Monday, 18 February 2019
Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018; Second Reading
A royal commission into aged-care services must not put the brakes on making urgent reforms in the sector, including greater transparency around staffing ratios. My son Carl is in aged-care worker and doctors in our general practice provide GP services to aged-care facilities, so I have some insight into the difficulties faced by people trying to provide care for elderly residents, many of whom have significant age related disabilities, including various degrees of dementia, and are on multiple medications. We need to act quickly to address our community's very real concerns about understaffing and the low, sometimes nonexistent, number of registered nurses in our aged-care facilities as well as poor training and retention rates for aged-care workers.
The Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018 will force residential aged-care facilities to provide their staff-to-resident ratios every three months for publication. This will at least give people a more informed choice about which facility they choose for themselves or for their family members. At present there is no regulation around minimum acceptable levels of staff in residential aged-care facilities, just that providers must maintain an adequate number of appropriately skilled staff to ensure that the care needs of care recipients are met.
In my electorate of Wentworth, all eight aged-care facilities visited by the New South Wales Nurses' and Midwives Association in 2018 failed to provide an acceptable level of nurse care per resident. This audit of just eight facilities revealed an average ratio of one registered nurse to 74 residents on night shift, which is not what families expect or residents deserve. These are vulnerable people needing around-the-clock care. This is just a snapshot of what is happening in aged-care facilities across the country. This data highlights how widespread the staffing issues are in aged care, even in the most affluent suburbs. The poorest ratio uncovered was just one registered nurse to 116 residents. Examples of missed care as a result of understaffing include missed medications, increased falls, limited time to complete hygiene care and the inability to mobilise residents as often as needed. Unless we have ratios, it will be a matter of profit over person.
Last year, the six biggest for-profit aged-care providers received over the $2.17 billion in taxpayer subsidies, which accounted for around 70 per cent of their revenue. Currently there is no requirement for providers to report how government money is spent or a guarantee that it be tied to care. This is a sector whose providers profit over $1 billion a year and receive healthy government subsidies, large resident deposits and fortnightly part-pension payments yet it still has no guaranteed staffing or reporting requirements. Even when argued on pragmatic and detached economic grounds, reducing the information gap between the residents and their families and providers will lead to a more efficient, competitive market upon which competing residential aged-care services can more easily attract people through the greater quality of their service.
The Australian Medical Association has continually called for a regulated, registered nurse-to-resident ratio which adapts to the individual care needs of residents and ensures that nurses are available 24 hours a day. According to the AMA, there's been a decline in the proportion of full-time equivalent registered nurses and enrolled nurses in the residential care workforce and an increase in the proportion of personal care attendants. This trend goes against the increasing chronic, complex medical care needs of residents. AMA president Dr Tony Bartone notes that there are not enough registered nurses with aged-care experience to provide the clinical governance, oversight and leadership required in these facilities, leading to poor clinical care, inadequate communication and a lack of knowledge about individual residents. Personal care attendants cannot duplicate the work of registered nurses. Even then, personal care needs must be considered as a quality of life issue for elderly people with high dependency needs. I'm told that personal care attendants may have only 20 minutes per day to attend to all the resident's personal care needs, including showering, toilet, hair and dental hygiene.
With an ageing population and an aged-care reform moving to ensure older people can stay in their home for as long as appropriate, it's likely that the clinical attention required by those in residential facilities will become more intense. The government must, as a matter of urgency, ensure that the health and aged-care systems and their workforces are prepared for this. I wholeheartedly support the member for Mayo's legislation as an important first step in addressing community concerns about staffing ratios in our nursing homes.