16 June 2021
Article from April 2021 edition of INPractice
Abuse, malnourishment, sitting in faeces...welcome to our aged care nightmare.
Up to one in five nursing home residents have been assaulted, two-thirds are malnourished or at risk of malnourishment, many are left to suffer in pain and many also are left to sit in their own excrement because staff are too busy to take them to the toilet.
These are just a few of the shocking findings of the Royal Commission's Final Report into Aged Care Quality and Safety. Others include physical and sexual abuse by staff and other residents and a "clear overuse" of physical and chemical restraint.
The report found that half the people living in nursing homes have dementia, yet "we are deeply concerned that so many aged care providers do not seem to have the skills and capacity required to care adequately for people living with dementia".
"We have found many examples of substandard care in providing for the most basic of human needs, such as diet and nutrition, oral health, skin care, mobility, medication and prescription management, continence and incontinence, infection control, social and emotional needs, and diversity and cultural needs."
The report acknowledges that staff ratios should be introduced to ensure that there are sufficient nursing and other care staff present at all times in residential aged care.
Key recommendations include a new Aged Care Act that ensures older people receive high quality care in a safe and caring environment; establishing an Aged Care Advisory Council; abolishing the Aged Care Quality and Safety Commission and replacing it with an independent authority; urgently reviewing the aged care quality standards; and the regulation of restraint in aged care.
Other recommendations include mandatory minimum qualifications for personal care workers (PCWs), specifically a Certificate III, as well as a national registration scheme that includes ongoing training.
The Commissioners also recommend minimum staff time standards for residential care. Under the proposals, from July, 2022, aged care providers would be required to engage registered nurses, enrolled nurses, and PCWs to provide care for at least 200 minutes per resident per day for the average resident, with at least 40 minutes of the care provided by an RN.
Further, the minimum staff time standard should require at least one RN is on site at each aged care home for morning and afternoon shifts. From July, 2024, Commissioners recommend the standard should increase so that the average resident receives 215 minutes of care per day, with at least 44 minutes of the care provided by an RN. By this stage, at least one RN should be on site at all residential aged care facilities at all times.
Commissioner Lynelle Briggs said the report aimed to trigger fundamental reform of the aged care system and that aged care providers must shoulder some of the responsibility for the systemic problems plaguing the system.
“Specifically, providers have not focused sufficiently on the provision of high-quality and safe care, on older people’s wellbeing, on service innovation and excellence, on listening to older people and hearing their complaints, on effective clinical governance of their services, and on workforce leadership, development, skills and culture,” she states.
She also added that the workforce “is underpaid and under-skilled, and has been undermined by the replacement of qualified staff by less qualified and unregistered workers.”
Whilst the report recommends the establishment of minimum staffing levels the ANMF is disappointed with both the number of staff recommended and the mix of staff that will be delivered. We believe these are not adequate to achieve the goal of high-quality aged care.
The ANMF is firmly of the position that:
- Funding must be tied to care
- There must be accountability for any government funding for aged care
- The Morrison Government must act now – every day they delay, is another day residents will suffer
ANMF (SA Branch) CEO/Secretary Adj Associate Professor Elizabeth Dabars AM said aged care workers were "dedicated and passionate people who provide care with compassion and kindness".
However, there were simply not enough staff to provide quality care, noting that it was very common to have one Registered Nurse for 100 plus residents.
The Federal Government’s immediate response to the report was to announce a $452 million package as one of the first steps to addressing immediate priorities in the sector: investing more in home care; 1,500 extra audits of residential aged care facilities to improve quality and safety; growing the workforce, by investing $92 million to create 18,000 places for workers by mid-2023; and improving governance.
The Government says it will respond in full by May 31.
The ANMF will be watching the upcoming federal budget for clear commitments to implement the recommendations of the Royal Commission’s Final Report and we will be campaigning for safe staffing across the sector.
The National Ageing Research Institute (NARI) welcomed the Aged Care Royal Commission’s Final Report, particularly its recommendation for a new human-rights based Aged Care Act. However, it says the Government must make structural change to ensure the Act can be implemented to its full intent.
“This report is a defining moment for aged care reform in Australia. It presents opportunity for Government to drive transformational change to regain public trust in the aged care system,” said Professor Briony Dow, NARI Director.
“However, a human-rights based approach will remain simply rhetoric if the structural and resourcing issues in aged care remain unchanged.”
Everyone should have access to and experience safe, appropriate, best practice, and affordable care regardless of their location, health conditions, personal circumstances, and background.
To achieve this, there are five key areas which must be addressed throughout the Aged Care sector.
- Mandated staffing ratios - minimum staffing levels and skills mix
- Legislated requirements for clinical governance, leadership, and expertise
- Legislated transparency and accountability measures
- Guaranteeing workforce capacity and capability
- Registration for unregulated care workers
Learn more about the aged care campaign
Click here to read the April 2021 edition of INPractice.