The Queensland government has passed into law minimum care hours and fixed staff ratios for the state’s government-run residential aged care facilities.

In the wake of the Earle Haven emergency evacuation of more than 70 aged care residents in July, premier Annastacia Palaszczuk announced fixed staff ratios in state-owned residential aged care facilities and minimum care hours for residents.

Those changes became law on Thursday, when the Queensland parliament passed The Health Transparency Bill 2019.

The new laws require that the state’s 16 residential aged care facilities provide a minimum 3.65 hours of nursing care to each resident per day, and have staff ratios of 30 per cent registered nurses, 20 per cent enrolled nurses, and 50 per cent assistants in nursing.

In addition, all Queensland’s aged care facilities, including the state’s estimated 400 private facilities, will be asked to report their daily resident care hours and staffing skill mix, among other information. 

Though it will not be compulsory to report the information, facilities that fail to do so will be named on a public website. 

“More time to care”

Queensland Nurses and Midwives’ Union Acting Secretary, Sandra Eales, said the new standards will mean better care for residents of Queensland’s state-run aged care facilities.

“Nurses in state-run nursing homes will have more time to care for their residents,” Ms Eales said. 

“This is in contrast to the private sector, which is plagued by chronic understaffing and cuts to nursing hours,” Ms Eales said.

Staff numbers depend on resident need

Aged care’s peak bodies told HelloCare that staff skills and numbers should depend on residents’ needs.

Leading Age Services Australia CEO, Sean Rooney, told HelloCare determining the right number and mix of staff in residential aged care depends on “the clinical, social and personal care and support needs of the individual residents”.

“If the needs are of a higher clinical nature then you would expect sufficient hours would include qualified nurses and allied health staff, whereas if the support needs are more around responsive behaviour management and supports for personal care you may require more well trained carers,” he explained.

“Operational management within a facility is best placed to make staffing roster decisions,” Mr Rooney told HelloCare.

Aged & Community Services Australia CEO, Patricia Sparrow, said the changes in Queensland reduce aged care to “a numbers game”.

“Providers want to provide transparency, but must also be able to show and educate the community about the different models of care and how changing resident needs require flexibility and staffing and skills mix to provide quality care,” she said.

“It is only through having this kind of information available that older Australians and their families will be able to make effective comparisons and informed decisions about the best care for them,” said Ms Sparrow.

A win for transparency

Ms Eales said new legislation will improve transparency in Queensland’s aged care sector.

“Consumers have been crying out for more transparency,” said said.

“People want to know how their money is being spent, and whether it’s actually funding more nursing and better care.

“This legislation is a significant step towards achieving this,” she said.

Nurses unions calling on the federal government to implement ratios nation-wide

Nursing unions have for several years been campaigning the federal government to introduce minimum nurse-to-resident ratios right across the country. 

“These new Queensland laws address the core of the problem the aged care sector is currently facing – the need for more transparency, and more nursing hours so older Australians get the care they deserve,” Ms Eales said.

The QNMU is calling on the federal government “to wake up and take real action to fix our country’s broken aged care sector.”

More funding needed to increase staff numbers

Mr Rooney said if more staff are to be employed in aged care, more government funding is needed to reflect the “true costs” of care.

“LASA Members have consistently expressed their desire, and their need, to have more staff to deliver care and support to older Australians, and that these staff need to be appropriately skilled and qualified, as well as adequately remunerated.”

“Ensuring adequate industry funding that keeps pace with the real costs of meeting the needs of residents” is needed, he said.

“Change is required”: royal commission

The Royal Commission into Aged Care Quality and Safety has identified staff shortages as one of the most pressing issues holding the sector back, and is likely to make recommendations in this area. 

In his opening remarks to a fortnight of hearings dedicated to staffing issues, Mr Rozen said, “Witnesses have told (the commission) of the impact of inadequate numbers of staff on people in aged care. 

“Basic standards are often not met. Inadequate staffing levels mean that staff are overworked, rushed and generally under pressure. This impacts on their ability to provide high quality care and on their own health and safety.”

Mr Rozen said there is a “clear link” between the “numbers and quality of aged care workers and the quality and safety of aged care services.”

Mr Rozen also noted the trend towards employing fewer nurses and a higher proportion of personal care workers.

He described “the relative decline in the proportion of nurses in the residential aged care workforce and the corresponding increase who are personal care attendants” at a time when the residential aged care population was becoming more frail and with more complex healthcare needs.

Mr Rozen noted there are is no guidance for aged care operators to assess if their “number and mix of members of the workforce deployed enables the delivery and management of safe and quality care and services”, as stated in Standard 7.

“The Aged Care Quality and Safety Commission also does not provide guidance to assessors about the nurse hours per day that might be regarded as reasonable to provide care. On the evidence before you, such guidance is clearly available to be provided. It should be,” he said. 

Mr Rozen said, “There’s a strong argument for introducing a methodology to determine appropriate staffing numbers and mix of skills and for any methodology to be transparent. The models explained at this hearing are sophisticated and cannot be fairly described as blunt instruments.” 

“It is reasonable to conclude that change is required to ensure compliance with the requirement in section (7) of the Aged Care Act that approved providers maintain an adequate number of appropriately skilled staff to ensure that the care needs of recipients are met,” Mr Rozen said.

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