One of the most important outcomes of the Royal Commission on Aged Care was the federal government’s commitment this year to mandate a minimum staffing level in residential aged care homes by 2023.
Our study, published today, shows that only a small fraction of aged care homes will already comply with the new requirements.
A substantial increase in staffing across the region will be required, which will put even more pressure on an industry already struggling to meet the needs of a growing number of Australians.
Read more: 4 key facts from the Aged Care Royal Commission’s final report
What are the minimum staffing standards?
Minimum staffing standards are designed to ensure that all aged care homes have sufficient staff to meet the care needs of their residents. This type of regulation already exists in many countries, including the United States, Japan and Germany.
Japan and Germany both set minimum employee-to-resident ratios. In the United States, homes must have a certain number of employees on site each day and many states regulate the minimum amount of time employees spend with residents. Also, while some countries mandate requirements for all care workers, others target specific roles, such as licensed nurses.
Read more: Want to improve care in nursing homes? Mandate minimum staffing levels
In Australia, licensed nurses include both registered nurses (RNs) who have at least a bachelor’s degree, and enrolled nurses who have completed a two-year diploma.
However, most aged care is provided by unlicensed personal care workers, who do not require formal qualifications.
Australia’s new staffing standard has three requirements that will be mandatory from 1 October 2023:
Providers must ensure that residents receive at least 200 minutes of total care per day
At least 40 minutes of that care goes to an RN. should be provided by
One RN should be on site for morning and afternoon shifts each day.
These needs are described as industry averages, with the needs of each household accommodating based on the relative complexity of the care needs of their residents.
Why are minimum standards necessary?
The Royal Commission heard evidence that more than half (57.6%) of all Australian residents in aged care live in aged care homes with inadequate staff.
In the final report, it was stated
Too often, and despite the best of intentions, aged care workers do not have the requisite time, knowledge, skills and support to provide high quality care.
For example, the commission heard testimony from families of residents in a low-staff home in Victoria where staff did not have time to go to the toilet or eat meals, or help attend their clinical care.
The commission also heard about the dangers of not having adequately trained nurses. One witness described a field home where three nurses had to look after 80 residents on weekends.
The witness’s father, a resident living with dementia, was neglected and on several occasions collapsed due to hospitalization while he was released.
What did we find?
Our study of historical staffing levels found that some aged care homes (3.8%) had staff above all three requirements of the new standard.
While many homes (79.7%) would meet the requirement to have an on-site RN, some had levels above the daily requirements for total direct care (10.4%) or RN care (11.1%).
Homes that fall short of these two requirements will need to increase staff time from an average of 43 minutes of total care per day and RN time of 18 minutes per day.
Read more: Nearly 2 out of 3 nursing homes are short of staff. These 10 charts show why aged care is in crisis
We also found evidence that the new standard is likely to result in varying pressures for homes across the region. Homes at risk of non-compliance are more likely to be larger to care for residents, those located outside metropolitan cities and operated by smaller providers.
Interestingly, while smaller households were more likely to meet two requirements regarding daily minutes, they were much less likely to have an on-site RN for two shifts.
So what needs to be changed?
The new minimum standards are an important part of regulation to ensure that Australian aged care homes provide adequate staff to provide quality care to residents.
However, this requires a substantial expansion of the workforce already working under pressure. Staff shortages are already a problem due to the COVID-19 pandemic, with less immigration and the demand for additional work, such as infection control and handling family requests.
A report published in August by the Economic Development Committee of Australia suggests that even without minimum standards, Australia’s aged care workforce needs to grow by an additional 17,000 workers per year between now and 2030.
Our study highlights areas in need of immediate action. For example, the new requirements are likely to lead to a dramatic increase in the demand for RN. Training and retention initiatives recently announced in the federal budget will help, but halting the decline of RNs in the sector will require more such as improved working conditions and pay.
In addition, targeted government support will be needed to help homes outside major cities and smaller in size attract appropriate care workers to make up for the shortfall.
Such measures will be required so that appropriate changes can be made towards compliance with the minimum staffing standard within the sector.