Quite rightly, Australia has strict staff ratios for child care centres, (Australian Children’s Education & Care Quality Authority 2018) but this is not the case in residential aged care facilities.

Does society value small children more than it does elderly people with complex care needs?

A 13% reduction in qualified nursing staff working fulltime in aged care facilities occurred between 2003 to 2016, resulting in a significant decrease in minimum hours of care received by residents (Willis et al. 2016).

Older people have contributed to society and should be respected in return. As a wealthy, democratic country, all people in Australia should expect to feel safe in paid-for care environments.

Repeated studies overseas and nationally (Aiken et al. 2017, Duffield et al. 2011, Twigg et al. 2015 and ICN 2006), have demonstrated safe staffing saves lives: safe care is the right numbers of nurses leading clinical care and the right skills mix of nurses and care workers to meet care requirements. These studies have proven a skills mix with registered nurses produces statistically significant decreases in pressure injuries, falls, pneumonia and infections. This is no different whether the care is provided in acute care settings or residential aged care facilities, as a study of 195 nursing homes in the United States (Hyang et al. 2014) found higher registered nurse hours were associated with fewer pressure ulcers.

The Aged Care Act 1997 states approved providers have a responsibility to maintain an adequate number of appropriately skilled staff to ensure that the care needs of care recipients are met (Australian Government 1997). Use of ambiguous terms ‘adequate’ and ‘appropriate’ has led to variable interpretations on staffing numbers and qualification levels.

Worryingly, while the complexity of care requirements for residents has unquestionably increased over past years, particularly in terms of increased complexity of care and behavioural needs, medicines regimes and comorbidities, (Willis et al. 2016 p.14) the numbers of registered nurses and enrolled nurses have noticeably decreased in many aged care facilities (Mavromaras 2017). In the absence of registered and enrolled nurses, residents face missed or compromised care.

The impact of nurse and carer staffing in aged care had not been examined nationally until 2016 when the ANMF commissioned a study by researchers from Flinders University and the University of South Australia. The National Aged Care Staffing and Skills Mix Project Report 2016 titled Meeting residents’ care needs: A study of the requirement for nursing and personal care staff, provides an evidence-based methodology for both minimum staffing requirements and the ratio of qualified staff to carers to ‘ensure safe residential and restorative care’ (Willis et al. 2016 p. 9). This methodology specifies an average of four hours and eighteen minutes of care per day per resident, with a skills mix requirement of: registered nurses 30%, enrolled nurse 20% and carers 50%.

The ANMF’s national aged care campaign calls on federal politicians to legislate ratios for a more transparent aged care staffing structure, to give certainty for residents and their families that the right numbers of staff, and the right skills mix of qualified staff and carers are available for safe care.

Elizabeth Foley
Federal Professional Officer

References:

• Aiken,L.H, Sloane, D, Griffiths, P, Rafferty, A.M, Bruyneel, L, McHugh, M, Maier, C.B, Moreno-Casbas, T, Ball, J.E, Ausserhofer, D, Sermeus, W Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care, BMJ Quality & Safety, vol 26, no.7, 2017, pp559-568.
• Australian Children’s Education & Care Quality Authority, National Quality Framework: Child care ratios. viewed 31 August 2018, www.acecqa.gov.au/nqf/educator-to-child-ratios
• Duffield, C, Diers, D, O’Brien-Pallas, L, Roche, M, King, M & Aisbett, K 2011, Nursing staffing, nursing workload, the work environment and patient outcomes, Applied Nursing Research, 24, pp244-255.
• Hyang, Y, L., Blegen, M.A & Harrington, C, The effects of RN staffing hours on nursing home quality: A two-stage model, International Journal of Nursing Studies, 2014, vol 51, no. 3, pp409-417.
• Australian Government, Aged Care Act 1997 No. 112 1997, Compilation No. 67, p.253. viewed 31 August 2018, www.legislation.gov.au/Series/C2004A05206
• International Council of Nurses, 2006, Safe staffing saves lives, viewed 31 August 2018, www.icn.ch/images/stories/documents/publications/ind/indkit2006.pdf
• Mavromaras, K, Knight, G, Isherwood, L, Crettenden, A, Flavel, J, Karmel, T, Moskos, M, Smith, L, Walton, H & Wei, Z 2017, National Aged Care Workforce Census and Survey - The Aged Care Workforce, 2016, Australian Government, Department of Health.
• Twigg, D.E, Gelder, L, & Meyers, H 2015, The impact of understaffed shifts on nurse-sensitive outcomes. Journal of Advanced Nursing, vol 71, no. 7, pp1564-1572.
• Willis, E, Price, K, Bonner, R, Henderson, J, Gibson, T, Hurley, J, Blackman, I, Toffoli, L & Currie, T 2016, National Aged Care Staffing and Skills Mix Project Report 2016. Meeting residents’ care needs: A study of the requirement for nursing and personal care staff, Australian Nursing and Midwifery Federation.