Aged care needs a shake-up. For older Australians to receive the quality of care they deserve, aged-care homes require a highly skilled workforce plus robust regulation.
Caring for older people with health issues such as dementia and incontinence is a demanding job that requires specific expertise. Aged-care homes need staff who have time to talk with residents, encourage them to walk and give them food they like. When an aged-care home has insufficient staff, there may not be time for residents to be walked to the toilet or even helped out of bed.
Recently an elderly woman in an aged-care home died in excruciating pain because no one on duty was qualified to administer the prescribed morphine. The woman’s daughter was so traumatised by the situation, she could not remain at her mother’s bedside to hold her hand.
According to the Aged Care Act (1997), providers must “maintain an adequate number of appropriately skilled staff to ensure that the care needs of care recipients are met”. Determining how many staff and what level of skill are required is contested.
Over the past decade there has been a marked shift in the composition of the residential aged-care workforce. This coincides with the increased number of privately owned aged-care homes, and with an increase in the number of residents classified as requiring “high care”.
The staffing profile of aged-care homes today does not reflect the resident profile. If it did, we would have seen a big increase in the number of registered nurses. Instead, the number of registered nurses has decreased while the number of less-skilled personal-care attendants has risen substantially.
Registered nurses now account for fewer than 15 per cent of the residential aged-care workforce, and personal-care attendants make up 68 per cent. In addition, enrolled nurses now undertake duties that were once the responsibility of registered nurses, such as administering medication.
Peak bodies representing care providers have successfully lobbied the federal government for “flexibility in staffing”. Unlike childcare centres, hospitals and schools, there is no requirement for aged-care homes to have mandated staff-to-client ratios. This flexibility results in many aged-care homes being understaffed.
According to the Australian Nursing and Midwifery Association, the decision whether to have a registered nurse on duty should not be at the discretion of the provider. They propose mandating minimum staff-to-resident ratios. At the very least, one registered nurse should always be on duty when an aged-care home has residents classified as high care.
The accreditation process should play an important part in monitoring the standards of care in all aged-care homes, including whether adequate numbers of skilled staff are employed. The current accreditation standards are woefully inadequate. Vague phrases such as “sufficient staff” continue to be used. In some cases, “sufficient staff” means no registered nurse on duty. It may also mean an inadequate number of personal-care attendants.
Staffing costs are the main outgoings for operating an aged-care facility. Managers who are under pressure to meet their profit targets do so by employing cheaper and less-skilled personal-care attendants, rather than nurses. Many of these attendants have undertaken an “accredited”, fast-tracked course.
According to the 2013 audit of registered training organisations, 90 per cent of aged-care courses did not comply with training standards under the Australian Qualifications Framework. These courses do not equip graduates to work competently with older people.
Some personal-care attendants gained their qualification to work in an aged-care home after completing a five-week course. Considering the complexities of working in an aged-care home, it is inconceivable that someone with five weeks of training is qualified to provide competent care, particularly when there is no registered nurse on duty to supervise them. Is it any wonder recent inquiries into aged care have highlighted inadequate personal care, neglect, and negligence?
Recent Senate inquiries received numerous submissions from registered nurses who claimed the aged-care homes in which they worked were understaffed. These nurses expressed concern for the health and safety of residents, though this is often done anonymously to avoid negative consequences for speaking out.
The lack of mandated minimum staff-to-resident ratios has caused many registered nurses to leave aged care. Another barrier to attracting and retaining registered nurses in the sector is pay; there is significant wage disparity between registered nurses in aged care and those working elsewhere in the health-care system. A full-time registered nurse in aged care may earn $200 a week less than their colleagues working in public hospitals.
To ensure older people living in aged-care homes have the best possible quality of life, aged-care homes need to employ well-trained, competent, honest and caring staff – managers, registered nurses, personal care attendants, along with kitchen, reception and activities staff.
The federal government must improve regulation of the aged-care sector rather than rely on self-regulation. The care of vulnerable older people is too important to be left to the whims of the free market.
First published in The Age on 17 April 2016