15 October 2021
Article from October 2021 INPractice
Aged care from the inside.
There’s something very askew with our aged care system. On the one hand we have providers employing younger, less experienced staff in order to pay them minimal wages.
On the other hand, aged care providers are opening their doors to increasingly sicker people with more complex care needs as a means of increasing profits.
“Aged care providers are now only accepting residents with high needs into aged care facilities as the funding system works on the principle of ‘the sicker the resident the more money the Federal Government will give the provider’,’’ says aged care nurse Mary (not her real name).
“It’s all about the money … with no transparency of how that money is spent.
“So, care needs are getting worse. We are getting people who are really, really frail, lots of co-morbidities.’’
And all of this with less qualified and experienced staff to care for them.
The danger this scenario poses to the safety and wellbeing of residents and staff alike only exemplifies the urgent need for more staff, greatly enhanced staff-patient ratios and better skills mix.
As well as needing more personal care workers overall there is an urgent need to improve the skill mix and increase the number of Registered and Enrolled nurses with more time to spend assessing and caring for residents
The Royal Commission into Aged Care Quality and Safety found in its Final Report in February that Australia’s aged care system is understaffed, and the workforce underpaid and under-trained. It concluded that inadequate staffing levels, skills mix and training were the principal causes of substandard care in the current system.
“As an Enrolled Nurse I am passionate about the elderly and I ensure that I provide the best care I can provide in the very limited time available,’’ says Mary who looks after more than two dozen residents per shift.
“I am relatively new to the industry … but it has taken a toll on my life. I often wake during the night as I must dream about work and I stress that I have not done something as I am so time poor tending to so many residents with so many care needs.’’
She is also concerned about the lack of training for personal care workers and the absence of RNs and ENs.
The ANMF is calling for the establishment of a national registration scheme for personal care workers, designed to protect the public and residents of aged care, and ensure residents are being cared for by suitably trained and skilled workers.
“I was horrified that there were personal care workers with such little training, giving medication. They’d only done a six-hour training course in administering medications. As an EN we spend three months training in medication administration.
“Even more concerning was a cost-cutting exercise by a large proportion of residential aged care providers in making Enrolled Nurses redundant and replacing them with medication competent personal care workers, which is an oxymoron, given they had received only six hours of training in medication admin.’’
Mary says cost cutting “seems to be the overriding concern of aged care providers”.
“Many facilities do not have a Registered Nurse on site in the evening. This is particularly concerning as it could result in residents’ pain not being addressed correctly, leaving them in pain all night.
“Residents often deteriorate quickly and you need an RN to assess the seriousness of their condition.’’
In a move to make aged care the safe and caring sector it should be, the ANMF is advocating for an average of 4.3 hours (258 minutes) of care per day per resident, with 77 minutes from RNs, 52 minutes from ENs and 129 minutes from personal care workers.
These numbers are more than what the Royal Commission into Aged Care Quality and Safety recommends and more than what the Federal Government has committed to.
The ANMF is also addressing the lack of support and resources within aged care for new RN graduates.
“I currently work in a small facility and I am constantly being asked by RNs what I would do in a particular situation. I find this a particularly disturbing situation to be in,’’ Mary says.
The Australian Nursing and Midwifery Education Centre, a service of the ANMF (SA Branch), is pursuing a Transition into Professional Practice program to provide better support and systems for RN graduates when they first enter the aged care sector.
The urgency with which reform is needed is highlighted by the looming crisis in aged care. A report last month by the Committee for Economic Development Australia (CEDA) found Australia is facing a shortage of at least 110,000 direct aged-care workers within the next decade unless urgent action is taken to boost the workforce.
It says that shortage will blow out to 400,000 by 2050 at a time when demand for aged care will be much greater given our ageing population.
In a bid to stem and reverse the shortage, the ANMF and the Health Services Union have brought a case in the Fair Work Commission (FWC), which sets industries’ minimum pay rates, demanding a 25 per cent pay rise for aged care workers.
The ANMF says the Commonwealth needs to make funding available for wage increases to stop the exodus of workers from aged care to better paid jobs at other health care sites, as well as meeting the Royal Commission’s recommendations for extra staffing to ease the burden and stress on existing staff.
“A worker at Bunnings gets paid more than me, with no qualifications required, no supervision skills required and not having to deal with matters with life and death consequences,’’ Mary said.
“At one site, the RN was responsible for more than 90 residents. It is impossible to care for them all. Often they would stay back for two hours after their shift to get their work done.
Lindsay Whitelaw, an aged care and ICU Registered Nurse of more than 20 years’ experience, is a firm advocate for improved staff and skills mix ratios and increased staffing across the board.
“The place I work at is lovely, it’s got a beautiful feel to it and it’s quite a small place, it’s not one of those massive 100 – 150 beds where everybody’s just a number. You do get to know them,’’ Ms Whitelaw says.
She says increasing the number of RNs, particularly those experienced in acute care, will help dramatically reduce the flow of aged care residents to hospital acute care or ICUs.
“An RN can see the changes, like the swelling of ankles, noticing little things that perhaps a personal care worker or even an EN wouldn’t notice, perhaps the shortness of breath, things like that,’’ she says.
“We’ve always got an RN 24\7,’’ Ms Whitelaw says of her facility. “If you notice things early, you can actively start the treatment early if you need to.
“Sepsis is one of the biggest killers. If nurses have found an infection prior to even getting to sepsis you’ve dropped your hospital numbers dramatically.’’
Despite the Royal Commission’s many bombshell revelations about aged care’s “shocking tale of neglect” it’s not all gloom and doom. Mary and Ms Whitelaw get great personal reward out of caring for elderly people and getting to know them and their life stories. So too does Sue Emerson who chairs Palliative Care SA.
“I think aged care is an opportunity every day to make a meaningful difference to people’s lives. It is the most rewarding place, I’ve loved it,’’ Ms Emerson says.
“I chose to go there and there’s a lot of myths about aged care, don’t listen to them, come and find out for yourself.
“Sometimes people think nurses work in aged care because they can’t work anywhere else.
“I certainly chose to work there and studied in it and undertook a Gerontic certificate, postgraduate studies in Nursing (Aged Care) as well as a Master Health Service Management and specialised in it,’’ she says.
“Aged care is a speciality, it is a really complex area. I don’t think people always know what really goes on, so we need to illuminate the brilliance of working in aged care and support student nurses and care workers. It’s a great place to work.
‘We definitely have to be very, very swift in our planning to prepare for that workforce of the future whilst looking after the workforce of today in an increasingly complex environment.’’
Click here to read the October 2021 Edition of INPractice