Failure to maintain staffing numbers and nursing care levels in Australian aged care facilities is a disgrace

In June 1999, a little over a year into the first term of the Howard Coalition Government,  there were an estimated 132,420 older Australians in residential aged care facilities, with 61 per cent having “high care” dependency status.  

Between 1994 and 1999 there was a 13.9% decrease in the number of registered nurses and a 26.0% decrease in the number of enrolled nurses, so that by 1999 there were 19,517 registered nurses employed full-time in residential aged care facilities and 13,818 enrolled nurses.

A decade later and the percentage of registered nurses working in residential aged care facilities fell from 11 per cent (or 18,313 individuals) in 2003 to 8 per cent (or 16,431 individuals) in 2009 and the number of enrolled nurses fell from 29 per cent (or 12,933) to 21 per cent (or 10,030) in 2009.

In 2011 the number of permanent residents in aged care numbered an est. 165,032 people.

By 2012 the percentage of the residential aged care workforce being registered nurses or enrolled nurses working in residential aged care had only risen to 14.7 per cent (or 13,939 individuals) and 11.6 percent (or 10,999 individuals) respectively, which is an actual fall in total numbers of RNs & ENs in the aged care workforce.

During the course of the 2013–14 financial year 270,559 people were admitted to age care facilities either on a permanent or respite basis. Nationally in March 2014 registered nurses comprised 15.3% of the residential aged care workforce and enrolled nurses made up 21.9% [Aged and Community Services NSW & ACT].  By June 2014 the “high care” dependency level of aged care residents had risen to 83 percent.

However, in 2014 the Abbott Government changed the federal Aged Care Act 1997 in such a way that allowed residential aged care operators to reduce the number of registered nurses employed in their nursing homes, as well as deregulating fees charged and accommodation bonds levied. 

In response the NSW Government effectively grandfathers facilities subject to the current NSW Requirements for a period of 18 months in order to block any moves to reduce state legislated provision of a minimum of one registered nurse on duty 24/7 in nursing homes containing “high care” beds.  This reprieve appears to come to an end around February this year but the state government’s formal response to the NSW Legislative Council report it ordered is not due until 29 April.

Meanwhile The Sydney Morning Herald reported on 1 January 2016 that: The profits of aged care homes surged 40 per cent in the past year as operators cut hours of nursing care while claiming higher payments from the federal government for servicing more of the most frail patients. The earnings boom in the sector comes after the government introduced widespread reforms of aged care in 2014…Yet while nursing homes report they are looking after more needy residents, the time spent caring for them declined by 7 per cent over the past year. In 2015, hours by care staff (nurses, care assistants and therapists) fell from 42.71 hours per fortnight to 39.80 hours per fortnight. At 2.8 hours a day, the average is well below the minimum of 4.5 hours per day of nursing care mandated in the US, said Lynda Saltarelli from the Aged Care Crisis advocacy group."Australia has no recommended levels for staffing," she said. "Over half of all nursing homes in Australia have nursing levels so low that most residents suffer harm."

Australia currently has about 2,800 residential aged care facilities providing care to more than 160,000 elderly people. Over the next ten years, the number of residents is projected to reach more than 250,000 and the highest area of growth will be among residents aged 95 or over. During that same ten-year period the number of registered nurses and enrolled nurses employed in aged care facilities is expected to further decline, according to Health Workforce Australia.

Prime Minister Malcolm Bligh Turnbull and his Cabinet need to take a long hard look at this mess and use legislation and regulations to raise these staffing levels and hours of care received before the next federal election.

The issue is not going unnoticed by voters……

Letter to the Editor, The Age 3 January 2016:

Low nursing levels, low level of care

It is outrageous that nursing homes do not have recommended staffing levels. Elderly people with dementia or Alzheimer's disease – and who, in some cases, have paid bonds of hundreds of thousands of dollars as well as continuing monthly payments – deserve the best possible care. By law, childcare organisations have staff ratios yet children are able to learn and notify carers if they are in pain, hungry or need to be toileted. Dementia patients cannot do this and will only become more in need of care as their condition worsens. Thankfully my mother, who has late-stage Alzheimer's disease, is in a wonderful facility. However, in my search for a good home, I saw many where up to 15 dementia patients were cared for by one staff member. With an ageing society, the number of people entering nursing homes will increase, profits will continue to soar and our most vulnerable citizens will suffer. Staff ratios must be put in place.

Annie Jones, West Melbourne [my red bolding]