Parliamentary report calls for staff-to-resident ratios and licensing of personal care workers, which providers argue would cost the system $500 million if introduced nationally.
The national regulatory framework governing aged care is not prescriptive enough on staffing requirements in residential care, according to a NSW parliamentary inquiry that has called for staff-to-resident ratios and licensing of personal care workers.
The inquiry’s report, released last week, also called on the NSW Government to urge the Commonwealth to introduce new requirements for facilities to list their staffing skill sets on the My Aged Care website, and for additional federal training funds for registered nurses.
Nurse unions and some seniors groups have welcomed the inquiry’s findings, but aged care provider peaks said they were disappointed with the report, describing some of the findings as “borderline offensive.”
“It’s implying that we are in some way not caring about the quality of care being provided, and that the current system is broken, and we don’t believe it is,” said Illana Halliday, CEO of Aged & Community Services NSW & ACT.
The parliamentary inquiry into nursing staff levels in residential care was prompted by the removal of the high care/low care distinction in the federal Aged Care Act, which impacted on existing NSW legislation that required an RN be on duty at all times in a high care facility. NSW was the only state in Australia with such a requirement.
The inquiry found in support of retaining the current legislative requirement for an RN to be on duty at all times in NSW ‘nursing homes’, but it proposed changing the definition in the legislation to be based on residents’ assessed needs rather than the type of facility.
Responding to providers’ arguments that mandating RNs at all facilities 24/7 would not be financially viable, particularly for standalone and rural and remote facilities, the committee proposed exemptions be available, to be determined on a case-by-case basis.
But beyond addressing the NSW requirement, the cross-party committee also called for sweeping changes to the national aged care regulatory framework.
Acknowledging that the Commonwealth had regulatory and funding responsibility for aged care, the committee said it was “not convinced” that the national regulations “adequately ensures that a high standard of care is delivered to residents in aged care facilities through its staffing standards.”
The inquiry called for the NSW Government, through the Council of Australian Governments (COAG) process, to urge the Commonwealth to introduce minimum staff-to-resident ratios in aged care facilities; establish a licensing body for personal care workers; and to “take measures to address the wage disparity” between nurses in aged care and the public health system.
However in a ‘dissenting statement’ the committee’s three government members said they disagreed with the recommendations on minimum staffing ratios and wage disparity.
Mixed views over current regulations
The report noted there was “deep division” over the effectiveness of the Commonwealth’s aged care regulatory framework among the inquiry participants, which included providers and their peaks, GPs, nurses, unions, seniors advocates and researchers.
Some stakeholders opposed a mandated requirement for RNs on the basis that the Commonwealth framework already provided standards, outcomes, monitoring and sanctions, while others argued there were inadequacies with the system in regards to the accreditation, compliance and monitoring of facilities, and the staffing standards prescribed.
“While the committee acknowledges the flexibility of the current system in allowing aged care facilities to determine and provide the staffing skills and mix to meet the varying needs of residents, [it] shares the concerns of inquiry participants who feel that the staffing standard requiring ‘appropriately skilled and qualified staff’ is too vague and allows for wide latitude in its interpretation,” the inquiry concluded.
The accreditation standards did not prescribe the type of staff, qualifications required by staff or the number of staff who work in an aged care facility, the report noted. The way residential facilities were described by inquiry participants as being monitored and assessed against the accreditation standards was “troublesome,” it concluded.
Recommendations ‘impractical, unnecessary’
Responding to the findings, Ms Halliday said the committee was seemingly misinformed about the current regulatory framework, and the accreditation process in particular.
There were unannounced visits, which providers were not forewarned about, and assessors were very thorough about talking to residents and families, Ms Halliday said of the findings that the accreditation system relied on paperwork.
Ms Halliday said that providers did not argue about the need for RNs in high care facilities, but the issue was how to amend the NSW legislation so as to exclude low care facilities.
While she appreciated the committee had attempted to provide a solution to this – by suggesting the legislative requirement be based on residents’ needs rather than facility type – Ms Halliday argued the proposed method for measuring this was still too blunt. “I can’t think of a facility it wouldn’t pick up,” she said of the proposed change.
“I agree with going by a resident’s needs, which is why the accreditation standards say they will determine, during an audit and accreditation visit, whether a facility is getting the right mix of staff on duty available for the mix of residents,” she said.
Employing nurses at all facilities would require an additional 2,000 RNs and over $150 million a year in extra funding for NSW, Ms Halliday said. “One third of aged care takes place in this state, so you are looking at $500 million if this cascades across the whole of Australia,” she said.
LASA National chief executive Patrick Reid said the peak body held serious concerns about the report’s recommendations, which would impose significant costs on employers and government, and would unlikely improve outcomes.
“In 2011 the Productivity Commission stated that an across-the-board staffing ratio is unlikely to be an efficient way to improve the quality of care, and LASA supports this view.”
He said other countries such as the UK were investing in improving skills and diversifying training, which was “a far more sustainable approach”.
Federal department defends regulations
Australian Ageing Agenda asked Minister for Aged Care Sussan Ley for her response to the inquiry’s findings regarding the adequacy of the federal aged care regulatory framework, but she referred our request to the Department of Health.
The departmental response said that the recommendations were for “the NSW Government to consider in the first instance, and a matter for them whether they wish to take the matter up in COAG.”
The response went on to defend the current national regulations, reiterating that facilities were required to maintain “an adequate number of appropriately skilled staff to ensure the care needs of recipients are met.”
It also dismissed ratios, saying there was “no single optimum staffing level or mix that meets all circumstances in providing quality residential aged care.”
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