The aged care industry in Australia was definitely not built on the back of clear definitions.

Words like ‘appropriate’ and ‘care’ are extremely broad by themselves, and the term ‘appropriate care’ is almost indefinable without a series of examples and vague assumptions.

While there is absolutely no doubt that the vast majority of aged care workers do their best to provide for their residents, there is also no denying that a significant portion of staff feels overworked and unable to do their job to the best of their abilities due to time constraints.

The Royal Commission has given Australian’s a chance to voice their opinion regarding potential solutions for some of the issues that the industry currently faces, and it’s fair to say that pretty much everyone (except the aged care providers themselves) feels that a current lack of staffing is the biggest issue.

Recently, a number of unfortunate Australian families received a letter from the Department of Health stating that a certain Victorian aged care facility had been sanctioned by the Aged Care Quality and Safety Commission; and that this facility would need to provide an ‘appropriate level of staff’ to ensure that care was meeting Accreditation Standards.

But what is an appropriate level of staff for an aged care facility?

Research that was undertaken by the Australian Nursing and Midwifery Federation (ANMF) shows that the current aged care resident in Australia receives roughly 2.5 hours of care per day and the staffing mix is usually comprised of 70% Personal Care Workers and 15% of both Registered Nurses and Enrolled Nurses.

But according to some, this is simply not good enough.

The ANMF’s research has shown that the average individual living in residential aged care needs 4.3 hours of care per day – which is close to double the amount of care that the average resident currently receives and that the ideal mix of staff for a residential aged care facility is as follows:

  • 30% Registered Nurses
  • 20% Enrolled Nurses
  • 70% Personal Care Workers

That 4.3 hours of care per day equates to approximate ratio’s of:

  • AM shift – in charge RN plus 5-6 EN/PCAs (mathematically it’s about 5.5 – so enables 5 on some days and six on others)
  • PM Shift – in-charge plus five 5-6 EN/PCAs (as above)
  • ND shift – 8 staff (inclusive of in-charge)

Paul Gilbert, Assistant Secretary of the Victorian branch of the ANMF (VB) shared his thoughts with HelloCare on the ramifications of current staffing levels and the need for regulation.

In 2017 BUPA made 23 registered nurses redundant. At the time, Bupa employed 53 Care Managers and 25 Clinical Managers across its 26 aged care facilities in Victoria. It made the decision to abolish those positions, and appoint 55 Clinical Care Managers,” said Paul.

“Interestingly, the result of this restructure would be that 23 existing RN Care Managers and Clinical Managers positions would be made redundant, and since then they have featured strongly in adverse reports, and in many cases have at least temporarily put additional RNs back into the homes in order to avoid ongoing sanction.”

“Staffing levels and skill mix need to be regulated, we have experienced increasing complexity of resident care needs since staffing obligations were abolished in 1997, with a corresponding decrease in care hours and skill mix.”

Whether you agree with the ANMF’s ideal staffing mix and individual care requirements or not, they are actually one of the few parties in the aged care industry that seem to have any sort of an answer to what appropriate staffing levels could be – but they are far from being the only party with an opinion on the matter in general.

Dr. Rodney Jilek has spent a lifetime working within residential aged care facilities and advising aged care providers on how to improve their processes, and he was kind enough to share his thoughts regarding appropriate staffing levels to HelloCare.

“The difficult thing about staff ratios, in general, is that you have to take into consideration- the residents that you have and their specific needs, the building design, the equipment that you have, the technology that you have, and of course the skills of the staff,” said Dr. Jilek.

“The government will probably introduce a mandated staffing ratio but they will make it so low that it will be meaningless, because otherwise, everyone will come out with their excuses like ‘we are in the country, we can’t get any registered nurses’ or ‘we can’t afford it because of this or that reason’ etc.”

“The fact that you can’t simply walk into a facility and instantly know how many staff are needed to meet the needs of every individual makes staffing a very grey area.”

“NSW already has a mandated staff ratio for registered nurses that states that all aged care facilities must have at least one registered nurse 24 hours per day – and this can be appropriate if you run a 20-bed home, but it can be completely inappropriate if you run a 100-bed home, but the 100 bed facility can still claim to meet standards under that blanket ratio.”

Recent negativity has seen those governing the aged care industry take a much more rigid approach in the way that they assess aged care environments and also in what they deem to be appropriate care, but the fact that they are unable to define ratios or staffing mixes has meant that many providers are now playing catch-up and having to deal with the ramifications of not
asking themselves the tough questions.

Left to their own devices, aged care providers have shown that they will not provide appropriate staffing levels, and the responsible Department cannot tell them what appropriate staffing levels are, just that they must have them,” said Paul Gilbert.

Dr. Jilek was also critical of the lack of clarity regarding staff ratios and mixes from the government and the Safety Commission.

“The agency never even used to be pick-up ‘lack of staffing as an issue because it’s so grey of an area, and it’s good that their starting to actually pick that up but the problem is that their having to rely on failures within an aged care facility to let them know that there’s not enough staff,” said Dr. Jilek.

“The sad reality of aged care at the moment is that everything is reactive, there are not enough providers that are being proactive about this stuff and realistically asking themselves if they have enough staff to provide good care, or whether they are expecting their current staff to go beyond the scope of what’s actually reasonable.”

“How many more people will have to suffer before someone says ‘Hey, you know maybe having one registered nurse for 100 people is not appropriate?”

While Dr. Jilek did not offer any thoughts on his personal idea of the ideal staffing mix and ratio, he did share his thoughts on the ANMF’s proposed numbers as well as the ramifications for providers who provide residents with an increased amount of care-time per day.

“They’re not far out (ANMF), but they’re overreaching and these demands are a best-case scenario. A residents hours of care per-day needs to be an amount somewhere between the current standard and what the ANMF is asking. And even if that is the right number, the next question is, is that affordable?” said Dr. Jilek.

“The homes that I’m usually involved with, sit at around 3.5 hours of care per person per day, which is roughly halfway between current figures and the ANMF figure, and you can do a consistent and reasonable job of providing care with that.”

“Companies that do hover around the 3.5 hours a day aren’t making much money though, which is the flipside to that, but sometimes you have to weigh up if you would rather sleep well at night, or you want to make truckloads of money.”

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