Staff ratios are one of those issues that divide the aged care industry.

There are those who say mandated staff ratios are essential to delivering the standard of care we expect for our senior citizens, and then there are others who say mandated staff ratios will do little to improve quality of care, and may even mean some operators, especially those offering precious services in remote and regional areas, will have to close.

In an ideal world, aged care facilities would be staffed by an army of experienced and qualified staff. But it that realistic? If there is no flexibility, regardless of the circumstances, could mandated staff ratios have unfortunate unintended consequences?

Here at HelloCare, we wanted to get to the bottom of the issue, so we’ve asked the key voices in the industry about their views.

Fixed staff ratios a “recipe for disaster” for small rural and remote providers: Ken Wyatt

“Our Government is 100 per cent behind Australia’s dedicated aged care workers because we know a proud and professional workforce is the foundation for quality care,” Ken Wyatt MP said in a statement to HelloCare.

“No serious body that has looked at the issue of staff ratios has supported fixed inflexible ratios. This includes the Aged Care Workforce Strategy Taskforce, the Productivity Commission, the Senate Community Affairs Reference Committee and the Legislated Review of Aged Care.

“Remember that South Australia’s infamous Oakden facility had extremely high numbers of nurses yet the treatment of residents was despicable.

“Fixed and inflexible ratios almost certainly will not help aged care quality.

“This is a recipe for disaster in the bush, where inflexible ratios would effectively force the closure of aged care homes in regional, rural and remote Australia.

“They risk a massive impact on small rural and remote providers, who would be required to meet staff ratios set by reference to specialist large-scale city providers.

“Aged care providers are already required to ensure they have adequate numbers of staff to meet residents’ needs – the new Aged Care Quality and Safety Commission undertakes unannounced audits to ensure aged care facilities comply.

“We know this works without the need to mandate fixed and inflexible ratios for every provider regardless of their residents’ needs.

“In 2017-18, 12 aged care services across Australia had their accreditation revoked, including for inadequate provision of staff.”

Government must mandate minimum staffing levels: ANMF

Since early 2018, the Australian Nursing and Midwifery Federation has been campaigning for mandated staffing ratios in aged care.

The  ANMF’s recent Aged Care survey found that 89 per cent of the aged care staff surveyed said there were inadequate staffing in aged care. Three-quarters of the survey’s participants noted that staff ratios were inadequate,

Ahead of the federal election, Annei Butler, Federal Secretary of the ANMF said, “We cannot wait another 18 months until the conclusion of the Royal Commission – the pain and the suffering of the elderly in our care must be a… priority and a commitment to mandate minimum staffing levels is where they must start.”

(HelloCare reached out for a comment from the ANMF, but had not received a response at the time of publishing.)

More funding is needed to train quality staff: Sean Rooney, CEO LASA

Sean Rooney, CEO Leading Age Services Australia, told HelloCare, “The sector needs to work towards ensuring providers have the right number of staff, with the right mix of skills, to meet the different needs of every resident or client in their care. That must apply to every different type of aged care setting.

“Essential to this is appropriate resourcing of the sector that reflects the true costs of care and provides the capacity to train and retain quality staff. This means ensuring adequate industry funding and appropriate employee remuneration.

“The work of the Research Centre recently announced by the Federal Government will be well-placed to address priorities such as identifying optimal models of care that are linked to the aged care standards and determine the workforce skill mix and training such models require.”

We need more registered nurses in aged care: Sarah Russell, aged care researcher, founder Aged Care Matters

Sarah Russell, founder of Aged Care Matters, told HelloCare, “We must start the process of improving staffing levels and training in aged care homes. This requires all key stakeholders – aged care advocates, residents, relatives, staff, government and providers – having a robust conversation that is supported by evidence.

“Recent inquiries have made recommendations. Let’s start by implementing Recommendation 8 of the Future of Australia’s aged care sector workforce inquiry:

‘The committee recommends that the government examine the introduction of a minimum nursing requirement for aged care facilities in recognition that an increasing majority of people entering residential aged care have complex and greater needs now than the proportions entering aged care in the past, and that this trend will continue.’

“My articles in The Conversation (2016) ‘Here’s why we need nurse-resident ratios in aged care homes’ and ABC online (2018) ‘Better aged-care begins with more registered nurses in homes’ show that I have consistently supported legislation to mandate at least one registered nurse on site (i.e. not merely ‘on roster’) in every aged care home 24 hours per day.

“My recent research – in which I asked 396 people who work in an aged care home ‘Does the aged care home where you work have a registered nurse on site each shift?’ – indicated that 25 per cent of aged care homes do not have a registered nurse on site 24 hours per day.

“I also support the Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018 that mandates the publication of staff-to-resident ratios by job description on the My Aged Care website. This will help the public to choose a good aged care home and avoid the bad aged care homes.

“I support evidence-based policies. Evidence shows that when registered nurses are on site, residents have better health outcomes, a higher quality of life and fewer hospital admissions.

“Unfortunately, as demonstrated in my article in HelloCare (2018) ‘To ratio or not to ratio: that is the question’, many key stakeholders base their views on opinions not evidence.

“Mandating ratios of staff (i.e. registered nurses, PCAs, activity staff) will have a minimal impact on good aged care homes. A good aged care homes employs significantly more and better-qualified direct care and trained activities staff than a bad aged care home.

“Mandating staff ratios will have a negative impact on bad aged care homes because these providers will be forced to employ more staff. Hopefully it will encourage those providers who prioritise profits over care to leave the sector.”

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