3 October 2022
Article from October 2022 edition of INPractice
To quote one RN - where once there was no light at the end of the tunnel, ‘now the light is really starting to shine quite brightly’.
There is a palpable glimmer of hope within the embattled aged care sector that real and drastically needed change is at hand.
The speed with which Anthony Albanese’s Labor Government has acted to deliver on his pre-election promises to the ANMF has surprised and delighted many in the sector.
“For years we have campaigned for governments to act to fix a sector in serious decline, one which had deteriorated in standards of care so badly it presented a real danger to the health and wellbeing of the elderly in its care, as well as staff,’’ ANMF (SA Branch) CEO/Secretary Adj Associate Professor Elizabeth Dabars AM said.
“We heard endless horrific reports of malnutrition rife in nursing homes, reports of missed meals, missed medicines and missed care due to chronic staff shortages, shortages also exacerbated by a system which rewarded dedicated, over-worked staff with some of the lowest wages in Australia.
“Shortages exacerbated by the COVID-19 onslaught for which the aged care sector was clearly unprepared and ill-equipped to cope with, tragically resulting in more than 3,000 deaths,’’ Ms Dabars said.
“Prior to the May 21 Federal Election, we presented to the incumbent Morrison Government and the Albanese Opposition the four most urgent actions needed to be taken to address the issues, namely Registered Nurses 24/7 at all sites, mandated minimum care, transparency and accountability, and higher wages.
“The Morrison Government chose to do nothing. The Albanese Opposition, by contrast, pledged to act on our four key points. We then took our campaign to the voting public to fix aged care.
“Make no mistake, the ANMF in South Australia and nationally played its part in getting a government elected that would finally take seriously the plight of the aged care sector and the suffering and neglect of older Australians and staff alike. In South Australia, Labor won the crucial swing seat of Boothby, ending a 70-year Liberal stronghold over the electorate.
“Our members were prominent at Boothby sites on election day, handing out ‘Vote to Fix Aged Care’ voting cards.’’
Thankfully, it didn’t take long for the Albanese Government to commence delivering on its promises.
On August 2, Australia’s 47th Parliament passed its first Bill, one which implements nine measures to improve aged care and responds to 17 Aged Care Royal Commission recommendations, including new residential funding, a code of conduct for staff and providers, an independent pricing authority and a star rating system for services.
The Bill extends the Serious Incident Response Scheme to all in-home care providers, introduces new governance and reporting responsibilities for approved providers and also extends the functions of the Independent Health and Aged Care Pricing Authority, which will lead to better price-setting for aged care.
The Government also introduced legislation to ensure a registered nurse is on-site in every nursing home 24/7 and that all residents receive minimum standards of quality care every day.
The Bill, still before Parliament at the time of writing, also aims to improve transparency across the sector, with greater scrutiny of what providers spend on care, nursing, food, maintenance, cleaning, administration as well as profits.
The Federal Government has also introduced a submission to the Fair Work Commission supporting a pay rise for aged care workers. The ANMF and other unions are pushing the case to the Commission for a 25 per cent pay rise for all aged care workers.
While the Government has not committed to a specific figure, it has committed to funding any wage boost agreed to by the Commission.
“Addressing low pay is critical to recruiting the workforce needed to provide safe, quality care to the growing number of older Australians,’’ Health Minister Mark Butler said.
“Aged care work and caring work more broadly has been historically undervalued. The vast majority of dedicated and hardworking personal care workers and nurses are women. We support workers’ call for better pay. We’ve committed to the funding of the outcome of this important case.’’
Asked if the Government’s swift actions brought a sense of hope, one aged care Registered Nurse responded: “Oh, absolutely’’.
“One side of me says they haven’t gone far enough but the other side of me says this is actually the first time we’ve seen hope.
”I used to say to people all the time there was no light at the end of the tunnel. Now the light is really starting to shine quite brightly.
“I’d like to see them jump up to the 215 minutes of daily mandated minimum care per resident immediately.
“I’d like to see registered nurses 24/7 implemented promptly as well. My sense is aged care is in crisis, it’s in crisis now.
There’s no point in waiting for two years or a year to actually get it happening, we should be doing it right now.
“However, I completely understand the problem is inadequate workforce out there and how do they find the workforce,’’ the RN said.
“They have to literally pull out all stoppers to try and get people into the industry”.
“It’s fantastic this legislation is being rolled out,’’ said home care provider Susan Paltridge of Adelaide Quality Care.
“We’ve had a Royal Commission (the Final Report tabled in March, 2021) and there has been very little obvious change, from a provider perspective, up until now.
“I’m very impressed there appears to be a lot of work going into developing the Code of Conduct, however it does become ‘another piece of paper’ if there is no checking process.
“We’ve got the Code of Conduct, but to date there is no regulatory checking process. Who do I report poor conduct to, knowing it will be actioned and recorded? Unlike other health professionals that are held accountable for their actions by AHPRA, there is currently no similar process in place for care workers, no governing body to report improper conduct to.’’
Earlier this year staff shortages were so acute, the former Morrison government in February deployed more than 1,700 Australian Defence Force personnel to assist staff in residential homes with clinical and non-clinical duties such as delivering meals, general cleaning and companionship.
In mid-July, almost a third of South Australian nursing homes, 81 in all, had COVID-19 outbreaks, with 319 COVID-positive residents and 228 staff.
The Albanese Government extended ADF support for aged care homes battling COVID-19 outbreaks until the end of September.
One local aged care facility to utilise ADF personnel was Barossa-based Tanunda Lutheran Home.
“Just after Christmas last year we had up to 40 odd staff affected one way or another with COVID,’’ said Tanunda Lutheran Home CEO Lee Martin of his 200-strong workforce.
“At the time we didn’t have any residents affected. COVID was really all out in the community, but we didn’t have it in the home.
“So it really got to the stage where the staff that were able to come to work were getting so tired and frustrated that I put my hand up for some workforce support.
“We actually had ADF staff for almost four weeks. The first group we had there was a Registered Nurse, two Enrolled Nurses and four general duties staff.
Literally the day they arrived they went to work, so the Registered Nurse on evening or night shifts took over the whole home.
“They were accommodated locally and they really did very well,’’ Mr Martin said.
“I’m a military veteran, I was a Lieutenant Colonel nursing officer in the regular army and army reserve. I had 33 years working as a military nurse so I knew what the staff were capable of. I encouraged the staff to wear their camouflage uniforms which the residents loved.
“One of the guys we had was about 6 foot four tall and weighed about 130kg. He was a big boy.
“He, one lunch time, sat down at a table with four little old ladies and one of them doesn’t eat her food. So this young guy picked up a fork and put a bit of food on it and offered it to this little old lady and she took it and she ended up eating the whole meal looking into the eyes of this huge young bloke.
Below: Australian Army officer Captain Chanel Aguilar with Ms Lisa Morgan at Tanunda Lutheran Home.
“The funny part was the three other ladies were begging him to feed them as well. It was just one of those situations, you needed to be there to just see how much dedication, love, you name it, that this young guy showed to those four women.
“We were extremely proud of that moment and really that’s what set the tone throughout the home. These young guys are scrambled to talk to any of the veterans around.
“We had a 97-year-old veteran, they loved talking to him. The residents loved the uniforms and were just so thankful to have more pairs of hands around. It really was, as far as an organization, extremely positive. For the residents extremely positive in the social sense and in the care sense, and for the soldiers it was really a professional and uplifting experience.’’
At the time of writing, Tanunda Lutheran Home had largely regained its staffing numbers and was able to operate efficiently without ADF support.
“Throughout the whole industry of aged care there is certainly a lot of smaller rural remote facilities doing it very tough.’’
Aged Care Minister Anika Wells said Health Department modelling found 869 more nurses were needed to meet the 24/7 nurse requirements. However, others within the aged care sector say the figure is more likely to be around 1,400.
Ms Wells said one way of finding those extra nurses was “through pulling every lever”.
“I don’t shy away from the fact that we have drastic workforce shortages in aged care, so when I speak about 869 additional nurses being the additional nurses, we need to make 24/7 nursing happen by 1 July 2023,’’ she said.
”We’re doing our very best to give them a pay rise. We’re looking at migration, at improvements to conditions, at additional fee-free TAFE places ... additional university places, creating more pathways.’’
So where to for the ANMF’s aged care campaign from here?
“There are two elements,’’ ANMF (SA Branch) aged care director Megan Corlis said.
“One is making sure the proposed staff modelling happens. But I think there’s a whole raft of secondary issues that came out of the Royal Commission that still need to be considered.
“I think training is a pretty good example. It’s one thing to pay people and get more people out there but we also should be making sure everyone’s got the right level of education to deliver the care to the older people because of the complexity.
“So there’s a raft of things that still need to be considered, a mandatory qualification level for staff. We still have a situation where even though a lot of providers do demand a Certificate III in Aged Care there is actually no mandated level of qualification, so you and I could just walk in and start delivering care in an aged care facility as a care worker. Wash people, take them to the toilet, feed them.
“That carries a huge burden of risk,’’ Ms Corlis said. “The standards demand you have to have people who understand what they are doing, but technically speaking there is no mandated level of qualification.
“We need to make sure that what’s been promised happens and then we need to make sure the other things that were highlighted by the Royal Commission get considered.’’
The ANMF (SA Branch) will continue to hold the Labor Government to account as the legislation progresses.
We are encouraged by its stated intent to deliver on pre-election promises but our advocacy won’t stop until meaningful change is seen at aged care facilities.
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here to read the October 2022 edition of INPractice.