should be provided by a mix of nurses and carers, that is a skills mix, of 30% registered nurses, 20% enrolled nurses and 50% carers.
“We also have strong evidence from a large and increasing number of international and Australian studies, which demonstrate the relationship between low nurse staffing levels and adverse patient outcomes, including higher mortality rates. And conversely, higher nurse staffing levels with improved patient outcomes.
“The ANMF acknowledges there’s been a lot of recent commentary from the aged care sector, and the Aged Care Workforce Taskforce in particular, about the need to improve qualifications of workers in the sector. We do not disagree; aged care is a specialist area requiring specialist skills and knowledge. Hence the Project’s skills mix recommendations stated above.
“However, focusing just on the need to improve workers’ qualifications in the sector ignores the bigger and much more pressing problem – the need to improve the number of workers in the sector. There may be the most highly qualified registered nurse working in a facility but when that one nurse is expected to manage the overall care for 115 residents or more, quality care is just not possible.
“The Minister attempts to use Oakden as an example of the failure of ratios. While the Minister, like all of us, was deeply disturbed by the events at Oakden and is rightly looking for solutions, his criticism of ratios in this instance is misguided. While Oakden did have mandatory staffing requirements, they were not implemented nor was the staffing skills mix appropriate for the facility, leaving the facility consistently understaffed by staff members who lacked the skills to care for the residents properly.
“Oakden, at the time, was treated as an ordinary aged care facility rather than a specialist mental health facility, which required a different set of skills, namely mental health nursing skills. A fact recognised in the recommendations of the Inquiry into Oakden which states: all dementia-related and other mental health services delivered in an aged care context must be correctly classified as health services not aged care services.
“Ensuring the right number of people with right mix of skills to care for our elderly Australian is what can be delivered by mandating minimum staffing ratios and skills mix. It works in our public hospitals and in works in our child care centres."
17 April 2018.